Carvedilol reduced left ventricular end systolic volume by 9.2 mL (P=0.023) and increased ejection fraction by 3.9% (P=0.015) at 6 months compared to placebo in patients post-AMI.
RCT (n=127)
Blinded
Yes
Does carvedilol improve left ventricular remodeling in patients with left ventricular dysfunction after acute myocardial infarction treated with ACE inhibitors?
Carvedilol significantly improves left ventricular remodeling by reducing end-systolic volume and increasing ejection fraction in post-MI patients with LV dysfunction receiving ACE inhibitors.
Effect estimate: 9.2 mL reduction
p-value: p=0.023
BACKGROUND: The CAPRICORN trial has shown that carvedilol improved outcome in patients with left ventricular dysfunction after acute myocardial infarction treated with ACE inhibitors. The aim of this substudy was to determine the effects of carvedilol on left ventricular remodeling in this patient group. METHODS AND RESULTS: Patients entering the CAPRICORN trial from 13 centers in New Zealand, Australia, and Spain were recruited for this echocardiographic substudy. In 127 patients, quantitative 2D echocardiography was performed according to a standard protocol before randomization and repeated after 1, 3, and 6 months of treatment with carvedilol or placebo. Left ventricular volumes, ejection fraction (Simpson's method), and wall motion score index were determined in a blinded analysis at the Core Echo Laboratory. At 6 months, left ventricular end systolic volume was 9.2 mL less in the carvedilol group than in the placebo group (P=0.023), and left ventricular ejection fraction was 3.9% higher (P=0.015). Left ventricular end diastolic volume and wall motion score index were not statistically different between the 2 groups at 6 months. CONCLUSIONS: In patients with left ventricular dysfunction after acute myocardial infarction treated with ACE inhibitors, carvedilol had a beneficial effect on ventricular remodeling, which may, in part, mediate the substantial clinical beneficial effects of carvedilol in this patient population.
Doughty et al. (2004) conducted an RCT in Left ventricular dysfunction after acute myocardial infarction (n=127). Carvedilol vs. Placebo was evaluated on Left ventricular end systolic volume (9.2 mL reduction, p=0.023). Carvedilol reduced left ventricular end systolic volume by 9.2 mL (P=0.023) and increased ejection fraction by 3.9% (P=0.015) at 6 months compared to placebo in patients post-AMI.