Carvedilol and nebivolol improve left ventricular systolic functions in patients with non-ischemic heart failure

Abstract

Objective:It is unclear whether carvedilol and nebivolol produce different effects on short-term left ventricle (LV) systolic function in heart failure (HF). These drugs could improve systolic and diastolic functions of the LV. Thus, we aimed to compare their effects on LV systolic functions in patients with non-ischemic HF.Methods:This study included 61 symptomatic non-ischemic HF patients with low ejection fraction (EF) (EF≤40%) between September 2008 and November 2010. The patients were randomized to carvedilol (n=31, 16 males) or nebivolol (n=30, 19 male). They were evaluated clinically and echocardiographically at baseline and 3 and 6 months after target dose; 42% of patients in the carvedilol group and 47% in the nebivolol group achieved the target dose before randomization. LV systolic functions were evaluated with ventricle diameters, EF, ejection time (ET), isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and myocardial performance index (MPI).Results:At 6 months, carvedilol and nebivolol similarly improved EF (from 33±4% to 36±5%, p<0.01 and from 34±5% to 37±5%, p<0.01, inter-group p=0.30, respectively) and MPI (from 0.71±0.10 to 0.53±0.07, p<0.01 and from 0.69±0.13 to 0.52±0.08, p<0.01, intergroup p=0.45, respectively). LV diameter was reduced by a similar extent in both groups. In each group, IVCT and IVRT were significantly shortened and ET was prolonged, but there was no inter-group difference. Functional capacity improved similarly (from NYHA Class II-III to Class I-0) in both groups, as did heart rate and blood pressure. Reduction of pro-B-type natriuretic peptide levels was also comparable in both groups (p=0.41).Conclusion:Carvedilol and nebivolol can similarly improve LV systolic functions in non-ischemic HF patients.

The significance of left ventricular ejection time in heart failure with reduced ejection fraction

“…In varieties of cardiovascular diseases, LVET has shown utility ( Table 1 ). 19–22,25,34–36,39–48 Patients with primary pulmonary hypertension seem to demonstrate a marked shortening of LVET shortly before death or clinical deterioration 41,49 . In patients with cardiac amyloidosis, shortened LVET was a predictor of mortality 40 .…”

“…Additionally, beta‐blockers increase stroke volume over the long term 59 . Accordingly, LVET increases 47 …”

“…19,39 In varieties of cardiovascular diseases, LVET has shown utility (Table 1). [19][20][21][22]25,[34][35][36][39][40][41][42][43][44][45][46][47][48] before death or clinical deterioration. 41,49 In patients with cardiac amyloidosis, shortened LVET was a predictor of mortality.…”

“…59 Accordingly, LVET increases. 47 Angiotensin-converting enzyme inhibitors are also indicated for the treatment of patients with HFrEF. 60 They act by inhibiting angiotensin-converting enzyme and thus prevent the formation of angiotensin II from angiotensin I, promoting diuresis and natriuresis.…”

Nebivolol: An Appealing, Awaited and Nitric Oxide Potentiator Drug for the Treatment of Heart Failure

“…IVCT, IVRT, and LV diameter are the parameters for finding the LV systolic functions. 29 In another comparative study by Lombardo et al the effects of nebivolol and carvedilol on the LV function in the patients suffering from HF were assessed. In this study, 70 patients with reduced Ejection fraction (≤40%) were randomly assigned carvedilol or nebivolol for 6 months.…”