Nebivolol, a selective beta-1-blocker with vasodilator properties,
reduces end-systolic and end-diastolic volume of the left ventricle
and improves ejection fraction in elderly patients with heart
failure and advanced systolic left ventricular dysfunction, European
investigators report.

Most previous trials examining the effect of beta blockade on heart
failure have included younger patients with preserved left
ventricular function, Dr. Stefano Ghio and associates report in the
March issue of the European Heart Journal.

The SENIORS (Study of the Effects of Nebivolol Intervention on
Outcomes and Hospitalization in Seniors with Heart Failure) trial
included 104 subjects age 70 or older. Forty-three had an ejection
fraction of 35% or less. Patients were randomized to nebivolol or
placebo for 12 months, after which echocardiograms were compared
with those obtained at baseline.

Among patients with a low ejection fraction, left ventricular end-
systolic volume was reduced from 160 to 141 mL in the nebivolol
group, while it increased from 159 to 166 mL in the placebo group (p
= 0.016). The drug was also associated with reduction in end-
diastolic volume, though the difference was not statistically
significant.

Nebivolol improved ejection fraction from 27.0% to 31.6%, while
placebo had no effect (p = 008).

"The reverse remodeling effect of nebivolol in chronic heart failure
patients with systolic left ventricular dysfunction could be the key
explanation for the improvement in the composite end point of all-
cause death or cardiovascular hospital admission found in the
SENIORS trial," Dr. Ghio, of the IRCCS Policlinico San Matteo,
Pavia, Italy, and associates suggest.

Among the 61 patients with mildly impaired or preserved systolic
function, echocardiograms showed no significant effect of nebivolol
on diastolic parameters. However, nebivolol is known to reduce all-
cause mortality and cardiovascular hospital admission in this group.

The authors theorize that "the prevention of episodes of excessive
tachycardia and of severe blood pressure rise, as well as a
modulation of the vascular tone and of the elasticity of the
vascular system exerted by nebivolol, may also play a significant
role in improving the outcome in such patients."

Eur Heart J 2006;27:562-568