Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial

CHRISTMAS Investigators, JGF Cleland*, DJ Pennell, SG Ray, AJ Coats, PW Macfarlane, GD Murray, JD Mule, Z Vered, A Lahiri

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background The improvement in left-ventricular ejection fraction (LVEF) in response to beta blockers is heterogeneous in patients with heart failure due to ischaemic heart disease, possibly indicating variations in the myocardial substrate underlying left-ventricular dysfunction. We investigated whether improvement in LVEF was associated with the volume of hibernating myocardium (viable myocardium with contractile failure).

Methods We did a double-blind, randomised trial to compare placebo and carvedilol for 6 months in individuals with stable, chronic heart failure due to ischaemic left-ventricular systolic dysfunction. We enrolled 489 patients, of whom 387 were randomised. Patients were designated hibernators or non-hibernators according to the volume of hibernating myocardium. The primary endpoint was change in LVEF, measured by radionuclide ventriculography, in hibernators versus non-hibernators, on carvedilol compared with placebo. Analysis was by intention to treat.

Results 82 patients dropped out of the study because of adverse events, withdrawal of consent, or failure to complete the investigation. Thus, 305 (79%) were analysed. LVEF was unchanged with placebo (mean change -0.4 [SE 0.9] and -0.4 [0.8] for non-hibernators and hibernators, respectively) but increased with carvedilol (2.5 [0.9] and 32 [0.8], respectively; p

Interpretation Some of the effect of carvedilol on LVEF might be mediated by improved function of hibernating or ischaemic myocardium, or both. Medical treatment might be an important adjunct or alternative to revascularisation for patients with hibernating myocardium.

Original languageEnglish
Pages (from-to)14-21
Number of pages8
JournalThe Lancet
Volume362
Issue number9377
Publication statusPublished - 5 Jul 2003

Keywords

  • REVERSIBLE ISCHEMIA TRIAL
  • LEFT-VENTRICULAR FUNCTION
  • CORONARY-ARTERY DISEASE
  • CHRONIC HIBERNATION
  • SUCCESS CHRISTMAS
  • REVASCULARIZATION
  • METOPROLOL
  • CARDIOMYOPATHY
  • METAANALYSIS
  • IMPROVEMENT

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