Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study

Hiroshi Okamoto, Masatsugu Hori, Masunori Matsuzaki, Hiroyuki Tsutsui, Tsutomu Yamazaki, Ryozo Nagai, Tsutomu Yoshikawa, Yasushi Fujio, Shinpei Nonen, Junichi Azuma, Tohru Izumi, Yasuo Ohashi, Akira Kitabatake

研究成果: Contribution to journalArticle査読

22 被引用数 (Scopus)

抄録

AbstractBackground In chronic heart failure (CHF), it remains unclear whether the minimal dose of beta-blockade is related to survival benefits and which parameter predicts morbidity and mortality. We sought to determine the minimal dose related to survival benefits by comparing the efficacy and safety of three doses of carvedilol and the best predictive parameter for effective outcomes in Japanese patients with CHF. Methods In this prospective, randomized, stratified trial, 364 patients with mild to moderate CHF were assigned to a daily carvedilol dose of 2.5, 5, or 20 mg, plus optimal standard therapy. Findings During the mean 3-year follow-up, resting heart rate (HR) and BNP were significantly reduced with dose-response relations in the early period but without dose-response relations in the late period. The LVEF and the LVDd were increased and decreased, respectively, without a dose-response relation. No significant difference was seen in the composite primary endpoint of all-cause mortality and hospitalization for cardiovascular diseases and heart failure. Multivariate analysis indicated early decreases in HR and BNP predicted long-term outcomes. However, adverse events increased dose-dependently. Among 237 polymorphisms in 87 heart failure-related genes, the osteopontin G-156 del genotype was associated with an event-free survival rate (Wilcoxon test, P = 0.030). Conclusions A low carvedilol dose is effective if the HR and/or plasma BNP has been reduced. Carvedilol therapy should be guided by reductions in HR and/or BNP, especially by initial HR reduction, but not only by its dose. OPN might be a surrogate genetic marker for long-term event-free survival.

本文言語英語
ページ(範囲)238-244
ページ数7
ジャーナルInternational Journal of Cardiology
164
2
DOI
出版ステータス出版済み - 4 5 2013
外部発表はい

All Science Journal Classification (ASJC) codes

  • 循環器および心血管医学

フィンガープリント

「Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study」の研究トピックを掘り下げます。これらがまとまってユニークなフィンガープリントを構成します。

引用スタイル