- Poster presentation
- Open Access
Short-term hemodynamic effects of nebivolol in acute decompensated heart failure: a randomized clinical trial
Critical Care volume 16, Article number: P188 (2012)
Acute decompensation heart failure in patients in use of β-blocker has become frequent and maintenance of this drug remains controversial, mainly in low cardiac output. Nitric-oxide-dependent vasodilation of nebivolol could be useful in this situation.
We evaluated hospitalized patients with acute decompensated heart failure, NYHA IV, EF <0.45, in use of dobutamine and carvedilol. Intervention: patients were randomly assigned to carvedilol maintenance or exchange to nebivolol according to Table 1. Hemodynamic parameters were compared using a noninvasive model flow technique (Nexfin®; BMEYE), 24 hours before, 6 and 24 hours after the randomization. P < 0.05 was significant.
We selected 30 patients, 75% men, age 56.0 (SD = 13.0) years, ejection fraction 23.4 (SD = 7.2)%, ischemic myocardiopathy present in 16.7%, Chagas disease in 40% and 43.3% of patients were nonischemic/non-Chagas. Baseline indexed systemic vascular resistance was 2,255.9 (SD = 792.4) dynes.second/cm5/m2, and cardiac index was 2.7 (SD = 0.6) l/minute/m. In the nebivolol group (n = 15) the indexed systemic vascular resistance reduced 0.6% and in the carvedilol group (n = 15) it reduced 5.0% in 24 hours (mean difference 4.4%; 95% CI: -12.6 to 21.4%; P = 0.513). The cardiac index maintained unchanged (P = 0.274). Comparing patients that received a high dose of nebivolol (5 to 10 mg/day) to those with a low dose (<5 mg/day) or carvedilol, we observed a tendency to superiority of high dose in reduction of systemic vascular resistance, although not statistically significant (Figure 1).
Short-term nebivolol use in decompensated heart failure was hemodynamically safe. Further studies should be done to clarify this matter.
About this article
Cite this article
Puig, R., Ochiai, M., Cardoso, J. et al. Short-term hemodynamic effects of nebivolol in acute decompensated heart failure: a randomized clinical trial. Crit Care 16, P188 (2012). https://doi.org/10.1186/cc10795
- Cardiac Output
- Ejection Fraction
- Cardiac Index
- Model Flow