title: Improvement in left ventricular function in response to carvedilol is accompanied by attenuation of neurohumoral activation in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  We sought to evaluate whether improvement in ejection fraction (EF) with carvedilol therapy is accompanied by improvement in neurohumoral factors.
  
  
  RESULTS
  Forty-two patients with dilated cardiomyopathy were given carvedilol for 3 to 5 months. Changes in EF, plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and norepinephrine levels were determined. Iodine-123 metaiodobenzylguanidine (MIBG) images were also obtained before and after carvedilol therapy. Myocardial uptake of MIBG was calculated as the heart to mediastinal activity ratio (H/M). Storage and release of MIBG was calculated as percent myocardial MIBG washout rate (WR). We divided patients into 2 groups: 27 responders whose EF increased by more than 5% and 15 nonresponders whose EF increased by 5% or less. EF of responders increased by 15 +/- 5% and that of nonresponders by 1 +/- 4%. Although MIBG image-derived indexes of nonresponders remained unchanged, the delayed H/M (1.91 +/- 0.34 v 2.24 +/- 0.53, P < .01) and WR (49 +/- 11 v 39 +/- 9%, P < .01) of responders improved, respectively. The plasma ANP (51 +/- 50 v 27 +/- 24 pg/mL, P < .01) and BNP (194 +/- 197 v 49 +/- 62 pg/mL, P < .01) levels of responders decreased. The degree of changes in the plasma BNP level correlated with changes in EF (r = -.698, P < .01).
  
  
  CONCLUSIONS
  The improvement in EF with carvedilol therapy was proved to be accompanied by an improvement in neurohumoral factors.
authors.affiliation: Department of Medicine, National Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujimura
authors.forename: Y
authors.initials: Y
authors.lastname: Yasumura
authors.forename: Y
authors.initials: Y
authors.lastname: Ishida
authors.forename: S
authors.initials: S
authors.lastname: Nakatani
authors.forename: K
authors.initials: K
authors.lastname: Komamura
authors.forename: M
authors.initials: M
authors.lastname: Yamagishi
authors.forename: K
authors.initials: K
authors.lastname: Miyatake
mesh_terms: D019797:3-Iodobenzylguanidine; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D009320:Atrial Natriuretic Factor / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002227:Carbazoles / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D000077261:Carvedilol; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009638:Norepinephrine / Q000097:blood*; D011412:Propanolamines / Q000627:therapeutic use*; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology*
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D002227:Carbazoles; D011412:Propanolamines; D019275:Radiopharmaceuticals; D000077261:Carvedilol; D020097:Natriuretic Peptide, Brain; D019797:3-Iodobenzylguanidine; D009320:Atrial Natriuretic Factor; D009638:Norepinephrine