Remme W J
Cardiovasc Drugs Ther. 2001 Jan;15(1):69-77. doi: 10.1023/a:1011166919718.
Inhibition or reversal of ventricular remodelling in heart failure patients is regarded as of prime importance in the treatment of heart failure and in determining long term outcome. Recent studies have demonstrated that the addition of carvedilol to Angiotensin Converting Enzyme (ACE) inhibitors and other routine heart failure therapy results in a valuable improvement in the clinical status and life expectancy of mild, moderate and severe heart failure patients. ACE inhibitors have become the cornerstone of heart failure therapy. Also, carvedilol in combination with standard therapy (including ACE inhibitors) has demonstrable beneficial effects on left ventricular remodelling. Each new treatment has to be added, this quickly leads to polypharmacy, which may not be necessary and even unwanted in the individual patient, as the pharmacological profile of carvedilol compares favourably to ACE inhibitors, this suggests that it could challenge ACE inhibitors as first-line treatment for heart failure. The CARMEN trial (Carvedilol and ACE-Inhibitor Remodelling Mild Heart Failure EvaluatioN) was designed to compare the effects of carvedilol alone and of carvedilol plus an ACE inhibitor (enalapril) with the effect of an ACE inhibitor alone on different parameters of left ventricular remodelling as well as morbidity and mortality in patients with chronic mild heart failure, thereby allowing conclusions on whether combination therapy may be replaced by the multiple action adrenergic inhibitor carvedilol in the future.
抑制或逆转心力衰竭患者的心室重构被认为在心力衰竭治疗及决定长期预后方面至关重要。最近的研究表明，在血管紧张素转换酶（ACE）抑制剂及其他常规心力衰竭治疗基础上加用卡维地洛，可使轻、中、重度心力衰竭患者的临床状况和预期寿命得到显著改善。ACE抑制剂已成为心力衰竭治疗的基石。此外，卡维地洛与标准治疗（包括ACE抑制剂）联合应用对左心室重构具有明显的有益作用。每种新的治疗方法都需添加，这很快导致了联合用药，而这在个体患者中可能并非必要甚至有害，由于卡维地洛的药理学特性优于ACE抑制剂，这表明它可能挑战ACE抑制剂作为心力衰竭的一线治疗药物。卡门试验（卡维地洛与ACE抑制剂治疗轻度心力衰竭重塑评估）旨在比较单独使用卡维地洛、卡维地洛加ACE抑制剂（依那普利）与单独使用ACE抑制剂对慢性轻度心力衰竭患者左心室重构不同参数以及发病率和死亡率的影响，从而得出关于联合治疗未来是否可能被多效肾上腺素能抑制剂卡维地洛所取代的结论。
