The American Heart Hospital Journal
group, 764.25±31.21 mg/m2 in the group receiving 12.5 mg carvedilol, 770.90±25.17 mg/m2 in the group receiving 25 mg carvedilol, and 768.44±26.87 mg/m2 in the case group. In this regard, no statistically significant difference was observed between the control and case groups (p=0.744).
Five patients in the control group, five patients in the group receiving 12.5 mg carvedilol, and one patient in the group receiving 25 mg carvedilol (a total of six patients in the case group) developed systolic cardiomyopathy. In this regard, no statistically significant difference was observed between the control and case groups (p=0.284). Also, there was no statistically significant difference in the frequency of systolic cardiomyopathy between the control group and the group receiving 12.5 mg carvedilol (p=1), between the control group and the group receiving 25 mg carvedilol (p=0.077),and between the two groups receiving carvedilol (p=0.093).
Five patients in the control group, three patients in the group receiving 12.5 mg carvedilol, and three patients in the group receiving 25 mg carvedilol (a total of six patients in the case group) developed pure diastolic cardiomyopathy. In this regard, no statistically significant difference was observed between the control and case groups (p=0.284). Also, there was no statistically significant difference in the frequency of diastolic cardiomyopathy between the control group and the group receiving 12.5 mg carvedilol (p=0.438), between the control group and the group receiving 25 mg carvedilol (p=0.432), and between the two groups receiving carvedilol (p=1) (see Table 2).
Discussion
This study considered the effects of carvedilol in preventing cardiomyopathy resulting from anthracycline treatment in patients suffering from breast cancer and lymphoma. Carvedilol was prescribed at either 12.5 mg or 25 mg per day for four months. At the end of the study, although the frequency of pure systolic and diastolic cardiomyopathy was lower in the group receiving carvedilol than in the control group (27.8 % versus 14.6 %), the difference was not statistically significant. On the other hand, studies using 2D echocardiography and color Doppler have demonstrated that carvedilol at a daily dose of 12.5 mg has a protective effect against diastolic disorders and at a daily dose of 25 mg had a protective effect against both systolic and diastolic disorders.
In 2002, Santos et al. demonstrated that prophylactic prescription of carvedilol may prevent mitochondrial cardiomyopathy caused by doxorubicin.15
In 2007, Cruz et al., using a hamster model, suggested that carvedilol at a Winter 2011
Original Contribution
Table 2: Inter- and Intra-group Comparison of Echocardiography and Tissue Doppler Variables
Placebo 12.5 mg 25 mg
LEFT VENTRICULAR MUTATION FRACTION (P=0.375) Baseline
Carvedilol Carvedilol Carvedilol (Both Groups) 58.56±3.62 60.5±5.07 61.00±7.06 58.56±3.62
4 months later 53.94±3.80 53.15±7.76 56.81±6.20 53.94±3.80 DIASTOLIC END DIAMETER OF LEFT VENTRICLE (MM) (P=0.226) Baseline
4.13±0.61 4.17±0.39 3.93±0.34 4.13±0.61
4 months later 4.56±0.57 4.50±0.46 4.09±0.37 4.56±0.57 SYSTOLIC END DIAMETER OF LEFT VENTRICLE (MM) (P=0.069) Baseline
3.00±0.35 2.92±0.44 2.73±0.29 3.01±0.35
4 months later 3.24±0.44 3.00±0.55 2.85±0.35 3.24±0.44 E WAVE VELOCITY (CM/S) (P=0.086) Baseline
0.99±0.45 7.03±0.21 0.83±0.17 0.99±0.45
4 months later 0.86±0.33 1.00±0.38 0.81±0.17 0.86±0.33 MAXIMUM SYSTOLIC VELOCITY OF MITRAL VALVE (P=0.939) Baseline
68.5±14.67 75.5±13.71 67.38±5.04 67.38±5.04
4 months later 63.1±10.71 71.35±12.68 66.43±5.03 63.06±10.71 E/A RATIO (P=0.087) Baseline
17.56±2.38 17.25±2.77 17.33±2.92 17.56±2.38
4 months later 16.61±1.50 17.05±3.24 15.38±4.34 16.61±1.50 EI/EA RATIO (P=0.518) Baseline
3.53±1.02 3.37±0.97 3.69±0.66 3.53±1.02
4 months later 3.88±0.78 3.51±0.80 3.79±0.66 3.88±0.78 INTERIOR–POSTERIOR MOVEMENT OF MITRAL VALVE (MM) (P=0.061) Baseline
16.94±3.11 17.00±2.36 18.81±2.29 16.94±3.11
4 months later 15.44±1.89 16.36±1.42 18.67±2.44 15.44±1.86 SPEED DEVELOPMENT (CM/S) (P=0.053) Baseline
58.72±8.17 65.90±10.78 66.38±12.09 58.72±8.17 4 months later 52.17±8.83 62.95±9.58 64.90±9.80 52.17±8.83
daily dose of 1 mg/kg body weight may lead to improved cardiac function.16
Thus, these two studies confirm the
protective effect of carvedilol in animal models. In a study in Turkey in 2006, Kalay et al. randomized 50 patients suffering from breast cancer or lymphoma to receive placebo or carvedilol. This study showed that carvedilol (at the mentioned dose) had a protective effect on systolic and diastolic disorders of the left ventricle resulting from anthracycline treatment.17
As discussed above, our study
observed a protective effect on both systolic and diastolic disorders with the 25 mg dose of carvedilol daily, while the 12.5 mg daily dose maintained diastolic (but not systolic) function of the left ventricle.
There are two main limitations in the study by Kalay et al., including the low-density sample and failure to study the long-term effects of anthracycline in cardiac cases. According to the results of this study, a daily dose of 25 mg of carvedilol may play a protective role in preventing systolic and diastolic disorders of the left ventricle, although there was no statistically significant difference in the frequency of clinical cardiomyopathy between the groups studied. Kalay et al. reported mortality rates in the control and case groups of 16 % and 4 %, respectively. The result was not statistically significant; however, the study concluded that, although the
Protective Effect of Carvedilol in Cardiomyopathy Caused by Anthracyclines 97
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