Comparison of the effects of carvedilol and metoprolol on exercise ventilatory efficiency in patients with congestive heart failure

Masaharu Kataoka, Toru Satoh, Tsutomu Yoshikawa, Iwao Nakamura, Takashi Kohno, Akihiro Yoshizawa, Toshihisa Anzai, Satoshi Ogawa

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Background: The slope of the relationship between ventilation and carbon dioxide production (V̇E/V̇CO2 slope), obtained during symptom-limited ramp exercise testing, reflects exercise ventilatory efficiency. Importantly, the V̇E/V̇CO2 slope is related to prognosis in patients with congestive heart failure (CHF). The aim of the present study was to determine the relationship between the institution of β-blockers, carvedilol or metoprolol, and the V̇E/V̇CO2 slope during exercise in patients with CHF. Methods and Results: Fifty-seven patients with New York Heart Association functional class II or III with a radionuclide left ventricular ejection fraction (LVEF) of less than 40% received carvedilol or metoprolol in a randomized fashion. The V̇E/V̇CO2 slope, LVEF and plasma brain natriuretic peptide (BNP) concentration were determined before and after 16 weeks of treatment. LVEF improved (p<0.01), but the V̇E/V̇CO2 slope and BNP did not. A significant improvement in the V̇E/V̇CO2 slope was observed in patients with LVEF <29% or BNP >63 pg/ml (respective baseline median values) (p<0.05, p<0.05). In patients with BNP >63pg/ml, the improvement effect on the V̇E/V̇CO2 slope with carvedilol was significantly greater than that with metoprolol (p<0.05) and a significant improvement in the V̇E/V̇CO2 slope was observed only in those who took carvedilol (p<0.01). Conclusions: The V̇E/V̇CO2 slope was not improved after β-blocker therapy in any of the patients. However, it did improve in patients with a lower LVEF or higher BNP level at baseline, and carvedilol was more effective than metoprolol in improving the V̇E/V̇CO2 slope in patients with higher BNP levels at baseline.

Original languageEnglish
Pages (from-to)358-363
Number of pages6
JournalCirculation Journal
Issue number3
Publication statusPublished - 2008



  • Beta-blockers
  • Exercise
  • Heart failure
  • Ventilatory efficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

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