- Email: [email protected]
Is carvedilol safe and efficaceous in severe heart failure patients accepted for heart transplantation?
250
Abstracts
The Journal of Heart and Lung Transplantation February 2001
nificant differences for key adverse events at 3 years. At 1 year: 3/43 (7.0%) Tac and 1/23 (4.3%) CyA pts required insulin on ⬎30 consecutive days for new onset diabetes (ns), antihypertensive agents were required by 59.5% Tac vs 87.5% CyA pts (p⫽0.025), and lipid lowering drugs by 11.9% Tac vs 29.2% CyA pts (ns). Conclusion: These patient survival figures are in line with ISHLT 3-year data of around 79% in the 1996-1999 era. Immunosuppression with Tac provides a viable alternative to CyA following cardiac transplantation. 293 MONOTHERAPY WITH ANTI-CD40 LIGAND ANTIBODY (IDEC 131) FOR NON-HUMAN PRIMATE ALLOGRAFT HEART TRANSPLANTATION S. Pfeiffer1, G.L. Zorn Iii1, A.M. Azimzadeh1, J. Atkinson1, R. Newman2, R.N. Pierson III1; 1Vanderbilt University, Nashville, TN; 2IDEC Pharmaceuticals, San Diego, CA, USA Objective: To evaluate whether higher dose or more frequently administered aCD40L antibody (IDEC 131) monotherapy prevents cellular infiltrate or consistently prolongs graft survival of primate cardiac allografts. Methods: Heterotopic cardiac allografts were performed in MHC-class II mismatched cynomolgus monkeys (SI⬎5). Animals were assigned to 4 groups of different aCD154 regimens during the first month. Protocol biopsies were taken on postop days 5-7, 14, and then monthly. All survivors in groups 2-4 received 20 mg/kg monthly until graft failure. No additional immunosuppression was given; rejection episodes were not treated. Results: Control grafts reject in this model by day 7 (n⫽3, not shown). Anti-CD40L was well tolerated, with no evidence of allergic reaction, bleeding or infection. Sustained dosing (groups 2-4) was necessary to achieve long term graft survival (⬎56d). Dosing on day 3-5 prevented early graft loss (⬍15d), whereas delaying the second treatment until day 7 was associated with 50% incidence of early graft loss (see table). No regimen entirely prevented early cellular infiltrates. However, lower dose regimens were associated with more frequent and severe cellular infiltrates (p⬍0.05); graft dysfunction was infrequent even with intense infiltrates, and infiltrates typically resolved in surviving grafts. Late histology of long-surviving grafts showed occlusive arteriopathy, usually without cellular infiltration, consistent with cardiac allograft vasculopathy (CAV). Conclusions: 1) aCD40L antibody monotherapy prevents acute cardiac allograft rejection. 2) Both dose and frequency of therapy appear to be important to prevent early graft loss. 3) Arteriopathy, seen in all treatment groups, was not prevented by any regimen tested. Defining whether these CAVlike lesions are CD40L-independent is an important remaining question. Table 1 Group (n)
Dose (mg/kg)
Days of therapy
Survival (days)
Early (cellular infiltrate episodes (obtained biopsies)
1 2 3 4 *
20 40 60 120
0,5,14 0,5,14,28,42,56,70, ... 0,7,14,28,56,84, 0, 3, 7, 14, 28, 56, 84,
14,19,35,49,52,56 56,106,245 8,10,95,269 43,58,112
9 6 3 3
(6) (3) (4) (3) p⬍0.05 vs. groups 1 and 2
(9) (6) (5)* (6)*
294 SWAN GANZ CATHETER ASSESSMENT OF DONOR HEARTS - OUTCOME OF ORGANS WITH BORDERLINE HAEMODYNAMICS S.C. Stoica1, D.K. Satchithananda1, S. Charman1, S. Smith1, A.N. Redington2, S. Tsui1, J. Wallwork1, S.R. Large1; 1Papworth Hospital, Cambridge, UK; 2Ormond Street Hospital, London, United Kingdom High dosage of inotropes or periods of hypotension lead to turning down of donor hearts. At our institution we do not reject potential donors based on these criteria alone prior to Swan Ganz catheter (SGC) assessment. Purpose: To evaluate the role of the SGC in donor heart resuscitation and selection and to assess the outcome of borderline organs. Methods: Retrospective analysis of 129 donors assessed between 02/96-12/99, all with complete haemodynamic data. Selection bias was excluded by comparing outcome for organs with complete and incomplete haemodynamic data. Two sets of SGC measurements were analysed: on first assessment and prior to organ harvesting. The physiological targets were: mean BP⬎60mmHg, RA pressure⬍12mmHg, PCWP⬍12 mmHg, LVSWI⬎15mg-M/ beat/m2, and use of one inotrope only. A poorly functioning heart was defined as failing on 2 criteria or more. Haemodynamic categories were defined as: A⫽good function throughout assessment; B⫽suboptimal then improved; C⫽declining or poor throughout. There was no policy to allocate suboptimal organs to high-risk recipients. Results: Of the 129 organs studied, 8 had structural problems, 5 were rejected on haemodynamic grounds, 2 usable hearts could not be matched and 39 transplanted as heart-lung blocks are not reported further here. The 75 heart transplants were in categories A⫽53, B⫽9 and C⫽13. Of these, 60 (80%) had improved their haemodynamic score between the two SGC measurements, and the inotrope was the same or decreased in 66 (88%). There was no significant difference in length of ITU stay, requirement of mechanical support, 30-day mortality and survival overall between categories A, B and C. One-year survival rates were A-79%, B-78% and C-77% (p⫽1.00). Ischaemic time was the only significant risk factor for death in uni- and multivariate analysis (p⫽0.002). Conclusion: Usage of organs from categories B and C permitted expansion of the donor pool by up to 45% without compromising short and medium-term outcome. It should be employed with caution in combination with long ischaemic times and may influence recipient selection. 295 IS CARVEDILOL SAFE AND EFFICACEOUS IN SEVERE HEART FAILURE PATIENTS ACCEPTED FOR HEART TRANSPLANTATION? C.E. Angermann1, A. Costard-Jaeckle2, M.C. Deng3, EFICAT Investigators4; 1Universitaet Muenchen, Mu ¨nchen, Germany; 2 Christian-Albrechts-Universitaet Kiel, Kiel, Germany; 3Muenster University, Muenster, Germany; 4Muenchen, Kiel, and Muenster, Germany Background: Carvedilol has shown beneficial effects on mortality in NYHA class II-IV patients with congestive heart failure (CHF). This study was performed to determine effects of Carve-
The Journal of Heart and Lung Transplantation Volume 20, Number 2 dilol in patients with end stage CHF accepted for transplantation (TX). Methods: The study was designed as a double-blind, randomized, placebo-controlled trial and conducted in 3 German transplant centers. Study duration was 12 months. Patients accepted for TX with advanced left ventricular (LV) systolic dysfunction categorized as NYHA IV at least once since onset of CHF were eligible. The primary endpoint was the absolute change from baseline to latest available LV ejection fraction (EF) measurement determined by radionuclide ventriculography between Carvedilol and placebo. Results: The trial prospectively randomized 118 patients with CHF of ischemic (n⫽44) or non-ischemic (n⫽74) etiology, a mean ⫾SD [median] age of 53.3⫾9.8 [55.5] years, and a mean LVEF at baseline of 19.9⫾6.6 [20.1]%. Mean ⫾SD [median] absolute change of LVEF from baseline was ⫹6.0⫾9.3 [⫹3.9]% in the Carvedilol group versus ⫹0.7⫾7.1 [0.0]% in the placebo treated patients (p⬍0.008 [⬍0.006, Wilcoxon, 2-sided]) in the intention-to-treat population (n⫽74) and ⫹8.2⫾10.3 [⫹6.0]% in Carvedilol versus ⫹1.4⫾7.9 [0.0]% on placebo (p⬍0.011 [⬍0.013, Wilcoxon, 2-sided]) in the per-protocol population (n⫽52). Serious adverse events were experienced by 33/60 patients (13 deaths) on placebo and 29/58 patients (9 deaths) on Carvedilol. Conclusion: Even in patients with endstage CHF accepted for TX pharmacological therapy may significantly improve cardiac function over a prolonged period of time. Carvedilol appears to be an appropriate and safe drug also in this severely ill patient population. Thus, the EFICAT trial extends the observations made in COPERNICUS. 296 B-TYPE NATRIURETIC PEPTIDES (BNP AND PRO-BNP) PREDICT LONGTERM SURVIVAL IN PATIENTS WITH ADVANCED HEART FAILURE TREATED WITH ATENOLOL R. Berger, B. Stanek, B. Frey, B. Sturm, M. Huelsmann, J. Bergler-Klein, R. Pacher; University of Vienna, Vienna, Austria In heart failure norepinephrine (NE) endothelin (ET), and cardiac natriuretic peptides have prognostic meaning. In 91 heart failure pts (LVEF ⬍25%) on 40 mg enalapril/d and double-blind atenolol (50 ⫺ 100 mg/d) vs placebo plasma levels of NE, big ET, N-t-atrial natriuretic peptide, BNP and pro-BNP were measured at month 0, 3, 6, 12 and 24. After the double-blind phase of the original study (mean 395 days) pts were tracked up to 4 years when 60 pts were still alive, while 31 pts (atenolol group 10 pts, placebo group 21 pts) had died from a cardiovascular cause. Initial BNP levels by outcome were 38⫹6 vs 74⫹13 fmol/ml in the atenolol group and 21⫹6 vs 85⫹21 fmol/ml in the placebo group. Stepwise multivariate Cox analysis was performed before and during study (incorporating the last values prior to death and in survivors the last available hormone level, NYHA class and LVEF within or at mo 24). Before study, log BNP plasma level (x2⫽13.9, p⫽0.0002), treatment allocation, (x2⫽9.5, p⫽0.002) and LVEF (x2⫽5.6, p⫽0.017) were independently related to mortality. During study log BNP plasma level (x2⫽21.3, p⫽0.0001) LFEV (x2⫽11.2, p⫽0.0008) and treatment allocation (x2⫽6.4, p⫽0.0109) retained their predictive value, while log pro BNP (x2⫽8.9, p⫽0.0027) provided additional prognostic information. Repetitive proBNP levels by outcome were 160⫹28 vs 475⫹65 fmol/ml in the atenolol group and 210⫹49 vs 421⫹42 fmol/ml in the placebo group.
Abstracts
251
Conclusion: In patients with advanced LV dysfunction on high dose ACE inhibitor and ß-blocker therapy, BNP plasma levels indentify patients at highest mortality risk. To monitor the effect of ß-blockade repetitive levels of pro BNP might be also helpful. 297 ARE BETA BLOCKERS EFFECTIVE IN AFRICAN AMERICANS WITH SYSTOLIC HEART FAILURE? R.L. Scott, A. Samal, T. Hamdan, M.H. Park, R. Howard, M.R. Mehra; Ochsner Cardiomyopathy and Heart Transplant Center, New Orleans, LA, USA Background: The majority of the systolic heart failure trials using beta-adrenergic blocking agents have included very few African American patients forcing clinicians to extrapolate the data form non-African American patients. This is particularly concerning given the trend towards an adverse outcome noted in African Americans patients with systolic heart failure treated with Bucindolol in the BEST Trial. Methods: We sought to retrospectively examine 231 patients with systolic heart failure (LVEF ⬍0.35, NYHA Class II-IV) treated with beta-adrenergic blocking agents in our heart failure clinic (88 African American, 143 Caucasian). The principle outcomes evaluated included markers of reverse remodeling (change in ejection fraction) and improvement in NYHA class. Adjustments were made for Age, co-morbidities and concomitant use of angiotensin converting enzyme inhibitor and digoxin. Results: Our investigation demonstrated a significant improvement in both the ejection fraction and the New York Heart Association Class inpatients maintained on beta-blocker therapy (p⬍.05). Furthermore the improvement was present in both African American and Caucasian patients. There was no significant difference in the Age, use of angiotensin converting enzyme inhibitors or the use of digoxin between the African American and Caucasian patients. Conclusions: This investigation suggests that African Americans treated with beta-adrenergic blockade who suffer from symptomatic systolic heart failure benefit in a similar manner to Caucasians. Furthermore, this data calls into question previously held beliefs regarding the potential lack of efficacy of beta blockade in this distinct ethnic population.
African American Caucasian
Pre NYHA
Post NYHA
p value
Pre EF%
Post EF%
p value
2.5 2.3
2.1 1.8
⬍0.005 ⬍0.005
24 26
30 28
⬍0.005 ⬍0.005
298 METOPROLOL REDUCES SYMPATHETIC NERVE HYPERACTIVITY IN PATIENTS WITH HEART FAILURE B. Rundqvist1, Y. Bergmann-Sverrisdottir2, B. Andersson1, M. Elam2, G. Eisenhofer3, F. Waagstein1, P. Friberg1; 1Heart and Lung Institute, Goteborg, Sweden; 2Institute for Clinical Neuroscience, Goteborg, Sweden; 3National Institutes of Health, Bethesda, MD, USA Beta-blockade therapy improves cardiac function and reduces mortality in heart failure. However, how this treatment affects sympathetic activity within organs is not known. The aim of this study was to examine the effects of metoprolol treatment on cardiac, renal and muscle sympathetic activity in patients with heart failure.
Abstracts
The Journal of Heart and Lung Transplantation February 2001
nificant differences for key adverse events at 3 years. At 1 year: 3/43 (7.0%) Tac and 1/23 (4.3%) CyA pts required insulin on ⬎30 consecutive days for new onset diabetes (ns), antihypertensive agents were required by 59.5% Tac vs 87.5% CyA pts (p⫽0.025), and lipid lowering drugs by 11.9% Tac vs 29.2% CyA pts (ns). Conclusion: These patient survival figures are in line with ISHLT 3-year data of around 79% in the 1996-1999 era. Immunosuppression with Tac provides a viable alternative to CyA following cardiac transplantation. 293 MONOTHERAPY WITH ANTI-CD40 LIGAND ANTIBODY (IDEC 131) FOR NON-HUMAN PRIMATE ALLOGRAFT HEART TRANSPLANTATION S. Pfeiffer1, G.L. Zorn Iii1, A.M. Azimzadeh1, J. Atkinson1, R. Newman2, R.N. Pierson III1; 1Vanderbilt University, Nashville, TN; 2IDEC Pharmaceuticals, San Diego, CA, USA Objective: To evaluate whether higher dose or more frequently administered aCD40L antibody (IDEC 131) monotherapy prevents cellular infiltrate or consistently prolongs graft survival of primate cardiac allografts. Methods: Heterotopic cardiac allografts were performed in MHC-class II mismatched cynomolgus monkeys (SI⬎5). Animals were assigned to 4 groups of different aCD154 regimens during the first month. Protocol biopsies were taken on postop days 5-7, 14, and then monthly. All survivors in groups 2-4 received 20 mg/kg monthly until graft failure. No additional immunosuppression was given; rejection episodes were not treated. Results: Control grafts reject in this model by day 7 (n⫽3, not shown). Anti-CD40L was well tolerated, with no evidence of allergic reaction, bleeding or infection. Sustained dosing (groups 2-4) was necessary to achieve long term graft survival (⬎56d). Dosing on day 3-5 prevented early graft loss (⬍15d), whereas delaying the second treatment until day 7 was associated with 50% incidence of early graft loss (see table). No regimen entirely prevented early cellular infiltrates. However, lower dose regimens were associated with more frequent and severe cellular infiltrates (p⬍0.05); graft dysfunction was infrequent even with intense infiltrates, and infiltrates typically resolved in surviving grafts. Late histology of long-surviving grafts showed occlusive arteriopathy, usually without cellular infiltration, consistent with cardiac allograft vasculopathy (CAV). Conclusions: 1) aCD40L antibody monotherapy prevents acute cardiac allograft rejection. 2) Both dose and frequency of therapy appear to be important to prevent early graft loss. 3) Arteriopathy, seen in all treatment groups, was not prevented by any regimen tested. Defining whether these CAVlike lesions are CD40L-independent is an important remaining question. Table 1 Group (n)
Dose (mg/kg)
Days of therapy
Survival (days)
Early (cellular infiltrate episodes (obtained biopsies)
1 2 3 4 *
20 40 60 120
0,5,14 0,5,14,28,42,56,70, ... 0,7,14,28,56,84, 0, 3, 7, 14, 28, 56, 84,
14,19,35,49,52,56 56,106,245 8,10,95,269 43,58,112
9 6 3 3
(6) (3) (4) (3) p⬍0.05 vs. groups 1 and 2
(9) (6) (5)* (6)*
294 SWAN GANZ CATHETER ASSESSMENT OF DONOR HEARTS - OUTCOME OF ORGANS WITH BORDERLINE HAEMODYNAMICS S.C. Stoica1, D.K. Satchithananda1, S. Charman1, S. Smith1, A.N. Redington2, S. Tsui1, J. Wallwork1, S.R. Large1; 1Papworth Hospital, Cambridge, UK; 2Ormond Street Hospital, London, United Kingdom High dosage of inotropes or periods of hypotension lead to turning down of donor hearts. At our institution we do not reject potential donors based on these criteria alone prior to Swan Ganz catheter (SGC) assessment. Purpose: To evaluate the role of the SGC in donor heart resuscitation and selection and to assess the outcome of borderline organs. Methods: Retrospective analysis of 129 donors assessed between 02/96-12/99, all with complete haemodynamic data. Selection bias was excluded by comparing outcome for organs with complete and incomplete haemodynamic data. Two sets of SGC measurements were analysed: on first assessment and prior to organ harvesting. The physiological targets were: mean BP⬎60mmHg, RA pressure⬍12mmHg, PCWP⬍12 mmHg, LVSWI⬎15mg-M/ beat/m2, and use of one inotrope only. A poorly functioning heart was defined as failing on 2 criteria or more. Haemodynamic categories were defined as: A⫽good function throughout assessment; B⫽suboptimal then improved; C⫽declining or poor throughout. There was no policy to allocate suboptimal organs to high-risk recipients. Results: Of the 129 organs studied, 8 had structural problems, 5 were rejected on haemodynamic grounds, 2 usable hearts could not be matched and 39 transplanted as heart-lung blocks are not reported further here. The 75 heart transplants were in categories A⫽53, B⫽9 and C⫽13. Of these, 60 (80%) had improved their haemodynamic score between the two SGC measurements, and the inotrope was the same or decreased in 66 (88%). There was no significant difference in length of ITU stay, requirement of mechanical support, 30-day mortality and survival overall between categories A, B and C. One-year survival rates were A-79%, B-78% and C-77% (p⫽1.00). Ischaemic time was the only significant risk factor for death in uni- and multivariate analysis (p⫽0.002). Conclusion: Usage of organs from categories B and C permitted expansion of the donor pool by up to 45% without compromising short and medium-term outcome. It should be employed with caution in combination with long ischaemic times and may influence recipient selection. 295 IS CARVEDILOL SAFE AND EFFICACEOUS IN SEVERE HEART FAILURE PATIENTS ACCEPTED FOR HEART TRANSPLANTATION? C.E. Angermann1, A. Costard-Jaeckle2, M.C. Deng3, EFICAT Investigators4; 1Universitaet Muenchen, Mu ¨nchen, Germany; 2 Christian-Albrechts-Universitaet Kiel, Kiel, Germany; 3Muenster University, Muenster, Germany; 4Muenchen, Kiel, and Muenster, Germany Background: Carvedilol has shown beneficial effects on mortality in NYHA class II-IV patients with congestive heart failure (CHF). This study was performed to determine effects of Carve-
The Journal of Heart and Lung Transplantation Volume 20, Number 2 dilol in patients with end stage CHF accepted for transplantation (TX). Methods: The study was designed as a double-blind, randomized, placebo-controlled trial and conducted in 3 German transplant centers. Study duration was 12 months. Patients accepted for TX with advanced left ventricular (LV) systolic dysfunction categorized as NYHA IV at least once since onset of CHF were eligible. The primary endpoint was the absolute change from baseline to latest available LV ejection fraction (EF) measurement determined by radionuclide ventriculography between Carvedilol and placebo. Results: The trial prospectively randomized 118 patients with CHF of ischemic (n⫽44) or non-ischemic (n⫽74) etiology, a mean ⫾SD [median] age of 53.3⫾9.8 [55.5] years, and a mean LVEF at baseline of 19.9⫾6.6 [20.1]%. Mean ⫾SD [median] absolute change of LVEF from baseline was ⫹6.0⫾9.3 [⫹3.9]% in the Carvedilol group versus ⫹0.7⫾7.1 [0.0]% in the placebo treated patients (p⬍0.008 [⬍0.006, Wilcoxon, 2-sided]) in the intention-to-treat population (n⫽74) and ⫹8.2⫾10.3 [⫹6.0]% in Carvedilol versus ⫹1.4⫾7.9 [0.0]% on placebo (p⬍0.011 [⬍0.013, Wilcoxon, 2-sided]) in the per-protocol population (n⫽52). Serious adverse events were experienced by 33/60 patients (13 deaths) on placebo and 29/58 patients (9 deaths) on Carvedilol. Conclusion: Even in patients with endstage CHF accepted for TX pharmacological therapy may significantly improve cardiac function over a prolonged period of time. Carvedilol appears to be an appropriate and safe drug also in this severely ill patient population. Thus, the EFICAT trial extends the observations made in COPERNICUS. 296 B-TYPE NATRIURETIC PEPTIDES (BNP AND PRO-BNP) PREDICT LONGTERM SURVIVAL IN PATIENTS WITH ADVANCED HEART FAILURE TREATED WITH ATENOLOL R. Berger, B. Stanek, B. Frey, B. Sturm, M. Huelsmann, J. Bergler-Klein, R. Pacher; University of Vienna, Vienna, Austria In heart failure norepinephrine (NE) endothelin (ET), and cardiac natriuretic peptides have prognostic meaning. In 91 heart failure pts (LVEF ⬍25%) on 40 mg enalapril/d and double-blind atenolol (50 ⫺ 100 mg/d) vs placebo plasma levels of NE, big ET, N-t-atrial natriuretic peptide, BNP and pro-BNP were measured at month 0, 3, 6, 12 and 24. After the double-blind phase of the original study (mean 395 days) pts were tracked up to 4 years when 60 pts were still alive, while 31 pts (atenolol group 10 pts, placebo group 21 pts) had died from a cardiovascular cause. Initial BNP levels by outcome were 38⫹6 vs 74⫹13 fmol/ml in the atenolol group and 21⫹6 vs 85⫹21 fmol/ml in the placebo group. Stepwise multivariate Cox analysis was performed before and during study (incorporating the last values prior to death and in survivors the last available hormone level, NYHA class and LVEF within or at mo 24). Before study, log BNP plasma level (x2⫽13.9, p⫽0.0002), treatment allocation, (x2⫽9.5, p⫽0.002) and LVEF (x2⫽5.6, p⫽0.017) were independently related to mortality. During study log BNP plasma level (x2⫽21.3, p⫽0.0001) LFEV (x2⫽11.2, p⫽0.0008) and treatment allocation (x2⫽6.4, p⫽0.0109) retained their predictive value, while log pro BNP (x2⫽8.9, p⫽0.0027) provided additional prognostic information. Repetitive proBNP levels by outcome were 160⫹28 vs 475⫹65 fmol/ml in the atenolol group and 210⫹49 vs 421⫹42 fmol/ml in the placebo group.
Abstracts
251
Conclusion: In patients with advanced LV dysfunction on high dose ACE inhibitor and ß-blocker therapy, BNP plasma levels indentify patients at highest mortality risk. To monitor the effect of ß-blockade repetitive levels of pro BNP might be also helpful. 297 ARE BETA BLOCKERS EFFECTIVE IN AFRICAN AMERICANS WITH SYSTOLIC HEART FAILURE? R.L. Scott, A. Samal, T. Hamdan, M.H. Park, R. Howard, M.R. Mehra; Ochsner Cardiomyopathy and Heart Transplant Center, New Orleans, LA, USA Background: The majority of the systolic heart failure trials using beta-adrenergic blocking agents have included very few African American patients forcing clinicians to extrapolate the data form non-African American patients. This is particularly concerning given the trend towards an adverse outcome noted in African Americans patients with systolic heart failure treated with Bucindolol in the BEST Trial. Methods: We sought to retrospectively examine 231 patients with systolic heart failure (LVEF ⬍0.35, NYHA Class II-IV) treated with beta-adrenergic blocking agents in our heart failure clinic (88 African American, 143 Caucasian). The principle outcomes evaluated included markers of reverse remodeling (change in ejection fraction) and improvement in NYHA class. Adjustments were made for Age, co-morbidities and concomitant use of angiotensin converting enzyme inhibitor and digoxin. Results: Our investigation demonstrated a significant improvement in both the ejection fraction and the New York Heart Association Class inpatients maintained on beta-blocker therapy (p⬍.05). Furthermore the improvement was present in both African American and Caucasian patients. There was no significant difference in the Age, use of angiotensin converting enzyme inhibitors or the use of digoxin between the African American and Caucasian patients. Conclusions: This investigation suggests that African Americans treated with beta-adrenergic blockade who suffer from symptomatic systolic heart failure benefit in a similar manner to Caucasians. Furthermore, this data calls into question previously held beliefs regarding the potential lack of efficacy of beta blockade in this distinct ethnic population.
African American Caucasian
Pre NYHA
Post NYHA
p value
Pre EF%
Post EF%
p value
2.5 2.3
2.1 1.8
⬍0.005 ⬍0.005
24 26
30 28
⬍0.005 ⬍0.005
298 METOPROLOL REDUCES SYMPATHETIC NERVE HYPERACTIVITY IN PATIENTS WITH HEART FAILURE B. Rundqvist1, Y. Bergmann-Sverrisdottir2, B. Andersson1, M. Elam2, G. Eisenhofer3, F. Waagstein1, P. Friberg1; 1Heart and Lung Institute, Goteborg, Sweden; 2Institute for Clinical Neuroscience, Goteborg, Sweden; 3National Institutes of Health, Bethesda, MD, USA Beta-blockade therapy improves cardiac function and reduces mortality in heart failure. However, how this treatment affects sympathetic activity within organs is not known. The aim of this study was to examine the effects of metoprolol treatment on cardiac, renal and muscle sympathetic activity in patients with heart failure.