Differential Effects of β-Blockers in Patients With Heart Failure

Metra, Marco; Giubbini, Raffaele; Nodari, Savina; Boldi, E; Modena, Maria Grazia; Dei, Livio

doi:10.1161/01.cir.102.5.546

Cited by 293 publications

(61 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…First, Doppler-echocardiographic measurements had not shown major changes with beta-blocker therapy in patients with HFPEF [31]. Second, the 6-min walking test distance is related to symptoms as well as to patients' outcomes [26,28,32,33] and it is less dependent on peak exercise heart rate, a limiting factor for exercise capacity in HFPEF [34]. Third, single center trials have shown that walking distance is responsive to therapeutic changes, including betablockers [28].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the 6-min walking test distance is related to symptoms as well as to patients' outcomes [26,28,32,33] and it is less dependent on peak exercise heart rate, a limiting factor for exercise capacity in HFPEF [34]. Third, single center trials have shown that walking distance is responsive to therapeutic changes, including betablockers [28]. However, until now, these agents have not been associated with significant benefits in exercise capacity in patients with heart failure in multicenter trials [33].…”

Section: Discussionmentioning

confidence: 99%

“…In a previous study in patients with LV systolic dysfunction, we found an increase in the 6MWT from 416 ± 121 to 479 ± 138 m with metoprolol treatment and from 447 ± 136 to 497 ± 126 m with carvedilol treatment (n.s. for differences between the two agents; both p \ 0.001 for changes from baseline) [28]. We assumed that nebivolol administration may be conservatively associated in the patients enrolled in ELANDD with a similar improvement in 6-min test walk distance from baseline versus no change from baseline in the placebo group.…”

Section: Statistical Considerationsmentioning

confidence: 99%

See 2 more Smart Citations

Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study

et al. 2009

Self Cite

View full text Add to dashboard Cite

Background The SENIORS trial demonstrated that nebivolol has beneficial effects in patients with heart failure. However, the role of beta-blocker therapy in patients with heart failure and preserved left ventricular ejection fraction (HFPEF) is still unsettled. Objective To assess the long-term effects of administration of nebivolol, compared to placebo, on the clinical symptoms, exercise capacity and parameters of left ventricular (LV) function in patients with HFPEF. Methods The Effect of Long-term Administration of Nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with Diastolic Dysfunction (ELANDD) study is a prospective multicenter European trial in 120 patients with HFPEF randomised to nebivolol or placebo. HFPEF is defined as symptoms or signs of heart failure, a LV ejection fraction [45% and evidence of diastolic LV dysfunction by Doppler echocardiography. Procedures include a baseline clinical examination, 6-min walk test (6MWT), electrocardiography, Doppler echocardiography and Minnesota QoL questionnaire. Nebivolol or placebo is started at 2.5 mg/day and gradually uptitrated to 10 mg/day. After initiation of the study, patients are assessed at 1, 2, 5 and 6 weeks (titration phase) and at weeks 12 and 26. The primary endpoint is the change from baseline in the 6MWT distance with nebivolol versus placebo. Sample size calculations are based on an anticipated 15% difference (70 m) in the 6MWT distance between nebivolol and placebo-treated patients. This study will allow the collection of data regarding the possible For the ELANDD investigators.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Statistical Considerationsmentioning

confidence: 99%

See 1 more Smart Citation

Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study

et al. 2009

Self Cite

View full text Add to dashboard Cite

show abstract

“…Neurohormonal antagonists slow (but probably rarely prevent) this progression, thereby delaying death and avoiding or postponing hospital admissions [1,2]. The effect of these drugs on patients' symptoms is less well defined and that on functional capacity less convincing [3,4]. Implantable cardioverter defibrillators (ICDs) also reduce the risk of sudden death, which causes a larger proportion of deaths in patients with mild HF, compared to those with severe HF.…”

Section: Introduction: Changing Clinical Characteristics Of Heart Faimentioning

confidence: 99%

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Metra

Ponikowski²,

Dickstein

et al. 2007

European J of Heart Fail

Self Cite

347

242

View full text Add to dashboard Cite

Therapy has improved the survival of heart failure (HF) patients. However, many patients progress to advanced chronic HF (ACHF). We propose a practical clinical definition and describe the characteristics of this condition.Patients that are generally recognised as ACHF often exhibit the following characteristics: 1) severe symptoms (NYHA class III to IV); 2) episodes with clinical signs of fluid retention and/or peripheral hypoperfusion; 3) objective evidence of severe cardiac dysfunction, shown by at least one of the following: left ventricular ejection fraction b 30%, pseudonormal or restrictive mitral inflow pattern at Dopplerechocardiography; high left and/or right ventricular filling pressures; elevated B-type natriuretic peptides; 4) severe impairment of functional capacity demonstrated by either inability to exercise, a 6-minute walk test distance b 300 m or a peak oxygen uptake b 12-14 ml/kg/min; 5) history of N1 HF hospitalisation in the past 6 months; 6) presence of all the previous features despite optimal therapy. This definition identifies a group of patients with compromised quality of life, poor prognosis, and a high risk of clinical events. These patients deserve effective therapeutic options and should be potential targets for future clinical research initiatives.

show abstract

“…Both the incidence and prevalence of h s disease are increasing as our population continues to age. In the Framingham Study, the prevalence of heart failure was estimated to be 1 % in persons aged SG.59 years, doubling each decade to4% in those aged [70][71][72][73][74][75][76][77][78][79].' Mortality rates vary depending on the severity of heart failure, ranging from 50% in 5 years in those with mild disease to as high as 50% at 1 year in those with advanced heart failure.2 Heart failure is a heterogeneous disorder consisting of a constellation of symptoms and signs that can result from a variety of pathophysiologic processes reflecting both systolic and diastolic dysfunction.'…”

Section: Introductionmentioning

confidence: 99%

Carvedilol in the failing heart

Lombardi

Gilbert

2001

Clinical Cardiology

View full text Add to dashboard Cite

Summary:Patients with chronic heart failure due to left ventricular systolic dysfunction of ischemic or nonischemic etiology have shown improvement in morbidity and mortality with carvedilol therapy. In patients with symptomatic (New York Heart Association class 11-IV) heart failure, carvedilol improves left ventricularejection fraction and clinical status, and slows disease progression, reducing the combined risk of mortality and hospitalization. Despite the overwhelming evidence for their benefit, there continues to be a large treatment gap between those who would derive benefit and those who actually receive the drug. In this article, the pharmacology, clinical trial evidence, and the potential differences between carvedilol and other beta blockers are discussed. Carvedilol provides powerful therapy in the treatment of chronic heart failure caused by a variety of etiologies and in a wide array of clinical settings.

show abstract

Differential Effects of β-Blockers in Patients With Heart Failure

Cited by 293 publications

References 32 publications

Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study

Effect of the long-term administration of nebivolol on clinical symptoms, exercise capacity and left ventricular function in patients with heart failure and preserved left ventricular ejection fraction: background, aims and design of the ELANDD study

Advanced chronic heart failure: A position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology

Carvedilol in the failing heart

Contact Info

Product

Resources

About