Document Detail

The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart failure.
MedLine Citation:
PMID:  19481278     Owner:  NLM     Status:  In-Process    
BACKGROUND: In CIBIS III, initiating chronic heart failure (CHF) treatment with bisoprolol (target dose 10 mg q.d.) followed by combination therapy with enalapril (target dose 10 mg b.i.d.), compared to the opposite order, showed similar effects on survival and hospitalization. By echocardiography, we evaluated the effects of these treatment strategies on cardiac structure and function.
METHODS: In a single-centre substudy, we compared the impact on left ventricular (LV) dimensions and ejection fraction (EF) of treatment with bisoprolol-first (n=21) and enalapril-first (n=19) in 40 beta-blocker and angiotensin-converting-enzyme-inhibitor naive patients, with stable, mild or moderate CHF (NYHA II-III) and LVEF ≤35%. Echocardiography was performed at baseline, after the 6-month monotherapy phase and after 12 months, i.e. after 6 months combination therapy.
RESULTS: Baseline characteristics were similar across treatment groups. After 6 months LVEF increased by 5.1±4.0 EF-% (P<0.0001) with Bisoprolol and 4.0±4.0 EF-% (P=0.0005), with enalapril (between-group P=0.47). LV end-diastolic volume (LVEDV) decreased by 8.1±4.7 ml (P<0.0001) with bisoprolol and by 4.6±8.2 ml (P=0.03) with enalapril (between-group P=0.16). Mean wall thickness (WT) decreased by 0.31±0.43 mm (P=0.004) with bisoprolol and by 0.18±0.48 mm (P=0.11) with enalapril (between-group P=0.29). From baseline to 12 months, LVEF increased by 7.5±4.0 EF-% (P<0.0001) in Bisoprolol first group and 6.0±4.6 EF-% (P<0.0001), in the enalapril first group (between-group P=0.31). LVEDV decreased by 12.9±6.3 ml (P<0.0001) with bisoprolol-first and by 7.9±7.7 ml (P=0.0006) with enalapril-first (between-group P=0.16) and WT decreased by 0.38±0.44 mm (P=0.0008) and 0.59±0.54 mm (P=0.0004), respectively (between-group P=0.10).
CONCLUSION: During both monotherapy and combined therapy, bisoprolol-first and enalapril-first similarly reversed cardiac remodelling and improved LVEF.
Louis L M van de Ven; Dirk J van Veldhuisen; Michael Goulder; Zsolt Zilahi; Wilfried R Meyer; Ronnie Willenheimer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-05-28
Journal Detail:
Title:  International journal of cardiology     Volume:  144     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-10-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  59-63     Citation Subset:  IM    
Copyright Information:
Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.
Clinquest Europe, Oss, Netherlands.
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