Long-Term Effects of Carvedilol or Metoprolol on Left Ventricular Function in Ischemic and Nonischemic Cardiomyopathy

Anshelevich, Michael; Talreja, Ashok; Burcham, Joyce; Ravi, Srinivas M.; Shirani, Jamshid; Jemtel, Thierry H. Le

doi:10.1016/j.amjcard.2005.01.030

Cited by 10 publications

(5 citation statements)

References 10 publications

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“…After a decrease from baseline in the 1st- and 3rd-month follow-ups, the EF increased above the baseline in the 6th- and 12th-month follow-ups. The HR decreased by 16–20 bpm at the 12th-month follow-up in this study with both doses of metoprolol, and as a compensatory mechanism, the LVEF was amplified from 6th-month follow-up onwards through 12th-month in both the dose groups with an average increase of 12% and this is consistent with the previously published reports 30,32,33. The initial delay in the augmentation of EF could be explained by the fact that hemodynamic responses to beta-adrenergic blockade often require more than 2 months to develop as per reports of Williams et al and Floras et al34,35 Similar outcomes have been shown in patients with NYHA II–IV grade CHF with improved EF, lowered LVEF, and cardiac frequency 36…”

Section: Discussionsupporting

confidence: 93%

Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF

Zhang

Shu

et al. 2018

TCRM

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ObjectiveThe objective of the study was to evaluate the dose-related influence of metoprolol on cardiac performance, motor function, quality of life (QoL), and mental status in Chinese patients with chronic heart failure (CHF).Patients and methodsThis was a prospectively designed single-center study which enrolled CHF patients with resting heart rate (HR) >80 bpm belonging to the New York Heart Association (NYHA) III/IV functional classification. Patients were initiated with 12.5 mg of metoprolol, and every second week, the dose was escalated until the target HR level (60–70 bpm) was achieved during the follow-up at 1st, 3rd, 6th, and 12th months. Patients were divided into two groups depending on the doses administered: 47.5 mg (n=37) and 118.75 mg (n=74), respectively, for comparison in terms of change in cardiac function, motor function, QoL, and mental status.ResultsAmong the 111 patients with CHF, no significant difference was shown between the two doses administered. Irrespective of the dose, the cardiac performance, motor function, QoL, and anxiety improved and there was an increase in depression, whereas the effect on burnout, calculated as Copenhagen Burnout Inventory (CBI), equally was insignificant throughout the 1-year follow-up period in both the CHF patient groups.ConclusionLower dose of metoprolol (47.5 mg) is as effective as higher dose (118.75 mg) in Chinese population with CHF to improve the cardiac function, motor function, QoL, and mental status.

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Section: Discussionsupporting

confidence: 93%

Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF

Zhang

Shu

et al. 2018

TCRM

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“…6,8 There are few data on the long-term persistence of improvement in LV structure and function. Green et al 7 recently reported that the beneficial effects of metoprolol on LVEF and LV end-diastolic dimension were fully maintained 40 months after initiation of therapy in patients with idiopathic dilated cardiomyopathy. Our study indicates that the beneficial effect of medical therapy appears to be sustained (88% of patients) at 44 ± 21 months follow-up, although a small minority may deteriorate over time.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported improved prognosis in HF patients with intensive medical therapy [6][7][8]19,20 ; however, long-term survival data are very limited. Our study revealed a trend toward improved long-term survival in individuals with an early improvement in LVEF with medical therapy, but the study groups are not large enough to obtain statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Clinical trials have demonstrated a benefit in morbidity and mortality with neurohormonal blockade in patients with heart failure (HF) caused by systolic LV dysfunction. 4,5 For some, there may also be improvements in LV function and reverse remodeling after initiation of medical therapy, especially with β-blockade [6][7][8] ; however, the long-term stability of ventricular function in such patients is not well described. This retrospective study was primarily designed to determine the long-term persistence of LV systolic functional improvement in patients with HF receiving optimal medical therapy.…”

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confidence: 99%

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Improvement of Cardiac Function Persists Long Term With Medical Therapy for Left Ventricular Systolic Dysfunction

Chen

Chang

Umakanthan

et al. 2007

J Cardiovasc Pharmacol Ther

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In certain patients with left ventricular (LV) systolic dysfunction, improvements in cardiac function are seen after initiation of medical therapy; however, the long-term stability of ventricular function in such patients is not well described. We retrospectively analyzed 171 patients who had a baseline ejection fraction of 45% or less, a follow-up echocardiogram at 2 to 12 months after initiation of medical therapy, and a final echocardiogram. We found that 48.5% of the patients demonstrated initial improvements in LV function after initiation of medical therapy, and the improvements appear to be sustained (88% of patients) at 44 +/- 21 months follow-up. A nonischemic etiology and younger age were the only independent predictors of change of LV ejection fraction of 10 or more at a mean 8.4 +/- 3.4 months after optimal medical therapy. Our study revealed a trend toward improved long-term survival in individuals with an early improvement in LV ejection fraction with medical therapy, especially in those with sustained improvement.

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“…Some studies indicated that carvedilol could increase left ventricular ejection fraction (LVEF), reduce the heart rate and further protect heart function. [9] Rather, the beta-blockers are not beneficial for all DCM patients. Carvedilol insignificantly increase ejection fraction in early onset of LVEF reduction.…”

Section: Introductionmentioning

confidence: 99%

Clinical efficacy of carvedilol treatment for dilated cardiomyopathy

Li¹,

Yuan²,

Ma³

et al. 2019

Medicine

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Background: Clinical trials examining the therapeutic benefit of carvedilol on patients with dilated cardiomyopathy have reported inconsistent results. The aim of this study was to evaluate the clinical efficacy of carvedilol on patients with dilated cardiomyopathy. Methods: PubMed, Embase, Cochrane Library, web of science, China National Knowledge Infrastructure (CNKI), Wanfang, and Chinese Scientific and Technological Journal (VIP) databases were searched for randomized controlled trials (RCTs) before March 2018. Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were used to evaluate the effects of carvedilol on patients with dilated cardiomyopathy. Results: Twenty one studies including 1146 participants were included. There were significant improvements on heart rate (HR) (WMD = –14.18, 95% CI: –17.72 to –10.63, P < .001), LVEF (WMD = 7.28, 95% CI: 6.53–8.03, P < .001), SBP (WMD = –10.74, 95% CI: –12.78 to –8.70, P < .001), DBP (WMD = –4.61, 95% CI: –7.32 to –1.90, P = .001), LVEDD (WMD = –2.76, 95% CI: −4.89 to −0.62, P = .011), LVESD (WMD = –3.63, 95% CI: –6.55 to –0.71, P = .015), LVEDV (WMD = –9.30, 95% CI: –11.89 to –6.71, P < .001), LVESV (WMD = –12.28, 95% CI: –14.86 to –9.70, P < .001) under carvedilol treatment compared with control. Conclusion: This meta-analysis demonstrates that carvedilol significantly improves cardiac function on patients with dilated cardiomyopathy. Further large scale, high-quality and multicenter RCTs are still required to confirm the impacts of carvedilol on patients with dilated cardiomyopathy.

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Long-Term Effects of Carvedilol or Metoprolol on Left Ventricular Function in Ischemic and Nonischemic Cardiomyopathy

Cited by 10 publications

References 10 publications

Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF

Dose-independent influence of metoprolol on cardiac and motor functions, QoL, and mental status in Chinese patients with CHF

Improvement of Cardiac Function Persists Long Term With Medical Therapy for Left Ventricular Systolic Dysfunction

Clinical efficacy of carvedilol treatment for dilated cardiomyopathy

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