Effect Of Carvedilol On Cardiac Function And Prognosis In Primary Dilated Cardiomyopathy

Background and objective:The prognosis of dilated cardiomyopathy is not good,and the 5-year survival rate is about 50%after diagnosis.Foreign studies have shown that carvedilol can reduce left ventricular end-diastolic diameter and increase ejection fraction in DCM patients.The Chinese also reported that carvedilol can improve ventricular remodeling in DCM patients,and tolerance is better^[1].However,in recent years,there have been few reports on the effect of carvedilol on reversing left ventricular cavity size and cardiac complex endpoint events.This study aimed to investigate the effect of carvedilol on left ventricular cavity size,cardiac function and clinical outcome in patients with primary dilated cardiomyopathy.Methods:According to the guidelines for diagnosis and treatment of dilated cardiomyopathy in China issued in 2018,65 patients with primary dilated cardiomyopathy were selected as the subjects from September 2018 to July 2019 in Inner Mongolia International Mongolian Medical Hospital,Random grouping,The test group was 33 cases of carvedilol,The control group was 32 cases in the metololol group.Collect general data of the candidates（age,history,blood pressure,heart rate,etc.）,The cardiac function grade（NYHA）、6 minute walking test（6 MWT）、NT-pro BNP and echocardiography of before and after treatment were used as indexes to evaluate cardiac function.Both groups were given routine anti-heart failure treatment,the experimental group plus carvedilol,the control group plus metoprolol.The patients were outpatient follow-up after they entry groups 6,12 and 18 months to assess the status of medication（dose,compliance）,cardiac function grading（NYHA）,6 minutes walking test（6 MWT）,NT-pro BNP and echocardiography were reviewed at 12 months,heart failure rehospitalization and cardiogenic death were defined as endpoint events and recorded at 18 months.To analyze the difference of cardiac function,left ventricular cavity size and incidence of complex endpoint events between the two groups after the intervention of carvedilol and metoprolol and analysis of prognosis of treatment differences.Results:1.Comparison of general data,cardiac function indexes（cardiac function grade、6WMT、NT-proBNP、LVESD、LVEDD、LVEF and LVFS）between the two groups,there was no statistical difference（P>0.05）,suggesting that the baseline data of the two groups were comparable.2.The cardiac function grade and 6WMT of carvedilol group were better than metoprolol group at 6 months and 12 months,the difference was statistically significant（P<0.05）;the cardiac function grade and 6WMT in carvedilol group were still superior to metoprolol group at 18 months of treatment,but P>0.05.3.When treated for 12 months,the changes of NT-proBNP decreased in carvedilol group was higher than that in metololol group（-4007.10±1686.29 pgml vs-3117.89±1323.71 pg/ml）,and the difference was statistically significant（P<0.05）.4.When treated for 12 months,the changes of LVEDD decrease and LVEF increase in carvedilol group were higher than those in metoprolol group[-7.00（-9.00--5.00）mm vs-4.00（-6.00--4.00）mm]、[10.00（7.00-11.00）%vs7.00（5.00-9.00）%],and the difference was statistically significant（P<0.05）.5.At 18 months of treatment,the incidence of complex endpoint events in the carvedilol group was lower than that in the metoprolol group（P<0.05）.There were 9cases of complex endpoint events in carvedilol group（2 cases of cardiogenic death and 7 cases of rehospitalization due to heart failure）and 17 cases in metoprolol group（4 cases of cardiogenic death and 13 cases of rehospitalization due to heart failure）.Conclusion:1.Carvedilol was superior to metoprolol in improving DCM cardiac function and exercise tolerance.2.Carvedilol reversed DCM left ventricular size was better than metoprolol.3.Carvedilol decreased rehospitalization and cardiogenic mortality due to heart failure than metoprolol.