Abstract ID : 104696

Carvedilol and Left Ventricular Remodeling Following Acute Myocardial Infarction: Variable Effects Over Time and Possible Mechanisms. The CAPRICORN Echo Substudy

Robert N Doughty
Authors: Norman Sharpe; Helen Walsh; Gillian A Whalley; Robert N Doughty; Greg D Gamble

Background: The CAPRICORN Echo Substudy has previously reported reverse remodeling with carvedilol (C) at 6 months. The earlier effects of C on remodeling and mechanisms of benefit are uncertain.

Methods: The substudy was undertaken at 12 sites in New Zealand, Australia and Spain. Quantitative 2-D echocardiograms were recorded at baseline, 1, 3 & 6 months of study treatment. LV end-diastolic & end-systolic volumes (LVEDV and LVESV) & wall motion score index (ASE) were measured off-line at the Core Echo Lab.

Results: 129 patients were included. Heart rate was decreased by 7-8bpm between the C and placebo groups at 1, 3 & 6 months. Between group changes in blood pressure (BP) at 1, 3 and 6 months were: 7/7 (p<0.05), 6/2 (p=NS) and 3/1mmHg (p=NS) respectively. Remodeling effects are shown in the table. At one month there was an improvement in SV and LVEF associated with the reduction in HR and BP. Improvement in wall motion score was also evident at 1 month, suggesting an early functional improvement. These changes were maintained at 3 months. In addition, at 6 months there were significant reductions in LVEDV and LVESV with C.

Conclusions: The early effects of carvedilol appear primarily associated with the reduction in heart rate and vasodilating properties of carvedilol. The reverse remodeling effects are not evident early but are significant and substantial at 6 months.

 
BL to 1 mth
BL to 3 mths
BL to 6 mths
LVEDV, ml
-1.1
-2.1
-8.6*
LVESV, ml
-6.3
-7.2
-10.8*
SV, ml
+5.5*
+4.7*
+2.3
LVEF, %
+3.8*
+4*
+4.1*
WMSI
-0.2*
-0.16
-0.11*
Values = mean change between groups.
*p<0.05 carvedilol vs placebo