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Can intravenous beta blockade predict long-term haemodynamic benefit in chronic congestive heart failure secondary to ischaemic heart disease? A comparison between intravenous and oral carvedilol

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Summary

Several studies in the past have shown the long-term beneficial effects of β-blockers in congestive heart failure. Despite the interest in this mode of therapy, their clinical application has been limited due to their negative inotropic effect. A subset of the heart failure patients do not show any improvements with standard β-blocker therapy. Carvedilol, a new, non-selective β-blocking agent with concurrent α-blocking properties, was evaluated in 17 patients with chronic heart failure secondary to ischaemic heart disease. All had resting left ventricular ejection fraction ≤45% and were maintained on diuretic therapy. Acute haemodynamic measurements were made after intravenous carvedilol (2.5–7.5 mg) and also after chronic therapy for 8 weeks (carvedilol 12.5–50 mg b.d.). Radionuclide ventriculography, ambulatory intra-arterial blood pressure monitoring and right heart catheterization were performed before and after 8 weeks of chronic therapy. Twelve patients completed the study and 5 were withdrawn. Symptomatic and haemodynamic improvement was demonstrated in 11 of the 12 patients after 8 weeks of therapy. Mean±standard error systolic intraarterial blood pressure (133 ± 6 to 114 ± 5 mmHg, P <0.005), heart rate (81 ± 3 to 61 ± 1 beats/min, P <0.0001), pulmonary artery wedge pressure (19 ± 2 to 12 ± 1 mmHg, P <0.001) and systemic vascular resistance (1748 ± 115 to 1497 ± 89 dynes/ s/cm5/m2, P < 0.02) were reduced with an increase in mean ± SE of stroke volume index (31 ± 1.8 to 40 ± 1.6 ml/m2/beat, P < 0.0005) and left ventricular ejection fraction (25 ± 3 % to 32 ± 3 %, P < 0.01) after 8 weeks of therapy with carvedilol. This is in contrast to the acute haemodynamic effects of carvedilol, which only showed a reduction in heart rate (81 ± 3 to 74 ± 3 beats/min, P < 0.0001), systolic intra-arterial blood pressure (133 ± 6 to 117 ±6 mmHg, P < 0.0005) and pulmonary artery wedge pressure (19 ± 2 to 14 ± 2 mmHg, P < 0.002) at 10 min post-injection. The systemic vascular resistance, left ventricular ejection fraction and stroke volume index failed to show any significant improvement. Thus intravenous carvedilol produces a reduction in filling pressure, which is maintained after chronic treatment. This property is clearly beneficial for chronic heart failure patients and differs from standard β-blockers. The discrepancy of the haemodynamic changes between the acute and chronic long-term response to carvedilol lends further support to the concept of upregulation of β-adrenoceptors in cognestive heart failure.

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References

  1. 1.

    Waagstein F, Hjalmarson A, Varnauskas E, Wallentin I (1975) Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 37:1022–1036

  2. 2.

    Swedberg K, Hjalmarson A, Waagstein F, Wallentin I (1980) Beneficial effects of long term beta-blockade in congestive cardiomyopathy. Br Heart J 44:117–133

  3. 3.

    Engelmeier RS, O'Connell JB, Walsh R, Rad N, Scanlon PJ, Gunnar RM (1985) Improvements in symptoms and exercise tolerance by metoprolol in patients with dilated cardiomyopathy: a double blind, randomised, placebo-controlled trial. Circulation 72:536–546

  4. 4.

    Gilbert EM, Anderson JL, Deitchman D, Yanowitz FG, O'Connell JB, Renlund DG, Bartholomew M, Mealey PC, Larrabee P, Bristow MR (1990) Long term β-blocker vasodilator therapy improve cardiac function in idiopathic dilated cardiomyopathy: a double blind, randomized study of bucinodolol versus placebo. Am J Med 88:223–229

  5. 5.

    Ikram H, Chan W, Bennet SI, Bones PJ (1979) Haemodynamic effects of acute beta-adrenergic receptor blockade in congestive cardiomyopathy. Br Heart J 42:311–315

  6. 6.

    Curie PJ, Kelly MJ, McKenzie A et al (1984) Oral betaadrenergic blockade with metoprolol in chronic severe dilated cardiomyopathy. J Am Coll Cardiol 3:203–209

  7. 7.

    Cohn JN, Levine TB, Olivari MT, Garberg V, Lura D, Francis GS, Simon AB, Rector T (1984) Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:819–893

  8. 8.

    Chidsey CA, Braunwald E, Marrow AG (1965) Catecholamine excretion and cardiac stress of norepinephrine in congestive heart failure. Am J Med 39:442–451

  9. 9.

    Francis GS, Goldsmith SR, Olivari MT, Levine TB, Cohn JN (1984) The neurohumoral axis in congestive heart failure. Ann Intern Med 101:370–377

  10. 10.

    Mueller HS, Ayres SM, Religa A, Evans RG (1974) Propranolol in the treatment of acute myocardial infarction: effect on myocardial oxygenation and haemodynamics. Circulation 49:1078–1087

  11. 11.

    Braunwald E, Mueller HS, Kloner RA, Maroko RR (1983) Role of beta adrenergic blockade in the therapy of patients with myocardial infarction. Am J Med 74:113–123

  12. 12.

    Julian DG (1983) Can beta blockers be safely used in patients with recent myocardial infarction who also have congestive heart failure? Circulation 67 [Suppl 1]:1–91

  13. 13.

    Sponer G, Bartsch W, Strein K, Muller-Beckmann B, Bohm E (1987) Pharmacological profile of carvedilol as a β-blocking agent with vasodilating and hypotensive properties. J Cardiovasc Pharmacol 9:317–327

  14. 14.

    Tomlinson B, Cronin CJ, Graham BR, Prichard BNC (1987) Haemodynamics of carvedilol in normal subjects compared with propranolol, pindolol and labetolol. J Cardiovasc Pharmacol 10 [Suppl II]:S69-S75

  15. 15.

    The Criteria Committee of the New York Heart Association, Inc (1964) Diseases of the heart and blood vessels: nomenclature and criteria for diagnosis, 6th edn. Little Brown & Co, Boston

  16. 16.

    Hains A, Al-Khawaja IM, Hinge D, Lahiri A, Raftery EB (1987) Radionuclide left ventricular ejection fraction: a comparison of three methods. Br Heart J 57:242–246

  17. 17.

    Lahiri A, Bowles MJ, Jones RI, Crawley JC, Raftery EB (1984) Assessment of left ventricular function in coronary artery disease with nuclear probe during intervention studies. Br Heart J 52:422–430

  18. 18.

    Lahiri A, Rodrigues EA, Carboni GP, Raftery EB (1990) Effects of long term treatment with calcium antagonists on left ventricular diastolic function in stable angina and heart failure. Circulation 81 [Suppl III]:130–138

  19. 19.

    O'Hara MJ, Jones RI, Lahiri A, Raftery EB (1986) Changes in left ventricular function during exercise and their relation to ST-segment changes in patients with angina. Br Heart J 55:148–154

  20. 20.

    Berger HJ, Davies RA, Batsford WP, Heffer PB, Gottschalk A, Zaret BL (1981) Beat-to-beat left ventricular performance assessed from the equilibrium cardiac blood pool using a computerised nuclear probe. Circulation 63:133–142

  21. 21.

    Milar-Craig MW, Hawes D, Whittington J (1978) New system for recording ambulatory blood pressure in man. Med Biol Eng Comput 16:727–731

  22. 22.

    DasGupta P, Broadhurst P, Raftery EB, Lahiri A (1991) Value of carvedilol in congestive heart failure secondary to coronary artery disease. J Am Coll Cardiol 66:1118–1123

  23. 23.

    Heber ME, Brigden GS, Caruana MP, Lahiri A, Raftery EB (1986) Carvedilol for systemic hypertension. Am J Cardiol 59:400–405

  24. 24.

    Rodrigues EA, Lahiri A, Hughes LO, Kohli RS, Whittington J, Raftery EB (1986) Antianginal efficacy of carvedilol: a between blocking drug with vasodilating activity. Am J Cardiol 58:916–921

  25. 25.

    Lahiri A, Rodrigues EA, Al-Khawaja I, Raftery EB (1987) Effects of a new vasodilating beta-blocking drug, carvedilol, on left ventricular function in stable angina pectoris. Am J Cardiol 59:769–774

  26. 26.

    Fowler MB, Bristow MR (1985) Rationale for beta-adrenergic blocking drugs in cardiomyopathy. Am J Cardiol 55:120D-124D

  27. 27.

    Hoffbrand BI (1980) Beta adrenergic blockade in congestive cardiomyopathy. Lancet I:1031–1033

  28. 28.

    Bristow MR, Ginsburg R, Umans V, Fowler M, Minobe W et al (1986) β1- and β2-adrenergic receptor subpopulations in nonfailing and failing human ventricular myocardium: coupling of both receptor subtypes to muscle contraction and selective β1-receptor down regulation in heart failure. Circ Res 59:297–309

  29. 29.

    Bristow MR, Ginsburg R, Minobe W, Cubicciotti RS, Saggman WS, Lurie K, Billingham ME (1982) Decreased catecholamine sensitivity and beta-adrenergic receptor density in failing human hearts. N Engl J Med 207:205–211

  30. 30.

    Di Lenarda A, Gilbert EM, Olsen SL, Mealey PC, Bristow MR (1991) Acute haemodynamic effects of carvedilol versus metoprolol in idiopathic dilated cardiomyopathy. J Am Coll Cardiol 17 [Suppl A]:142A

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DasGupta, P., Lahiri, A. Can intravenous beta blockade predict long-term haemodynamic benefit in chronic congestive heart failure secondary to ischaemic heart disease? A comparison between intravenous and oral carvedilol. Clin Investig 70, S98–S104 (1992). https://doi.org/10.1007/BF00207619

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Key words

  • Congestive heart failure
  • Left ventricular ejection fraction
  • Vasodilating β-blocker