![]() The underlying cardioprotective mechanism relies on protection against the deleterious consequences of cardiac sympathetic stimulation. The potential therapeutic effect of β-blocker treatment on survival in heart failure is still being actively investigated through large-scale, randomized trials such as CIBIS II 1 with bisoprolol, BEST 2 with bucindolol, and MERIT with metoprolol. Short-term β-blocker–induced cardiac effects could provide a means to identify those patients who will experience improved survival over the long term. Finally, it could be demonstrated that each of the three factors (heart rate change over time, LVFS change over time, and bisoprolol treatment) made a specific contribution to mortality rate.Ĭonclusions Preservation of left ventricular function appears to play a key role in the bisoprolol-induced beneficial effects on prognosis in heart failure. Patients who demonstrated improvement of LVFS over time (82% and 51% of patients in the bisoprolol and the placebo groups, respectively P<.02) were at lower risk, but the hazard did not further decrease with a further increase of fractional shortening, and there was no significant difference between study treatment groups. Using a nonparametric approach, we demonstrated a significant interaction between study treatment group and LVFS over time. ![]() LVFS change over time was also significantly correlated with further survival ( P<.02 by Cox analysis). Left ventricular fractional shortening (LVFS) significantly increased in the bisoprolol group compared with the placebo group 5 months after inclusion (+0.04☐.06 versus −0.001☐.05, respectively P<.001 n=160). Heart rate change over time had the highest predictive value for survival ( P<.01). ![]() Methods and Results In 557 patients studied, bisoprolol significantly reduced heart rate (−16.3☑5.3 versus −1.6☑3.4 bpm, respectively P<.001) compared with placebo at 2 months after inclusion in the study.
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