title: Improvement of Ventricular-Arterial Coupling in Elderly Patients with Heart Failure After Beta Blocker Therapy: Results from the CIBIS-ELD Trial.
abstract: The interaction between the heart and the arterial system (ventricular-arterial coupling - VA) is an important determinant of cardiovascular performance. Vascular stiffness (Ea) and left ventricular (LV) endsystolic stiffness (Elv) augment with age and in heart failure (HF). Beta blockers (BB) are recommended therapy for patients with HF. However, data about the effects of BB on VA coupling are scarce.
  
  
  OBJECTIVE
  TO ASSESS: 1) changes in VA after BB therapy; 2) interactions between VA and LV functions, 3) predictive factors influencing VA change.
  
  
  METHODS
  Eight hundred seventy-seven elderly patients with HF (aged ≥ 65, NYHA ≥ II, LV ejection fraction (LVEF) ≤ 45%), treated with BB according to the CIBIS-ELD protocol of up-titration, underwent Doppler echocardiography with clinical and laboratory assessment before and after 12 weeks of BB. VA coupling was calculated as Ea/Elv ratio.
  
  
  RESULTS
  Ventriculo-arterial interaction improved after 12 weeks of BB in elderly patients with HF. Values of Ea significantly decreased from 2.73 ± 1.16 to 2.40 ± 1.01, p < 0.001, resulting in a VA level close to the optimal range i.e. from 1.70 ± 1.05 (1.46) to 1.50 ± 0.94 (1.29), p < 0.001. A similar degree of VA change was found in the patients with ischemic and non-ischemic HF after the treatment. Improvement in the clinical stage of HF closely correlated with VA coupling change after BB (p = 0.006). The strongest predictor of VA coupling alteration during BB was the improvement in global LVEF (p < 0.001) followed by the age of patients (p = 0.014).
  
  
  CONCLUSIONS
  The beneficial effect of BB in elderly patients with HF was achieved by optimizing VA coupling close to recommended range, associated with an improvement in LVEF and contractility.
authors.affiliation: University Clinical Centar "Zvezdara", Belgrade, Serbia, dekleva.milica@gmail.com.
authors.forename: Milica
authors.initials: M
authors.lastname: Dekleva
authors.forename: Jelena Suzic
authors.initials: JS
authors.lastname: Lazic
authors.forename: Ivan
authors.initials: I
authors.lastname: Soldatovic
authors.forename: Simone
authors.initials: S
authors.lastname: Inkrot
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Arandjelovic
authors.forename: Finn
authors.initials: F
authors.lastname: Waagstein
authors.forename: Goetz
authors.initials: G
authors.lastname: Gelbrich
authors.forename: Dane
authors.initials: D
authors.lastname: Cvijanovic
authors.forename: Hans Dirk
authors.initials: HD
authors.lastname: Dungen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology* / Q000627:therapeutic use*; D000368:Aged; D001158:Arteries / Q000187:drug effects*; D017298:Bisoprolol / Q000494:pharmacology* / Q000627:therapeutic use*; D004311:Double-Blind Method; D015150:Echocardiography, Doppler / Q000187:drug effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D008297:Male; D013318:Stroke Volume / Q000187:drug effects*; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists; D017298:Bisoprolol