Clin Res Cardiol 101, Suppl 1, April 2012

P694 - Carvedilol but not bisoprolol reduces forced expiratory volume in the first second in elderly patients with heart failure: Insight from CIBIS-ELD
 
M. Lainscak1, G. Gelbrich2, A. Neskovic3, S. Inkrot4, E. Tahirovic4, W. Döhner5, B. Putnikovic3, S. Apostolovic6, F. Waagstein7, S. D. Anker8, W. Haverkamp9, R. Wachter10, F. Edelmann10, H.-D. Düngen4 , KNHI
 
1Division of Cardiology, University Clinic Golnik, Golnik, Slowenien; 2Zentrum für Klinische Studien, Universität Leipzig, Leipzig; 3Department of Cardiology, University of Belgrade, Clinical Hospital Center Zemun, Belgrade, Serbien und Montenegro; 4Medizinische Klinik m. S. Kardiologie, Kompetenznetz Herzinsuffizienz, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; 5Centrum für Schlaganfallforschung Berlin - CSB, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; 6Department of Cardiology, Clinical Center Nis, Clinical Center Nis, Nis, Serbien und Montenegro; 7Department of Molecular and Clinical Medicine - Cardiology, Sahlgrenska University, Wallenberg Laboratory for Cardiovascular Research, Göteborg, Schweden; 8Medizinische Klinik m. S. Kardiologie, Angewandte Kachexieforschung, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin; 9CC11, Medizinische Klinik m.S. Kardiologie, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin; 10Herzzentrum, Abt. Kardiologie und Pneumologie, Universitätsklinikum Göttingen, Göttingen;
 
Background: Concerns regarding pulmonary side effects and coexisting chronic obstructive pulmonary disease (COPD) are major limitations for beta-blocker use in patients with heart failure (HF). Comparative data of the potentially differing effects of selective vs non-selective beta-blockers are lacking. Therefore, we analyzed pulmonary function and pulmonary adverse events during carvedilol vs bisoprolol treatment in the Cardiac Insufficiency Bisoprolol Study in Elderly (CIBIS-ELD).
Methods: We perfomed spirometry  in 813 patients (72±6 years, 63% men, 8% history of COPD) at baseline. There were no differences in pulmonary function between patients randomized to carvedilol or bisoprolol. 202 (25%) patients fulfilled the Global Initiative of Lung Disease (GOLD) criteria for COPD. After fortnightly titration to target or maximally tolerated dose, spirometry was repeated at week 12. 
Results: Carvedilol (-42ml, 95% confidence interval [CI] -73ml to -11ml, p=0.007) but not bisoprolol (+3ml, 95% CI -32ml to +39ml, p=0.86) reduced forced expiratory volume in the first second  (FEV1) (carvedilol vs. bisoprolol difference -50ml, 95% CI -95ml to -4ml, p=0.03). Similar was observed in the subgroup of patients with a history of COPD (carvedilol: -137ml, 95% CI -288ml to +15ml, p=0.08; bisoprolol: +69ml, 95% CI -17ml to +155ml, p=0.11; carvedilol vs bisoprolol difference +200ml, 95% CI +26ml to 373ml, p=0.03). Carvedilol caused more pulmonary adverse events (10% vs 4%, p<0.001). In multivariate logistic regression, carvedilol (odds ratio [OR] 3.60, 95% CI 1.89-6.86) and COPD (OR 3.00, 95% CI 1.42-6.33) independently predicted adverse events.
Conclusions: Our results suggest that bisoprolol has a better pulmonary safety profile than carvedilol in elderly patients with HF.
 
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6

http://www.abstractserver.de/dgk2012/ft/abstracts/P694.htm