- 作者：Mauro Contini ; Anna Apostolo ; Gaia Cattadori ; Stefania Paolillo ; Annamaria Iorio ; Erika Bertella ; Elisabetta Salvioni ; Marina Alimento ; Stefania Farina ; Pietro Palermo ; Monica Loguercio ; Valentina Mantegazza ; Marlus Karsten ; Susanna Sciomer ; Damiano Magr¨¬ ; Cesare Fiorentini ; Piergiuseppe Agostoni
- 关键词：¦Â-Blockers ; Ventilation efficiency ; Hypoxia ; Chemoreflex
- 刊名：International Journal of Cardiology
- 出版年：2013
- 出版时间：3 October, 2013
- 年：2013
- 卷：168
- 期：3
- 页码：2134-2140
- 全文大小：394 K
Background
Several ¦Â-blockers, with different pharmacological characteristics, are available for heart failure (HF) treatment. We compared Carvedilol (¦Â1-¦Â2-¦Á-blocker), Bisoprolol (¦Â1-blocker), and Nebivolol (¦Â1-blocker, NO-releasing activity).Methods
Sixty-one moderate HF patients completed a cross-over randomized trial, receiving, for 2 months each, Carvedilol, Nebivolol, Bisoprolol (25.6 ¡À 12.6, 5.0 ¡À 2.4 and 5.0 ¡À 2.4 mg daily, respectively). At the end of each period, patients underwent: clinical evaluation, laboratory testing, echocardiography, spirometry (including total DLCO and membrane diffusion), O2/CO2 chemoreceptor sensitivity, constant workload, in normoxia and hypoxia (FiO2 = 16 % ), and maximal cardiopulmonary exercise test.
Results
No significant differences were observed for clinical evaluation (NYHA classification, Minnesota questionnaire), laboratory findings (including kidney function and BNP), echocardiography, and lung mechanics. DLCO was lower on Carvedilol (18.3 ¡À 4.8* mL/min/mm Hg) compared to Nebivolol (19.9 ¡À 5.1) and Bisoprolol (20.0 ¡À 5.0) due to membrane diffusion 20 % reduction (* = p < 0.0001). Constant workload exercise showed in hypoxia a faster VO2 kinetic and a lower ventilation with Carvedilol. Peripheral and central sensitivity to CO2 was lower in Carvedilol while response to hypoxia was higher in Bisoprolol. Ventilation efficiency (VE/VCO2 slope) was 26.9 ¡À 4.1* (Carvedilol), 28.8 ¡À 4.0 (Nebivolol), and 29.0 ¡À 4.4 (Bisoprolol). Peak VO2 was 15.8 ¡À 3.6* mL/kg/min (Carvedilol), 16.9 ¡À 4.1 (Nebivolol), and 16.9 ¡À 3.6 (Bisoprolol).
Conclusions
¦Â-Blockers differently affect several cardiopulmonary functions. Lung diffusion and exercise performance, the former likely due to lower interference with ¦Â2-mediated alveolar fluid clearance, were higher in Nebivolol and Bisoprolol. On the other hand, Carvedilol allowed a better ventilation efficiency during exercise, likely via a different chemoreceptor modulation. Results from this study represent the basis for identifying the best match between a specific ¦Â-blocker and a specific HF patient.