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Short-term hemodynamic effects of nebivolol in acute decompensated heart failure: a randomized clinical trial

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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.

Table 1 Table 1


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).

Figure 1

Systemic vascular resistance change: nebivolol high×nebivolol low or carvedilol.


Short-term nebivolol use in decompensated heart failure was hemodynamically safe. Further studies should be done to clarify this matter.

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Correspondence to R Puig.

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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).

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  • Cardiac Output
  • Ejection Fraction
  • Cardiac Index
  • Model Flow
  • Dobutamine