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The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart failure

Van de Ven, Louis L. M.; van Veldhuisen, Dirk J.; Goulder, Michael; Zilahi, Zsolt; Meyer, Wilfried R. and Willenheimer, Ronnie LU (2010) In International Journal of Cardiology 144(1). p.59-63
Abstract
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%.... (More)
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. (C) 2009 Elsevier Ireland Ltd. All rights reserved. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heart failure, Angiotensin-converting enzyme inhibitors, Drugs, Cardiac remodelling, Adrenergic beta-antagonists
in
International Journal of Cardiology
volume
144
issue
1
pages
59 - 63
publisher
Elsevier
external identifiers
  • wos:000282679000017
  • scopus:77957863834
ISSN
0167-5273
DOI
10.1016/j.ijcard.2009.04.040
language
English
LU publication?
yes
id
ca1032e5-6d3f-4f27-b9e0-aec2f9268b85 (old id 1727095)
date added to LUP
2010-12-01 13:21:55
date last changed
2018-06-24 03:38:23
@article{ca1032e5-6d3f-4f27-b9e0-aec2f9268b85,
  abstract     = {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 &lt;= 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&lt;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&lt;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&lt;0.0001) in Bisoprolol first group and 6.0 +/- 4.6 EF-% (P&lt;0.0001), in the enalapril first group (between-group P = 0.31). LVEDV decreased by 12.9 +/- 6.3 ml (P&lt;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. (C) 2009 Elsevier Ireland Ltd. All rights reserved.},
  author       = {Van de Ven, Louis L. M. and van Veldhuisen, Dirk J. and Goulder, Michael and Zilahi, Zsolt and Meyer, Wilfried R. and Willenheimer, Ronnie},
  issn         = {0167-5273},
  keyword      = {Heart failure,Angiotensin-converting enzyme inhibitors,Drugs,Cardiac remodelling,Adrenergic beta-antagonists},
  language     = {eng},
  number       = {1},
  pages        = {59--63},
  publisher    = {Elsevier},
  series       = {International Journal of Cardiology},
  title        = {The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart failure},
  url          = {http://dx.doi.org/10.1016/j.ijcard.2009.04.040},
  volume       = {144},
  year         = {2010},
}