CARDIOVASCULAR MEDICINE

¹ Royal Brompton Hospital, London, UK
² Northwick Park Hospital, London, UK
³ University of Edinburgh, Edinburgh, UK
⁴ University of Hull, Hull, UK

Correspondence to:
Correspondence to:
Professor Dudley Pennell
Centre for Advanced MR in Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK; d.pennell{at}ic.ac.uk

Background: The ability of ß 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 –9 v placebo +3 ml/m², p = 0.0004; carvedilol –8 v placebo 0 ml/m², p = 0.05). The ejection fraction increased significantly between the groups (carvedilol +3% v placebo –2%, 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.

Abbreviations: CHRISTMAS, carvedilol hibernation reversible ischaemia trial, marker of success; CMR, cardiovascular magnetic resonance; COI, cardiac output index; COMET, carvedilol or metoprolol European trial; EDV_I, end diastolic volume index; EF, ejection fraction; ESV_I, end systolic volume index; LVEDV, left ventricular end diastolic volume; LVESV, left ventricular end systolic volume; LVM_I, left ventricular mass index; LVSV_I, left ventricular stroke volume index

Keywords: ß blockers; remodelling; heart failure; magnetic resonance imaging

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