title: Effects of the long-term administration of nebivolol on the clinical symptoms, exercise capacity, and left ventricular function of patients with diastolic dysfunction: results of the ELANDD study.
abstract: OBJECTIVE
  We hypothesized that nebivolol, a beta-blocker with nitric oxide-releasing properties, could favourably affect exercise capacity in patients with heart failure and preserved left ventricular ejection fraction (HFPEF).
  
  
  RESULTS
  A total of 116 subjects with HFPEF, in New York Heart Association (NYHA) functional class II-III, with left ventricular ejection fraction (LVEF) >45%, and with echo-Doppler signs of LV diastolic dysfunction, were randomized to 6 months treatment with nebivolol or placebo, following a double-blind, parallel group design. The primary endpoint of the study was the change in 6 min walk test distance (6MWTD) after 6 months. Nebivolol did not improve 6MWTD (from 420 ± 143 to 428 ± 141 m with nebivolol vs. from 412 ± 123 to 446 ± 119 m with placebo, P = 0.004 for interaction) compared with placebo, and the peak oxygen uptake also remained unchanged (peakVO(2); from 17.02 ± 4.79 to 16.32 ± 3.76 mL/kg/min with nebivolol vs. from 17.79 ± 5.96 to 18.59 ± 5.64 mL/kg/min with placebo, P = 0.63 for interaction). Resting and peak blood pressure and heart rate decreased with nebivolol. A significant correlation was found between the change in peak exercise heart rate and that in peakVO(2) (r = 0.391; P = 0.003) for the nebivolol group. Quality of life, assessed using the Minnesota Living with Heart Failure Questionnaire, and NYHA classification improved to a similar extent in both groups, whereas N-terminal pro brain natriuretic peptide (NT-pro BNP) plasma levels remained unchanged.
  
  
  CONCLUSIONS
  Compared with placebo, 6 months treatment with nebivolol did not improve exercise capacity in patients with HFPEF. Its negative chronotropic effect may have contributed to this result.
authors.affiliation: Department of Cardiology, Antwerp University Hospital, Edegem, Belgium, University of Antwerp, Antwerp, Belgium.
authors.forename: Viviane M
authors.initials: VM
authors.lastname: Conraads
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Otto
authors.initials: O
authors.lastname: Kamp
authors.forename: Gilles W
authors.initials: GW
authors.lastname: De Keulenaer
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: José
authors.initials: J
authors.lastname: Zamorano
authors.forename: Panos E
authors.initials: PE
authors.lastname: Vardas
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Livio
authors.initials: L
authors.lastname: Dei Cas
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use; D000368:Aged; D001578:Benzopyrans / Q000494:pharmacology* / Q000627:therapeutic use; D003971:Diastole; D004311:Double-Blind Method; D004983:Ethanolamines / Q000494:pharmacology* / Q000627:therapeutic use; D005080:Exercise Test / Q000187:drug effects; D017079:Exercise Tolerance / Q000187:drug effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000068577:Nebivolol; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000319:Adrenergic beta-Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol