Efficacy of Add-on Therapy with Carvedilol and the Direct Renin Inhibitor Aliskiren for Improving Cardiac Sympathetic Nerve Activity, Cardiac Function, Symptoms, Exercise Capacity and Brain Natriuretic Peptide in Patients with Dilated Cardiomyopathy

Takuji Toyama; Shu Kasama; Yusuke Miyaishi; Hakuken Kan; Eiji Yamashita; Ren Kawaguchi; Hitoshi Adachi; Hiroshi Hoshizaki; Shigeru Ohshima

doi:10.17996/anc.21-00139

Efficacy of Add-on Therapy with Carvedilol and the Direct Renin Inhibitor Aliskiren for Improving Cardiac Sympathetic Nerve Activity, Cardiac Function, Symptoms, Exercise Capacity and Brain Natriuretic Peptide in Patients with Dilated Cardiomyopathy

Ann Nucl Cardiol. 2021;7(1):33-42. doi: 10.17996/anc.21-00139. Epub 2021 Aug 31.

Authors

Takuji Toyama¹, Shu Kasama², Yusuke Miyaishi³, Hakuken Kan³, Eiji Yamashita³, Ren Kawaguchi³, Hitoshi Adachi³, Hiroshi Hoshizaki³, Shigeru Ohshima³

Affiliations

¹ Division of Cardiology, Toyama Cardiovascular Clinic, Maebashi, Japan.
² Clinical Research Center, Nara Medical University Graduate School of Medicine, Nara, Japan.
³ Division of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.

Abstract

Purpose/Method: Aliskiren is a direct renin inhibitor that has been reported to be effective for CHF, but the usefulness of combined therapy with carvedilol and aliskiren has not been reported. Forty-four patients with dilated cardiomyopathy (DCM) were randomized into a group receiving add-on therapy with carvedilol plus aliskiren and another group receiving carvedilol alone for 6 months. Nuclear imagings with ¹²³I-Metaiodobenzylguanidine (MIBG) and ^99mTc-Sestamibi were performed. Exercise capacity using a specific activity scale (SAS) and the New York Heart Association (NYHA) class were evaluated. Cardiac sympathetic nerve activity was evaluated by ¹²³I-MIBG imaging, with the delayed heart-to-mediastinum activity ratio (H/M), delayed total defect score (TDS), and washout rate (WR). Results: Combined add-on therapy with carvedilol and aliskiren improved several parameters much more than carvedilol alone (p<0.05) with respect to TDS, ejection fraction (EF), NYHA, SAS on 6 months and the changes in TDS, EF, end-diastolic volume and brain natriuretic peptide (BNP). Conclusion: Add-on therapy with carvedilol and aliskiren is more effective than carvedilol alone for improving cardiac sympathetic nerve activity, cardiac function, symptoms, exercise capacity, and brain natriuretic peptide in patients with DCM.

Keywords: 123I-metaiodobenzylguanidine imaging; Aliskiren; Brain natriuretic peptide; Cardiac sympathetic nerve activity; Carvedilol; Dilated cardiomyopathy.