Effects of Nebivolol versus Carvedilol on Left Ventricular Function in Patients with Chronic Heart Failure and Reduced Left Ventricular Systolic Function

Abstract

Beta-adrenoceptor antagonist (beta-blocker) therapy results in a significant improvement in left ventricular (LV) systolic function and prognosis in patients with chronic heart failure. Both carvedilol and nebivolol produce hemodynamic and clinical benefits in chronic heart failure, but it is unknown whether their peculiar pharmacologic properties produce different effects on LV function. To assess the effects on LV function of nebivolol compared with carvedilol in patients with chronic heart failure and reduced LV systolic function. Seventy patients with a LV ejection fraction <or=40% and in New York Heart Association (NYHA) functional class II or III were randomly assigned to receive carvedilol or nebivolol therapy for 6 months. At baseline and after 6 months of treatment, all patients were assessed clinically and by biochemical and hematological investigation, ECG, 24-hour Holter monitoring, echocardiogram, measurement of ventilatory function, and a 6-minute walk test. Compared with baseline values LV end-systolic volume decreased and LV ejection fraction increased in both the carvedilol (from 79 +/- 38mL to 73 +/- 43mL and from 33% +/- 6% to 37% +/- 11%) and the nebivolol group (from 72 +/- 35mL to 66 +/- 32mL and from 34% +/- 7% to 38% +/- 10%), although the between-group differences were not statistically significant. ECG data showed a decrease in resting HR in both groups (from 83 +/- 20 bpm to 66 +/- 11 bpm for carvedilol and from 81 +/- 15 bpm to 65 +/- 11 bpm for nebivolol; p < 0.001 vs baseline for both groups) but no difference in the PQ, QRS, and QT intervals. Hematologic (in particular, N-terminal pro-brain natriuretic peptide), Holter monitoring (with the exception of HR), and respiratory functional data did not show any significant variation in either group after 6 months' therapy. SBP and DBP decreased in both groups. A small reduction in mean NYHA functional class from baseline was seen in both groups (from 2.5 +/- 0.5 to 2.2 +/- 0.5 for carvedilol [p < 0.05] and from 2.3 +/- 0.4 to 2.2 +/- 0.5 for nebivolol [not significant]). The 6-minute walk test showed a trend toward an increase in the walking distance in both groups. During 6 months of treatment no significant differences in adverse events were observed between the groups. Nebivolol is as effective as carvedilol in patients with symptomatic chronic heart failure and reduced LV systolic function.