Background: Exercise capacity is critical for therapy and prognosis in patients with heart failure (HF). Effect of beta-blockers (BB) on exercise capacity in elderly patients with HF remains unclear. Objectives: To assess contribution of BB to functional capacity and left ventricular (LV) function in the elderly with HF. Design: According to the protocol of CIBIS-ELD study group, elderly patients were treated with BB during 12 weeks. In CPET subgroup, an integral part of the CIBIS ELD study group, patients were performed Doppler echocardiography and cardiopulmonary exercise testing (CPET) before BB therapy and after 12 weeks. Setting: Randomized patients with HF beta blockers naïve. Participants: thirty patients with HF aged over 65 years were included in CPET subgroup, while 847 were incorporated in CIBIS ELD study group. Results: Heart rate (HR) and systolic blood pressure (SBP) after BB significantly decreased at rest (p<0.001) and during exercise (p<0.05), with sustained level of peak VO2. Observed changes of resting HR and peak HR were closely correlated (p<0.001). Significant improvement of LV ejection fraction after BB was obtained (p=0.003) and symptoms of breathlessness were reduced (p=0.001). Left ventricular diastolic dysfunction at rest significantly contributed to exercise capacity (p=0.019). Conclusions: Beta-blockers in elderly patients with HF are related to a significant decrease of HR and SBP, improvement of systolic LV function and sustained exercise tolerance. Resting LV diastolic dysfunction is strongly associated with lower exercise capacity.

Exercise capacity is correlated with overall cardiac beta receptors density, but effects of ß blockers on exercise ability and capacity in elderly patients with HF remains unclear. In present study we estimated the impact of ß blockers therapy on cardiopulmonary functional capacity and LV function in elderly patients with HF. Methods: Thirty consecutive patients aged over 65 with clinical existence of systolic HF treated with ß blockers during 8 weeks. All patients were in NYHA class II-III. Cardiopulmonary exercise testing (CPET) were performed according to a submaximal test protocol before therapy and after 12 week follow up. Left atrium dimensions (LA), LV volumes (EDV/bsa, ESV/bsa) and ejection fraction (LVEF), filling velocities (E and A) and annular s and e wave were obtained by Doppler echocardiography. Results: Heart rate after ß blockers up titration was significantly decreased at rest and during exercise (p < 0.001), but systolic blood pressure only during exercise (p < 0.05). Changes of heart rate at rest and during CPET were closely correlated (p < 0.001).There were significant rise of LVEF (p = 0.003) longitudinal LV function (s) (p = 0.006) with modest decrease of LV stiffness (p = 0.027) and level of LV filling pressure, (E/e) (p = 0.044). Significant decrease of respiratory exchange ratio (RER) at maximal oxygen consumption (peak VO2) was found after therapy (p = 0.001).Symptoms of breathlessness were reduced at the end of the test after therapy (Borg score) (p = 0.001).Close correlations were found between LV diastolic dysfunction and exercise cardiopulmonary variables ie peak VO2 and LA dimension (r = 0.375, p = 0.049), maximal loading time of exercise and LV stiffness index (r = 0.399, p = 0.039), and between e and VE/VCO2 slope (r = – 0.449, p = 0.019). Conclusion: In eldrely patients with HF ß blockers significantly decrease heart rate and blood pressdure at rest and during exercise and impoved LV systolic and diastolic function with sustained level of exercise capacity at 3 month follow up. Impaired diastolic dysfunction determined level of functional capacity.