Effect of nebivolol on left ventricular function in patients with chronic heart failure: a pilot study

Abstract

Background: Sympathetic activity is a significant predictor of a poor prognosis in heart failure. Beta-blockers have been shown to improve the prognosis of patients with heart failure. Aim: This pilot study examined the tolerability and efficacy of the new b-blocker nebivolol on left ventricular function in patients with chronic heart failure. Methods and Results: Twelve patients with an ejection fraction of 13-39% were included in this double blind, placebo-controlled randomized trial of nebivolol administered in addition to standard therapy. Exercise time, heart rate, left ventricular function and tolerability were examined at baseline and after 3 months of orally administered nebivolol (2.5 and 5 mg, ns6) or placebo (ns6). Nebivolol was well tolerated and the NYHA class improved in four patients. Heart rate decreased while the maximal exercise duration and performance remained stable. Left ventricular function increased (ejection fraction 31.5"10.11 to 42.0"10.99%, PF0.01) after 12 weeks of nebivolol. The left ventricular end-systolic diameter decreased in the nebivolol-group from 56.5"9.40 to 50.2"9.43 mm (PF0.02). Conclusion: These data indicate that nebivolol might improve cardiac function in patients with reduced left ventricular function.

Nebivolol for the treatment of heart failure

“…In the trial conducted by Wisenbaugh et al, 16 two patients withdrew due to new or worsening diabetes mellitus, but there were few reported adverse events and no admissions for worsened heart failure during the three-month study. Similarly, Brehm et al 17 reported no serious clinical adverse events, including significant bradycardia and hypotension, and no patients experienced deterioration in cardiac function. In both trials comparing nebivolol with carvedilol, reported adverse events were similar between treatment groups, with 63% of patients receiving nebivolol reaching the target dosage of 5 mg daily in one study, while 83% reached the same target dosage in the other trial.…”

“…Brehm et al Brehm et al 17 conducted a similar trial examining the tolerability and efficacy of nebivolol on left ventricular function. Twelve patients with stable NYHA functional class III heart failure and an LVEF of ≤39% (mean, 29.7%) and receiving an ACE inhibitor, a diuretic, and digoxin were randomized to receive either nebivolol 2.5 mg daily or placebo; after 2 weeks, the daily dose of nebivolol was increased to 5 mg and continued for an additional 10 weeks.…”

Nebivolol for the treatment of heart failure

“…In most of these studies nebivolol was administered at a dosage of 5 mg, both in HF of ischemic origin and idiopathic dilated cardiomyopathy [57][58][59][60][61][62][63]. Apart from reducing HR and BP, it also showed an increase in LVEF [59][60][61][62][63][64], an enhancement of myocardial contractility [57,59] and improvement in coronary flow reserve [63]. Contradictory data are available about the effect of nebivolol on exercise capacity [60,62].…”

Nebivolol in chronic heart failure: current evidence and future perspectives

“…Brehm et al examined the tolerability and efficacy of nebivolol (2.5 or 5 mg) on left ventricular function in 12 patients with CHF [41]. LVEF increased (from 31 to 42%) and the left ventricular (LV) end-systolic diameter decreased after 12 weeks of nebivolol treatment.…”