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

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• 作者：Frank Edelmann ; MD^a ; ^b ; ^c ; ^d ; Lindy Musial-Bright ; MD^a ; Goetz Gelbrich ; PhD^e ; ^f ; Tobias Trippel ; MD^a ; ^c ; Sara Radenovic ; MSc^a ; ^c ; Rolf Wachter ; MD^b ; ^d ; Simone Inkrot ; MScN^a ; Goran Loncar ; MD^g ; Elvis Tahirovic ; MBA^a ; ^c ; Vera Celic ; MD^h ; Jovan Veskovic ; Dipl Ecc^a ; Marija Zdravkovic ; MDⁱ ; Mitja Lainscak ; MD^j ; ^k ; Svetlana Apostolović ; MD^l ; Aleksandar N. Neskovic ; MD^m ; Burkert Pieske ; MD^a ; ^c ; Hans-Dirk Dü ; ngen ; MD^a ; ^c ; ^{hans-dirk.duengen@charite.de" class="auth_mail" title="E-mail the corresponding author} ; on behalf of the CIBIS-ELD Investigators ; Project Multicenter Trials in the Competence Network Heart Failure
• 关键词：beta-blockers ; heart failure ; HFpEF ; HFrEF ; tolerability
• 刊名：JACC: Heart Failure
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：4
• 期：2
• 页码：140-149
• 全文大小：329 K

文摘

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)