Comparison of the effects of carvedilol and nebivolol on diastolic functions of the left ventricle in patients with non-ischemic heart failure

• Published in: Cardiology journal 2014-01, Vol.21 (1), p.76-82
• Main Authors: Dogan, Abdullah, Karabacak, Mustafa, Tayyar, Senol, Erdogan, Dogan, Ozaydin, Mehmet
• Format: Article
• Language: English
• Subjects: Adrenergic alpha-1 Receptor Antagonists - administration & dosage; Adrenergic beta-1 Receptor Agonists - administration & dosage; Carbazoles - administration & dosage; Diastole; Dose-Response Relationship, Drug; Echocardiography; Female; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart Ventricles - diagnostic imaging; Heart Ventricles - drug effects; Heart Ventricles - physiopathology; Humans; Male; Middle Aged; Myocardial Ischemia - complications; Myocardial Ischemia - drug therapy; Myocardial Ischemia - physiopathology; Nebivolol - administration & dosage; Propanolamines - administration & dosage; Single-Blind Method; Treatment Outcome; Vasodilator Agents - therapeutic use
• ISSN: 1897-5593; 1897-5593; 1898-018X
• DOI: 10.5603/CJ.a2013.0062

We investigated whether carvediolol or nebiovolol with vasodilator properties will produce different effects on diastolic function of the left ventricle (LV) in heart failure (HF) with low ejection fraction (EF). Sixty-one non-ischemic HF patients with EF ≤40% randomly received carvedilol (n = 31, 16 male) or nebivolol (n = 30, 19 male). Clinical and echocardiographic evaluations were performed at baseline, 3 and 6 months after therapy. Mitral inflow velocities (E and A waves), deceleration time of E wave (DT), isovolumetric relaxation time (IVRT), mitral annular velocities (Ea and Aa waves) were evaluated. Mitral E/A and E/Ea ratios were calculated. In carvediolol and nebivolol groups, mitral E/A ratio (from 1.08 ± 0.31 to 0.87 ± 0.30 vs. from 0.98 ± 0.20 to 0.80 ± 0.20, p = 0.30) and IVRT (from 108 ± 13 to 94 ± 10 ms vs. from 107 ± 22 to 92 ± 10 ms, p = 0.25) similarly decreased while DT prolonged (from 184 ± 40 to 218 ± 42 ms vs. from 193 ± 37 to 222 ± 36 ms, p = 0.71). Also, E/Ea ratio significantly decreased in each group (p = 0.01), but it was lower in nebivolol group than carvedilol group at 6 months (10.2 ± 2 vs. 11.8 ± 2, p = 0.01). Carvediolol and nebivolol reduced similarly N-terminal pro-B type natriuretic peptide level (from 666 to 137 vs. 661 to 123 pg/dL, p = 0.41, respectively) and improved functional capacity (p > 0.05). At 6 month follow-up, carvedilol and nebivolol appear to similarly improve LV diastolic functions in non-ischemic HF patients.