Abstract

PICHARDO, Rafael et al. Efectos del Carvedilol en la insuficiencia cardíaca congestiva grado II-IV y establecimiento de la morbimortalidad a 12 meses. Rev. costarric. cardiol [online]. 2001, vol.3, n.1, pp.35-41. ISSN 1409-4142.

Objetives: The purpose of this study was established the tolerability and the efficacy of carvedilol in patients with a functional classification of the New York Association (NYHA) type II, III and IV. Background. Carvedilol a nonselective beta-adrenergic blocking drug with alpha-adrenergic blocking and antioxidants properties, has been shown very effective in improving the left ventricular function, clinical outcomes and survival in patients with mild to moderate chronic heart failure. Methods: We studied prospectively 27 patients with congestive heart failure NYHA II, III and some type IV, with a ejection fraction < 0.40 % and left ventricular diastolic diameter 55 mm. The patients should be stabilized with digoxin, diuretics and ACE inhitors, beginning with a dose of 3.125 mg b.i.d. and titrage until arrive to 25 mg b.i.d.. The patients should be complete 9 visits or one year of follow-up and the minimal dose accepted was 12.5 mg b.i.d. in order to consider a patient like included. Results: Of the total 27 patients 18 completed their follow-up (66.7 %). The blood pressure doesn’t modify during the treatment and the heart beat decreased significantly of 85 l/min on the average to 70 l/ min at the end of the study. The ejection fraction (EF) rises from 0.28 to 0.36 for an increase of 28.5 % (P < .001).Of the 18 patients 13 concluded in functional classification type I (72.2 %) including a patient type IV at beginning. Three patients were hospitalized (11.1%) for deterioration including a patient that developped a myocardial infarction. Two patients died of sudden death in their houses and this represented the 11.1 % of the total that the study began. The tolerance was excellent and we excluded only one patient for significant hypotension. Conclusions: We are demostrated that patients with ventricular dilated but functional classification II and III, are able to use carvedilol without consequences provided dosage at minimal dose and the tolerability was excellent.

Keywords : carvedilol; heart failure; morbimortality; Rep. Dominicana.