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


CONCLUSIONS
During both monotherapy and combined therapy, bisoprolol-first and enalapril-first similarly reversed cardiac remodelling and improved LVEF.
van de Ven
Louis L M
LL
Clinquest Europe, Oss, Netherlands.
van Veldhuisen
Dirk J
DJ
Goulder
Michael
M
Zilahi
Zsolt
Z
Meyer
Wilfried R
WR
Willenheimer
Ronnie
R
D058671:Adrenergic beta-1 Receptor Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D017298:Bisoprolol / Q000008:administration & dosage / Q000627:therapeutic use*; D001794:Blood Pressure; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D004656:Enalapril / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology; D020257:Ventricular Remodeling / Q000187:drug effects*
D058671:Adrenergic beta-1 Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D017298:Bisoprolol