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European Heart Journal Advance Access originally published online on January 27, 2006
European Heart Journal 2006 27(5):562-568; doi:10.1093/eurheartj/ehi735
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Effects of nebivolol in elderly heart failure patients with or without systolic left ventricular dysfunction: results of the SENIORS echocardiographic substudy

Stefano Ghio1,*, Giulia Magrini1, Alessandra Serio1, Catherine Klersy2, Alessandro Fucilli3, Aleksandr Ronaszèki4, Pal Karpati5, Giacomo Mordenti6, Angela Capriati6, Philip A. Poole-Wilson7, Luigi Tavazzi1 on behalf of the SENIORS investigators

1Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
2Biometry and Clinical Epidemiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
3Cardiology Department, Arcispedale S. Anna, Ferrara, Italy
4Péterfy Hospital, Budapest, Hungary
5St Stepan Hospital I, Budapest, Hungary
6Menarini Ricerche SpA, Florence, Italy
7National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK

Received 22 July 2005; revised 20 December 2005; accepted 22 December 2005; online publish-ahead-of-print 27 January 2006.

* Corresponding author. Tel: +39 0382 503718; fax: +39 0382 501884. E-mail address: s.ghio{at}smatteo.pv.it

See page 506 for the editorial comment on this article (doi:10.1093/eurheartj/ehi693)

Aims The SENIORS trial recently demonstrated that nebivolol reduces the composite risk of all-cause mortality and cardiovascular hospital admission in elderly patients with chronic heart failure and, importantly, that ejection fraction does not influence the clinical effects of nebivolol. An echocardiographic substudy was designed to evaluate the effects of nebivolol on systolic and diastolic left ventricular (LV) function in patients stratified according to the presence or absence of systolic LV dysfunction.

Methods and results The substudy randomized 112 patients in 29 European centres, of whom 104 were evaluable for the study; 43 had an ejection fraction (EF) ≤35% and 61 had an EF>35%. LV end-systolic volume (ESV), EF, mitral valve E/A ratio, and E-wave deceleration time were assessed at baseline and after 12 months. Echocardiograms were submitted to a core laboratory to perform quantitative analysis in blinded condition. In the group with EF≤35%, nebivolol reduced ESV (adjusted difference between treatments 25.8 mL, 95%CI: –46.6; –5.0, P=0.016) and improved EF (adjusted difference between treatments 4.6%, 95%CI: 1.3;7.9, P=0.008); no changes were observed in the E/A ratio or E-wave deceleration time. In EF>35% group, no significant changes in either systolic or diastolic parameters were observed.

Conclusion In patients with heart failure and advanced systolic LV dysfunction, nebivolol reduces ventricular size and improves EF. The absence of detectable changes with standard echocardiography in patients with predominant diastolic heart failure questions the mechanism of benefit on morbidity/mortality in such patients.

Key Words: Heart failure • Diastole • Echocardiography


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