TY - JOUR
T1 - Effects of bisoprolol fumarate on left ventricular size, function, and exercise capacity in patients with heart failure
T2 - Analysis with magnetic resonance myocardial tagging
AU - Dubach, Paul
AU - Myers, Jonathan
AU - Bonetti, Piero
AU - Schertler, Thomas
AU - Froelicher, Victor
AU - Wagner, Doris
AU - Scheidegger, Markus
AU - Stuber, Matthias
AU - Luchinger, Roger
AU - Schwitter, Juerg
AU - Hess, Otto
N1 - Funding Information:
From the aCardiology Divisions, Kantonsspital Chur and University Hospital, and bInstitut for Biomedical Techniques and Cardiology, University of Zurich, and cPalo Alto Veterans Affairs Medical Center and Stanford University. Supported in part by a grant from Schweizerische Herzstiftung, Switzerland, and Merck Switzerland. Submitted February 27, 2001; accepted October 8, 2001. Reprint requests: Jonathan Myers, PhD, Palo Alto VA Health Care System, Cardiology Division - 111C, 3801 Miranda Ave, Palo Alto, CA 94304. Copyright 2002 by Mosby, Inc. 0002-8703/2002/$35.00 + 0 4/1/121269 doi:10.1067/mhj.2002.121269
PY - 2002
Y1 - 2002
N2 - Background: Recent data suggest that beta-blockers can be beneficial in subgroups of patients with chronic heart failure (CHF). For metoprolol and carvedilol, an increase in ejection fraction has been shown and favorable effects on the myocardial remodeling process have been reported in some studies. We examined the effects of bisoprolol fumarate on exercise capacity and left ventricular volume with magnetic resonance imaging (MRI) and applied a novel high-resolution MRI tagging technique to determine myocardial rotation and relaxation velocity. Methods: Twenty-eight patients (mean age, 57 ± 11 years; mean ejection fraction, 26 ± 6%) were randomized to bisoprolol fumarate (n = 13) or to placebo therapy (n = 15). The dosage of the drugs was titrated to match that of the the Cardiac Insufficiency Bisoprolol Study protocol. Hemodynamic and gas exchange responses to exercise, MRI measurements of left ventricular end-systolic and end-diastolic volumes and ejection fraction, and left ventricular rotation and relaxation velocities were measured before the administration of the drug and 6 and 12 months later. Results: After 1 year, heart rate was reduced in the bisoprolol fumarate group both at rest (81 ± 12 before therapy versus 61 ± 11 after therapy; P < .01) and peak exercise (144 ± 20 before therapy versus 127 ± 17 after therapy; P < .01), which indicated a reduction in sympathetic drive. No differences were observed in heart rate responses in the placebo group. No differences were observed within or between groups in peak oxygen uptake, although work rate achieved was higher (117.9 ± 36 watts versus 146.1 ± 33 watts; P < .05) and exercise time tended to be higher (9.1 ± 1.7 minutes versus 11.4 ± 2.8 minutes; P = .06) in the bisoprolol fumarate group. A trend for a reduction in left ventricular end-diastolic volume (-54 mL) and left ventricular end-systolic volume (-62 mL) in the bisoprolol fumarate group occurred after 1 year. Ejection fraction was higher in the bisoprolol fumarate group (25.0 ± 7 versus 36.2 ± 9%; P < .05), and the placebo group remained unchanged. Most changes in volume and ejection fraction occurred during the latter 6 months of treatment. With myocardial tagging, insignificant reductions in left ventricular rotation velocity were observed in both groups, whereas relaxation velocity was reduced only after bisoprolol fumarate therapy (by 39%; P < .05). Conclusion: One year of bisoprolol fumarate therapy resulted in an improvement in exercise capacity, showed trends for reductions in end-diastolic and end-systolic volumes, increased ejection fraction, and significantly reduced relaxation velocity. Although these results generally confirm the beneficial effects of beta-blockade in patients with chronic heart failure, they show differential effects on systolic and diastolic function.
AB - Background: Recent data suggest that beta-blockers can be beneficial in subgroups of patients with chronic heart failure (CHF). For metoprolol and carvedilol, an increase in ejection fraction has been shown and favorable effects on the myocardial remodeling process have been reported in some studies. We examined the effects of bisoprolol fumarate on exercise capacity and left ventricular volume with magnetic resonance imaging (MRI) and applied a novel high-resolution MRI tagging technique to determine myocardial rotation and relaxation velocity. Methods: Twenty-eight patients (mean age, 57 ± 11 years; mean ejection fraction, 26 ± 6%) were randomized to bisoprolol fumarate (n = 13) or to placebo therapy (n = 15). The dosage of the drugs was titrated to match that of the the Cardiac Insufficiency Bisoprolol Study protocol. Hemodynamic and gas exchange responses to exercise, MRI measurements of left ventricular end-systolic and end-diastolic volumes and ejection fraction, and left ventricular rotation and relaxation velocities were measured before the administration of the drug and 6 and 12 months later. Results: After 1 year, heart rate was reduced in the bisoprolol fumarate group both at rest (81 ± 12 before therapy versus 61 ± 11 after therapy; P < .01) and peak exercise (144 ± 20 before therapy versus 127 ± 17 after therapy; P < .01), which indicated a reduction in sympathetic drive. No differences were observed in heart rate responses in the placebo group. No differences were observed within or between groups in peak oxygen uptake, although work rate achieved was higher (117.9 ± 36 watts versus 146.1 ± 33 watts; P < .05) and exercise time tended to be higher (9.1 ± 1.7 minutes versus 11.4 ± 2.8 minutes; P = .06) in the bisoprolol fumarate group. A trend for a reduction in left ventricular end-diastolic volume (-54 mL) and left ventricular end-systolic volume (-62 mL) in the bisoprolol fumarate group occurred after 1 year. Ejection fraction was higher in the bisoprolol fumarate group (25.0 ± 7 versus 36.2 ± 9%; P < .05), and the placebo group remained unchanged. Most changes in volume and ejection fraction occurred during the latter 6 months of treatment. With myocardial tagging, insignificant reductions in left ventricular rotation velocity were observed in both groups, whereas relaxation velocity was reduced only after bisoprolol fumarate therapy (by 39%; P < .05). Conclusion: One year of bisoprolol fumarate therapy resulted in an improvement in exercise capacity, showed trends for reductions in end-diastolic and end-systolic volumes, increased ejection fraction, and significantly reduced relaxation velocity. Although these results generally confirm the beneficial effects of beta-blockade in patients with chronic heart failure, they show differential effects on systolic and diastolic function.
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U2 - 10.1067/mhj.2002.121269
DO - 10.1067/mhj.2002.121269
M3 - Article
C2 - 11923805
AN - SCOPUS:18744425643
SN - 0002-8703
VL - 143
SP - 676
EP - 683
JO - American heart journal
JF - American heart journal
IS - 4
ER -