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Effects of nebivolol versus carvedilol on left ventricular function in patients with chronic heart failure and
Renzo M R Lombardo1, Caterina Reina, Maurizio G Abrignani
1Department of Cardiology, Ospedale S. Antonio Abate, Trapani, Italy. renzolombardo@libero.it
Insights
Nebivolol and carvedilol both improve heart function in chronic heart failure patients. This study found nebivolol to be as effective as carvedilol in enhancing left ventricular (LV) function and patient outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Beta-blocker therapy improves left ventricular (LV) systolic function and prognosis in chronic heart failure.
- Both carvedilol and nebivolol offer hemodynamic and clinical benefits in chronic heart failure.
- The comparative effects of carvedilol and nebivolol on LV function remain unclear.
Purpose of the Study:
- To compare the effects of nebivolol versus carvedilol on LV function in patients with chronic heart failure and reduced LV systolic function.
- To assess clinical, biochemical, hematological, and functional outcomes after 6 months of treatment.
Main Methods:
- Seventy patients with LV ejection fraction ≤40% and NYHA class II-III were randomized to carvedilol or nebivolol for 6 months.
- Comprehensive assessments included clinical evaluation, ECG, 24-hour Holter monitoring, echocardiography, ventilatory function tests, and a 6-minute walk test.
- Data were analyzed at baseline and after 6 months of treatment.
Main Results:
- Both carvedilol and nebivolol increased LV ejection fraction and decreased LV end-systolic volume, with no significant between-group differences.
- Resting heart rate decreased significantly in both groups, without changes in ECG intervals.
- No significant differences in hematologic markers, Holter data (except HR), respiratory function, or adverse events were observed between groups.
Conclusions:
- Nebivolol demonstrates comparable efficacy to carvedilol in improving left ventricular function in patients with symptomatic chronic heart failure.
- Both agents provide significant clinical benefits, supporting their use in managing chronic heart failure with reduced LV systolic function.
Background:
Beta-adrenoceptor antagonist (beta-blocker) therapy results in a significant improvement in left ventricular (LV) systolic function and prognosis in patients with chronic heart failure. Both carvedilol and nebivolol produce hemodynamic and clinical benefits in chronic heart failure, but it is unknown whether their peculiar pharmacologic properties produce different effects on LV function.
Objective:
To assess the effects on LV function of nebivolol compared with carvedilol in patients with chronic heart failure and reduced LV systolic function.
Methods:
Seventy patients with a LV ejection fraction
Results:
Compared with baseline values LV end-systolic volume decreased and LV ejection fraction increased in both the carvedilol (from 79 +/- 38mL to 73 +/- 43mL and from 33% +/- 6% to 37% +/- 11%) and the nebivolol group (from 72 +/- 35mL to 66 +/- 32mL and from 34% +/- 7% to 38% +/- 10%), although the between-group differences were not statistically significant. ECG data showed a decrease in resting HR in both groups (from 83 +/- 20 bpm to 66 +/- 11 bpm for carvedilol and from 81 +/- 15 bpm to 65 +/- 11 bpm for nebivolol; p < 0.001 vs baseline for both groups) but no difference in the PQ, QRS, and QT intervals. Hematologic (in particular, N-terminal pro-brain natriuretic peptide), Holter monitoring (with the exception of HR), and respiratory functional data did not show any significant variation in either group after 6 months' therapy. SBP and DBP decreased in both groups. A small reduction in mean NYHA functional class from baseline was seen in both groups (from 2.5 +/- 0.5 to 2.2 +/- 0.5 for carvedilol [p < 0.05] and from 2.3 +/- 0.4 to 2.2 +/- 0.5 for nebivolol [not significant]). The 6-minute walk test showed a trend toward an increase in the walking distance in both groups. During 6 months of treatment no significant differences in adverse events were observed between the groups.
Conclusion:
Nebivolol is as effective as carvedilol in patients with symptomatic chronic heart failure and reduced LV systolic function.
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