ASSESSMENT OF DIASTOLIC FUNCTION OF THE LEFT VENTRICLE, INTIMA-MEDIA THICKNESS AND EXERCISE TOLERANCE IN CHD PATIENTS TAKING BISOPROLOL AND IVABRADINE

Abstract

Aim. To assess the parameters of the left ventricle diastolic function, intima-media thickness, exercise tolerance in stable angina and CHF I-III FC (NYHA) with sinus rhythm and HR >70 bpm; with the signs of diastolic dysfunction of I type and EF >50% taking bisoprolol and ivabradine (Coraxan®, Les Laboratories Servier, France).Material and methods. Totally, 73 patients studied with stable angina of II and III FC with CHF I-III FC (NYHA) at the age 40-65 y.o., HR >70 bpm and I type diastolic dysfunction of the left ventricle (LV), during 12 weeks.Patients were randomized to 3 groups: group A consisted of 27 patients who received bisoprolol with dose titration up to 10 mg per day; group B — 24 patients taking combination therapy with bisoprolol and Coraxan®, group В — 22 patients taking Coraxan® up to 15 mg per day. Patients of all groups received basic therapy by angiotensin converting enzyme inhibitors (ACEi), antiplatelet drugs, statins, short acting nitrates for angina attacks. To assess the results of the study, 6-minute walking test was performed, with echocardiography and Doppler, electrocardiography (ECG), ultrasound duplex scan of arteries of the head (UDSAH).Results. By the results of our study, in all three groups there was target HR achievement, that was followed by statistically significant increase of exercise tolerance by the results of 6-minute walking test, most prominent in the group of patients taking bisoprolol with Coraxan®.Echo in three groups at baseline and in 12 week showed significant deceleration of diastolic flow through mitral valve only in the group receiving Coraxan® (р<0,05), and increase of the velocity of early diastolic filling in this group (р<0,01).the results of UDSAH, there was tendency to decrease of intima-media thickness in all groups.Conclusion. In stable angina patients with CHF I-III FC taking complex therapy with β-blocker bisoprolol and/or Coraxan®, was the target level of HR reached, that retained for 12 weeks and was followed by increase of exercise tolerance (p<0,05 to <0,01). In the group of patients who received ivabradine, there was improvement of the values of diastolic function of the left ventricle that helped to increase effective duration of diastolic filling of the left ventricle.

Keywords

• chronic heart failure
• diastolic dysfunction
• angina pectoris
• heart rate
• 6-minute walking test
• intima-media complex