74
VOLUME 11 NUMBER 2 • JUNE 2014
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
ventricular relaxation, filling, diastolic distensibility or diastolic
stiffness.
2,8
Signs and symptoms of congestive heart failure include
paroxysmal nocturnal dyspnoea, orthopnoea, gallop sounds, lung
crepitations, pulmonary oedema, and peripheral oedema.
3
A diagnosis of diastolic heart failure requires the presence of
normal or mildly abnormal left ventricular systolic function. To meet
this criterion, ventricular ejection fraction must be at least 45%.
Left ventricular relaxation and filling affect left ventricular diastolic
distensibility. So diagnostic of diastolic heart failure can be obtained
from analysis of indices of diastolic function such as relaxation,
chamber and myocardial stiffness, and diastolic filling characteristics.
This analysis can be performed using invasive or non-invasive
techniques. Therefore echo-Doppler studies can provide information
about relaxation (isovolumic relaxation time), abnormalities of filling
and changes in left ventricular diastolic pressure.
5
How to treat diastolic heart failure
Treatment of diastolic heart failure is not well documented.
Nevertheless there are studies that attempt to show the role of
nebivolol in the treatment of diastolic heart failure.
1,3
Via the action of nitric oxide release, nebivolol is one of the most
powerful lusitropic agents with additional vasodilating properties.
Therefore nebivolol has important therapeutic implications against
cardiovascular risk factors and especially on atherosclerosis.
11
Prospective randomised trials comparing the effects of nebivolol
and atenolol in hypertensive patients with diastolic dysfunction
showed that nebivolol improves haemodynamic status both at rest
and stress. Nebivolol improves the diastolic function and lowers
blood pressure and heart rate at rest and at peak stress; it also
decreases ventricular mass. The beneficial effect of nebivolol versus
atenolol may be explained by the secondary vasodilatory action of
nitric oxide release.
12,13
It is known that drugs that increase the release of nitric oxide
significantly reduce the arterial reflected wave. Other studies
have shown that in hypertension nebivolol decreases not only
aortic stiffness but also reflected wave and the central aortic
pulse pressure. Several studies have shown that early longitudinal
diastolic function significantly increased only in patients treated
with nebivolol.
13,14
Nebivolol also significantly increased the longitudinal
displacement and the ejection time, thus providing an improved
haemodynamic profile. The latest beta-blockers such as nebivolol
improve filling pressure independently of the presence of left
ventricular hypertrophy. Effects of nebivolol on diastolic function
are influenced by the duration of treatment and the potential
release of nitric oxide. To achieve the desired effects duration of
treatment must be at least three months.
11,12
Regarding the metabolic effect, nebivolol has recently been
shown not to worsen glucose tolerance compared with placebo.
The haemodynamic profile of nebivolol, characterised by preserving
cardiac output, ejection time prolongation, reduction of peripheral
resistance and improved diastolic function, has relevant benefits on
the impairment in diastolic function.
15
We followed 48 patients diagnosed with hypertension and
diabetes who had left ventricular hypertrophy without coronary
heart disease. They were treated for six months with nebivolol and
this treatment resulted in improved diastolic function.
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