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Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure.
Circ J. 2008 Mar; 72(3):358-63.CJ

Abstract

BACKGROUND

The slope of the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the VE/VCO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of beta-blockers, carvedilol or metoprolol, and the VE/VCO2 slope during exercise in patients with CHF.

METHODS AND RESULTS

Fifty-seven patients with New York Heart Association functional class II or III with a radionuclide left ventricular ejection fraction (LVEF) of less than 40% received carvedilol or metoprolol in a randomized fashion. The VE/VCO2 slope, LVEF and plasma brain natriuretic peptide (BNP) concentration were determined before and after 16 weeks of treatment. LVEF improved (p<0.01), but the VE/VCO2 slope and BNP did not. A significant improvement in the VE/VCO2 slope was observed in patients with LVEF <29% or BNP >63 pg/ml (respective baseline median values) (p<0.05, p<0.05). In patients with BNP >63 pg/ml, the improvement effect on the VE/VCO2 slope with carvedilol was significantly greater than that with metoprolol (p<0.05) and a significant improvement in the VE/VCO2 slope was observed only in those who took carvedilol (p<0.01).

CONCLUSIONS

The VE/VCO2 slope was not improved after beta-blocker therapy in any of the patients. However, it did improve in patients with a lower LVEF or higher BNP level at baseline, and carvedilol was more effective than metoprolol in improving the VE/VCO2 slope in patients with higher BNP levels at baseline.

Authors+Show Affiliations

Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

18296829

Citation

Kataoka, Masaharu, et al. "Comparison of the Effects of Carvedilol and Metoprolol On Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure." Circulation Journal : Official Journal of the Japanese Circulation Society, vol. 72, no. 3, 2008, pp. 358-63.
Kataoka M, Satoh T, Yoshikawa T, et al. Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure. Circ J. 2008;72(3):358-63.
Kataoka, M., Satoh, T., Yoshikawa, T., Nakamura, I., Kohno, T., Yoshizawa, A., Anzai, T., & Ogawa, S. (2008). Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure. Circulation Journal : Official Journal of the Japanese Circulation Society, 72(3), 358-63.
Kataoka M, et al. Comparison of the Effects of Carvedilol and Metoprolol On Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure. Circ J. 2008;72(3):358-63. PubMed PMID: 18296829.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure. AU - Kataoka,Masaharu, AU - Satoh,Toru, AU - Yoshikawa,Tsutomu, AU - Nakamura,Iwao, AU - Kohno,Takashi, AU - Yoshizawa,Akihiro, AU - Anzai,Toshihisa, AU - Ogawa,Satoshi, PY - 2008/2/26/pubmed PY - 2008/7/4/medline PY - 2008/2/26/entrez SP - 358 EP - 63 JF - Circulation journal : official journal of the Japanese Circulation Society JO - Circ J VL - 72 IS - 3 N2 - BACKGROUND: The slope of the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the VE/VCO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of beta-blockers, carvedilol or metoprolol, and the VE/VCO2 slope during exercise in patients with CHF. METHODS AND RESULTS: Fifty-seven patients with New York Heart Association functional class II or III with a radionuclide left ventricular ejection fraction (LVEF) of less than 40% received carvedilol or metoprolol in a randomized fashion. The VE/VCO2 slope, LVEF and plasma brain natriuretic peptide (BNP) concentration were determined before and after 16 weeks of treatment. LVEF improved (p<0.01), but the VE/VCO2 slope and BNP did not. A significant improvement in the VE/VCO2 slope was observed in patients with LVEF <29% or BNP >63 pg/ml (respective baseline median values) (p<0.05, p<0.05). In patients with BNP >63 pg/ml, the improvement effect on the VE/VCO2 slope with carvedilol was significantly greater than that with metoprolol (p<0.05) and a significant improvement in the VE/VCO2 slope was observed only in those who took carvedilol (p<0.01). CONCLUSIONS: The VE/VCO2 slope was not improved after beta-blocker therapy in any of the patients. However, it did improve in patients with a lower LVEF or higher BNP level at baseline, and carvedilol was more effective than metoprolol in improving the VE/VCO2 slope in patients with higher BNP levels at baseline. SN - 1346-9843 UR - https://www.unboundmedicine.com/medline/citation/18296829/Comparison_of_the_effects_of_carvedilol_and_metoprolol_on_exercise_ventilatory_efficiency_in_patients_with_congestive_heart_failure_ L2 - https://joi.jlc.jst.go.jp/JST.JSTAGE/circj/72.358?from=PubMed DB - PRIME DP - Unbound Medicine ER -