@article{EdelmannMusialBrightGelbrichetal.2016,
  author    = {Edelmann, Frank and Musial-Bright, Lindy and Gelbrich, Goetz and Trippel, Tobias and Radenovic, Sara and Wachter, Rolf and Inkrot, Simone and Loncar, Goran and Tahirovic, Elvis and Celic, Vera and Veskovic, Jovan and Zdravkovic, Marija and Lainscak, Mitja and Apostolović, Svetlana and Neskovic, Aleksandar N. and Pieske, Burkert and D{\"u}ngen, Hans-Dirk},
  title     = {Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial},
  series = {JACC: Heart Failure},
  volume    = {4},
  journal   = {JACC: Heart Failure},
  number    = {2},
  doi       = {10.1016/j.jchf.2015.10.008},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-191022},
  pages     = {140-149},
  year      = {2016},
  abstract  = {OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23\% vs. HFrEF: 34\%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306).},
  language  = {en}
}
@article{EdelmannStahrenbergGelbrichetal.2011,
  author    = {Edelmann, Frank and Stahrenberg, Raoul and Gelbrich, G{\"o}tz and Durstewitz, Kathleen and Angermann, Christiane E. and D{\"u}ngen, Hans-Dirk and Scheffold, Thomas and Zugck, Christian and Maisch, Bernhard and Regitz-Zagrosek, Vera and Hasenfuß, Gerd and Pieske, Burkert M. and Wachter, Rolf},
  title     = {Contribution of comorbidities to functional impairment is higher in heart failure with preserved than with reduced ejection fraction},
  series = {Clinical Research in Cardiology},
  volume    = {100},
  journal   = {Clinical Research in Cardiology},
  number    = {9},
  doi       = {10.1007/s00392-011-0305-4},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-134354},
  pages     = {755-764},
  year      = {2011},
  abstract  = {Background Comorbidities negatively affect prognosis more strongly in heart failure with preserved (HFpEF) than with reduced (HFrEF) ejection fraction. Their comparative impact on physical impairment in HFpEF and HFrEF has not been evaluated so far. Methods and results The frequency of 12 comorbidities and their impact on NYHA class and SF-36 physical functioning score (SF-36 PF) were evaluated in 1,294 patients with HFpEF and 2,785 with HFrEF. HFpEF patients had lower NYHA class (2.0 ± 0.6 vs. 2.4 ± 0.6, p < 0.001) and higher SF-36 PF score (54.4 ± 28.3 vs. 54.4 ± 27.7, p < 0.001). All comorbidities were significantly (p < 0.05) more frequent in HFrEF, except hypertension and obesity, which were more frequent in HFpEF (p < 0.001). Adjusting for age and gender, COPD, anemia, hyperuricemia, atrial fibrillation, renal dysfunction, cerebrovascular disease and diabetes had a similar (p for interaction > 0.05) negative effect in both groups. Obesity, coronary artery disease and peripheral arterial occlusive disease exerted a significantly (p < 0.05) more adverse effect in HFpEF, while hypertension and hyperlipidemia were associated with fewer (p < 0.05) symptoms in HFrEF only. The total impact of comorbidities on NYHA (AUC for prediction of NYHA III/IV vs. I/II) and SF-36 PF (r 2) in multivariate analyses was approximately 1.5-fold higher in HFpEF, and also much stronger than the impact of a 10\% decrease in ejection fraction in HFrEF or a 5 mm decrease in left ventricular end-diastolic diameter in HFpEF. Conclusion The impact of comorbidities on physical impairment is higher in HFpEF than in HFrEF. This should be considered in the differential diagnosis and in the treatment of patients with HFpEF.},
  language  = {en}
}
@article{EdelmannWachterDuengenetal.2011,
  author    = {Edelmann, Frank and Wachter, Rolf and D{\"u}ngen, Hans-Dirk and St{\"o}rk, Stefan and Richter, Annette and Stahrenberg, Raoul and Neumann, Till and L{\"u}ers, Claus and Angermann, Christiane E. and Mehrhof, Felix and Gelbrich, G{\"o}tz and Pieske, Burkert},
  title     = {Heart failure therapy in diabetic patients-comparison with the recent ESC/EASD guideline},
  series = {Cardiovascular Diabetology},
  volume    = {10},
  journal   = {Cardiovascular Diabetology},
  number    = {15},
  doi       = {10.1186/1475-2840-10-15},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-140397},
  pages     = {1-8},
  year      = {2011},
  abstract  = {Background: To assess heart failure therapies in diabetic patients with preserved as compared to impaired systolic ventricular function. Methods: 3304 patients with heart failure from 9 different studies were included (mean age 63 +/- 14 years); out of these, 711 subjects had preserved left ventricular ejection fraction (>= 50\%) and 994 patients in the whole cohort suffered from diabetes. Results: The majority (>90\%) of heart failure patients with reduced ejection fraction (SHF) and diabetes were treated with an ACE inhibitor (ACEi) or angiotensin receptor blocker (ARB) or with beta-blockers. By contrast, patients with diabetes and preserved ejection fraction (HFNEF) were less likely to receive these substance classes (p < 0.001) and had a worse blood pressure control (p < 0.001). In comparison to patients without diabetes, the probability to receive these therapies was increased in diabetic HFNEF patients (p < 0.001), but not in diabetic SHF patients. Aldosterone receptor blockers were given more often to diabetic patients with reduced ejection fraction (p < 0.001), and the presence and severity of diabetes decreased the probability to receive this substance class, irrespective of renal function. Conclusions: Diabetic patients with HFNEF received less heart failure medication and showed a poorer control of blood pressure as compared to diabetic patients with SHF. SHF patients with diabetes were less likely to receive aldosterone receptor blocker therapy, irrespective of renal function.},
  language  = {en}
}