What is the clinical evidence from this study?

Study design: RCT. Population: congestive heart failure (CHF) (n=57). Intervention: carvedilol vs. metoprolol. Primary outcome: VE/VCO2 slope.

January 1, 2008Open Access

Comparison of the Effects of Carvedilol and Metoprolol on Exercise Ventilatory Efficiency in Patients With Congestive Heart Failure

Q: What does this research mean for the field?

Carvedilol and metoprolol do not improve the VE/VCO2 slope overall in heart failure patients, but carvedilol is more effective than metoprolol in improving the slope in patients with baseline BNP >63 pg/ml. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Resultado clave

Carvedilol and metoprolol did not improve the VE/VCO2 slope overall, but carvedilol was more effective than metoprolol in improving the slope in patients with baseline BNP >63 pg/ml (p<0.05).

Diseño del estudio

Tipo

RCT (n=57)

Aleatorización

randomized

PICO estructurado

Does carvedilol improve exercise ventilatory efficiency (VE/VCO2 slope) compared to metoprolol in patients with congestive heart failure?

Población

57 patients with New York Heart Association (NYHA) functional class II or III congestive heart failure, radionuclide left ventricular ejection fraction (LVEF) <40%, clinically stable on conventional medical treatment (digitalis, diuretics, ACEi/ARB) for >3 months. Exclusions included heart rate <50 beats/min, systolic blood pressure <90 mmHg, significant bradyarrhythmia, AV block, serum creatinine >3.0 mg/dl, stenotic valvular heart disease, alcohol abuse, active myocarditis, or hypertrophic obstructive cardiomyopathy.

Intervención

Carvedilol (started at 2.5 mg/day, gradually increased to target 20 mg/day) added to usual treatment for 16 weeks.

Comparador

Metoprolol tartrate (started at 5 mg/day, gradually increased to target 80 mg/day) added to usual treatment for 16 weeks.

Resultado

Change in the slope of the relationship between ventilation and carbon dioxide production (VE/VCO2 slope) during symptom-limited ramp exercise testing at 16 weeks.surrogate

While neither beta-blocker improved exercise ventilatory efficiency in the overall mild heart failure cohort, carvedilol may offer superior improvement in VE/VCO2 slope compared to metoprolol in patients with more advanced disease (higher BNP).

Resumen

BACKGROUND: The slope of the relationship between ventilation and carbon dioxide production (VE/VCO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the VE/VCO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of beta-blockers, carvedilol or metoprolol, and the VE/VCO2 slope during exercise in patients with CHF. METHODS AND RESULTS: Fifty-seven patients with New York Heart Association functional class II or III with a radionuclide left ventricular ejection fraction (LVEF) of less than 40% received carvedilol or metoprolol in a randomized fashion. The VE/VCO2 slope, LVEF and plasma brain natriuretic peptide (BNP) concentration were determined before and after 16 weeks of treatment. LVEF improved (p63 pg/ml (respective baseline median values) (p63 pg/ml, the improvement effect on the VE/VCO2 slope with carvedilol was significantly greater than that with metoprolol (p<0.05) and a significant improvement in the VE/VCO2 slope was observed only in those who took carvedilol (p<0.01). CONCLUSIONS: The VE/VCO2 slope was not improved after beta-blocker therapy in any of the patients. However, it did improve in patients with a lower LVEF or higher BNP level at baseline, and carvedilol was more effective than metoprolol in improving the VE/VCO2 slope in patients with higher BNP levels at baseline.

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