Effect of Nebivolol on MIBG Parameters and Exercise in Heart Failure with Normal Ejection Fraction

Overview

Journal Arq Bras Cardiol

Specialty Cardiology & Vascular Diseases

Date 2016 Apr 21

PMID 27096522

Citations 2

Authors

Leandro Rocha Messias

Aryanne Guimaraes Ferreira

Sandra Marina Ribeiro de Miranda

Jose Antonio Caldas Teixeira

Jader Cunha de Azevedo

Ana Carolina Nader Vasconcelos Messias

Elisabeth Marostica

Claudio Tinoco Mesquita

Affiliations

Soon will be listed here.

Abstract

Background: More than 50% of the patients with heart failure have normal ejection fraction (HFNEF). Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy and cardiopulmonary exercise test (CPET) are prognostic markers in HFNEF. Nebivolol is a beta-blocker with vasodilating properties.

Objectives: To evaluate the impact of nebivolol therapy on CPET and123I-MIBG scintigraphic parameters in patients with HFNEF.

Methods: Twenty-five patients underwent 123I-MIBG scintigraphy to determine the washout rate and early and late heart-to-mediastinum ratios. During the CPET, we analyzed the systolic blood pressure (SBP) response, heart rate (HR) during effort and recovery (HRR), and oxygen uptake (VO2). After the initial evaluation, we divided our cohort into control and intervention groups. We then started nebivolol and repeated the tests after 3 months.

Results: After treatment, the intervention group showed improvement in rest SBP (149 mmHg [143.5-171 mmHg] versus 135 mmHg [125-151 mmHg, p = 0.016]), rest HR (78 bpm [65.5-84 bpm] versus 64.5 bpm [57.5-75.5 bpm, p = 0.028]), peak SBP (235 mmHg [216.5-249 mmHg] versus 198 mmHg [191-220.5 mmHg], p = 0.001), peak HR (124.5 bpm [115-142 bpm] versus 115 bpm [103.7-124 bpm], p= 0.043), HRR on the 1st minute (6.5 bpm [4.75-12.75 bpm] versus 14.5 bpm [6.7-22 bpm], p = 0.025) and HRR on the 2nd minute (15.5 bpm [13-21.75 bpm] versus 23.5 bpm [16-31.7 bpm], p = 0.005), but no change in peak VO2 and 123I-MIBG scintigraphic parameters.

Conclusion: Despite a better control in SBP, HR during rest and exercise, and improvement in HRR, nebivolol failed to show a positive effect on peak VO2 and 123I-MIBG scintigraphic parameters. The lack of effect on adrenergic activity may be the cause of the lack of effect on functional capacity.

Citing Articles

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction.

Martin N, Manoharan K, Davies C, Lumbers R Cochrane Database Syst Rev. 2021; 5:CD012721.

PMID: 34022072 PMC: 8140651. DOI: 10.1002/14651858.CD012721.pub3.

Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction.

Martin N, Manoharan K, Thomas J, Davies C, Lumbers R Cochrane Database Syst Rev. 2018; 6:CD012721.

PMID: 29952095 PMC: 6513293. DOI: 10.1002/14651858.CD012721.pub2.

References

Treglia G, Stefanelli A, Bruno I, Giordano A . Clinical usefulness of myocardial innervation imaging using Iodine-123-meta-iodobenzylguanidine scintigraphy in evaluating the effectiveness of pharmacological treatments in patients with heart failure: an overview. Eur Rev Med Pharmacol Sci. 2013; 17(1):56-68. View

Wessler B, Udelson J . Neuronal dysfunction and medical therapy in heart failure: can an imaging biomarker help to "personalize" therapy?. J Nucl Med. 2015; 56 Suppl 4:20S-24S. DOI: 10.2967/jnumed.114.142778. View

Del Sindaco D, Tinti M, Monzo L, Pulignano G . Clinical and economic aspects of the use of nebivolol in the treatment of elderly patients with heart failure. Clin Interv Aging. 2010; 5:381-93. PMC: 2998246. DOI: 10.2147/CIA.S4482. View

McMurray J, Adamopoulos S, Anker S, Auricchio A, Bohm M, Dickstein K . ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the.... Eur J Heart Fail. 2012; 14(8):803-69. DOI: 10.1093/eurjhf/hfs105. View

Kindermann M, Reil J, Pieske B, Van Veldhuisen D, Bohm M . Heart failure with normal left ventricular ejection fraction: what is the evidence?. Trends Cardiovasc Med. 2009; 18(8):280-92. DOI: 10.1016/j.tcm.2008.12.003. View

Messias L, Carreira M, Miranda S, Azevedo J, Gava I, Rodrigues R . Relationship between cardiac adrenergic image and exercise testing in heart failure. Arq Bras Cardiol. 2011; 96(5):370-5. DOI: 10.1590/s0066-782x2011005000044. View

Floras J . Sympathetic nervous system activation in human heart failure: clinical implications of an updated model. J Am Coll Cardiol. 2009; 54(5):375-85. DOI: 10.1016/j.jacc.2009.03.061. View

COLE C, Blackstone E, Pashkow F, Snader C, Lauer M . Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med. 1999; 341(18):1351-7. DOI: 10.1056/NEJM199910283411804. View

Guazzi M, Myers J, Arena R . Cardiopulmonary exercise testing in the clinical and prognostic assessment of diastolic heart failure. J Am Coll Cardiol. 2005; 46(10):1883-90. DOI: 10.1016/j.jacc.2005.07.051. View

10.

Munzel T, Gori T . Nebivolol: the somewhat-different beta-adrenergic receptor blocker. J Am Coll Cardiol. 2009; 54(16):1491-9. DOI: 10.1016/j.jacc.2009.05.066. View

11.

Miranda S, Mesquita E, Dohmann H, Azevedo J, Barbirato G, Freire F . Effects of short-term carvedilol on the cardiac sympathetic activity assessed by 123I-MIBG scintigraphy. Arq Bras Cardiol. 2010; 94(3):308-12, 328-32. DOI: 10.1590/s0066-782x2010000300008. View

12.

Maeder M, Thompson B, Htun N, Kaye D . Hemodynamic determinants of the abnormal cardiopulmonary exercise response in heart failure with preserved left ventricular ejection fraction. J Card Fail. 2012; 18(9):702-10. DOI: 10.1016/j.cardfail.2012.06.530. View

13.

Phan T, Shivu G, Abozguia K, Davies C, Nassimizadeh M, Jimenez D . Impaired heart rate recovery and chronotropic incompetence in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2009; 3(1):29-34. DOI: 10.1161/CIRCHEARTFAILURE.109.877720. View

14.

Arena R, Myers J, Abella J, Peberdy M, Bensimhon D, Chase P . Development of a ventilatory classification system in patients with heart failure. Circulation. 2007; 115(18):2410-7. DOI: 10.1161/CIRCULATIONAHA.107.686576. View

15.

Shazia S, Badaam K, Deore D . Assessment of aerobic capacity in overweight young females: A cross-sectional study. Int J Appl Basic Med Res. 2015; 5(1):18-20. PMC: 4318094. DOI: 10.4103/2229-516X.149224. View

16.

Cohen-Solal A, Esanu Y, Logeart D, Pessione F, Dubois C, Dreyfus G . Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis. J Am Coll Cardiol. 1999; 33(3):759-66. DOI: 10.1016/s0735-1097(98)00608-1. View

17.

SCANLON P, Faxon D, Audet A, Carabello B, Dehmer G, Eagle K . ACC/AHA guidelines for coronary angiography. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (Committee on Coronary Angiography). Developed in collaboration with the Society for Cardiac.... J Am Coll Cardiol. 1999; 33(6):1756-824. DOI: 10.1016/s0735-1097(99)00126-6. View

18.

Guazzi M, Myers J, Peberdy M, Bensimhon D, Chase P, Arena R . Cardiopulmonary exercise testing variables reflect the degree of diastolic dysfunction in patients with heart failure-normal ejection fraction. J Cardiopulm Rehabil Prev. 2010; 30(3):165-72. DOI: 10.1097/HCR.0b013e3181d0c1ad. View

19.

Nishiyama Y, Morita H, Harada H, Katoh A, Adachi H, Koga Y . Systolic blood pressure response to exercise as a predictor of mortality in patients with chronic heart failure. Int Heart J. 2010; 51(2):111-5. DOI: 10.1536/ihj.51.111. View

20.

Giubbini R, Milan E, Bertagna F, Mut F, Metra M, Rodella C . Nuclear cardiology and heart failure. Eur J Nucl Med Mol Imaging. 2009; 36(12):2068-80. DOI: 10.1007/s00259-009-1246-2. View