Protective effects of carvedilol against anthracycline-induced cardiomyopathy.
OBJECTIVE
The aim of this study was to determine the protective effect of carvedilol in anthracycline (ANT)-induced cardiomyopathy (CMP).


BACKGROUND
Despite its broad effectiveness, ANT therapy is associated with ANT-induced CMP. Recent animal studies and experimental observations showed that carvedilol prevented development of CMP due to chemotherapeutics. However, there is no placebo-controlled clinical trial concerning prophylactic carvedilol use in preventing ANT-induced CMP.


METHODS
Patients in whom ANT therapy was planned were randomized to administration of carvedilol or placebo. We enrolled 25 patients in carvedilol and control groups. In the carvedilol group, 12.5 mg once-daily oral carvedilol was given during 6 months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated.


RESULTS
At the end of 6 months of follow-up, 1 patient in the carvedilol group and 4 in the control group had died. Control EF was below 50% in 1 patient in the carvedilol group and in 5 in the control group. The mean EF of the carvedilol group was similar at baseline and control echocardiography (70.5 vs. 69.7, respectively; p = 0.3), but in the control group the mean EF at control echocardiography was significantly lower (68.9 vs. 52.3; p < 0.001). Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group. In Doppler study, whereas E velocities in the carvedilol group decreased, E velocities and E/A ratios were significantly reduced in the control group.


CONCLUSIONS
Prophylactic use of carvedilol in patients receiving ANT may protect both systolic and diastolic functions of the left ventricle.
Kalay
Nihat
N
Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey. nihatkalay@hotmail.com
Basar
Emrullah
E
Ozdogru
Ibrahim
I
Er
Ozlem
O
Cetinkaya
Yakup
Y
Dogan
Ali
A
Inanc
Tugrul
T
Oguzhan
Abdurrahman
A
Eryol
Namik Kemal
NK
Topsakal
Ramazan
R
Ergin
Ali
A
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects; D001783:Blood Flow Velocity; D002227:Carbazoles / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000517:prevention & control*; D000077261:Carvedilol; D003326:Coronary Circulation; D003971:Diastole; D004317:Doxorubicin / Q000009:adverse effects; D015150:Echocardiography, Doppler; D015251:Epirubicin / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality; D011412:Propanolamines / Q000627:therapeutic use*; D016037:Single-Blind Method; D013318:Stroke Volume; D013599:Systole; D016277:Ventricular Function, Left
D000317:Adrenergic alpha-Antagonists; D000319:Adrenergic beta-Antagonists; D018943:Anthracyclines; D000903:Antibiotics, Antineoplastic; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D015251:Epirubicin; D004317:Doxorubicin