© 2007 European Society of Cardiology
Lung function with carvedilol and bisoprolol in chronic heart failure: Is β selectivity relevant?
a Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano Milan, Italy
b Division of Respiratory and Critical Care Medicine, Department of Medicine, University of Washington Seattle, WA 98185, USA
c Dipartimento di Scienze Cardiovascolari, Respiratorie e Morfologiche, Università La Sapienza Roma, Italy
* Corresponding author. Centro Cardiologico Monzino, IRCCS, Istituto di Cardiologia, Università di Milano, via Parea 4, 20138 Milan, Italy. Tel.: +39 02 58002299; fax: +39 02 58011039. E-mail address: piergiuseppe.agostoni{at}ccfm.it
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Abstract |
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Background: Carvedilol is a β-blocker with similar affinity for β1- and β2 receptors, while bisoprolol has higher β1 affinity. The respiratory system is characterized by β2-receptor prevalence. Airway β receptors regulate bronchial tone and alveolar β receptors regulate alveolar fluid re-absorption which influences gas diffusion.
Aims: To compare the effects of carvedilol and bisoprolol on lung function in patients with chronic heart failure (CHF).
Methods and results: We performed a double-blind, cross-over study in 53 CHF patients. After 2 months of full dose treatment with either carvedilol or bisoprolol, we assessed lung function by salbutamol challenge, carbon monoxide lung diffusion (DLCO), including membrane conductance (DM), and gas exchange during exercise. FEV1 and FVC were similar; after salbutamol FEV1 was higher with bisoprolol (p<0.04). DLCO was 82±21% of predicted with carvedilol and 90±20% with bisoprolol (p<0.01) due to DM changes. Peak VO2 was 17.8±4.5 mL/min/kg on bisoprolol and 17.0±4.6 on carvedilol, (p<0.05) with no differences in bronchial tone (same expiratory time) throughout exercise. Differences were greater in the 22 subjects with DLCO<80%.
Conclusion: Carvedilol and bisoprolol have different effects on DLCO and response to salbutamol. DLCO differences, being DM related, are due to changes in active membrane transport which is under alveolar β2-receptor control. Peak VO2 was slightly higher with bisoprolol particularly in CHF patients with reduced DLCO.
Key Words: Exercise • Heart failure • Bisoprolol • Carvedilol • Lung diffusion
Received December 14, 2006; Accepted April 26, 2007
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