Carvedilol in HF With Preserved EF

Overview

Beta-blockers improve clinical outcomes in heart failure and reduced ejection fraction (HFrEF); but not in those with preserved EF. Global longitudinal strain (GLS) is a prognostic factor independent of left ventricular ejection fraction (LVEF). In a retrospective with 1969 patients with HF and LVEF of ≥40%, beta-blocker was associated with improved survival in those with low GLS (GLS <14%), but not in those with GLS ≥14%. In this prospective, randomized clinical study, the investigators will assess the effect of slow-release carvedilol in patients with HFpEF and hypertension. The primary endpoint is the time-averaged proportional changes in NT-proBNP level and GLS change from baseline to month 6.

Eligibility

Inclusion Criteria:

• age ≥20 yrs
• symptomatic HFpEF with LVEF≥50%
• NT-proBNP ≥220 pg/ml (sinus rhythm) or ≥660 pg/ml(AF) (BNP ≥80 pg/ml (sinus rhythm) or ≥240 pg/ml(AF) )
• SBP≥140mmHg and/or DBP ≥90mmHg, or if taking anti-hypertensive medication, SBP ≥110mmHg.
• LAVI≥29(sinus rhythm)/34ml/m2 (AF) or LVMI≥115(male)/95(female) g/m2
• meet one the following
  1. Average E/e'≥ 9
  2. Septal e' < 7 cm/s
  3. Lateral e' <10 cm/s
  4. TR velocity > 2.8 m/s
  5. PASP > 35 mmHg
  6. GLS < 16%

Exclusion Criteria:

• systolic blood pressure < 110 mmHg, or heart rate < 60 beats/min
• contra-indication to beta-blockers
• creatinine> 2.4mg/dL
• amyloidosis, hypertrophic cardiomyopathy with obstruction, severe aortic or mitral valve disease, acute coronary syndrome, Cerebrovascular event within 6 months, PCI within 3 months before
• AST/ALT >3 x normal upper range