0110: Predictive factors of tolerance to carvedilol in systolic heart failure

Abstract

Heart failure experiencing exponential growth in Algeria. Among the recommended therapeutic, the b blockers are largely under prescribed. The objective of this study was to determine predicting factors of tolerance to carvedilol in systolic heart failure. Carvedilol has been introduced in 100 consecutive patients hospitalized with systolic heart failure. Clinical parameters, the BNP levels and echocardiographic indices were measured blind to admission to the first and second week. The average age of patients was 66±1 year. The FE: 31±1%, the NYHA 2.8±0.1, BNP 620±48pg/mL, E/A: 1 8±0.3, TDE 160±7, E/E’,9.1±0.3, PAPS: 36±0.4, VCI: 15+1mm. An acute decompensation episode occurred in 21patients and b blocker was arrested at 9 of them without the possibility of reintroduction. In univariate analysis, the values on admission NYHA stage, the plasma level of BNP, the TDE and reports E/A and E/E’ predicted the occurrence of acute decompensation. The combination of NYHA class 4 to a BNP level greater than 410pg/mL or at elevated filling pressures predicted the occurrence of decompensation in 100% of cases. Despite the directives of learned societies, b blockers remain largely under prescribed in systolic heart failure. The combined use of BNP or echocardiographic indices to NYHA stage allows to accurately predict the occurrence of acute decompensation.