Oral Bisoprolol Research Articles

A Comparative Study to Investigate the Effects of Bisoprolol in Patients with Chronic Heart Failure and Hypertension When Switched from Tablets to Transdermal Patches.

Oral beta-blockers are effective for heart failure and hypertension. Here, we conducted a prospective study to investigate the efficacy of the beta-blocker bisoprolol in patients switching from the oral tablet to the transdermal patch. We studied 50 outpatients receiving oral bisoprolol for chronic heart failure and hypertension. After patients switched treatments, we measured heart rate (HR) over 24 h by Holter echocardiography as the primary endpoint. Secondary endpoints were (1) HR at 00:00, 06:00, 12:00, and 18:00, (2) the total number of premature atrial contractions (PACs) over 24 h and the incidence rate per time segment, and the total number of premature ventricular contractions (PVCs) over 24 h and the incidence rate per time segment, (3) blood pressure, (4) atrial natriuretic peptide and B-type natriuretic peptide, and (5) echocardiography. Minimum, maximum, mean, and total HR over 24 h was not significantly different between the two groups. Mean and maximum HR at 06:00, total PACs, total PVCs, and PVCs at 00:00 to 05:59 and 06:00 to 11:59 were significantly lower in the patch group. Compared with oral bisoprolol, the bisoprolol transdermal patch lowers HR at 06:00 and inhibits the onset of PVCs during sleep and in the morning.

Managing postoperative atrial fibrillation after open-heart surgery using transdermal β1 blockers

BackgroundPostoperative atrial fibrillation (POAF) after open-heart surgery is a non-negligible complication. We aimed to describe the efficacy of a transdermal patch of bisoprolol for managing POAF and flutter in thoracic surgical procedures.MethodsWe analyzed the data of 384 patients who underwent open-heart surgery at our hospital and received oral bisoprolol to prevent POAF. Among them, 65 patients (16.9%) also received a 4-mg transdermal patch of bisoprolol to control the heart rate due to POAF. We applied the bisoprolol transdermal patch when the heart rate was > 80 bpm and removed it at ≤ 60 bpm; an additional patch was applied when the heart rate was > 140 bpm. Heparin calcium injections were administered twice daily for anticoagulation between 2 and 6 days postoperatively.ResultsThe average number of prescriptions for transdermal patches of bisoprolol during hospitalization was 1.8 ± 1.1 (1–5). The median first prescription date was on postoperative day 2 (range: days 0–37). Sinus rhythm recovered within 24 h in 18 patients (27.7%). Eight patients (12.3%) were switched to continuous landiolol infusion because of persistent tachycardia. In three patients, the transdermal patch was removed owing to severe bradycardia. Fifteen patients experienced persistent atrial fibrillation and were treated with electrical cardioversion during hospitalization. We did not observe any serious complications that could be directly attributed to bisoprolol transdermal patch use.ConclusionsSingle-use bisoprolol transdermal patch may help control the heart rate during the initial treatment of POAF after open-heart surgery.

To Evaluate the ‘Real World’ Clinical Performance of Bisoprolol in Post-Myocardial Infarction with Left-Ventricular Dysfunction: TENACITY Study

Beta-blockers are the cornerstone in management of heart failure and are well studied in Acute Coronary Syndromes (ACS). There is paucity of data of Bisoprolol in acute ICU setting in patients admitted with left ventricular systolic dysfunction (LVSD) with recent ACS, especially amongst Asian Indians. We evaluated the impact of Bisoprolol on Heart Rate (HR) and Left Ventricular Ejection Fraction (LVEF) along with metabolic indicators of HbA1C and lipid profile in post-ACS patients with LVSD at 1 year as compared to baseline.This non-interventional, retrospective, single center, secondary data collection study captured demographics, comorbidities, hemodynamics, concomitant medications and assessed the effectiveness of oral Bisoprolol (1.25, 2.5 mg, 5 mg and 10mg) treatment over a 1-year follow up period, in post-ACS patients with LVSD (i.e., HFmrEF and HFrEF; LVEF <50%). Data-records of 400 patients hospitalized between August 1, 2016 to November 30, 2018 were evaluated for change in LVEF as primary endpoint and change in HR and Lipid profile, HBA1C and ST segment deviation of J point at 1 year as compared to baseline as secondary outcomes.The mean age of 400 patients was 55.28±7.9 years of which 29.75% were female. Significant improvement in LVEF (41.45±5.1% vs 48.73±5.5%) with significant reduction in heart rate (85.06±5.64 bpm vs 76.73±4.6 bpm) was observed at the end of 1-year treatment as compared to baseline (p=0.0001 and p=0.0001 respectively) on treatment with Bisoprolol (mean 4.15 + 1.4 mg). NYHA class improved from 1.6 + 0.5 to 1.11 + 0.31 at the end of 1 year. Bisoprolol along with GDMT was neutral for HbA1C (6.2±0.6 % vs 6.1±0.7%; p=0.64), while serum lipids (Total Cholesterol: 199.7 + 7.6 vs 127.6 + 4.85 mg% p=0.001; TG: 196.2 +12.1 vs 111.7 + 6.88 mg%, p=0.001; LDL: 126.9 + 9.1 vs 62.4 + 5.51 p=0.001; HDL: 33.7 + 3 vs 42.8 +1.9 p=0.001) improved at 1 year due to statins. Maximum ST deviation at J point in resting ECG was also lesser at 1 year as compared to baseline (0.29 + 1.5 mm vs 0.05 + 0.22 mm; p=0.0001).Bisoprolol administered along with GDMT to patients post-ACS with LVSD significantly improved LVEF with significant reduction in heart rate and ST segment deviation at J point at 1 year without adverse effect on lipid and HBA1C.

The influence of edema on the bisoprolol blood concentration after bisoprolol dermal patch application: A case-control study.

Background:Beta-blocking is important for critically ill patients. Although some patients are required to continue taking beta-blockers after they no longer need critical care, some of these patients have impaired swallowing abilities. Bisoprolol dermal patches have recently been introduced and appear to be a good alternative to oral bisoprolol tablets. However, it is still unclear whether the pharmacodynamics of such patches are affected by edema in patients who have experienced critical care. This study aimed to clarify the effects of systemic edema on beta-blocker absorption from dermal patches in critically ill patients.Method:Patients who exhibited tachycardia and impaired swallowing function after critical care were included in this study. They were assigned to either the edema group (n = 6) or no edema group (n = 6) depending on the presence/absence of edema in the lower extremities. A bisoprolol dermal patch was pasted onto each subject, and the blood bisoprolol concentration was checked at 8 timepoints over the next 24 hours. The area under the serum concentration time curve, maximum concentration observed (Cmax), and time of maximum concentration observed were also examined.Result:The mean blood bisoprolol concentrations of the 2 groups were not significantly different at 2, 4, 6, 8, 10, 12, 16, or 24 hours after the patch application. The area under the serum concentration time curve and maximum concentration observed were not different between the groups. The mean heart rates of the 2 groups were not significantly different at 6, 12, or 24 hours after the patch application (Student t test, P = .0588, P = .1080, and P = .2322, respectively).Conclusion:In this study, the blood concentration of bisoprolol and its heart rate-reducing effects after bisoprolol dermal patch application might not be affected by systemic edema in the lower extremities.

Preoperative gabapentin versus bisoprolol for haemodynamic and surgical field optimisation during endoscopic sinus surgery

Background and Aims:Appropriate premedication can optimise haemodynamics and hence surgical field visibility during endoscopic sinus surgery (ESS). This study aimed to compare the intraoperative effect of gabapentin 1200 mg versus bisoprolol 2.5 mg, given 2 hours before ESS.Methods:Patients were assigned into one of three groups. Patients of gabapentin group received preoperative oral gabapentin 1200 mg while, patients of bisoprolol and control groups received oral bisoprolol 2.5 mg and placebo respectively 2 hours before ESS. Primary outcome: reduction of blood loss and surgical field quality. Secondary outcome: haemodynamic control. mean arterial pressure (MAP) and heart rate (HR) were recorded as baseline, before and after induction of anaesthesia, at 1, 5, 10, 15 minutes after intubation and then every 15 minutes until the end of surgery. Data also included Fromm and Boezaart category scale (assessed every 15 min), intraoperative blood loss, surgeon satisfaction score, intraoperative anaesthetic/analgesic and vasoactive medications requirements.Results:Out of 66 eligible patients, 60 patients completed the study. Intraoperative MAP and HR were significantly lower and more stable in gabapentin and bisoprolol groups compared to control group (p < 0.05). The volume of blood loss was significantly lower (p 0.000) and operative field was more visible in gabapentin and bisoprolol groups than those in control group (p 0.000).Conclusion:The beneficial effect of gabapentin 1200 mg on intraoperative haemodynamic control and surgical field visibility is comparable to that of bisoprolol 2.5 mg when either of them is given as a single oral dose 2 hours before ESS.

Impact of Bisoprolol on Ventricular Arrhythmias in Experimental Myocardial Infarction.

Following acute myocardial infarction (AMI), early use of beta-blockers (BBs) reduced the incidences of ventricular arrhythmia (VA) and death in the pre reperfusion era. However, some studies have reported a worsening of clinical outcomes and therefore, this study used a porcine model of AMI to evaluate the efficacy of bisoprolol on VAs and mortality. Twenty pigs were divided into two groups with one group using oral bisoprolol which was given for 3 hours before the experiment and then maintained for 7 days. A loop recorder was implanted, AMI was induced by balloon occlusion for 60 min, and then, reperfusion. One week later, the echocardiography and loop recorder data were analyzed in the surviving animals. Bisoprolol did not increase the heart rate (62.9±14.5 vs 79.0±20.3; p=0.048), lower the rate of premature ventricular contractions (PVC) (0.8±0.8 vs 11.0±12.8; p=0.021) or tend to lower recurrent VA (0.6±0.5 vs 1.1±1.1; p=0.131) during coronary artery occlusion. After reperfusion, bisoprolol did reduce VA in the early AMI period (0.1±0.3 vs 4.2±4.6; p=0.001) and it was not associated with the extent of myocardial recovery. In this porcine model, early oral bisoprolol might help reduce the incidences of PVC and recurrent VA and determine whether effects are more pronounced during the early AMI period. Our results suggest that bisoprolol might help reduce lethal VA and cardiac death following AMI in this reperfusion era.

Oral Bisoprolol for the treatment of non-resolving central serous chorioretinopathy: A case report

Purpose: To evaluate the effect of the beta blocker Bisoprolol in the treatment of chronic central serous chorioretinopathy (CSC).

Bisoprolol transdermal patch for perioperative care of non-cardiac surgery in patients with hypertrophic obstructive cardiomyopathy

BackgroundNon-cardiac surgery for hypertrophic obstructive cardiomyopathy (HOCM) is considered to require meticulous perioperative care. β-blockers are considered the first-line drugs for patients with HOCM, and they play a key role in preventing cardiovascular complications in perioperative care. The bisoprolol transdermal patch has recently become available in Japan, and it is useful for patients who are unable to take oral medication during perioperative care. The aim of this case series was to assess the hemodynamic features of patients with HOCM who used the bisoprolol transdermal patch during perioperative care for non-cardiac surgery.MethodsBetween August 2016 and August 2018, we retrospectively analyzed 10 consecutive cases of HOCM with the patients using the bisoprolol transdermal patch during perioperative care. Hemodynamic and echocardiographic features were evaluated before and after patients were switched from oral bisoprolol to transdermal patch therapy or started transdermal patch therapy as a new β-blocker medication. In addition, cardiovascular complications (all-cause death, cardiac death, heart failure, ventricular tachycardia, and ventricular fibrillation) during the perioperative period were evaluated.ResultsThere was no significant change in the patients’ heart rate, blood pressure, ejection fraction, and pressure gradient in the left ventricle after switching from oral bisoprolol to the transdermal patch therapy. On the other hand, patients who started using the bisoprolol transdermal patch as a new ß-blocker medication tended to have a decreased heart rate and pressure gradient thereafter, but there was no significant difference in blood pressure or ejection fraction. No cardiovascular complications occurred during the perioperative period.ConclusionsWe described the utilization of the bisoprolol transdermal patch during perioperative care for non-cardiac surgery in patients with HOCM. We determined that the hemodynamic features of these patients did not change significantly after switching to patch therapy. Further, initiation of the bisoprolol transdermal patch as a new ß-blocker medication sufficiently tended to decrease the pressure gradient. This unique approach can be an alternate treatment option for HOCM.Trial registrationThe registry was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000036703). The date of registration was 10/5/2019 and it was “Retrospectively registered”.

P3754Comparison of the transdermal bisoprolol patch with the oral bisoprolol fumarate administration as a therapeutic agent for idiopathic frequent premature ventricular contractions

Abstract Background The transdermal bisoprolol patch (TB) was designed to maintain a sustained concentration of bisoprolol in plasma by higher trough concentration than the oral bisoporolol fumarate administration (OB). It is unclear whether the TB is as effective in treating idiopathic premature ventricular contractions (PVCs) as the OB. Purpose We compared the efficacy between the TB and OB in treating idiopathic PVCs while considering their duration of action. Methods Among 198 patients with a PVC count of ≥3,000 beats/24 hours, 84 patients were divided into groups treated with TB 4mg (n=50) or OB 2.5mg (n=34). The PVCs were divided into positive heart rate (HR)-dependent PVCs (P-PVCs) and non-positive HR-dependent PVCs (NP-PVCs) based on the relationship between the hourly PVCs density and hourly mean HR. To evaluate the efficacy, PVC counts by 24-hour Holter electrocardiograms were measured at baseline and at 1 month after the initiation of the therapy. Results There were no significant between-group differences for the mean HR, PVC count, or type of PVCs. Both the TB (from 16,692±9,737 to 10,442±10,711 beats/24 hours, P&lt;0.001) and OB (from 19,633±16,298 to 9,235±12,124 beats/24 hours, P&lt;0.001) significantly decreased the total PVC count after the initiation of therapy, and a comparison between the two drugs showed no significant difference (P=0.46). In the P-PVC group, both the TB and OB significantly decreased the total PVC count (P&lt;0.001, P=0.022 respectively), PVC count during the day-time (P&lt;0.001, P=0.030 respectively), and PVC count during the night-time (P=0.0038, P=0.022 respectively). In contrast, in the NP-PVC group, neither the TB nor OB made any significantly change in the total PVC count (P=0.079, P=0.10 respectively), PVC count during the day-time (P=0.35, P=0.12 respectively), or PVC count during the night-time (P=0.11, P=0.12 respectively). The TB exhibited a significant reduction during each time period regarding the changes within 24-hours in the P-PVC count from baseline, while the OB did not significantly reduce the P-PVC count from baseline during each time period between 0 and 5 o'clock. Conclusions Compared with the OB, the TB could be used with the same efficacy for reducing the PVC count. The TB could be a more useful therapeutic agent for idiopathic P-PVCs during a 24-hour period than the OB.

Advantages of prophylactic versus conventionally scheduled heart failure therapy in an experimental model of doxorubicin-induced cardiomyopathy

BackgroundChemotherapy-induced left ventricular dysfunction represents a major clinical problem, which is often only recognised at an advanced stage, when supportive therapy is ineffective. Although an early heart failure treatment could positively influence the health status and clinical outcome, there is still no evidence of routine prophylactic cardioprotection for the majority of patients without previous cardiovascular history awaiting potentially cardiotoxic chemotherapy. In this study, we set out to investigate whether a prophylactic cardioprotective therapy relative to a conventionally scheduled heart failure treatment is more effective in preventing cardiotoxicity in a rodent model of doxorubicin (DOX)-induced cardiomyopathy.MethodsMale Wistar rats (n = 7–11 per group) were divided into 4 subgroups, namely negative controls receiving intravenous saline (CON), positive controls receiving intravenous DOX (6 cycles; D-CON), and DOX-treated animals receiving either prophylactic (PRE, started 1 week before DOX) or conventionally applied (POST, started 1 month after DOX) combined heart failure therapy of oral bisoprolol, perindopril and eplerenone. Blood pressure, heart rate, body weight and echocardiographic parameters were monitored in vivo, whereas myocardial fibrosis, capillarisation, ultrastructure, myofilament function, apoptosis, oxidative stress and mitochondrial biogenesis were studied in vitro.ResultsThe survival rate in the PRE group was significantly improved compared to D-CON (p = 0.0207). DOX increased the heart rate of the animals (p = 0.0193), while the blood pressure (p ≤ 0.0105) and heart rate (p = 0.0029) were significantly reduced in the PRE group compared to D-CON and POST. The ejection fraction remained preserved in the PRE group compared to D-CON or POST (p ≤ 0.0237), while none of the treatments could prevent the DOX-induced increase in the isovolumetric relaxation time. DOX decreased the rate of the actin-myosin cross-bridge cycle, irrespective of any treatment applied (p ≤ 0.0433). The myocardium of the D-CON and POST animals displayed pronounced ultrastructural damage, which was not apparent in the PRE group (p ≤ 0.033). While the DOX-induced apoptotic activity could be reduced in both the PRE and POST groups (p ≤ 0.0433), no treatment was able to prevent fibrotic remodelling or the disturbed mitochondrial biogenesis.ConclusionFor attenuating DOX-induced adverse myocardial effects, prophylactic cardioprotection has many advantages compared to a late-applied treatment.

Incidence of postoperative atrial fibrillation in transdermal β-blocker patch users is lower than that in oral β-blocker users after cardiac and/or thoracic aortic surgery.

Postoperative atrial fibrillation (POAF) after open heart surgery is associated with a high risk of mortality and morbidity. Although oral β-blockers are usually recommended to prevent POAF, the efficacy of a transdermal β-blocker patch in preventing POAF is unclear. We compared the incidence of POAF between users of oral and transdermal bisoprolol. We investigated 108 patients who underwent cardiac and/or thoracic aortic surgery between April 2016 and February 2018. We compared perioperative clinical and hemodynamic variables between 49 patients treated with a transdermal bisoprolol patch and 59 patients treated with an oral bisoprolol fumarate. POAF occurred in 24% of patients in the transdermal and in 46% of patients in the oral bisoprolol groups (p = 0.027). No intergroup difference was observed in in-hospital mortality, perioperative blood pressures and heart rates, and other morbidities. Multivariable logistic regression analysis revealed that the use of transdermal bisoprolol was independently associated with a lower rate of POAF (odds ratio 0.21, 95% confidence interval 0.05-0.84, p = 0.027). A transdermal bisoprolol patch is an effective and safe β-blocker drug delivery system. The incidence of POAF in this group was lower than that in users of oral bisoprolol.

Exercise training reduces ventricular arrhythmias through restoring calcium handling and sympathetic tone in myocardial infarction mice.

Exercise can improve morbidity and mortality in heart failure patients; however, the underlying mechanisms remain to be fully investigated. Thus, we investigated the effects of exercise on cardiac function and ventricular arrhythmias in myocardial infarction (MI) induced heart failure mice. Wild‐type male mice underwent sham‐operation or permanent left coronary artery ligation to induce MI. MI mice were divided into a sedentary (MI‐Sed) and two intervention groups: MI‐Ex (underwent 6‐week treadmill exercise training) and MI‐βb (oral bisoprolol treatment (1 mg/kg/d) without exercise). Cardiac function and structure were assessed by echocardiography and histology. Exercise capacity and cardiopulmonary function was accepted as oxygen consumption at peak exercise (peak VO2). Autonomic nervous system function and the incidence of spontaneous ventricular arrhythmia were evaluated via telemetry recording. mRNA and protein expressions in the left ventricle (LV) were investigated by real‐time PCR and Western blotting. There were no differences in survival rate, MI size, cardiac function and structure, while exercise training improved peak VO2. Compared with MI‐Sed, MI‐Ex, and MI‐βb showed decreased sympathetic tone and lower incidence of spontaneous ventricular arrhythmia. By Western blot, the hyperphosphorylation of CaMKII and RyR2 were restored by exercise and β‐blocker treatment. Furthermore, elevated expression of miR‐1 and decreased expression of its target protein PP2A were recovered by exercise and β‐blocker treatment. Continuous intensive exercise training can suppress ventricular arrhythmias in subacute to chronic phase of MI through restoring autonomic imbalance and impaired calcium handling, similarly to that for β‐blockers.

To Study the Oral Bisoprolol for Improving Surgical Field in FESS

To Study the Oral Bisoprolol for Improving Surgical Field in FESS

Resistance to thyroid hormone accompanied by atrial fibrillation

SummaryResistance to thyroid hormone (RTH), which is primarily caused by mutations in the thyroid hormone (TH) receptor beta (THRB) gene, is dominantly inherited syndrome of variable tissue hyposensitivity to TH. We herein describe a case involving a 22-year-old Japanese man with RTH and atrial fibrillation (AF) complaining of palpitation and general fatigue. Electrocardiography results revealed AF. He exhibited elevated TH levels and an inappropriately normal level of thyroid-stimulating hormone (TSH). Despite being negative for anti-TSH receptor antibody, thyroid-stimulating antibody and anti-thyroperoxidase antibody, the patient was positive for anti-thyroglobulin (Tg) antibody. Genetic analysis of the THRB gene identified a missense mutation, F269L, leading to the diagnosis of RTH. Normal sinus rhythm was achieved after 1 week of oral bisoprolol fumarate (5 mg/day) administration. After 3 years on bisoprolol fumarate, the patient had been doing well with normal sinus rhythm, syndrome of inappropriate secretion of TSH (SITSH) and positive titer of anti-Tg antibody.Learning points:Atrial fibrillation can occur in patients with RTH.Only a few cases have been reported on the coexistence of RTH and atrial fibrillation.No consensus exists regarding the management of atrial fibrillation in patients with RTH.Administration of bisoprolol fumarate, a beta-blocker, can ameliorate atrial fibrillation in RTH.

Atypical Clinical Presentation of Extensive Aortic Dissection at Mulago Hospital: Case Report

Acute aortic dissection (AD) has a high morbidity and mortality rates, 1% to 2% of patients with aortic dissection die per hour for the first 24-48 hours after their admission in the hospital. Medical imaging plays a big role in the diagnosis of AD and treatment plan. The present case is a fifty-four year old male admitted at Mulago Hospital in Uganda with sudden onset chest pains, became unconscious for few minutes then recovered the consciousness with ability to walk, stand and sit. Clinical diagnosis prior to radiological investigation was acute coronary syndrome. Surprisingly cardiac Echo showed AD with aortic regurgitation. Computed tomography aortogram showed aortic dissection De Bakey type I. The immediate medical management included intravenous morphine and an oral beta blocker, with a target of maintaining the systolic blood pressure <100 mmHg and the resting heart rate between 60-70 bpm. The patient was discharged from the hospital after eleven days on medical therapy including oral bisoprolol, oral losartan and furosemide. Arrangements for Bentall procedure and Thoracic Endovascular Aortic Repair (TEVAR) were planned in two months at the time of discharge from hospital; unfortunately the patient has never been operated. He has been maintained on medical therapy for three years. The aim of this clinical report is to appreciate the role of radiological investigations in the diagnosis of atypical clinical presentation of extensive aortic dissection.

Efficacy and Safety of Switching From Oral Bisoprolol to Transdermal Patch in Japanese Patients With Chronic Heart Failure

TY-0201 (TY) is a transdermal formulation of bisoprolol that is the free base of bisoprolol fumarate (BO), a drug widely used to treat chronic heart failure (CHF). The objectives of this phase II study were to evaluate the efficacy and safety of TY when switching from oral BO to TY in patients with CHF whose drug therapy was optimized, and to determine the dose conversion rate of BO to TY.Methods and Results:The efficacy and safety of once daily TY patch use for 16 weeks was investigated in 40 patients with CHF who were stabilized with an optimized drug treatment, including BO, after switching from BO to TY at the dose conversion rate of 5:8. The pre-switch left ventricular ejection fraction was 50.13±11.09% (mean±SD). The post-switch value was 50.87±10.79% after 16 weeks, which was not significantly different, with similar results for other efficacy and safety parameters. The 16-week study was continued for all patients without changing doses after switching to TY. No cardiovascular deaths, hospitalizations for worsening HF, or significant safety concerns were observed. Efficacy was maintained without significant safety concerns in patients with CHF who were stabilized with BO treatment after switching to TY, suggesting the appropriateness of the dose conversion rate.

Effect of early bisoprolol administration on ventricular arrhythmia and cardiac death in patients with non-ST elevation myocardial infarction

ObjectiveTo investigate the impact of early oral beta blockade in patients presenting with acute non-ST elevation myocardial infarction (NSTEMI).MethodsWe retrospectively identified 890 consecutive patients presenting with NSTEMI to a single...

Reversible severe mitral regurgitation caused by systolic anterior motion of the mitral valve in the absence of left ventricular hypertrophy: A case report

A 67-year-old woman with exertional dyspnea was referred to our hospital. Transthoracic echocardiography revealed severe mitral regurgitation and significant left ventricular (LV) outflow tract obstruction due to prominent systolic anterior motion (SAM) of the mitral valve without LV hypertrophy. Oral bisoprolol remarkably attenuated SAM. Two- or three-dimensional echocardiographic analysis demonstrated the elongation of anterior and posterior mitral leaflets and interventricular septum (IVS) bulging due to narrow aorto-mitral angle. In the present case, elongation of mitral leaflet and hyperkinetic motion of left ventricle, and IVS bulging due to narrow aorto-mitral angle possibly play important roles in the development of SAM.<Learning objective: Mitral regurgitation due to systolic anterior motion (SAM) can be dramatically improved by beta-blocker therapy. Although the precise mechanism of SAM has not been fully elucidated, structural changes of mitral apparatus (elongation of mitral leaflet and papillary muscle displacement), and structural or functional features of left ventricle (hyperkinetic motion, small ventricle, interventricular septum bulging, narrow aorto-mitral angle) possibly play important roles in the development of SAM.>

Oral bisoprolol improves surgical field during functional endoscopic sinus surgery

Background:The success of functional endoscopic sinus surgery (FESS) depends on visual clarity of the surgical field, through the endoscope. The objective of this double-blind, randomized, controlled study was to determine if a pre-operative dose of bisoprolol (2.5 mg) would reduce the bleeding during FESS and improve the visualization of the operative field.Materials and Methods:Thirty American Society of Anesthesiologists I or II patients, scheduled for FESS were randomized to receive either a placebo (Group A) or 2.5 mg of bisoprolol (Group B) 90 min prior to the surgery. All the patients received standard anesthesia and monitoring. The aim was to maintain the mean arterial pressure (MAP) of 60-70 mmHg, by titrating dose of isoflurane and fentanyl. The concentration of isoflurane used was recorded every 15 min. At the end of the surgery, the volume of blood loss was measured and the surgeon was asked to grade the operative field as per the Fromme-Boezaart Scale.Result:The blood loss was significantly (P < 0.0001) more in the control group (398.67 ± 228.79 ml) as compared with that in the bisoprolol group (110.67 ± 45.35 ml). The surgical field was graded better in those who received bisoprolol as compared with those in the control group (P − 0.0001). The volume percent of isoflurane and the dose of fentanyl used was significantly lower in those who received bisoprolol. During the operative period, the MAPs were 70.0 ± 2.7 (Group A) and 62.6 ± 3.6 mmHg (Group B) and the heart rate was 99.8 ± 5.0/min (Group A) and 69.2 ± 4.4/min (Group B). These differences were statistically significant ( P − 0.001).Conclusion:This clinical trial has demonstrated that administration of a single pre-operative dose of bisoprolol (2.5 mg) can significantly reduce the blood loss during FESS and improve the visualization of the operating field.

Feasibility of landiolol and bisoprolol for prevention of atrial fibrillation after coronary artery bypass grafting: A pilot study

We previously performed a trial of intravenous landiolol hydrochloride during and after cardiac surgery (the PASCAL trial) and demonstrated a preventive effect on postoperative atrial fibrillation (AF). In the present study, we investigated the efficacy of increasing the dose and administration period of landiolol for prevention of postoperative AF, as well as the effect of oral bisoprolol in the early postoperative period. A total of 105 patients who underwent coronary artery bypass grafting were randomized to 3 groups: a group receiving intravenous landiolol perioperatively at 5 μg/kg/min for 3 days (group L), a group receiving oral bisoprolol postoperatively together with landiolol (group LB), and a control group without beta-blocker therapy (group C). The primary end point was the presence/absence of postoperative AF. Secondary end points were (1) the early clinical outcome, (2) hemodynamics, (3) cardiac enzymes (creatine kinase isoenzyme MB, troponin-I, and human heart fatty acid-binding protein), (4) high-sensitivity C-reactive protein (hs-CRP) and pentraxin-3, (5) asymmetric dimethylarginine (ADMA), and (6) brain natriuretic peptide. Postoperative AF occurred in 14.5% of group L, 9.1% of group LB, and 35.3% of group C. A significant difference was observed between groups LB and C. Significantly higher levels of troponin-I, human heart fatty acid-binding protein, hs-CRP, pentraxin-3, and ADMA were noted in group C than in groups L and LB. Landiolol and bisoprolol prevented postoperative AF. The anti-ischemic, anti-inflammatory, and anti-oxidant effects of these beta-blockers presumably inhibited the onset of AF.