Comparative Efficacy of Nebivolol v. Carvedilol on LV Function
Comparative Efficacy of Nebivolol v. Carvedilol on LV Function
Purpose: To compare the efficacy of nebivolol versus carvedilol on left ventricular (LV) function and exercise capacity in patients with nonischemic dilated cardiomyopathy (NIDC).
Methods: After enrollment in this double-blind trial, 72 patients, aged 55 ± 9.5 years, with NIDC, LV ejection fraction (LVEF) <45%, New York Heart Association classes II to III, were randomized to either nebivolol (34 patients) or carvedilol (38 patients) and were evaluated through echocardiography and exercise tests at baseline and 3 and 12 months after treatment.
Results: During follow-up, 4 patients discontinued nebivolol, although 3 patients stopped carvedilol. Patients in both the nebivolol and carvedilol groups showed a steady improvement in New York Heart Association class (P = .002 and <.001, at 12 months, respectively) and LVEF (P = .001 and <.001, at 12 months, respectively) that became significant from 3-month follow-up on. Intergroup analysis showed that carvedilol group had a greater increase in LVEF at 3 (P = .04) and 12 (P = .02) months' follow-up compared with nebivolol group. Advanced diastolic dysfunction regressed to earlier stages in carvedilol patients after 3 (P = .02) and 12 (P = .01) months' treatment, whereas in the nebivolol group, a significant improvement in diastolic dysfunction was found at the 12 months' follow-up (P = .02).
Exercise duration improved in both groups at 12 months' follow-up (both P = .01), but in the nebivolol group, there was an initial deterioration at 3 months (P = .07).
Conclusions: Both nebivolol and carvedilol appear relatively safe, with beneficial effects on LV systolic and diastolic function as well as exercise capacity in patients with NIDC after 12 months' treatment. However, carvedilol exhibits more favorable effects on LV function than does nebivolol.
Heart failure (HF) is a major health problem in developed countries, with a poor prognosis despite the recent advances in pharmaceutical treatment. Activation of the sympathetic nervous system is one of the cardinal pathophysiological abnormalities in HF, and circulating levels of catecholamines increase in proportion to the severity of the disease.
Certain ß-blockers have been shown to improve cardiac function and symptoms and reduce the risk of death and hospitalization in patients with HF, but they have also shown that they differ significantly in their effects on the natural history of the disease. In controlled clinical trials, bisoprolol, carvedilol, and metoprolol exerted favorable effects on survival, whereas bucindolol had little effect on mortality rates, and xamoterol was associated with an increased risk of death.
Recently, a debate concerning the relative efficacy of "second-generation" ß1-selective agents versus the "third-generation" nonselective ß-blocker carvedilol has been at least partially resolved by the results of the COMET trial, which suggest that carvedilol has a more beneficial effect on mortality when compared with metoprolol, although there has been criticism with regard to whether the metoprolol dose used was appropriate.
Nebivolol, a new third-generation ß1-selective blocker, which in addition to ß1-adrenergic receptor inhibition also increases endothelial nitric oxide (NO) release, thereby inducing peripheral vasodilatation recently showed a beneficial effect in decreasing the composite end point of hospitalization or mortality in elderly people having HF.
The aim of our study was to investigate the comparative effects of nebivolol and carvedilol on left ventricular (LV) function and exercise capacity in the treatment for patients with nonischemic dilated cardiomyopathy (NIDC) and mild to moderate HF.
Abstract and Introduction
Abstract
Purpose: To compare the efficacy of nebivolol versus carvedilol on left ventricular (LV) function and exercise capacity in patients with nonischemic dilated cardiomyopathy (NIDC).
Methods: After enrollment in this double-blind trial, 72 patients, aged 55 ± 9.5 years, with NIDC, LV ejection fraction (LVEF) <45%, New York Heart Association classes II to III, were randomized to either nebivolol (34 patients) or carvedilol (38 patients) and were evaluated through echocardiography and exercise tests at baseline and 3 and 12 months after treatment.
Results: During follow-up, 4 patients discontinued nebivolol, although 3 patients stopped carvedilol. Patients in both the nebivolol and carvedilol groups showed a steady improvement in New York Heart Association class (P = .002 and <.001, at 12 months, respectively) and LVEF (P = .001 and <.001, at 12 months, respectively) that became significant from 3-month follow-up on. Intergroup analysis showed that carvedilol group had a greater increase in LVEF at 3 (P = .04) and 12 (P = .02) months' follow-up compared with nebivolol group. Advanced diastolic dysfunction regressed to earlier stages in carvedilol patients after 3 (P = .02) and 12 (P = .01) months' treatment, whereas in the nebivolol group, a significant improvement in diastolic dysfunction was found at the 12 months' follow-up (P = .02).
Exercise duration improved in both groups at 12 months' follow-up (both P = .01), but in the nebivolol group, there was an initial deterioration at 3 months (P = .07).
Conclusions: Both nebivolol and carvedilol appear relatively safe, with beneficial effects on LV systolic and diastolic function as well as exercise capacity in patients with NIDC after 12 months' treatment. However, carvedilol exhibits more favorable effects on LV function than does nebivolol.
Introduction
Heart failure (HF) is a major health problem in developed countries, with a poor prognosis despite the recent advances in pharmaceutical treatment. Activation of the sympathetic nervous system is one of the cardinal pathophysiological abnormalities in HF, and circulating levels of catecholamines increase in proportion to the severity of the disease.
Certain ß-blockers have been shown to improve cardiac function and symptoms and reduce the risk of death and hospitalization in patients with HF, but they have also shown that they differ significantly in their effects on the natural history of the disease. In controlled clinical trials, bisoprolol, carvedilol, and metoprolol exerted favorable effects on survival, whereas bucindolol had little effect on mortality rates, and xamoterol was associated with an increased risk of death.
Recently, a debate concerning the relative efficacy of "second-generation" ß1-selective agents versus the "third-generation" nonselective ß-blocker carvedilol has been at least partially resolved by the results of the COMET trial, which suggest that carvedilol has a more beneficial effect on mortality when compared with metoprolol, although there has been criticism with regard to whether the metoprolol dose used was appropriate.
Nebivolol, a new third-generation ß1-selective blocker, which in addition to ß1-adrenergic receptor inhibition also increases endothelial nitric oxide (NO) release, thereby inducing peripheral vasodilatation recently showed a beneficial effect in decreasing the composite end point of hospitalization or mortality in elderly people having HF.
The aim of our study was to investigate the comparative effects of nebivolol and carvedilol on left ventricular (LV) function and exercise capacity in the treatment for patients with nonischemic dilated cardiomyopathy (NIDC) and mild to moderate HF.
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