(Circulation. 1997;96:2197-2205.)
© 1997 American Heart Association, Inc.
Articles |
Prognostic Value of Bisoprolol-Induced Hemodynamic Effects in Heart Failure During the Cardiac Insufficiency BIsoprolol Study (CIBIS)
From the Service de pharmacologie and Institut Fédératif de Recherche en Physiopathologie et Génétique Cardiovasculaire, Hôpital Pitié Salpétrière (P.L.), Paris, France; Unité INSERM U 436, Service d'informatique médicale, CHU Pitié Salpétrière (S.E., J.L.G., A.M.), Paris, France; Service de cardiologie, Hôpital de Corbeil (H.L.), Corbeil Essonne, France; Service de cardiologie, Hôpital Kremlin Bicètre (S.W.), Le Kremlin Bicètre, France; Medisch Centrum Alkmaar (J.A.H.), Almaar, Holland; Department Internal Medicine Cardiology, Philips University (B.M.), Marburg, Germany; Zentrum für Innere Medizin (M.H.), Universitätsklinikum, Obere Eselberg, Ulm, Germany; Unité de pharmacologie clinique, Hôpital Saint Antoine (P.J.), Paris, France; and Unité de pharmacologie clinique, Hôpitaux de Lyon (J.-P.B.), Lyon, France.
Correspondence to Philippe Lechat, Service de pharmacologie, Hôpital Pitié Salpétrière, 47 Boulevard de l'Hôpital, 75013 Paris, France. E-mail philippe.lechat{at}psl.ap-hop-paris.fr
Background To further evaluate the mechanism of ß-blocker–induced benefits in heart failure, the relationships between bisoprolol-induced hemodynamic effects and survival were studied during the Cardiac Insufficiency BIsoprolol Study (CIBIS).
Methods and Results In 557 patients studied, bisoprolol significantly reduced heart rate (-16.3±15.3 versus -1.6±13.4 bpm, respectively; P<.001) compared with placebo at 2 months after inclusion in the study. Heart rate change over time had the highest predictive value for survival (P<.01). Left ventricular fractional shortening (LVFS) significantly increased in the bisoprolol group compared with the placebo group 5 months after inclusion (+0.04±0.06 versus -0.001±0.05, respectively; P<.001; n=160). LVFS change over time was also significantly correlated with further survival (P<.02 by Cox analysis). Using a nonparametric approach, we demonstrated a significant interaction between study treatment group and LVFS over time. Patients who demonstrated improvement of LVFS over time (82% and 51% of patients in the bisoprolol and the placebo groups, respectively; P<.02) were at lower risk, but the hazard did not further decrease with a further increase of fractional shortening, and there was no significant difference between study treatment groups. Finally, it could be demonstrated that each of the three factors (heart rate change over time, LVFS change over time, and bisoprolol treatment) made a specific contribution to mortality rate.
Conclusions Preservation of left ventricular function appears to play a key role in the bisoprolol-induced beneficial effects on prognosis in heart failure. Short-term ß-blocker–induced cardiac effects could provide a means to identify those patients who will experience improved survival over the long term.
Key Words: heart failure • survival • bisoprolol
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