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CLINICAL RESEARCH: HEART FAILURE TREATMENT

Protective Effects of Carvedilol Against Anthracycline-Induced Cardiomyopathy

Nihat Kalay, MD^_*,_*, Emrullah Basar, MD^_*, Ibrahim Ozdogru, MD^_*, Ozlem Er, MD, Yakup Cetinkaya, MD^_*, Ali Dogan, MD^_*, Tugrul Inanc, MD, Abdurrahman Oguzhan, MD^_*, Namik Kemal Eryol, MD^_*, Ramazan Topsakal, MD^_* and Ali Ergin, MD^_*

^_* Department of Cardiology, Erciyes University School of Medicine, Kayseri, Turkey
Department of Oncology, Erciyes University School of Medicine, Kayseri, Turkey.

Manuscript received March 29, 2006; revised manuscript received June 27, 2006, accepted July 10, 2006.

^_* Reprint requests and correspondence: Dr. Nihat Kalay, Erciyes Üniversitesi, Kardiyoloji A.B.D., 38039 Kayseri, Turkey. (Email: nihatkalay{at}hotmail.com).

OBJECTIVES: The aim of this study was to determine the protective effect of carvedilol in anthracycline (ANT)-induced cardiomyopathy (CMP).

BACKGROUND: Despite its broad effectiveness, ANT therapy is associated with ANT-induced CMP. Recent animal studies and experimental observations showed that carvedilol prevented development of CMP due to chemotherapeutics. However, there is no placebo-controlled clinical trial concerning prophylactic carvedilol use in preventing ANT-induced CMP.

METHODS: Patients in whom ANT therapy was planned were randomized to administration of carvedilol or placebo. We enrolled 25 patients in carvedilol and control groups. In the carvedilol group, 12.5 mg once-daily oral carvedilol was given during 6 months. The patients were evaluated with echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated.

RESULTS: At the end of 6 months of follow-up, 1 patient in the carvedilol group and 4 in the control group had died. Control EF was below 50% in 1 patient in the carvedilol group and in 5 in the control group. The mean EF of the carvedilol group was similar at baseline and control echocardiography (70.5 vs. 69.7, respectively; p = 0.3), but in the control group the mean EF at control echocardiography was significantly lower (68.9 vs. 52.3; p < 0.001). Both systolic and diastolic diameters were significantly increased compared with basal measures in the control group. In Doppler study, whereas E velocities in the carvedilol group decreased, E velocities and E/A ratios were significantly reduced in the control group.

CONCLUSIONS: Prophylactic use of carvedilol in patients receiving ANT may protect both systolic and diastolic functions of the left ventricle.

Abbreviations and Acronyms   ANT = anthracycline   CMP = cardiomyopathy   CT = chemotherapy   EF = ejection fraction   LV = left ventricle/ventricular   SERCA2 = sarcoplasmic reticulum Ca2+-ATPase

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