Effects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure

doi:10.1016/S0002-9149(99)00059-4

The American Journal of Cardiology

Volume 83, Issue 8, 15 April 1999, Pages 1201-1205

https://doi.org/10.1016/S0002-9149(99)00059-4 Get rights and content

Abstract

We and others have previously shown that carvedilol improves left ventricular (LV) function and symptoms in chronic heart failure. This improvement in LV function has also been shown to be associated with an improvement in survival. This study evaluates the effect of carvedilol on LV mass, geometry, and degree of mitral regurgitation (MR). In 59 patients with symptomatic heart failure and LV ejection fraction <0.35, previously randomized to either treatment with carvedilol or placebo, we evaluated LV mass, geometry, and degree of MR over the time period of carvedilol treatment. LV mass decreased as early as 4 months into the treatment protocol and continued to decrease over a period of 1 year. LV geometry, defined by the length/diameter ratio, and severity of MR also improved with 4 months of therapy. Thus, compared with placebo treatment, carvedilol decreases LV mass while improving cardiac geometry and decreasing MR in patients with chronic heart failure. These changes occur in association with an improvement in LV systolic function. This process begins by 4 months of treatment and continues for 12 months.

Section snippets

Study design

The clinical study design, patient characteristics, and primary outcomes of the treatment phase using carvedilol have been published previously.4 This study was a prospective, randomized, double-blind, placebo-controlled trial of 4 months duration. Recruited subjects were randomized to carvedilol or placebo on a 3:2 basis with a block size of 5. At the end of 4 months all patients were placed on open-label carvedilol and followed for an additional 8 months. End points of the study included

Results

Average LV thickness was measured by 2-dimensional echocardiography. Twenty-one patients were excluded from analysis of LV mass secondary to inadequate echo windows. In the carvedilol group LV thickness decreased from 1.31 ± 0.04 cm at baseline to 1.22 ± 0.06 cm at 4 months (Figure 1 , p = 0.04) and in the placebo group LV thickness increased from 1.33 ± 0.04 to 1.41 ± 0.04 cm (p = 0.06). Between-group analysis indicated significant differences in the slopes (p = 0.01) and levels at 4 months (p

Discussion

The major finding of this study is that carvedilol can partially reverse LV hypertrophy and the altered chamber geometry that occurs in chronic heart failure, or partially reverse the remodeling process. Therefore, carvedilol improves LV ejection fraction while decreasing LV mass and improving cardiac geometry. The reversal of the remodeling process is detectable by 4 months of treatment and continues for up to 12 months. These changes were also associated with a decrease in the amount of MR.

References (11)

S.L. Olsen et al.
Carvedilol improves left ventricular function and symptoms in chronic heart failurea double-blind randomized study
J Am Coll Cardiol
(1995)
E.J. Eichhorn et al.
Effect of metoprolol on myocardial function and energetics in patients with non-ischemic dilated cardiomyopathya randomized double-blind, placebo-controlled study
J Am Coll Cardiol
(1994)
S.A. Hall et al.
Time course of improvement in left ventricular function, mass and geometry in patients with congestive heart failure treated with beta-adrenergic blockage
J Am Coll Cardiol
(1995)
E.J. Eichhorn et al.
Medical therapy can improve the biologic properties of the chronically failing hearta new era in the treatment of heart failure
Circulation
(1996)
M.R. Bristow et al.
Receptor pharmacology of carvedilol in the human heart
J Cardiovasc Pharmacol
(1992)

There are more references available in the full text version of this article.

Cited by (277)

Functional Mitral Regurgitation: Patient Selection and Optimization
2024, Interventional Cardiology Clinics
Valvular heart disease: from mechanisms to management
2024, The Lancet
Valvular heart disease is common and its prevalence is rapidly increasing worldwide. Effective medical therapies are insufficient and treatment was historically limited to the surgical techniques of valve repair or replacement, resulting in systematic underprovision of care to older patients and those with substantial comorbidities, frailty, or left ventricular dysfunction. Advances in imaging and surgical techniques over the past 20 years have transformed the management of valvular heart disease. Better understanding of the mechanisms and causes of disease and an increasingly extensive and robust evidence base provide a platform for the delivery of individualised treatment by multidisciplinary heart teams working within networks of diagnostic facilities and specialist heart valve centres. In this Series paper, we aim to provide an overview of the current and future management of valvular heart disease and propose treatment approaches based on an understanding of the underlying pathophysiology and the application of multidisciplinary treatment strategies to individual patients.
Heart Failure and Secondary Mitral Regurgitation: A Contemporary Review
2023, Journal of the Society for Cardiovascular Angiography and Interventions
Secondary mitral regurgitation (SMR) in patients with heart failure (HF) is associated with significant morbidity and mortality. In recent decades, SMR has received increasing scientific attention. Advances in echocardiography, computed tomography and cardiac magnetic resonance imaging have refined our ability to diagnose, quantify and characterize SMR. Concurrently, the treatment options for this high-risk patient population have continued to evolve. Guideline-directed medical therapies including beta-blockers, angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists and sodium-glucose cotransporter-2 inhibitors target the underlying cardiomyopathy, and along with diuretics to treat pulmonary congestion, remain the cornerstone of therapy. Cardiac resynchronization therapy also reduces MR, alleviates symptoms and prolongs life in selected HF patients with SMR. While data supporting surgical mitral valve repair or replacement for SMR are limited, transcatheter edge-to-edge repair (TEER) has been demonstrated to improve survival, reduce the rate of hospitalization for heart failure, and improve functional capacity and quality-of-life in select patients with SMR who remain symptomatic despite medical therapy. Emerging transcatheter mitral valve repair and replacement technologies are undergoing investigation in TEER-eligible and TEER-ineligible patients. The optimal management of HF patients with SMR requires a multidisciplinary team of cardiologists, cardiac surgeons, imaging experts, and other organ specialists to select the best treatment approaches to improve the prognosis of these high-risk patients.
Editorial commentary: Functional mitral regurgitation - a moving target in patients with heart failure
2023, Trends in Cardiovascular Medicine
New Perspective on Pathophysiology and Management of Functional Mitral Regurgitation
2023, Trends in Cardiovascular Medicine
Functional mitral regurgitation (FMR) occurs as a result of global or segmental left ventricular (LV) dysfunction or left atrial dilatation, leading to mitral annular dilatation, papillary muscle displacement, mitral valve (MV) leaflet tethering, and leaflet remodeling. The prevalence of FMR continues to rise in the United States. Even mild FMR is associated with adverse clinical outcomes. Echocardiography is the primary imaging modality used to assess the type and severity of mitral regurgitation. FMR treatment depends on the etiology. Evidence-based pharmacologic and cardiac resynchronization therapies for underlying LV dysfunction remain the mainstay of treatment. Patients who remain symptomatic despite optimal medical therapy can be considered for surgical or percutaneous MV intervention. This article reviews the pathophysiology, imaging evaluation, and therapeutic options of FMR, highlighting the most recent developments in a rapidly evolving field.
Mitral Regurgitation in Female Patients: Sex Differences and Disparities
2023, Journal of the Society for Cardiovascular Angiography and Interventions
Mitral regurgitation is the most common valvular disease, particularly in older adults. Recent literature has consistently supported that there are significant differences in mitral regurgitation outcomes between male and female patients and that this is likely multifactorial. Numerous sex differences in anatomy and pathophysiology may play a role in delayed diagnoses, referrals, and treatments for female patients. Despite the recognition of these discrepancies in the literature, many guidelines that steer clinical care do not incorporate these factors into society recommendations. Identifying and validating sex-specific diagnostic parameters and increasing the representation of female patients in trials of new mitral regurgitation treatment modalities are key factors in improving outcomes for female patients.

View all citing articles on Scopus

^☆: This study was supported by Grant HL48013 from the National Institutes of Health, Bethesda, Maryland, and SmithKline Beecham, King of Prussia, Pennsylvania.

View full text

Congestive Heart FailureEffects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure☆

Abstract

Section snippets

Study design

Results

Discussion

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Medical therapy can improve the biologic properties of the chronically failing hearta new era in the treatment of heart failure

Circulation

Receptor pharmacology of carvedilol in the human heart

J Cardiovasc Pharmacol

Congestive Heart Failure
Effects of carvedilol on left ventricular mass, chamber geometry, and mitral regurgitation in chronic heart failure☆