Combined therapy with carvedilol and amiodarone is more effective in improving cardiac symptoms, function, and sympathetic nerve activity in patients with dilated cardiomyopathy: comparison with carvedilol therapy alone.
BACKGROUND
Carvedilol therapy has been reported to be more effective than other beta-blockers in patients with chronic heart failure (CHF). Amiodarone is an anti-arrhythmic medicine that has also been reported to be effective in patients with CHF. But the usefulness of combined therapy with carvedilol and amiodarone has not been reported.


METHODS
We compared 15 patients (M/F = 3/12, age = 57 +/- 8 y) with dilated cardiomyopathy (DCM) receiving carvedilol and amiodarone with 15 patients (M/F = 3/12, age = 61 +/- 9 y) receiving carvedilol alone. Patients were studied before and after 1 year of treatment (1Y). NYHA class and exercise capacity based on the specific-activity-scale (SAS), were assessed. Cardiac sympathetic nerve activity was estimated using total defect score (TDS), H/M ratio and washout rate (WR) of 123I-MIBG imaging. Cardiac function was evaluated using 99mTc-MIBI QGS.


RESULTS
Combined therapy improved several parameters much more than carvedilol alone (p < 0.05) including delta-TDS (15.0 +/- 8.6 vs. 7.6 +/- 7.2) and delta-WR (15.9 +/- 11.0% vs. 7.3 +/- 10.0%) for 123I-MIBG imaging, delta-LVEF (26.1 +/- 11.4% vs. 15.5 +/- 13.8%), delta-end-systolic volume (100 +/- 63.8 ml vs. 58.9 +/- 47.3 ml), 1Y NYHA class (1.5 +/- 0.5 vs. 1.9 +/- 0.5), 1Y SAS (7.3 +/- 0.7 Mets vs. 6.2 +/- 1.0 Mets), and delta-SAS (3.4 +/- 0.8 Mets vs. 2.6 +/- 1.1 Mets).


CONCLUSIONS
Combined therapy with carvedilol and amiodarone is more effective in improving cardiac symptoms, exercise capacity, cardiac function and cardiac sympathetic nerve activity in patients with DCM.
Toyama
Takuji
T
Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan. toyama.t@cvc.pref.gunma.jp
Hoshizaki
Hiroshi
H
Yoshimura
Yuko
Y
Kasama
Shu
S
Isobe
Naoki
N
Adachi
Hitoshi
H
Oshima
Shigeru
S
Taniguchi
Koichi
K
D000638:Amiodarone / Q000008:administration & dosage*; D001342:Autonomic Nervous System Diseases / Q000188:drug therapy* / Q000209:etiology; D001794:Blood Pressure / Q000187:drug effects*; D002227:Carbazoles / Q000008:administration & dosage*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy*; D000077261:Carvedilol; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage*; D013318:Stroke Volume / Q000187:drug effects*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy* / Q000209:etiology
D002227:Carbazoles; D011412:Propanolamines; D014665:Vasodilator Agents; D000077261:Carvedilol; D000638:Amiodarone