Skip to main content

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

Introduction

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.

Methods

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

Results

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
figure1

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

Conclusion

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

Author information

Affiliations

Authors

Corresponding author

Correspondence to R Puig.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

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

Download citation

Keywords

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