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Updated: Jun 22, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

The effect of treatment with bisoprolol-first versus enalapril-first on cardiac structure and function in heart

Louis L M van de Ven1, Dirk J van Veldhuisen, Michael Goulder

  • 1Clinquest Europe, Oss, Netherlands.

International Journal of Cardiology
|June 2, 2009
PubMed

Insights

Initiating chronic heart failure treatment with either bisoprolol or enalapril first similarly improved cardiac function and reversed adverse remodeling. Both drug sequencing strategies demonstrated comparable efficacy in enhancing left ventricular ejection fraction and reducing cardiac volumes.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • The CIBIS III trial compared initiating chronic heart failure (CHF) treatment with bisoprolol followed by enalapril versus the reverse sequence.
  • Both strategies showed similar effects on survival and hospitalization rates.
  • This substudy utilized echocardiography to assess cardiac structure and function changes.

Purpose of the Study:

  • To evaluate the impact of initiating therapy with bisoprolol first versus enalapril first on cardiac remodeling in patients with CHF.
  • To compare changes in left ventricular (LV) dimensions and ejection fraction (EF) between the two treatment sequences.

Main Methods:

  • A single-centre substudy involving 40 treatment-naive patients with stable, mild to moderate CHF (NYHA II-III) and LVEF ≤35%.
  • Patients were randomized to either bisoprolol-first (n=21) or enalapril-first (n=19) monotherapy for 6 months, followed by 6 months of combination therapy.
  • Echocardiography was performed at baseline, after 6 months (monotherapy), and after 12 months (combination therapy).

Main Results:

  • Both bisoprolol and enalapril monotherapy significantly improved LVEF and reduced LV end-diastolic volume (LVEDV) and wall thickness (WT) after 6 months.
  • No significant between-group differences were observed in LVEF, LVEDV, or WT changes after 6 months of monotherapy.
  • Over 12 months, both sequences led to sustained improvements in LVEF and reductions in LVEDV and WT, with no significant differences between the bisoprolol-first and enalapril-first groups.

Conclusions:

  • Initiating chronic heart failure treatment with either bisoprolol-first or enalapril-first similarly reversed cardiac remodeling.
  • Both therapeutic sequences effectively improved left ventricular ejection fraction (LVEF) during both monotherapy and combination therapy phases.
  • The order of initiating bisoprolol and enalapril does not differentially impact cardiac structural and functional improvements in CHF patients.
Abstract

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