Different ventricular remodelling and autonomic modulation after long-term beta-blocker treatment in hypertensive, ischaemic and idiopathic dilated cardiomyopathy.
OBJECTIVE
In this retrospective analysis, we investigated the influence of aetiology on autonomic modulation and reverse ventricular remodelling induced by beta-blockade in heart failure.


METHODS
Twenty-three heart failure patients without comorbidities (mean age 61 +/- 4 years, New York Heart Association class 3.1 +/- 0.1, treated with angiotensin-converting enzyme inhibitors and diuretics) were divided into three groups according to aetiology: hypertensive (group 1, n = 7), ischaemic (group 2, n = 6), and idiopathic (group 3, n = 10). Before and after 6 months of carvedilol (53 +/- 10 mg/day), patients underwent cardiopulmonary test, echocardiography and autonomic evaluation with spectral analysis of RR variability (10 min of rest plus 10 min of standing: the low frequency/high frequency ratio between low and high frequency components of each spectrum was the index of sympathovagal balance).


RESULTS
Carvedilol improved New York Heart Association class and exercise performance. In group 1, ejection fraction and left ventricular end-diastolic volume normalised, and interventricular septum thickness increased. No remodelling occurred in group 2. In group 3, interventricular septum thickness was unchanged, ejection fraction and left ventricular end-diastolic volume improved. Also autonomic modulation differed. At baseline, adrenergic activation was observed either at rest or during standing. After carvedilol treatment, group 1 did not show any change in the low frequency/high frequency ratio in both conditions, whereas groups 2 and 3 showed reduced adrenergic activation at rest and normal response to standing.


CONCLUSIONS
Despite favourable ventricular remodelling, the poor autonomic modulation observed with beta-blockade indicates a persistent central adrenergic activation in hypertensive heart failure patients.
Malfatto
Gabriella
G
Division of Cardiology, Istituto Scientifico Ospedale San Luca, Istituto Auxologico Italiano IRCCS, Milan, Italy. Malfi@Auxologico.it
Branzi
Giovanna
G
Ciambellotti
Francesca
F
Valli
Paola
P
Bizzi
Caterina
C
Facchini
Mario
M
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D001341:Autonomic Nervous System / Q000503:physiopathology; D002227:Carbazoles / Q000008:administration & dosage*; D002311:Cardiomyopathy, Dilated / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology*; D000077261:Carvedilol; D006801:Humans; D006973:Hypertension / Q000150:complications*; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D013318:Stroke Volume / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol