Effects of carvedilol on left ventricular remodelling in chronic stable heart failure: a cardiovascular magnetic resonance study

Abstract

Background: The ability of b blockers to improve left ventricular function has been demonstrated, but data on the effects on cardiac remodelling are limited. Objective: To investigate, using cardiovascular magnetic resonance (CMR), the effects of carvedilol on left ventricular remodelling in patients with chronic stable heart failure and left ventricular systolic dysfunction caused by coronary artery disease. Design: Randomised, double blind, placebo controlled study. Setting: Chronic stable heart failure. Patients and intervention: 34 patients with chronic stable heart failure and left ventricular systolic function taking part in the CHRISTMAS trial (double blind carvedilol v placebo) underwent CMR before randomisation and after six months of treatment. Main outcome measure: Left ventricular remodelling at six months. Results: The carvedilol and placebo groups were well balanced at baseline, with no significant intergroup differences. Over the study period, there was a significant reduction in end systolic volume index (ESV I ) and end diastolic volume index (EDV I ) between the carvedilol and the placebo group (carvedilol 29 v placebo +3 ml/m 2 , p = 0.0004; carvedilol 28 v placebo 0 ml/m 2 , p = 0.05). The ejection fraction increased significantly between the groups (carvedilol +3% v placebo 22%, p = 0.003). Conclusions: Treatment of chronic stable heart failure with carvedilol results in significant improvement in left ventricular volumes and function. These effects might contribute to the benefits of carvedilol on mortality and morbidity in patients with chronic heart failure.

Delayed Contrast Enhancement Magnetic Resonance Imaging for the Assessment of Cardiac Disease

“…30 CMR is the method of choice for longitudinal followup of patients after therapeutic interventions due to its excellent interstudy reproducibility 34 and can reduce the number of patients and total costs required to complete clinical trials. [32][33][34] CMR compares favourably with radionuclide imaging techniques for myocardial viability assessment: areas of hyperenhancement demonstrated with DCE in dysfunctional myocardium regions of patients with coronary artery disease correspond closely to fixed defects on Thallium-201 single photon emission computed tomography (SPECT) 35,36 or areas of matched flow/ metabolism decrease on FDG-positron emission tomography (PET). [37][38][39][40] DCE has a sensitivity of 94% and a specificity of 84% compared with FDG-PET (the gold standard for myocardial viability assessment) in patients with decreased LV systolic function due to ischaemic cardiomyopathy 38 and may be superior to nuclear imaging for the identification of myocardial segments that are unlikely to recover function after revascularisation.…”

Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report?

“…162,163 Phase 2 trials and sub-studies in phase 3 trials are being conducted using CMR as primary endpoints. 164,165 Regional contractile function is also well-assessed by CMR with visual inspection of cines or quantification of wall motion and thickening for both the RV, 166,167 and LV. [168][169][170][171] However, the CMR tagging technique permits the determination of the strain of the myocardium as a measure of contractility, 172 By monitoring the progressive distortion of the tags during the course of the cardiac cycle, regional ventricular strain myocardial rotational deformation, ventricular non-uniformity, and differences in endocardial and epicardial wall motion can be calculated.…”

Heart failure : biomarker effect and influence on quality of life

“…A number of factors contribute to the effect of BB. BB decrease LV end-diastolic and end systolic volume and have a beneficial effect on LV remodelling [40,41,89].…”