Regional functions of the left ventricle in patients with coronary slow flow and the effects of nebivolol

Abstract

Abstract:Background: Microvascular and endothelial dysfunction have been implicated for coronary slow flow (CSF). Nebivolol, besides its beta-receptor blocking activity, causes an endotheliumdependent vasodilatation through increased nitric oxide release. Methods: This study included 27 patients with CSF and 27 subjects with normal coronary arteries. Segmental functions of the left ventricle (LV) were assessed using myocardial tissue Doppler velocities before and 3 months after treatment with nebivolol 5 mg/day. Results: Compared with the control group, mitral deceleration time (DT) was significantly longer, and E/A ratio, systolic velocity of lateral mitral annulus (S m ) and regional myocardial peak systolic and early diastolic velocities (V s , V d ) were significantly lower in patients with CSF. The reason for coronary angiography was typical angina in 21 (77.8%) and positive treadmill test in six (22.2%) CSF patients. There were significant correlations between presence of CSF in left anterior descending artery (LAD) with S m (r ¼ À0.404, p ¼ 0.002) and V s in anterior (r ¼ À0.531, p < 0.001) and lateral (r ¼ À0.495, p < 0.001) segments and between presence of CSF in RCA and V s in posterior segments (r ¼ À0.501, p < 0.001). Treatment with nebivolol significantly decreased blood pressures (128.5±12.5/82.5±8.8 to 119.8±12.6/76.4±7.4 mmHg, p < 0.001), DT (252.3±53.6 to 222.0±41.0 ms, p < 0.001) and IVRT (115.7±19.9 to 103.3±17.0 ms, p < 0.001), and increased exercise capacity (8.7±1.3 to 10.4±0.9 METs, p < 0.001), E/A ratio (0.87±0.26 to 1.08±0.23, p < 0.001) and myocardial velocities (p < 0.001). All the patients were free of angina after treatment. Patients with CSF had impaired diastolic and regional LV functions. Conclusions: Nebivolol may therefore be useful in improving angina, exercise capacity and LV functions in patients with CSF.

Retinal fluorescein angiography: A sensitive and specific tool to predict coronary slow flow

“…These findings are in agreement with Signori et al 11 who found that BMI was higher in CSF patients than in control groups with p < 0.044 and also, Gunes et al found that BMI was higher in CSF patients compared to control group, although it was within normal limits also 15 . However, Mir Hossein et al found that there were no significant differences between CSF and control group 16 .…”

Função endotelial vascular em pacientes com fluxo coronário lento e os efeitos do nebivolol

“…Although it was within normal limits, LVEF was slightly but significantly lower among CSF patients in this study. However, Barutcu et al 20 found no differences in left ventricular systolic function between patients with CSF and the control group. In another study, Sezgin et al 17 found diastolic filling abnormalities but normal LV systolic function in patients with CSF.…”

“…In addition, intracoronary nebivolol has been associated with a significant increase in coronary flow reserve both in patients with coronary artery disease and patients with normal coronary arteries33. Furthermore, it has been shown that nebivolol may be effective for improvement of LV functions and symptoms and brachial FMD in patients with CSF 20,34,35 . Improvement of FMD with nebivolol in this study may be associated with the fact that endothelial dysfunction may be a generalized process and can be detected both in coronary and peripheral arteries.…”

Decreased risk of ventricular arrhythmias with treatment of nebivolol in patients with coronary slow flow

“…Beta-blockers reduce oxygen consumption of the myocardium and thus diminish myocardial ischaemia. It has been shown that treatment with nebivolol significantly improved angina, exercise capacity, and diastolic and regional systolic functions in patients with CSF [19,20]. Nebivolol has also been shown to be associated with improved endothelial function in patients with CSF [21].…”