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Impact of initiating carvedilol before angiotensin-converting enzyme inhibitor therapy on cardiac function in newly diagnosed heart failure

Karen Sliwa, MD, PhD^*,*, Gavin R. Norton, MD, PhD, Ngalulawa Kone, MD, Geoffrey Candy, PhD^*, John Kachope, MD^*, Angela J. Woodiwiss, PhD, Carlos Libhaber, MD^*, Pinhas Sareli, MD^* and Rafique Essop, MD^*

^* Department of Cardiology, Chris-Hani-Baragwanath Hospital, Johannesburg, South Africa
Department of Chemical Pathology, Chris-Hani-Baragwanath Hospital, Johannesburg, South Africa
Department of Physiology, University of the Witwatersrand, Johannesburg, South Africa

View larger version (17K): [in a new window]   Figure 1 Impact of initiating carvedilol before perindopril therapy (beta-blocker [BB]-first group) compared with the effect of the commencement of perindopril first (angiotensin-converting enzyme inhibitor [ACEI]-first group) on New York Heart Association functional class (NYHA FC). *p < 0.05 versus baseline data (0 months); p < 0.05 versus absolute values and change from baseline in the ACEI-first group.

View larger version (15K): [in a new window]   Figure 2 Impact of initiating carvedilol before perindopril therapy (beta-blocker [BB]-first group) compared with the effect of the commencement of perindopril first (angiotensin-converting enzyme inhibitor [ACEI]-first group) on left ventricular ejection fraction (EF), determined using radionuclide techniques. *p < 0.05; **p < 0.001 versus baseline data (0 months); p < 0.05 versus absolute values and change from baseline in the ACEI-first group. Muga = multiple gated equilibrium cardiac blood pool scintigraphic technique.

View larger version (19K): [in a new window]   Figure 3 Impact of initiating carvedilol before perindopril therapy (beta-blocker [BB]-first group) compared with the effect of the commencement of perindopril first (angiotensin-converting enzyme inhibitor [ACEI]-first group) on plasma N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) concentrations. *p < 0.0005 versus baseline data (0 months); p < 0.01 versus absolute values and change from baseline in the ACEI-first group.