Park Kyungil, Park Tae-Ho
Regional Cardiocerebrovascular Center, Dong-A University Hospital; Division of Cardiology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea.
Int J Cardiol Cardiovasc Risk Prev. 2023 Jul 28;18:200201. doi: 10.1016/j.ijcrp.2023.200201. eCollection 2023 Sep.
Although many studies have compared carvedilol and nebivolol in heart failure (HF) patients with reduced left ventricular ejection fraction (LVEF), such comparative studies for the elderly have not been reported yet. Nebivolol is known to be effective for improving diastolic function of elderly patients with HF. Thus, this study aimed to determine whether nebivolol could improve LV diastolic function to a greater extent than carvedilol in older patients aged over 70 years.
This trial was a prospective, randomized, open-label, single-center, active-controlled study that enrolled 62 patients with class II or III HF over 70 years of age with an LVEF ≥40%. Patients were randomized into a carvedilol group or a nebivolol group. Transthoracic echocardiography was performed at baseline and 12 months by the same investigator who was blinded to clinical data. The primary endpoint was E/e' measured by echocardiographic evaluation 12 months after treatment.
The median duration of follow-up was 24 months. Baseline clinical characteristics and echocardiographic parameters, such as LV diastolic function indices, did not differ significantly between carvedilol and nebivolol groups. Twelve-month follow-up echocardiography data showed no significant difference in E/e' or other LV diastolic function indices between the two groups. There were no significant changes in echocardiographic parameters over 12 months in either group.
There was no difference between carvedilol and nebivolol for improving diastolic function of elderly HF patients with LVEF ≥40%. This study showed no superiority of nebivolol over carvedilol in elderly patients with HF.
尽管许多研究已对卡维地洛和奈必洛尔在左心室射血分数（LVEF）降低的心力衰竭（HF）患者中的疗效进行了比较，但尚未有针对老年人的此类比较研究报道。已知奈必洛尔对改善老年HF患者的舒张功能有效。因此，本研究旨在确定在70岁以上的老年患者中，奈必洛尔改善左心室舒张功能的程度是否大于卡维地洛。
本试验是一项前瞻性、随机、开放标签、单中心、活性药物对照研究，纳入了62例年龄超过70岁、LVEF≥40%的II或III级HF患者。患者被随机分为卡维地洛组或奈必洛尔组。在基线和12个月时，由对临床数据不知情的同一名研究人员进行经胸超声心动图检查。主要终点是治疗12个月后通过超声心动图评估测得的E/e'。
中位随访时间为24个月。卡维地洛组和奈必洛尔组之间的基线临床特征和超声心动图参数，如左心室舒张功能指标，无显著差异。12个月随访的超声心动图数据显示，两组之间的E/e'或其他左心室舒张功能指标无显著差异。两组在12个月内超声心动图参数均无显著变化。
对于LVEF≥40%的老年HF患者，卡维地洛和奈必洛尔在改善舒张功能方面无差异。本研究表明，在老年HF患者中，奈必洛尔并不优于卡维地洛。
