Dose-Dependent Prognostic Effect of Carvedilol in Patients With Chronic Heart Failure Special Reference to Ranscardiac Gradient of Norepinephrine

• Published in: Circulation Journal Vol. 73; no. 12; pp. 2270 - 2275
• Main Authors: Nishiyama, Keizo, Tsutamoto, Takayoshi, Yamaji, Masayuki, Kawahara, Chiho, Yamamoto, Takashi, Fujii, Masanori, Horie, Minoru
• Format: Journal Article
• Language: English
• Published: The Japanese Circulation Society 2009
• Subjects: BNP; Carvedilol; Chronic heart failure; Norepinephrine; Prognosis
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-09-0456

Background: The effect of the dose of carvedilol on cardiac sympathetic nerve activity (CSA) and mortality remain uncertain in patients with chronic heart failure (CHF). Methods and Results: To compare the dose of carvedilol and the transcardiac gradient of norepinephrine (NE), a biomarker of CSA, and prognosis in patients with CHF, hemodynamic parameters and plasma levels of NE, N-terminal brain natriuretic peptide (NT-proBNP) in the aortic root and coronary sinus were measured in 107 patients with systolic CHF who received carvedilol. Patients were divided into 2 groups [group I: low dose (<10 mg/day, n=41) and group II: high dose (≥10 mg/day, n=66)]. There was no difference between the 2 groups for the hemodynamic parameters. The dose of carvedilol did not correlate with plasma NE, but was significantly correlated with the transcardiac increase in NE. During a median follow-up of 4.3 years, 13 patients died of cardiac disease. In the Cox stepwise multivariate analyses, a high level of transcardiac increase in NE (P<0.001), high level of plasma log NT-proBNP (P=0.004) and low dose of carvedilol (P=0.012) were significant independent predictors. Conclusion: The carvedilol dose is important for the management of CSA and prognosis in patients with systolic CHF. (Circ J 2009; 73: 2270-2275)