Nebivolol improves coronary flow reserve in patients with idiopathic dilated cardiomyopathy

Abstract

Background: Impaired coronary flow reserve (CFR) is a significant predictor of poor prognosis in patients with idiopathic dilated cardiomyopathy (IDC). Nebivolol reduces mortality and morbidity in patients with heart failure and left ventricular dysfunction, including cases caused by IDC. Objective: To assess the effects of nebivolol on CFR in patients with IDC. Methods: CFR was measured in 21 clinically stable patients with IDC (mean (SD) ejection fraction 35.7 (6.2)) at baseline and after 1 month of treatment with nebivolol once daily. A control group of apparently healthy subjects who were matched for age and sex was used for comparison. Resting and hyperaemic coronary flows were measured using transthoracic second-harmonic Doppler echocardiography. None of the subjects had any systemic disease. Results: After 1 month of treatment, heart rate was reduced significantly (p,0.001). The blood pressure was decreased significantly (p,0.001). The left ventricular end-diastolic diameter and stroke volume were not changed significantly, but end-systolic diameter was decreased significantly (p,0.05). Resting rate-pressure product was lower after treatment with nebivolol, but dipyridamole-induced change was not influenced by the treatment. Nebivolol treatment reduced significantly coronary velocities at rest (p,0.02) and also caused a significant increase in coronary velocities after dipyridamole (p,0.02), leading to a greater CFR (2.02 (0.35) vs 2.61 (0.43), p,0.001). Nebivolol induced an absolute increase of 6% in the CFR in 17 of 21 patients (80.9%). Conclusions: In patients with IDC, 1 month of treatment with nebivolol induces a marked increase in CFR.

Treatment of CMD in Myocardial Diseases

“…Nebivolol also was shown to significantly improve CMD in patients with idiopathic dilated cardiomyopathy [11]. CFR was measured in 21 patients at baseline and 1 month after treatment and was found to increase significantly.…”

Beta-Blockers and Coronary Flow Reserve

“…In particular, Togni et al (20) (21). With the exception of the observation of Gullu (7), where the improvement of CFVR was exclusively due to the decrease of CBF velocities at rest, in the other 4 studies nebivolol increased significantly hyperemic CBF velocities (18)(19)(20)(21). Coronary vasodilation due to either adenosine or dipyridamole is primarily endothelium independent but the increment in CBF may trigger further flow-induced vasodilation, which is endothelium dependent (25,26).…”

“…The influence of these two drugs on CFR has been tested in the clinical setting. The improvement of coronary microvascular function obtainable by both carvedilol (14)(15)(16)(17) and nebivolol (7,(18)(19)(20)(21) could be at least one of the substrates underlying the improvement in LV function due to both these drugs. Except for the experience of Koepfli et al (14), where a significant drug-induced increase on PETderived CFR was achieved only pooling 36 patients with coronary artery disease treated by either carvedilol or atenolol (12 week treatment), all the other clinical studies demonstrated a positive effect of carvedilol or nebivolol on CFR (Table 1) (22).…”

“…In these experiences, the increase of CFVR was mainly due to the increase of maximal CBF velocity, attributable to diminution of extravascular compressive forces and of LV filling pressure (5,6), to blunted heart rate response beneficially affecting the diastolic myocardial perfusion during hyperemia (6), to alpha-adrenergic blocking action and to improved endothelial function (23,24) possibly producing a better hyperemic microvascular vasodilation.. The studies performed by using nebivolol involved several clinical settings, such as patients with arterial hypertension (7,18,21), idiopathic dilated cardiomyopathy (19) and coronary artery disease (20). In particular, Togni et al (20) (21).…”

Unique Effect of Nebivolol on Coronary Hemodynamics: It’s All a Matter of Flow

“…Erdogan et al recently reported that in patients with idiopathic dilated cardiomyopathy one month of oral nebivolol treatment was associated with a significant increase in CFR, as measured by trans-thoracic Doppler echocardiography [6]. Similarly, Galderisi et al have shown that in hypertensive patients free of coronary artery disease, one month of oral nebivolol therapy induces a significant increase in CFR, as assessed by Doppler echocardiography [7].…”