European Heart Journal Advance Access published online on January 27, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi735
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1 Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy
* To whom correspondence should be addressed. 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) 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.
Received July 22, 2005
Revised December 20, 2005
Accepted December 22, 2005
Clinical research
Effects of nebivolol in elderly heart failure patients with or without systolic left ventricular dysfunction: results of the SENIORS echocardiographic substudy
Stefano Ghio 1 *,
Giulia Magrini 1,
Alessandra Serio 1,
Catherine Klersy 2,
Alessandro Fucilli 3,
Aleksandr Ronaszèki 4,
Pal Karpati 5,
Giacomo Mordenti 6,
Angela Capriati 6,
Philip A. Poole Wilson 7,
Luigi Tavazzi 1,
and
on behalf of the SENIORS investigators
2 Biometry and Clinical Epidemiology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
3 Cardiology Department, Arcispedale S. Anna, Ferrara, Italy
4 Péterfy Hospital, Budapest, Hungary
5 St Stepan Hospital I, Budapest, Hungary
6 Menarini Ricerche SpA, Florence, Italy
7 National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, UK
Stefano Ghio, E-mail: s.ghio{at}smatteo.pv.it
Abstract 
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.
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