Effects of Nebivolol on left ventricular function and exercise capacity in patients with non-ischaemic dilated cardiomyopathy. A randomised placebo-controlled study.
BACKGROUND
This study assessed the effects of Nebivolol on left ventricular (LV) function and exercise capacity in patients with non-ischaemic dilated cardiomyopathy (NIDC).


METHODS
After enrolment in this double-blind trial, 60 patients, aged 55 +/- 9.5 years, with angiographically proven NIDC, LV ejection fraction (EF) < 45%, NYHA class II-III, were randomised to either Nebivolol (target dose 5 mg) or placebo and were evaluated using echocardiography and exercise tests over 3 months.


RESULTS
There were no baseline differences between the 2 groups regarding NYHA class, heart rate (HR), blood pressure (BP), LVEF or other echocardiographic variables. During follow-up, 4 patients in the Nebivolol and 5 in the placebo group discontinued treatment. After 3-months' treatment a significant decrease in NYHA class (p = 0.001), resting HR (p = 0.03), systolic and diastolic BP (both p < 0.001), left atrial diameter (p = 0.01) and LV end-systolic volume (p = 0.046), and an increase in LVEF (p = 0.01) were observed in the Nebivolol group compared to placebo. The atrial contribution to total LV filling (p = 0.007) and the pulmonary venous (PV) systolic wave velocity (p = 0.007) increased, whereas the atrial PV component decreased (p < 0.001) in the Nebivolol patients compared to placebo. Exercise duration decreased at 3 months (p = 0.01) compared to placebo, probably as a result of reduced maximal exercise HR (p < 0.001).


CONCLUSIONS
Nebivolol is a safe and well-tolerated drug that improves NYHA class, systolic and diastolic LV function in NIDC patients, although it is associated with a lower maximal exercise duration at 3 months.
Cardiology Department, University Hospital of Heraklion, Crete, Greece. cardio@med.uoc.gr
Alexandros P
AP
Patrianakos
Fragiskos I
FI
Parthenakis
Hercules E
HE
Mavrakis
Maria
M
Saatsaki
Georgios F
GF
Diakakis
Gregorios I
GI
Chlouverakis
Panos E
PE
Vardas
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001578:Benzopyrans / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D015150:Echocardiography, Doppler; D004983:Ethanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068577:Nebivolol; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol