PURPOSE: The effects of beta-blockers on severe heart failure are not well known. We investigated the effects of carvedilol (<FONT FACE=Symbol>b1,b2,a1</FONT>-blocker) on symptoms, functional class (FC), and left ventricular function in patients with refractory heart failure. METHODS: We studied 21 patients, mean age 56±10 years, 9 in FC IV, e 12 in FC III (intermittently with class IV). The initial dosage was 6.25mg, and it was increased progressively as tolerated. The mean dose was 42±11mg. The patients were submitted to routine clinical evaluation, and electrocardiogram. We determined after 196±60 days of follow-up the left ventricular end diastolic dimension (by echocardiogram), and left ventricular ejection fraction (using MUGA). RESULTS: Carvedilol was well tolerated by 16 (76%) patients. One patient is in FC II during increment of the dosage. Eight patients were in FC I, and 7 in FC II at 196±60 days of follow-up. Heart rate decreased from 96±15 to 67±10bpm (p<0.0001), left ventricular end diastolic diameter from 73±13 to 66±12mm (p<0.009), and the left ventricular ejection fraction increased from 0.21±0.06 to 0.34±0.12 (p<0.0003). CONCLUSION: Carvedilol may have beneficial effects on cardiac function, remodeling process, and FC. If tolerated, it seems to be a potential alternative option in the medical treatment of refractory heart failure. However, investigations are still necessary to clarify the long-term effects of carvedilol on this specific subgroup of patients.
congestive heart failure; adrenergic beta-antagonists; transplantation
