Is Carvedilol Effective in Preventing and Modulating Concentric Cardiac Remodelling? A Comprehensive Systematic Review and Meta-Analyses.

BACKGROUND

Carvedilol, commonly used to treat hypertension and known for its vasodilatory and pleiotropic effects, has been studied in various patient populations. However, its specific impact on diastolic dysfunction and heart failure with preserved ejection fraction (HFpEF) remains unclear.

AIM: The aim of the study is to evaluate carvedilol's efficacy in preventing concentric cardiac remodelling in at-risk individuals and modulating it in patients with HFpEF.

METHODS

In adherence to PRISMA guidelines, we searched PubMed and ScienceDirect up to March 2024 using terms related to carvedilol and HFpEF. We included randomised controlled trials and prospective cohort studies published in English. Outcomes include changes in natriuretic peptides and echocardiography parameters of diastolic function. Exclusion criteria encompassed non-English studies, nonhuman studies and studies not using carvedilol or exclusively involving HFrEF patients. Risk of bias was assessed using the revised Cochrane tool and Newcastle-Ottawa Scale. Data synthesis was performed using a random-effects meta-analysis with sensitivity analyses and a leave-one-out procedure to explore heterogeneity.

RESULTS

Eighteen studies involving 2233 participants were included. Various populations were included: those with HFpEF or undergoing cardiotoxic chemotherapy. Meta-analysis did not reveal significant effects of carvedilol on echocardiography parameters such as E/A ratio (mean difference 0.04, 95% CI -0.01 to 0.08), E/e⁣' ratio (mean difference -0.50, 95% CI -1.39 to 0.39) and LVMI (mean difference 0.21, 95% CI -3.13 to 3.55), with substantial heterogeneity observed in LVEF, LVMI and BNP.

CONCLUSION

Carvedilol does not significantly impact diastolic dysfunction across various populations. However, the diversity of study populations and outcomes contributes to the heterogeneity of results.