Effects of Carvedilol on Myocardial Sympathetic Innervation in Patients with Chronic Heart Failure

Effects of Carvedilol on Myocardial Sympathetic Innervation in Patients with Chronic Heart Failure

Alain Cohen-Solal, MD, PhD¹, François Rouzet, MD², Alain Berdeaux, MD, PhD³, Dominique Le Guludec, MD, PhD², Eric Abergel, MD⁴, André Syrota, MD, PhD⁵ and Pascal Merlet, MD, PhD²

¹ Department of Cardiology, University Hospital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France
² Department of Nuclear Medicine, University Hospital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
³ Department of Cardiology, University Hospital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
⁴ Department of Cardiology, European University Hospital Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
⁵ Department of Nuclear Medicine Frédéric Joliot, Commissariat à l’Energie Atomique—Direction des Sciences du Vivant, Orsay, France

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FIGURE 1. ¹²³I-MIBG planar imaging and SPECT obtained in patient with dilated cardiomyopathy randomized to the carvedilol group. (A) Clear increase in cardiac ¹²³I-MIBG uptake is seen when comparing delayed ¹²³I-MIBG image obtained before (M0) and after 6-mo ß-blocking therapy (M6), especially in the anterolateral wall, whereas level of background activity seems comparable in these 2 images. (B) When comparing bull’s eye images of delayed ¹²³I-MIBG SPECT before (M0) and after therapy (M6), a decrease in the extent of defect is observed in the inferolateral myocardial wall.

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FIGURE 2. Therapeutic effect of carvedilol on late ¹²³I-MIBG uptake. After 6-mo therapy, ¹²³I-MIBG uptake, as assessed by late H/M ratio, increased from 142% ± 18% to 149% ± 21% in the carvedilol group, whereas it decreased from 146% ± 24% to 143% ± 24% in the placebo group. *P = 0.003.

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FIGURE 3. Therapeutic effect of carvedilol on regional late SPECT ¹²³I-MIBG imaging. After 6-mo therapy, DE on the bull’s eye image decreased from 20.4% ± 11.2% to 15.0% ± 12.2% (P = 0.03) in the carvedilol group, whereas it remained unaltered in the placebo group (from 21.8% ± 12.9% to 21.3% ± 10.6%; P = NS). *P = 0.004.

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FIGURE 4. Therapeutic effect of carvedilol on LVEF. After 6-mo therapy, LVEF increased from 25% ± 11% to 31% ± 12% in the carvedilol group, whereas it remained unaltered in the placebo group (from 27% ± 12% to 28% ± 12%, respectively; P = NS). *P = 0.03.