Remme, Willem J. and Riegger, Guenter A. J. and Hildebrandt, Per and Komajda, Michel and Jaarsma, Wybren and Bobbio, Marco and Soler-Soler, Jordi and Scherhag, Armin and Lutiger, Beatrix and Ryden, Lars (2004) The benefits of early combination treatment of carvedilol and an ACE-inhibitor in mild heart failure and left ventricular Systolic dysfunction. The carvedilol and ACE-inhibitor remodelling mild heart failure evaluation trial (CARMEN). CARDIOVASCULAR DRUGS AND THERAPY, 18 (1). pp. 57-66. ISSN 0920-3206
Full text not available from this repository. (Request a copy)Abstract
Aims: Heart failure (HF) treatment guidelines of the ESC recommend ACE-inhibitors (ACE-I) as first-line treatment and beta-blockers added if patients remain symptomatic. CARMEN explored the need for combined treatment for remodelling and order of introduction by comparing the ACE-I enalapril against carvedilol and their combination. Methods: In a parallel-group, 3-arm study of 18 months duration, 572 mild heart failure patients were randomly assigned to carvedilol (N = 191), enalapril ( N = 190) or their combination ( N = 191). In the latter, carvedilol was up-titrated before enalapril. Left ventricular (LV) remodelling was assessed by transthoracic echocardiography ( biplane, modified Simpson) at baseline and after 6, 12 and 18 months of maintenance therapy. Primary comparisons considered the change in LV end-systolic volume index (LVESVI) from baseline to month 18 between the combination and enalapril, and between carvedilol and enalapril. Results: In the first primary comparison, LVESVI was reduced by 5.4 ml/m(2) (p = 0.0015) in favour of combination therapy compared to enalapril. The second primary comparison tended to favour carvedilol to enalapril (NS). In the within treatment arm analyses, carvedilol significantly reduced LVESVI by 2.8 ml/m(2) (p = 0.018) compared to baseline, whereas enalapril did not. LVESVI decreased by 6.3 ml/m(2) (p = 0.0001) with combination therapy. All three arms showed similar safety profiles and withdrawal rates. Conclusion: CARMEN is the first study to demonstrate that early combination of ACE-I and carvedilol reverses LV remodelling in patients with mild to moderate HF and LV systolic dysfunction. The results of the CARMEN study support a therapeutic strategy in which the institution of beta-blockade should not be delayed.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MYOCARDIAL-INFARCTION; BETA-BLOCKADE; PRIMARY-CARE; METOPROLOL; GUIDELINES; MANAGEMENT; DIAGNOSIS; TERM; ANTIOXIDANT; PROGRAM; carvedilol; ACE inhibition; heart failure; ventricular remodelling; guidelines; echocardiography; first-line therapy; combined treatment; monotherapy; CARMEN; randomised controlled trial |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 03 Aug 2021 11:50 |
| Last Modified: | 03 Aug 2021 11:50 |
| URI: | https://pred.uni-regensburg.de/id/eprint/38124 |
Actions (login required)
 |
View Item |
