title: [Effects of carvedilol (beta 1, beta 2, alpha 1 bloker) on refractory congestive heart failure].
abstract: OBJECTIVE
  The effects of beta-blockers on severe heart failure are not well known. We investigated the effects of carvedilol (beta 1, beta 2, alpha 1-blocker) on symptoms, functional class (FC), and left ventricular function in patients with refractory heart failure.
  
  
  METHODS
  We studied 21 patients, mean age 56 +/- 10 years, 9 in FC IV, e 12 in FC III (intermittently with class IV). The initial dosage was 6.25 mg, and it was increased progressively as tolerated. The mean dose was 42 +/- 11 mg. The patients were submitted to routine clinical evaluation, and electrocardiogram. We determined after 196 +/- 60 days of follow-up the left ventricular end diastolic dimension (by echocardiogram), and left ventricular ejection fraction (using MUGA).
  
  
  RESULTS
  Carvedilol was well tolerated by 16 (76%) patients. One patient is in FC II during increment of the dosage. Eight patients were in FC I, and 7 in FC II at 196 +/- 60 days of follow-up. Heart rate decreased from 96 +/- 15 to 67 +/- 10 bpm (p < 0.0001), left ventricular end diastolic diameter from 73 +/- 13 to 66 +/- 12 mm (p < 0.009), and the left ventricular ejection fraction increased from 0.21 +/- 0.06 to 0.34 +/- 0.12 (p < 0.0003).
  
  
  CONCLUSIONS
  Carvedilol may have beneficial effects on cardiac function, remodeling process, and FC. If tolerated, it seems to be a potential alternative option in the medical treatment of refractory heart failure. However, investigations are still necessary to clarify the long-term effects of carvedilol on this specific subgroup of patients.
authors.affiliation: Instituto do Coração do Hospital das Clínicas, FMUSP.
authors.forename: E A
authors.initials: EA
authors.lastname: Bocchi
authors.forename: F
authors.initials: F
authors.lastname: Bacal
authors.forename: G
authors.initials: G
authors.lastname: Bellotti
authors.forename: D
authors.initials: D
authors.lastname: Carrara
authors.forename: J A
authors.initials: JA
authors.lastname: Ramires
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D004361:Drug Tolerance; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000627:therapeutic use*; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol
vernacular_title: Efeitos do carvedilol (bloqueador beta 1, beta 2, alpha 1) na insuficiência cardíaca refratária.