Impact of Heart Rate Reduction with Maximal Tolerable Dose of Bisoprolol on Left Ventricular Reverse Remodeling

Figures

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  Fig. 1. Preset schedule of dose titration of bisoprolol. Bisoprolol was initially prescribed from 1.25 mg/day and increased by 1.25 mg at each visit up to 5 mg/day, and then by 2.5 mg until reaching a target dose of 10 mg/day. If there was no contraindication to increasing bisoprolol dose (hypotension, bradycardia, dyspnea, or weakness), bisoprolol was increased to the next dosage. NT-proBNP = N-terminal prohormone brain natriuretic peptide, GAS = global assessment score.

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  Fig. 2. Flow diagram of study patients. A total of 157 patients were included in the analysis after exclusion of several violation cases were excluded. Finally, 112 patients with high baseline HR (≥ 75 bpm) and 45 patients with low baseline HR (< 75 bpm) were compared in the analysis. HR = heart rate, bpm = beats per minute, AV = atrioventricular.

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  Fig. 3. Changes of echocardiographic parameters after 6-month treatment of bisoprolol. Although both low and high HR groups showed improved echocardiographic parameters, more favorable morphologic improvement was observed in high HR group. Vertical bars mean standard error of the mean. HR = heart rate, LVEDD = left ventricular end-diastolic dimension, LVESD = left ventricular end-systolic dimension, LVEF = left ventricular ejection fraction.

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  Fig. 4. Improvement of NT-proBNP and GAS after treatment with bisoprolol according to baseline HR 75 bpm. Improvements of log NT-proBNP and GAS were only indicated in patients with high baseline HR. NT-proBNP = N-terminal prohormone brain natriuretic peptide, GAS = global assessment score, HR = heart rate, bpm = beats per minute.