THE EFFECTS OF CARVEDILOL ON LEFT VENTRICULAR FUNCTIONS AND ARRHYTHMIAS IN PATIENTS WITH SEVERE CARDIAC FAILURE
Journal Name:
- İstanbul Tıp Fakültesi Dergisi
Keywords (Original Language):
Abstract (2. Language):
Objective: Arrhythmia are seen frequently in patients with heart failure (HF). Carvedilol which has both beta-blocker
and alfa-blocker properties has led to new expectations in the treatment of HF. Our aim is to explore the effect
of carvedilol on left ventricular (LV) function and development of arrhythmia in patients with HF.
Materials and method: Thirty-one patients (60±10 years, F/M:11/20) were enrolled for the study who had advanced
HF in sinus rhythm. After echocardiography, 24 hour Holter, heart rate variability analysis (HRV), signal averaged
ECG, carvedilol was added to their treatment(diuretic and ACEI). Carvedilol dosage was increased to the upper
tolerable limit. The same analysis were repeated in 12th and 24th week.
Results: Marked improvement was found in LV function in 12 and 24th week (respectively; EF %30.1 ± 6.3 vs
33.8 ± 6.8, p:0.005, Tei index: 0.50 ± 0.21 vs 0.40 ± 0.15, p:0.006 and EF % 30.1 ± 6.3 vs 33.7 ± 6.6, p:0.01, Teiindex: 0.50 ± 0.21 vs 0.41 ± 0.19, p:0.03). Before carvedilol, arrhythmias including VT were found in eight patients
in holter , whereas they were observed in five patients at 12th week. While late potential positivity was found
in 10 patients initially and was found in 7 patients at 24th week. Total QRS was decreased significantly (120.6 ±
28.8 vs 116.3 ± 24.3, p:0.03). Significant increases were observed in SDNN both at 12th week and 24th week (respectively
64.2±30.3, 89.5±36.2, 93.5±37, p<0.001) and SDANN (16.1±8.3, 22.8±16.5, 20.6±8.8, p:0.02, p:0.003).
Conclusion: Carvedilol causes improvement in LV systolic function, decreases the frequency of arrhythmia, decreases
late potential positivity and improves HRV parameters in HF patients.
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Abstract (Original Language):
Amaç: ‹leri evre kalp yetersizli¤i(KY) olan hastalarda sempatik sistemde art›fla ba¤l› aritmi ve ani ölüm s›kd›r. Beta
bloker ve alfa-bloker özelli¤i olan karvedilol, KY tedavisinde beklentilere neden olmufltur. Çal›flmam›z›n amac›
ileri evre KY olan hastalarda tedaviye eklenen karvedilolün sol ventrikül fonksiyonlar› ve aritmi geliflimine etkisini
araflt›rmakt›r.
Gereç ve yöntem: Çal›flmaya sinüs ritminde ileri evre KY olan, beta bloker kullanmayan 31 hasta (ortalama yafl:
60 ± 10 y›l, K /E:11/20) al›nd›. Hastalara ekokardiyografi, 24 saatlik ritm Holteri ve kalp h›z› de¤iflkenlik analizi
(HRV), sinyal ortalamal› EKG analizi yap›ld›ktan sonra, almakta olduklar› (diüretik ve ACEI) tedaviye ilaveten,
karvedilol 2 x 3.125 baflland›. Karvedilol dozu tolere edebildikleri üst s›n›ra ç›k›ld›, 12. ve 24. haftada tetkikler tekrarland›.
Bulgular: 12.ve 24. haftan›n sonunda sol ventrikül sistolik fonksiyonlar›nda belirgin düzelme saptand› (s›ras›yla;
EF %30,1 ± 6,3 vs 33,8 ± 6,8, p:0,005, Tei index: 0,50 ± 0,21 vs 0,40 ± 0,15, p:0,006 ve EF % 30,1 ± 6,3 vs 33,7
± 6,6, p:0,01, Tei index: 0,50 ± 0,21 vs 0,41 ± 0,19, p:0,03). Holterde 8 hastada saptanan VT dahil kompleks aritmi,
12. haftada 5 hastada saptand›. Sinyal ortalamal› EKG’de 10 hastada saptanan geç potansiyel pozitifli¤i 12. haftada
8, 24. haftada 7 hastada gözlendi. Total QRS de anlaml› azalma oldu¤u saptand›(120,6 ± 28,8 vs 116,3 ± 24,3,
p:0,03). HRV parametrelerinden SDNN (12. haftada, 64,2 ± 30,3 vs 89,5 ± 36,2, p<0,001, 24. haftada; 64,2 ± 30,3
vs 93,5 ± 37, p<0,001) ve SDANNda hem 12. haftada hem de 24. haftada anlaml› artma gözlendi (16,1 ± 8,3 vs
22,8 ± 16,5, p:0,02, 24. haftada; 16,1 ± 8,3 vs 20,6 ± 8,8, p:0,03).
Sonuç: ‹leri evre KY olan hastalarda tedaviye eklenen karvedilol, sol ventrikül sistolik fonksiyonlar›nda düzelme
sa¤lamaktad›r. Ani ölüme neden olan kompleks aritmi s›kl›¤›n›, geç potansiyel pozitifli¤ini azaltmakta, HRV parametrelerini
düzeltmektedir.
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