Impact of right bundle-branch block on systolic and diastolic function and B-type natriuretic peptide levels in patients with congestive heart failure

The effects on myocardial function and loading conditions of clinically relevant doses of the natriuretic peptides (NP) have not been established. The actions of single doses (100 ng ⋅ kg− 1 ⋅ min− 1iv over 30 min) of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and C-type natriuretic peptide (CNP) were studied in conscious normal dogs and in dogs with pacing-induced heart failure. All three NP reduced end-diastolic pressure in normal dogs, and ANP and BNP reduced end-diastolic volume. In heart failure ANP and BNP reduced EDP, and ANP reduced EDV. Arterial elastance was unchanged in normal dogs and in dogs with heart failure. ANP increased end-systolic elastance ( E es) in normal dogs, whereas BNP tended to increase E es ( P = 0.06). In dogs with heart failure, no inotropic effect was seen. In normal dogs, all NP reduced the time constant of isovolumic relaxation (τ), and ANP and BNP reduced τ in dogs with heart failure. Increases in plasma cGMP in dogs with heart failure were blunted. The NP reduced preload and enhanced systolic and diastolic function in normal dogs. Effects of ANP and BNP on preload and diastolic function were maintained in heart failure. Lack of negative inotropic effects in heart failure supports the validity of the NP as therapeutic agents.

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CHANGES IN CLINICAL MANIFESTATION OF CONGESTIVE HEART FAILURE AT THE BACKGROUND OF REGULAR RAMIPRIL INTAKE

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2014-4-41-46 ◽

2014 ◽

Vol 13 (4) ◽

pp. 41-46

Author(s):

A. G. Kuzmin ◽

V. V. Gorbunov ◽

O. V. Kuzmina

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Diastolic Function ◽

Exercise Tolerance ◽

Clinical Signs ◽

Life Quality ◽

Functional Class ◽

Functional Changes ◽

One Year ◽

Systolic And Diastolic Function

Aim. To study dynamics in clinical signs of congestive heart failure (CHF) while taking ramipril regularly.Material and methods. Totally 135 patients studied (124 men, 11 women), mean age 60±8,7, with Q-MI in anamnesis of different location 3 years ago, with clinical signs of CHF III NYHA. One year after hospitalization the adherence to therapy was evaluated by Moricki-Greene test. The parameters studied: life quality, signs of CHF, exercise tolerance, morphology and systolic and diastolic function of LV and RV, respiratory system parameters, and of kidneys.Results. By the Moricki-Greene test results all patients were divided into 2 groups: I group — non-adherent patients, II — compliant. In 1 year of follow-up in those of II group the positive dynamic observed. Functional class changed to II, clinical signs of CHF decreased, life quality improved, exercise tolerance increased, intra- and transventricular dyssynchrony decreased, dyspnea regressed from 3 to 2 by Modified Medical Research Council Scale, the NT-proBNP concentration, sudden death risk, BP and HR stabilized at normal values, microalbuminuria decreased, GFR increased. Also we marked the regress of LV and RV volumes, increase of EF, improvement of diastolic function, increase of heart rate variability by the decrease of sympathetic activity.Conclusion. Clinical signs of CHF after Q-MI with III NYHA are presupposed by morpho-functional changes in the heart, cardiopulmonary and cardiorenal continuum, that have common engine for progressing and showing worse outcomes. Therapy adherence with the usage of ramipril makes possible CHF compensation and decreases the chance for exacerbation and progressing of comorbidity.

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