Clinical, hemodynamic and neurohumoral effects of switching patients with chronic heart failure from not recommended -adrenoblockers to bisoprolol in ambulatory practice
Ageev, F.T.; Zhubrina, E.S.; Ovchinnikov, A.G.; Seredenina, E.M.
Kardiologiia 50(6): 41-47
2010
ISSN/ISBN: 0022-9040 PMID: 20659026 Document Number: 645665
At present only bisoprolol, metoprolol succinate, nebivolol, and carvedilol are considered to be beta adrenoblockers with proven efficacy relative to course and prognosis of chronic heart failure (CHF). However in real clinical practice most patients continue to receive preparations which are not recommended for application. Therefore we have conducted this study in order to assess efficacy of switching ambulatory patients from therapy with "not recommended" beta adrenoblockers to bisoprolol which is recommended for the treatment of CHF. We recruited 35 patients with stable class II-III CHF on standard therapy which included beta adrenoblockers not recommended for the treatment of CHF. In all patients at baseline and after 6 months of therapy we assessed clinical status, quality of life with the Minnesota questionnaire and visual analog scale, performed 6 min walk test and echocardiography for evaluation of left ventricular (LV) ejection fraction (EF) and measured level of N terminal fragment of pro brain natriuretic peptide in blood serum. Switching patients from "not recommended" beta adrenoblockers to bisoprolol was associated with significant improvement of clinical status with increase of 6 min walk distance, betterment of parameters of quality of life, and significant rise of LV EF combined with lowering of mean CHF functional class (all <0.01 compared with baseline). There was no significant dynamics of NT proBNP level in the whole group but in the subgroup with NT proBNP values above median significant lowering we noted its significant lowering (<0,05). No significant association between dynamics of main clinico-laboratory parameters and decrease of heart rate was observed. Switch of patients with moderate CHF to bisoprolol from therapy with beta adrenoblockers not recommended for application in this disease was associated with improvement of quality of life, clinical status, and LV systolic function. This was combined with lowering of initially elevated NT proBNP level irrespective of changes of heart rate.