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Regional functions of the left ventricle in patients with coronary slow flow and the effects of nebivolol

Yuzuncu Yil University, Faculty of Medicine, Cardiology Department, Van, Turkey

^* To whom correspondence should be addressed. E-mail: yilmazleman{at}yahoo.com.

	Abstract

Background: Microvascular and endothelial dysfunction have been implicated for coronary slow flow (CSF). Nebivolol, besides its beta-receptor blocking activity, causes an endothelium-dependent vasodilatation through increased nitric oxide release. Methods: This study included 27 patients with CSF and 27 subjects with normal coronary arteries. Segmental functions of the left ventricle (LV) were assessed using myocardial tissue Doppler velocities before and 3 months after treatment with nebivolol 5 mg/day. Results: Compared with the control group, mitral deceleration time (DT) was significantly longer, and E/A ratio, systolic velocity of lateral mitral annulus (S_m) and regional myocardial peak systolic and early diastolic velocities (V_s, V_d) were significantly lower in patients with CSF. The reason for coronary angiography was typical angina in 21 (77.8%) and positive treadmill test in six (22.2%) CSF patients. There were significant correlations between presence of CSF in left anterior descending artery (LAD) with S_m (r = -0.404, p = 0.002) and V_s in anterior (r = -0.531, p < 0.001) and lateral (r = -0.495, p < 0.001) segments and between presence of CSF in RCA and V_s in posterior segments (r = -0.501, p < 0.001). Treatment with nebivolol significantly decreased blood pressures (128.5 ± 12.5/82.5 ± 8.8 to 119.8 ± 12.6/76.4 ± 7.4 mmHg, p < 0.001), DT (252.3 ± 53.6 to 222.0 ± 41.0 ms, p < 0.001) and IVRT (115.7 ± 19.9 to 103.3 ± 17.0 ms, p < 0.001), and increased exercise capacity (8.7 ± 1.3 to 10.4 ± 0.9 METs, p < 0.001), E/A ratio (0.87 ± 0.26 to 1.08 ± 0.23, p < 0.001) and myocardial velocities (p < 0.001). All the patients were free of angina after treatment. Patients with CSF had impaired diastolic and regional LV functions. Conclusions: Nebivolol may therefore be useful in improving angina, exercise capacity and LV functions in patients with CSF.

First published on September 4, 2009
Therapeutic Advances in Cardiovascular Disease 2009, doi:10.1177/1753944709345926


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