Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study
Objective: To determine whether the process of reverse left ventricular remodelling in response to carvedilol is dependent on baseline heart rate (BHR), heart rhythm, or heart rate reduction (HRR) in response to carvedilol. Design: Retrospective analysis of serial echocardiograms in 257 patients wit...
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| Veröffentlicht in: | British heart journal 2003-03, Vol.89 (3), p.293-298 |
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| creator | Arnold, R H Kotlyar, E Hayward, C Keogh, A M Macdonald, P S |
| description | Objective: To determine whether the process of reverse left ventricular remodelling in response to carvedilol is dependent on baseline heart rate (BHR), heart rhythm, or heart rate reduction (HRR) in response to carvedilol. Design: Retrospective analysis of serial echocardiograms in 257 patients with chronic systolic heart failure at baseline and at 12–18 months after starting carvedilol. Reverse left ventricular remodelling was determined by changes in left ventricular end diastolic dimension (LVEDD), end systolic dimension (LVESD), and fractional shortening (LVFS). Setting: Heart failure clinic within a university teaching hospital. Main outcome measures: Changes in LVEDD, LVESD, and LVFS. Results: LVEDD and LVESD decreased by 2.6 (0.4) mm and 4.9 (0.5) mm, respectively (mean (SEM)), and LVFS increased by 4.3 (0.5)% (all p < 0.0001 v baseline). Simple regression revealed no significant relation between BHR or HRR and the changes in LVEDD, LVESD, or LVFS. Stratification of patients into high and low BHR groups (above and below the mean) or according to the baseline heart rhythm (sinus rhythm v atrial fibrillation) showed no differences between groups in the extent of reverse left ventricular remodelling. Improvements in left ventricular function and dimensions were associated with significant improvements in New York Heart Association functional class. Conclusions: The benefits of carvedilol in terms of reverse left ventricular remodelling and symptomatic improvement in patients with chronic heart failure are independent of BHR, heart rhythm, and the HRR that occurs in response to carvedilol. |
| doi_str_mv | 10.1136/heart.89.3.293 |
| format | Article |
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Design: Retrospective analysis of serial echocardiograms in 257 patients with chronic systolic heart failure at baseline and at 12–18 months after starting carvedilol. Reverse left ventricular remodelling was determined by changes in left ventricular end diastolic dimension (LVEDD), end systolic dimension (LVESD), and fractional shortening (LVFS). Setting: Heart failure clinic within a university teaching hospital. Main outcome measures: Changes in LVEDD, LVESD, and LVFS. Results: LVEDD and LVESD decreased by 2.6 (0.4) mm and 4.9 (0.5) mm, respectively (mean (SEM)), and LVFS increased by 4.3 (0.5)% (all p < 0.0001 v baseline). Simple regression revealed no significant relation between BHR or HRR and the changes in LVEDD, LVESD, or LVFS. Stratification of patients into high and low BHR groups (above and below the mean) or according to the baseline heart rhythm (sinus rhythm v atrial fibrillation) showed no differences between groups in the extent of reverse left ventricular remodelling. Improvements in left ventricular function and dimensions were associated with significant improvements in New York Heart Association functional class. Conclusions: The benefits of carvedilol in terms of reverse left ventricular remodelling and symptomatic improvement in patients with chronic heart failure are independent of BHR, heart rhythm, and the HRR that occurs in response to carvedilol.</description><identifier>ISSN: 1355-6037</identifier><identifier>ISSN: 0007-0769</identifier><identifier>EISSN: 1468-201X</identifier><identifier>DOI: 10.1136/heart.89.3.293</identifier><identifier>PMID: 12591834</identifier><language>eng</language><publisher>London: BMJ Publishing Group Ltd and British Cardiovascular Society</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Analysis ; baseline heart rate ; Beta blockers ; BHR ; Biological and medical sciences ; Carbazoles - therapeutic use ; Cardiac arrhythmia ; cardiac insufficiency bisoprolol study ; Cardiac Output, Low - drug therapy ; Cardiac Output, Low - physiopathology ; Cardiovascular Medicine ; Cardiovascular research ; Cardiovascular system ; Carvedilol ; CIBIS ; Clinical pharmacology ; Drug therapy ; Echocardiography ; Evaluation ; Female ; Follow-Up Studies ; Heart failure ; Heart function tests ; Heart rate ; Heart Rate - drug effects ; heart rate reduction ; HRR ; Humans ; left ventricular end diastolic dimension ; left ventricular end systolic dimension ; left ventricular fractional shortening ; LVEDD ; LVESD ; LVFS ; Male ; Medical sciences ; MERIT ; metoprolol CR/XL randomised intervention trial ; Middle Aged ; Miscellaneous ; Mortality ; New York Heart Association ; NYHA ; Pharmacology. Drug treatments ; Propanolamines - therapeutic use ; remodelling ; Sinuses ; Statistics ; Treatment Outcome ; Variables ; Ventricular Remodeling - drug effects ; β blocker</subject><ispartof>British heart journal, 2003-03, Vol.89 (3), p.293-298</ispartof><rights>Copyright 2003 by Heart</rights><rights>2003 INIST-CNRS</rights><rights>COPYRIGHT 2003 BMJ Publishing Group Ltd.</rights><rights>Copyright: 2003 Copyright 2003 by Heart</rights><rights>Copyright © Copyright 2003 by Heart 2003</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b591t-88bf990dfd914de647e2c9a2d382ef8af0997d17e46cbff0556521382fd3d173</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767578/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767578/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14531181$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12591834$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arnold, R H</creatorcontrib><creatorcontrib>Kotlyar, E</creatorcontrib><creatorcontrib>Hayward, C</creatorcontrib><creatorcontrib>Keogh, A M</creatorcontrib><creatorcontrib>Macdonald, P S</creatorcontrib><title>Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study</title><title>British heart journal</title><addtitle>Heart</addtitle><description>Objective: To determine whether the process of reverse left ventricular remodelling in response to carvedilol is dependent on baseline heart rate (BHR), heart rhythm, or heart rate reduction (HRR) in response to carvedilol. Design: Retrospective analysis of serial echocardiograms in 257 patients with chronic systolic heart failure at baseline and at 12–18 months after starting carvedilol. Reverse left ventricular remodelling was determined by changes in left ventricular end diastolic dimension (LVEDD), end systolic dimension (LVESD), and fractional shortening (LVFS). Setting: Heart failure clinic within a university teaching hospital. Main outcome measures: Changes in LVEDD, LVESD, and LVFS. Results: LVEDD and LVESD decreased by 2.6 (0.4) mm and 4.9 (0.5) mm, respectively (mean (SEM)), and LVFS increased by 4.3 (0.5)% (all p < 0.0001 v baseline). Simple regression revealed no significant relation between BHR or HRR and the changes in LVEDD, LVESD, or LVFS. Stratification of patients into high and low BHR groups (above and below the mean) or according to the baseline heart rhythm (sinus rhythm v atrial fibrillation) showed no differences between groups in the extent of reverse left ventricular remodelling. Improvements in left ventricular function and dimensions were associated with significant improvements in New York Heart Association functional class. Conclusions: The benefits of carvedilol in terms of reverse left ventricular remodelling and symptomatic improvement in patients with chronic heart failure are independent of BHR, heart rhythm, and the HRR that occurs in response to carvedilol.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Analysis</subject><subject>baseline heart rate</subject><subject>Beta blockers</subject><subject>BHR</subject><subject>Biological and medical sciences</subject><subject>Carbazoles - therapeutic use</subject><subject>Cardiac arrhythmia</subject><subject>cardiac insufficiency bisoprolol study</subject><subject>Cardiac Output, Low - drug therapy</subject><subject>Cardiac Output, Low - physiopathology</subject><subject>Cardiovascular Medicine</subject><subject>Cardiovascular research</subject><subject>Cardiovascular system</subject><subject>Carvedilol</subject><subject>CIBIS</subject><subject>Clinical pharmacology</subject><subject>Drug therapy</subject><subject>Echocardiography</subject><subject>Evaluation</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart failure</subject><subject>Heart function tests</subject><subject>Heart rate</subject><subject>Heart Rate - drug effects</subject><subject>heart rate reduction</subject><subject>HRR</subject><subject>Humans</subject><subject>left ventricular end diastolic dimension</subject><subject>left ventricular end systolic dimension</subject><subject>left ventricular fractional shortening</subject><subject>LVEDD</subject><subject>LVESD</subject><subject>LVFS</subject><subject>Male</subject><subject>Medical sciences</subject><subject>MERIT</subject><subject>metoprolol CR/XL randomised intervention trial</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Mortality</subject><subject>New York Heart Association</subject><subject>NYHA</subject><subject>Pharmacology. Drug treatments</subject><subject>Propanolamines - therapeutic use</subject><subject>remodelling</subject><subject>Sinuses</subject><subject>Statistics</subject><subject>Treatment Outcome</subject><subject>Variables</subject><subject>Ventricular Remodeling - drug effects</subject><subject>β blocker</subject><issn>1355-6037</issn><issn>0007-0769</issn><issn>1468-201X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkl1rFDEUhgdRbK3eeikBURB218lkPhIvhLJoFapCLdW7kMmc7GbNJGuS2bp_zV9n9sOuSkHmYjJ5n7zvOZmTZY9xPsGY1C_nIHycUDYhk4KRO9kxLms6LnL89W5ak6oa1zlpjrIHISzyPC8Zre9nR7ioGKakPM5-XoARUTuLWojXABZtHZEXEUa_1_N1nPcjJGyHPKzAB0AGVEQrsNFrORjhk9C7DozRdoa0TZ9h6WwCo0NS-BV02jizUZYpLp0L6FrHOZJz76yW-yQltBk8vEIChWRkAMlNRKrEtQH8alupMCjEoVs_zO4pYQI82r9Pssu3by6n78bnn87eT0_Px21qMo4pbRVjeac6hssO6rKBQjJRdIQWoKhQOWNNhxsoa9kqlVdVXRU4iaojaZucZK93tsuh7aHbFiQMX3rdC7_mTmj-t2L1nM_ciuOmbqqGJoPnewPvvg8QIu91kOmqhAU3BN6QnLB6m_T0H3DhBp_6DcmL5g2jJSWJGu2omTDAtVUupcoZWEjhzoLSafuUUZpsi43p-BY8PR30Wt7GT3a89C4ED-qmU5zzzcjx7a_ilHHC08ilA0_-vJ8Dvp-xBDzbAyJIYZQXVupw4MqKYEzxoVIdIvy40YX_xuuGNBX_eDXlZ1fN5-mXDyW_SPyLHd_2i_8V-QtCuwIF</recordid><startdate>20030301</startdate><enddate>20030301</enddate><creator>Arnold, R H</creator><creator>Kotlyar, E</creator><creator>Hayward, C</creator><creator>Keogh, A M</creator><creator>Macdonald, P S</creator><general>BMJ Publishing Group Ltd and British Cardiovascular Society</general><general>BMJ</general><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>Copyright 2003 by Heart</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20030301</creationdate><title>Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study</title><author>Arnold, R H ; Kotlyar, E ; Hayward, C ; Keogh, A M ; Macdonald, P S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b591t-88bf990dfd914de647e2c9a2d382ef8af0997d17e46cbff0556521382fd3d173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Analysis</topic><topic>baseline heart rate</topic><topic>Beta blockers</topic><topic>BHR</topic><topic>Biological and medical sciences</topic><topic>Carbazoles - therapeutic use</topic><topic>Cardiac arrhythmia</topic><topic>cardiac insufficiency bisoprolol study</topic><topic>Cardiac Output, Low - drug therapy</topic><topic>Cardiac Output, Low - physiopathology</topic><topic>Cardiovascular Medicine</topic><topic>Cardiovascular research</topic><topic>Cardiovascular system</topic><topic>Carvedilol</topic><topic>CIBIS</topic><topic>Clinical pharmacology</topic><topic>Drug therapy</topic><topic>Echocardiography</topic><topic>Evaluation</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart failure</topic><topic>Heart function tests</topic><topic>Heart rate</topic><topic>Heart Rate - drug effects</topic><topic>heart rate reduction</topic><topic>HRR</topic><topic>Humans</topic><topic>left ventricular end diastolic dimension</topic><topic>left ventricular end systolic dimension</topic><topic>left ventricular fractional shortening</topic><topic>LVEDD</topic><topic>LVESD</topic><topic>LVFS</topic><topic>Male</topic><topic>Medical sciences</topic><topic>MERIT</topic><topic>metoprolol CR/XL randomised intervention trial</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Mortality</topic><topic>New York Heart Association</topic><topic>NYHA</topic><topic>Pharmacology. Drug treatments</topic><topic>Propanolamines - therapeutic use</topic><topic>remodelling</topic><topic>Sinuses</topic><topic>Statistics</topic><topic>Treatment Outcome</topic><topic>Variables</topic><topic>Ventricular Remodeling - drug effects</topic><topic>β blocker</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Arnold, R H</creatorcontrib><creatorcontrib>Kotlyar, E</creatorcontrib><creatorcontrib>Hayward, C</creatorcontrib><creatorcontrib>Keogh, A M</creatorcontrib><creatorcontrib>Macdonald, P S</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Arnold, R H</au><au>Kotlyar, E</au><au>Hayward, C</au><au>Keogh, A M</au><au>Macdonald, P S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study</atitle><jtitle>British heart journal</jtitle><addtitle>Heart</addtitle><date>2003-03-01</date><risdate>2003</risdate><volume>89</volume><issue>3</issue><spage>293</spage><epage>298</epage><pages>293-298</pages><issn>1355-6037</issn><issn>0007-0769</issn><eissn>1468-201X</eissn><abstract>Objective: To determine whether the process of reverse left ventricular remodelling in response to carvedilol is dependent on baseline heart rate (BHR), heart rhythm, or heart rate reduction (HRR) in response to carvedilol. Design: Retrospective analysis of serial echocardiograms in 257 patients with chronic systolic heart failure at baseline and at 12–18 months after starting carvedilol. Reverse left ventricular remodelling was determined by changes in left ventricular end diastolic dimension (LVEDD), end systolic dimension (LVESD), and fractional shortening (LVFS). Setting: Heart failure clinic within a university teaching hospital. Main outcome measures: Changes in LVEDD, LVESD, and LVFS. Results: LVEDD and LVESD decreased by 2.6 (0.4) mm and 4.9 (0.5) mm, respectively (mean (SEM)), and LVFS increased by 4.3 (0.5)% (all p < 0.0001 v baseline). Simple regression revealed no significant relation between BHR or HRR and the changes in LVEDD, LVESD, or LVFS. Stratification of patients into high and low BHR groups (above and below the mean) or according to the baseline heart rhythm (sinus rhythm v atrial fibrillation) showed no differences between groups in the extent of reverse left ventricular remodelling. Improvements in left ventricular function and dimensions were associated with significant improvements in New York Heart Association functional class. Conclusions: The benefits of carvedilol in terms of reverse left ventricular remodelling and symptomatic improvement in patients with chronic heart failure are independent of BHR, heart rhythm, and the HRR that occurs in response to carvedilol.</abstract><cop>London</cop><pub>BMJ Publishing Group Ltd and British Cardiovascular Society</pub><pmid>12591834</pmid><doi>10.1136/heart.89.3.293</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adrenergic beta-Antagonists - therapeutic use Analysis baseline heart rate Beta blockers BHR Biological and medical sciences Carbazoles - therapeutic use Cardiac arrhythmia cardiac insufficiency bisoprolol study Cardiac Output, Low - drug therapy Cardiac Output, Low - physiopathology Cardiovascular Medicine Cardiovascular research Cardiovascular system Carvedilol CIBIS Clinical pharmacology Drug therapy Echocardiography Evaluation Female Follow-Up Studies Heart failure Heart function tests Heart rate Heart Rate - drug effects heart rate reduction HRR Humans left ventricular end diastolic dimension left ventricular end systolic dimension left ventricular fractional shortening LVEDD LVESD LVFS Male Medical sciences MERIT metoprolol CR/XL randomised intervention trial Middle Aged Miscellaneous Mortality New York Heart Association NYHA Pharmacology. Drug treatments Propanolamines - therapeutic use remodelling Sinuses Statistics Treatment Outcome Variables Ventricular Remodeling - drug effects β blocker |
| title | Relation between heart rate, heart rhythm, and reverse left ventricular remodelling in response to carvedilol in patients with chronic heart failure: a single centre, observational study |
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