Beta-blockade with bucindolol in heart failure caused by ischemic versus idiopathic dilated cardiomyopathy.
BACKGROUND
We investigated the effects of bucindolol, a nonselective, non-ISA beta-blocker with mild-vasodilatory properties, in patients with congestive heart failure from ischemic dilated cardiomyopathy (ISCDC, n = 27) and compared the results with those in subjects with heart failure from idiopathic dilated cardiomyopathy (IDC, n = 22).


RESULTS
Patients were randomized in a double-blind fashion to receive 12 weeks' treatment with either bucindolol or placebo, with randomization stratified for IDC or ISCDC: Invasive (right heart catheterization) and noninvasive (echo, MUGA, central venous norepinephrine, exercise treadmill studies, and symptom scores) tests of heart failure severity were determined at baseline and end of the study. For all subjects (ISCDC plus IDC), relative to placebo treatment, bucindolol-treated patients had significant improvement in ejection fraction, left ventricular size and filling pressure, stroke work index, symptom score, and central venous norepinephrine. However, most of these differences could be attributed to improvement in the IDC subgroup, as the only parameter with a statistically significant degree of improvement in the bucindolol-treated ISCDC subgroup was left ventricular size.


CONCLUSIONS
We conclude that beta-blockade may produce quantitatively different degrees of response in different kinds of heart muscle disease.
Heart Failure Treatment Program, University of Utah School of Medicine, Salt Lake City.
S L
SL
Woodley
E M
EM
Gilbert
J L
JL
Anderson
J B
JB
O'Connell
D
D
Deitchman
F G
FG
Yanowitz
P C
PC
Mealey
K
K
Volkman
D G
DG
Renlund
R
R
Menlove
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000367:Age Factors; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D004311:Double-Blind Method; D015444:Exercise; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D011412:Propanolamines / Q000627:therapeutic use*; D016277:Ventricular Function, Left / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D011412:Propanolamines; C024307:bucindolol; D009638:Norepinephrine