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Improvement of Ventricular-Arterial Coupling in Elderly Patients with Heart Failure After Beta Blocker Therapy: Results from the CIBIS-ELD Trial

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Abstract

ᅟ

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.

Aims of the Study: 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.

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Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Authors and Affiliations

  1. University Clinical Centar “Zvezdara”, Belgrade, Serbia

    Milica Dekleva, Aleksandra Arandjelovic & Dane Cvijanovic

  2. School of Medicine, University of Belgrade, Belgrade, Serbia

    Milica Dekleva, Ivan Soldatovic & Aleksandra Arandjelovic

  3. University Clinical Center “Dr. Dragisa Misovic-Dedinje”, Belgrade, Serbia

    Jelena Suzic Lazic

  4. University Clinical Hospital Charité, Berlin, Germany

    Simone Inkrot & Hans Dirk Dungen

  5. Wallenberg Laboratory, Sahlgrenska University Hospital, Goteborg, Sweden

    Finn Waagstein

  6. Clinical Trial Center, University of Leipzig, Leipzig, Germany

    Goetz Gelbrich

Authors
  1. Milica Dekleva
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  2. Jelena Suzic Lazic
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  3. Ivan Soldatovic
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  4. Simone Inkrot
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  6. Finn Waagstein
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  9. Hans Dirk Dungen
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Correspondence to Milica Dekleva.

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Dekleva, M., Lazic, J.S., Soldatovic, I. et al. Improvement of Ventricular-Arterial Coupling in Elderly Patients with Heart Failure After Beta Blocker Therapy: Results from the CIBIS-ELD Trial. Cardiovasc Drugs Ther 29, 287–294 (2015). https://doi.org/10.1007/s10557-015-6590-9

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  • DOI: https://doi.org/10.1007/s10557-015-6590-9

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