Tolerability and Feasibility of Beta-Blocker Titration in HFpEF Versus HFrEF Insights From the CIBIS-ELD Trial

被引：50

作者：

Edelmann, Frank ^{[1
,2
,3
,4
]}

Musial-Bright, Lindy ^{[1
]}

Gelbrich, Goetz ^{[5
,6
]}

Trippel, Tobias ^{[1
,3
]}

Radenovic, Sara ^{[1
,3
]}

Wachter, Rolf ^{[2
,4
]}

Inkrot, Simone ^{[1
]}

Loncar, Goran ^{[7
]}

Tahirovic, Elvis ^{[1
,3
]}

Celic, Vera ^{[8
,9
]}

Veskovic, Jovan ^{[1
]}

Zdravkovic, Marija ^{[10
]}

Lainscak, Mitja ^{[11
,12
,13
]}

Apostolovic, Svetlana ^{[14
]}

Neskovic, Aleksandar N. ^{[15
]}

Pieske, Burkert ^{[1
,3
]}

Duengen, Hans-Dirk ^{[1
,3
]}

机构：

[1] Charite, Dept Cardiol, Campus Virchow Klinkum, D-13353 Berlin, Germany

[2] Univ Gottingen, Med Ctr, Dept Cardiol & Pneumol, D-37073 Gottingen, Germany

[3] DZHK Partner Site Berlin, Berlin, Germany

[4] DZHK Partner Site Gottingen, Gottingen, Germany

[5] Univ Wurzburg, Inst Clin Epidemiol & Biometry, D-97070 Wurzburg, Germany

[6] Univ Hosp Wurzburg, Clin Trial Ctr, Wurzburg, Germany

[7] Clin Hosp Zvezdara, Dept Cardiol, Belgrade, Serbia

[8] Univ Clin Hosp Ctr Dr Dragisa Misovic, Dept Cardiol, Belgrade, Serbia

[9] Univ Belgrade, Fac Med, Belgrade, Serbia

[10] Univ Belgrade, Univ Hosp Med Ctr Bezanijska Kosa, Fac Med, Dept Cardiol, Belgrade, Serbia

[11] Gen Hosp Celje, Dept Cardiol, Celje, Slovenia

[12] Gen Hosp Celje, Dept Res & Educ, Celje, Slovenia

[13] Univ Ljubljana, Fac Med, Ljubljana, Slovenia

[14] Clin Ctr Nis, Clin Cardiovasc Dis, Nish, Serbia

[15] Univ Belgrade, Fac Med, Clin Hosp Ctr Zemun, Belgrade, Serbia

来源：

JACC-HEART FAILURE | 2016年 / 4卷 / 02期

关键词：

beta-blockers; heart failure; HFpEF; HFrEF; tolerability; PRESERVED EJECTION FRACTION; CHRONIC HEART-FAILURE; BISOPROLOL VS. CARVEDILOL; ELDERLY-PATIENTS; CLINICAL CHARACTERISTICS; EXERCISE CAPACITY; EUROPEAN-SOCIETY; RANDOMIZED-TRIAL; GUIDELINES; NEBIVOLOL;

D O I：

10.1016/j.jchf.2015.10.008

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23% vs. HFrEF: 34%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure [HF] Patients: A Randomised, Double-Blind Multicentre Study [CIBIS-ELD]; ISRCTN34827306) (C) 2016 by the American College of Cardiology Foundation.

引用

页码：140 / 149

页数：10

共 31 条

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Pfeffer, MA ;

Swedberg, K ;

Granger, CB ;

Held, P ;

McMurray, JJV ;

Michelson, EL ;

Olofsson, B ;

Östergren, J .

LANCET, 2003, 362 (9386) :777-781

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