Pharmacologic stress echocardiography: can we forget "state-of-the-art" protocols?

acteristics. Furthermore, to avoid a basic misunderstanding of the objective of our study, one specific point needs to be emphasized. The study was not designed to address the question of whether one betablocker is more effective than another, but rather (as clearly stated in our article) to evaluate whether carvedilol may provide additional benefits in a select subgroup of patients with dilated cardiomyopathy who were treated long term with metoprolol, as well as poor responders to metoprolol. Therefore, the lack of further benefits in patients randomized to continue taking metoprolol was, in some way, expected. However, from this evidence, we have not argued (or stated) that metoprolol is ineffective or less effective than carvedilol; rather, we have suggested that carvedilol treatment may be beneficial in patients showing unsatisfactory clinical responses to metoprolol treatment. Finally, we agree with the comments made by Drs. Fauchier and Giraudeau regarding the U.S. Carvedilol Study (2) and the MERIT-HF trial (3), even though it cannot be denied that the data from the U.S. program, at least, imply a beneficial effect of carvedilol on sudden death. In any case, whatever the opinion on this issue, the truth is that the comparative efficacy of carvedilol and metoprolol in preventing sudden death will remain an open question until the conclusion of the ongoing COMET trial. We thank Drs Fauchier and Giraudeau for having brought their pertinent criticisms to our attention.