THE 5-YEAR DYNAMICS OF CARDIAC STRUCTURE AND FUNCTION IN PATIENTS WITH CORONARY ARTERY DISEASE AFTER MYOCARDIAL REVASCULARIZATION

The aim: To estimate the dynamics of echocardiographic parameters in patients with CAD within 5 years after revascularization. Material and methods: 50 persons (males/females 39/11; mean age 59.9±9.3 years; STEMI 76%, non-STEMI 24%) were divided into two groups: n=38 after PCI with stenting (PCIwS); n=12 after CABG. Observation included regular echocardiography with LV myocardial mass (LVMM) and geometry estimation. Results: Groups were comparable by age, co-morbidity, BP, heart rate and BMI. Significantly severe baseline LV hypertrophy (LVH) and left atrial enlargement (LAE) in group 2 explained by spread coronary atherosclerosis. Later progressive LAE (4.37±0.22 cm, P0-60<0.05) in group 1, and aortic/LV dilatation (+0.4/+1.0 cm, respectively, both P0-60<0.05) in group 2 developed. In two years LVMM index increased by 13.4/17.5% in groups 1/2, respectively. Normal geometry and concentric remodeling completely disappeared in 3/1.5 years after PCIwS/CABG, respectively. Conclusions: Within the 1st year after revascularization, patients with CABG had more severe LVH. In 5 years after PCIwS the ratio between concentric/eccentric LVH was 2:1, whereas after CABG – 1:2.

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Approaches to reduce the risk of progression of peripheral artery disease from the standpoint of a cardiologist

Complex Issues of Cardiovascular Diseases ◽

10.17802/2306-1278-2021-10-1-55-64 ◽

2021 ◽

Vol 10 (1) ◽

pp. 55-64

Author(s):

A. N. Sumin ◽

Yu. D. Medvedeva ◽

A. V. Shcheglova ◽

L. S. Barbarash

Keyword(s):

Peripheral Artery Disease ◽

Myocardial Revascularization ◽

Walking Distance ◽

Adherence To Treatment ◽

Peripheral Artery ◽

Optimal Drug ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim. To determine the factors contributing to the progression of peripheral artery diseases in patients receiving outpatient care within the 3-year follow-up.Methods. 585 patients with peripheral artery disease undergoing outpatient treatment in the period from 2010 to 2016 were recruited in a study. The follow-up period was three years. Patients were divided into two groups: Group 1 patients (n = 225) with a favorable course of peripheral atherosclerosis, and Group 2 patients (n = 303) with an unfavorable course of peripheral atherosclerosis. Patients were assigned to the groups based on their medical history (a decrease in pain-free walking distance within three years, amputation) and/or data of duplex scanning of the lower extremity arteries (significant progression of stenosis >20% over three years).Results. 87.1% of patients from Group 1 and 70.63% of patients from Group 2 visited cardiologists regularly within 3 years (p<0.0001). A total of 69.33% of patients from Group 1 and 61.39% of patients from Group 2 (p = 0.058) visited vascular surgeons within the follow-up period. Within three years, 47 (8.9%) patients achieved hard endpoints. Of them, 18 deaths, 14 myocardial infarctions, and 15 ischemic strokes. 25 patients underwent myocardial revascularization. Adherence to treatment within 3-years follow-up was significantly higher in patients with a favorable course (57.33% vs. 45.21%, p = 0.006). Multivariate logistic regression reported that adherence to treatment years (р=0.0009) and regular visits to cardiologists (p<0.001) significantly improved the 3-year prognosis in patients with peripheral artery disease.Conclusion. 57% of patients had an adverse course of peripheral atherosclerosis within 3-years follow-up. These results show that regular outpatient examinations of patients with peripheral atherosclerosis by cardiologists allow prescribing optimal drug therapy and reducing the risk of atherosclerosis progression.

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Association between the severity of coronary artery disease and ST2 expression in patients with heart failure

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-7-399-405 ◽

2020 ◽

Vol 4 (7) ◽

pp. 399-405

Author(s):

E.V. Grakova ◽

◽

K.V. Kopieva ◽

A.T. Teplyakov ◽

M.V. Soldatenko ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Revascularization ◽

Patients With Heart Failure ◽

Lv Remodeling ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim: to study the association between ST2 (sST2) and severity of coronary artery lesion in patients with chronic heart failure (CHF), and to analyze changes in sST2 levels and left ventricle (LV) remodeling indicators depending on complete or incomplete myocardial revascularization (MR) after the 12-month follow-up period.Patients and Methods: a total of 118 patients (16.1% women, mean age of 62.5 [57; 68] years) with stable coronary heart disease (CHD) with LV ejection fraction 60% [46; 64] and CHF of NYHA functional class I–III were enrolled in the study. All patients underwent MR. Depending on the completeness of the performed MR, all patients were retrospectively divided into 2 groups: group 1 (n=75) consisted of patients with complete MR, group 2 (n=43) — with incomplete MR. Serum levels of sST2 were measured using an enzyme immunoassay before MR and after the 12-month follow-up period.Results: the sST2 level in patients with single vessel coronary artery disease was 29.92 [22.43; 32.68] ng/ml and was 21% lower (p=0.002) than in patients with two or more coronary arteries (CA) — 37.87 [37.87; 51.82] ng/ml. During 12-month follow-up, the incidence of adverse cardiovascular events (CVE) in group 1 was 18.7%, in group 2–46.5% (p=0.001). After 12-month follow-up, the level of sST2 in group 1 decreased by 33.6% (p=0.0001) (from 30.51 [26.38; 37.06] to 20.27 [16.56; 27.11] ng/ml), while in group 2 there was only a tendency to decrease in the level of this biomarker, which was 6.9%. In group 2, after 12-month follow-up, there was a tendency to increase in the LV EF, which increased by only 2.4%, as well as a tendency to increase in the end-systolic dimension (ESD), which increased by 5.4%. In the group of patients with complete MR, the increase in the LV EF was significant (p=0.001) — by 13.6% (from 54.0 [42.0; 63.0] to 62.5 [49.0; 64.0]%), and the ESD decreased by 3%, the final ESV — by 4.6%.Conclusion: the sST2 level can be used as a diagnostic marker for assessing the severity of atherosclerotic CA lesion in patients with CHF. Performing complete MR in patients with stable CHD with CHF has a predominance over incomplete MR, leading to reversed LV remodeling, a decrease in sST2 levels and, as a result, the incidence of adverse CVE during the 12-month follow-up. KEYWORDS: coronary atherosclerosis, soluble ST2, myocardial revascularization, heart failure, prognosis, left ventricular remodeling.FOR CITATION: Grakova E.V., Kopieva K.V., Teplyakov A.T., Soldatenko M.V. Association between the severity of coronary artery disease and ST expression in patients with heart failure. Russian Medical Inquiry. 2020;4(7):399–405. DOI: 10.32364/2587-6821-2020-4-7-399-405.

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Coronary endarterectomy in myocardial revascularization

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4310 ◽

2021 ◽

Vol 26 (8) ◽

pp. 4310

Author(s):

Ya. Yu. Visker ◽

D. N. Kovalchuk ◽

A. N. Molchanov ◽

O. R. Ibragimov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Mechanical Ventilation ◽

Coronary Artery ◽

Myocardial Revascularization ◽

Coronary Endarterectomy ◽

Perioperative Myocardial Infarction ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim. To compare the immediate outcomes of combined coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) and isolated CABG.Material and methods. This retrospective study included 192 patients with stable angina who underwent myocardial revascularization in the period from January 2016 to August 2018. The patients were divided into 2 groups. Group 1 included patients who underwent combined CABG and CE, while group 2 — patients who underwent isolated CABG. Patients in both groups did not differ in the main preoperative characteristics, with the exception of the incidence of obesity and right coronary artery disease.Results. In-hospital mortality in group 1 was 2,2% (n=2), in group 2 — 2% (n=2). The incidence of perioperative myocardial infarction in group 1 was 1% (n=1) and in group 2 — 0%. There were no significant differences between groups in the following postoperative parameters: in-hospital mortality, perioperative myocardial infarction, need and duration of inotropic support, duration of mechanical ventilation (MV) and need for long-term mechanical ventilation, stroke, arrhythmias, resternotomy for bleeding. In group 1, encephalopathy (11,8%) and respiratory failure (12,9%) were significantly more common.Conclusion. Combined CABG and CE is a safe technique for achieving complete myocardial revascularization in diffuse coronary artery disease, since, in comparison with isolated CABG, there is no increase in the incidence of death and perioperative myocardial infarction. However, in this category of patients, an increase in the incidence of non-lethal, non-disabling cerebral and pulmonary complications should be expected.

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Relationship of triglyceride–glucose index with chronic limb-threatening ischemia in lower extremity peripheral artery disease

Vascular ◽

10.1177/17085381211018332 ◽

2021 ◽

pp. 170853812110183

Author(s):

Arda Aybars Pala ◽

Yusuf Salim Urcun

Keyword(s):

Lower Extremity ◽

High Density Lipoprotein ◽

Peripheral Artery Disease ◽

Density Lipoprotein ◽

Peripheral Artery ◽

Tyg Index ◽

Triglyceride Glucose Index ◽

Group 2 ◽

Artery Disease ◽

Group 1

Objectives Triglyceride-glucose index (TyG index), which is defined as the simple and novel marker of insulin resistance, is becoming increasingly important as a promising predictive marker for atherosclerotic diseases. Chronic limb-threatening ischemia is defined as the most advanced stage of the lower extremity peripheral artery disease, whose main cause is atherosclerosis and is associated in this respect with amputation, impaired quality of life, and mortality. The main purpose of the present study was to investigate the relation between the calculated TyG index values and chronic limb-threatening ischemia development. Methods A total of 296 patients who were diagnosed with lower extremity peripheral artery disease in our outpatient clinic between October 2018 and October 2020 were included in this study retrospectively. Two groups were formed by clinically staging the patients according to Rutherford Classification. Patients who did not develop chronic limb-threatening ischemia were classified as “Group 1” ( n = 224) and those who developed were classified as “Group 2” ( n = 72). Results The mean TyG index values that were calculated in Group 2 were significantly higher than in Group 1 (9.27 ± 0.31 vs. 9.00 ± 0.34, p < 0.001). In the multivariate logistic regression analysis conducted to determine the predictors of chronic limb-threatening ischemia development, C-reactive protein (OR [Odds Ratio]: 1.220, 95% CI [confidence interval]: 1.092–1.363, p < 0.001), high-density lipoprotein cholesterol (OR: 0.775, 95% CI: 0.715–0.839, p < 0.001) and TyG index (OR: 5.796, 95% CI: 2.050–16.382, p = 0.001) were identified as independent predictors. Receiver operating characteristic analysis revealed that the cut-off value of TyG index was 9.13 (area under the curve: 0.721, p < 0.001) with 70.8% sensitivity and 65.2% specificity. The TyG index was significantly correlated with Rutherford category, high-density lipoprotein cholesterol and mean platelet volume. Conclusions Chronic limb-threatening ischemia development may be predicted with the TyG index value, which is calculated easily from routine biochemical parameters, in patients diagnosed with lower extremity peripheral artery disease.

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Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity

Angiology ◽

10.1177/0003319721991410 ◽

2021 ◽

pp. 000331972199141

Author(s):

Arafat Yildirim ◽

Mehmet Kucukosmanoglu ◽

Fethi Yavuz ◽

Nermin Yildiz Koyunsever ◽

Yusuf Cekici ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Vascular Disease ◽

Operating Characteristics ◽

Coronary Artery Disease Severity ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Artery Disease ◽

Group 1

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA2DS2-VASc ( r = 0.428), and CHA2DS2-VASc-HS ( r = 0.500) scores ( Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

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Intracoronary Injection of Autologous CD34+ Cells Improves One-Year Left Ventricular Systolic Function in Patients with Diffuse Coronary Artery Disease and Preserved Cardiac Performance—A Randomized, Open-Label, Controlled Phase II Clinical Trial

Journal of Clinical Medicine ◽

10.3390/jcm9041043 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1043 ◽

Cited By ~ 2

Author(s):

Pei-Hsun Sung ◽

Yi-Chen Li ◽

Mel S. Lee ◽

Hao-Yi Hsiao ◽

Ming-Chun Ma ◽

...

Keyword(s):

Systolic Function ◽

Coronary Intervention ◽

Left Ventricular ◽

Diffuse Coronary Artery Disease ◽

Cd34 Cells ◽

Group 2 ◽

Artery Disease ◽

One Year ◽

Lv Systolic Function ◽

Group 1

This phase II randomized controlled trial tested whether intracoronary autologous CD34+ cell therapy could further improve left ventricular (LV) systolic function in patients with diffuse coronary artery disease (CAD) with relatively preserved LV ejection fraction (defined as LVEF >40%) unsuitable for coronary intervention. Between December 2013 and November 2017, 60 consecutive patients were randomly allocated into group 1 (CD34+ cells, 3.0 × 107/vessel/n = 30) and group 2 (optimal medical therapy; n = 30). All patients were followed for one year, and preclinical and clinical parameters were compared between two groups. Three-dimensional echocardiography demonstrated no significant difference in LVEF between groups 1 and 2 (54.9% vs. 51.0%, respectively, p = 0.295) at 12 months. However, compared with baseline, 12-month LVEF was significantly increased in group 1 (p < 0.001) but not in group 2 (p = 0.297). From baseline, there were gradual increases in LVEF in group 1 compared to those in group 2 at 1-month, 3-months, 6-months and 12 months (+1.6%, +2.2%, +2.9% and +4.6% in the group 1 vs. −1.6%, −1.5%, −1.4% and −0.9% in the group 2; all p < 0.05). Additionally, one-year angiogenesis (2.8 ± 0.9 vs. 1.3 ± 1.1), angina (0.4 ± 0.8 vs. 1.8 ± 0.9) and HF (0.7 ± 0.8 vs. 1.8 ± 0.6) scores were significantly improved in group 1 compared to those in group 2 (all p < 0.001). In conclusion, autologous CD34+ cell therapy gradually and effectively improved LV systolic function in patients with diffuse CAD and preserved LVEF who were non-candidates for coronary intervention (Trial registration: ISRCTN26002902 on the website of ISRCTN registry).

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Prognostic value of per-vessel treatment adherence in stable coronary artery disease based on novel computational pressure-flow dynamics derived fractional flow reserve

European Heart Journal ◽

10.1093/eurheartj/ehab724.1405 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C K L Leung ◽

L Y Lam ◽

K Y Li ◽

A S Y Yu ◽

M Z Wu ◽

...

Keyword(s):

Treatment Adherence ◽

Fractional Flow Reserve ◽

Coronary Vessels ◽

Fractional Flow ◽

Flow Reserve ◽

Group 3 ◽

Group 2 ◽

Artery Disease ◽

Adherence Group ◽

Group 1

Abstract Background Computational pressure-flow dynamics derived fractional flow reserve (caFFR) is a novel index developed to evaluate the extent of myocardial ischemia in patients with coronary artery disease (CAD), which eliminates the need of invasive pressure guidewire and hyperaemic stimulus in conventional fractional flow reserve (FFR) measurement. Studies have shown improved clinical outcomes associated with adherence to functional myocardial ischemia assessment when deciding to perform percutaneous coronary intervention (PCI) at a per-patient level. However, the clinical significance of such treatment adherence at a per-vessel level remains uncertain. Methods A total of 928 patients (mean age 66.2±10.5, male 72.7%) with stable CAD were included in this study. The caFFR of all three major coronary vessels were obtained for every patient, and the FFR threshold of 0.8 was adopted as the threshold for caFFR to indicate functionally significant artery stenosis which warrants PCI, and vice versa. Based on the caFFR of each major coronary vessel and whether PCI was performed to the respective vessel, patients were stratified into 0–1 vessel with treatment adherence group (group 1) (n=105), 2 vessels with treatment adherence group (group 2) (n=338), and 3 vessels with treatment adherence group (group 3) (n=485). The primary endpoint was major adverse cardiac events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction and any subsequent revascularization. Results The severity of CAD based on SYNTAX score assessment was 18.6±10.2 in group 1, 14.6±8.9 in group 2, and 11.5±9.9 in group 3 (P<0.001). The rates of MACE at 3 years were significantly different across groups 1, 2 and 3 (17.1% vs. 12.1% vs. 7.4%; P=0.004). With reference to group 3, the risk of MACE at 3 years was increased in group 2 (adjusted hazard ratio [HR]=1.597; 95% confidence interval [CI]=1.020–2.501; P=0.041), and further increased in group 1 (adjusted HR=1.933; 95% CI=1.081–3.457; P=0.026). Conclusion In stable CAD patients, the risk of MACE is incremental when fewer major coronary vessels are treated with adherence to caFFR threshold of 0.8. Per-vessel treatment adherence significantly affects clinical outcomes in terms of MACE. FUNDunding Acknowledgement Type of funding sources: None.

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The risk of developing chronic heart failure in patients with hypertension depending on the actual arterial stiffness

Siberian Medical Journal ◽

10.29001/2073-8552-2020-35-2-98-105 ◽

2020 ◽

Vol 35 (2) ◽

pp. 98-105

Author(s):

A. I. Chernyavina ◽

N. A. Koziolova

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Arterial Stiffness ◽

Left Ventricular ◽

Myocardial Mass ◽

Developing Heart ◽

Group 2 ◽

Lv Volume ◽

Lv Diastolic Function ◽

Group 1

Objective. To determine the risk of developing chronic heart failure (CHF) in patients with hypertension (HTN) depending on the actual arterial stiffness.Material and Methods. The study included 175 patients with HTN without a verified diagnosis of heart failure. The average age was 48.5 ± 6.8 years. Patients underwent general clinical examination, volume sphygmoplethysmography assessments of cardio-ankle vascular index (CAVI), echocardiography study (left ventricular (LV) ejection fraction, LV diastolic function, LV myocardial mass index, indexed LV volume by echocardiography), and tests for serum N-terminal pro-B-type natriuretic peptide (NT-proBNP). Patients were divided into two groups depending on CAVI. Group 1 included 141 (80.6%) patients with CAVI < 9; group 2 included 34 (19.4%) patients with CAVI > 9.Results. In patients of group 1, the level of NT-proBNP was 0.008 [0.006; 5.770], which was significantly lower than the corresponding value in group 2, where the level of NT-proBNP was 13.08 [0.01; 350.65] ng/mL (p = 0.041). Indicators of odds ratio (OR) and relative risk (RR) were also significant. The chance of developing CHF with CAVI > 9 increased by almost 7 times (OR = 6.9; 95% CI = 2.8–16.8), and OR of CHF onset was 4.1 (95% CI = 2.2–7.6). Sensitivity and specificity rates were 55.9% and 84.4%, respectively. Correlation analysis revealed a medium degree of dependence and direct relationships between NT-proBNP level and CAVI values (r = 0.35; p <0.05).Conclusion. Serum level of NT-proBNP depended on the actual arterial stiffness. Patients with CAVI > 9 indicative of an increase in true arterial stiffness had a greater risk of developing heart failure assessed based on the level of NT-proBNP in the blood. Further studies are required to assess the effects of arterial stiffness, registered within the intermediate values of CAVI index, on the risk of heart failure onset.

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THE ROLE OF MYOCARDIAL REVASCULARIZATION IN THE SURVIVAL OF PATIENTS WITH ALTERED CORONARY BLOOD FLOW DETECTED BY TRANSTHORACIC ULTRASOUND

Siberian Medical Journal ◽

10.29001/2073-8552-2018-34-1-54-60 ◽

2019 ◽

Vol 34 (1) ◽

pp. 54-60

Author(s):

M. S. Kamenskikh ◽

A. V. Zagatina ◽

N. T. Zhuravskaya ◽

Yu. N. Fedotov ◽

D. V. Shmatov

Keyword(s):

Blood Flow ◽

Coronary Blood Flow ◽

Myocardial Revascularization ◽

Control Group ◽

P Value ◽

Coronary Events ◽

Group 2 ◽

Group 1 ◽

Flow Velocities

Aim of the study was to identify the effects of myocardial revascularization on the prognosis in patients with altered coronary blood flow detected by transthoracic ultrasound.Material and Methods. Four hundred and twelve (412) patients were included in the study. The inclusion criterion was coronary velocity more than 70 cm/s during echocardiography. The study population was divided into three groups: Group 1 comprised patients with high velocities in the coronary arteries detected by ultrasound, in whom myocardial revascularization was performed; Group 2 comprised patients with high velocities in the coronary arteries, in whom myocardial revascularization was not performed and; the Control Group comprised patients with normal coronary blood flow according to ultrasound. The follow-up period was 10–11 months.Results. Seventeen (17) deaths (4.7%) occurred during follow-up. Death rates were 1.6 vs. 8.1 vs. 0% in Group 1, Group 2 and the Control Group, respectively, with a p-value for the difference between Group 1 and Group 2 (p1) of <0.009; and a p-value for the differences compared with the Control group (р2) of <0.03. Death, myocardial infarction, pulmonary edema, and acute coronary syndrome were observed in 27 patients (7.7% of the study group with accelerated blood flow). The rates of these outcomes were 4.9 vs. 11.0 vs. 0% in Group 1, Group 2, and the Control Group, respectively (p1<0.05; p2<0.006). Discussion. The study showed high rates of mortality or acute coronary events in the group of patients with pathologically high coronary flow velocities. The positive effects of revascularization on survival in this group were verified.Conclusions: 1. Left artery coronary flow velocities over 70 cm/s indicate a high probability of death or acute coronary events within 10.5 months.2. Myocardial revascularization has a significant positive effect on the survival rate and incidence of acute coronary events in patients with coronary artery flow velocities greater than 70 cm/s.3. Patients with high coronary blood flow velocities should be referred to coronary angiography or other diagnostic tests without waiting for clinical manifestations and specific symptoms for coronary artery disease.

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Possibilities of cardioselective beta - blocker bisoprolol therapy in patients having coronary artery disease and bronchial asthma

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.09.000268 ◽

2019 ◽

Vol 91 (9) ◽

pp. 26-31

Author(s):

N Y Grigorieva ◽

T P Ilyushina ◽

E M Yashina

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Calcium Antagonist ◽

Beta Blocker ◽

Ventricular Extrasystoles ◽

Group 3 ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim: to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). Materials and methods. The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. Results. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. Conclusion. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

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