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Heart failure (HF) has a poor prognosis despite advances in its management. Clinical and experimental studies have provided substantial evidence that oxidative stress is enhanced in HF. The third-generation beta-blockers, carvediolol and nebivolol have other beneficial features such as vasodilator and antioxidant effects in addition to beta1 receptor blocking effect. Thus, they may be considered as first line therapy in HF patients. However, it is unclear that carvedilol may be superior to nebivolol in HF patients. Thus, we investigated the effects of carvedilol and nebivolol on oxidative stress parameters in non-ischemic HF patients.
We included 56 asymptomatic non-ischemic HF patients with ejection fraction (EF) ≤40%. The patients were randomized to carvedilol (n=29, 18 male) or nebivolol (n=27, 18 male) groups. We evaluated clinical and laboratory characteristics which are associated with oxidative stress such as total oxidative status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI), uric acit, gamma glutamyl transferase (GGT), alkaline phosphatase (ALP). Echocardiography was performed. The left atrial size, left ventricular (LV) diameter and volumes, wall thickness were measured. LV EF was calculated by Simpson's method. Isovolumetric relaxation time (IVRT), isovolumetric contraction time (IVKT), ejection time (ET) were measured. Also, myocardial performance index (MPI) were calculated.
Basaline clinic and demographic characteristics were similarly in carvediolol and nebivolol groups. LV EF (29.6±4.8 vs 31±5, p=0.20), MPI (0.70±0.13 vs 0.67±0.11, p=0.23), diameters and volumes was similar between two groups. TAC [1.25 (0.39-2.71) vs 1.23 (0.65-1.88) mmol Trolox Eq/l, p=0.92], TOS [2.64 (0.62-9.20) vs 2.45 (1.06-4.40) μmol H2O2 Eq/l, p=0.88], OSI [253 (45-1020) vs 213 (76-538) AU, p=0.44], üric acit (9.3±0.6 vs 9.3±0.6 mg/dl, p=0.32), ALP (77±37 vs 68±20 U/L, p=0.60), GGT [31 (11-106) vs 33 (8-88) U/L, p=0.58] were also comparable in both groups.
Our findings show that carvedilol and nebivolol appear similar to their effects on oxidative stress parameters in non-ischemic HF patients.
Key words: Heart Failure, Carvedilol, Nebivolol, Oxidative stres.