Comparative efficacy of nebivolol versus carvedilol on left ventricular function and exercise capacity in patients with nonischemic dilated cardiomyopathy. A 12-month study

Purpose To compare the efficacy of nebivolol versus carvedilol on left ventricular (LV) function and exercise capacity in patients with nonischemic dilated cardiomyopathy (NIDC). Methods After enrollment in this double-blind trial, 72 patients, aged 55 ± 9.5 years, with NIDC, LV ejection fraction (LVEF) <45%, New York Heart Association classes II to III, were randomized to either nebivolol (34 patients) or carvedilol (38 patients) and were evaluated through echocardiography and exercise tests at baseline and 3 and 12 months after treatment. Results During follow-up, 4 patients discontinued nebivolol, although 3 patients stopped carvedilol. Patients in both the nebivolol and carvedilol groups showed a steady improvement in New York Heart Association class (P = .002 and <.001, at 12 months, respectively) and LVEF (P = .001 and <.001, at 12 months, respectively) that became significant from 3-month follow-up on. Intergroup analysis showed that carvedilol group had a greater increase in LVEF at 3 (P = .04) and 12 (P = .02) monthsʹ follow-up compared with nebivolol group. Advanced diastolic dysfunction regressed to earlier stages in carvedilol patients after 3 (P = .02) and 12 (P = .01) monthsʹ treatment, whereas in the nebivolol group, a significant improvement in diastolic dysfunction was found at the 12 monthsʹ follow-up (P = .02). Exercise duration improved in both groups at 12 monthsʹ follow-up (both P = .01), but in the nebivolol group, there was an initial deterioration at 3 months (P = .07). Conclusions Both nebivolol and carvedilol appear relatively safe, with beneficial effects on LV systolic and diastolic function as well as exercise capacity in patients with NIDC after 12 monthsʹ treatment. However, carvedilol exhibits more favorable effects on LV function than does nebivolol.