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

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.

Keywords

coronary slow flow nebivolol tissue Doppler

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