2015


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2015/№4

Effect of long-term treatment with lisinopril and carvedilol on patients after unstable angina at rest

Strutynsky A. V., Kallaeva A. N., Banzelyuk E. N., Gazieva P. A., Glazunov A. B., Baranov A. P., Trishina V. V., Golubev Yu. Yu., Golubeva G. Yu.
State Budgetary Educational Institution of Higher Professional Education, “N. I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997

Keywords: carvedilol, lisinopril, instable angina, remodeling, segmental left ventricular electrical activity

DOI: 10.18087 / rhfj.2015.4.2099

Background. According to data from clinical studies, severe attacks of UA at rest considerably increase the risk of MI, sudden cardiac death, and CHF progression in patients with IHD and AH. At the same time, data on features of structural geometrical and functional LV remodeling, which largely determine prognosis in such patients, and effects of long-term ACEI and BB treatment on these changes are scarce in the literature. Aim. To study the effect of long-term treatment with an ACEI, lisinopril, and a vasodilatory α1-, β1, 2-adrenoblocker, carvedilol, on ischemic remodeling and segmental LV electric activity in patients with IHD and AH after severe attacks of UA at rest. Materials and methods. The study included 122 patients with IHD and AH after class IIB-III UA at rest according to the C.W. Hamm and E. Braunwald classification. 62 of these patients (main group) received lisinopril and carvedilol for 2 years after the stay in hospital. The control group consisted of 60 patients who were managed without these drugs. The study used standard methods of EchoCG, Holter 24-h ECG monitoring, 6-min walk test, SPECT, and an original method for evaluation of segmental LV electric activity using automatic multipolar ECG heart mapping with a Predictor BSM-32 instrument (USA). Results. Rapid progression of LV ischemic remodeling was observed in patients of the control group with IHD and AH after UA at rest. This remodeling was associated with progressive LV hypertrophy, LV spherization, increased LV dimensions, decreased LV systolic and diastolic function, and increased risk for MI, new UA episodes, and fatal outcome. These changes were associated with considerable disorders of segmental LV electric activity. Long-term, systematic treatment with lisinopril and carvedilol allows in most cases significantly slowing the process of LV ischemic remodeling and alleviate disorders of segmental electric activity to provide reverse development of LV hypertrophy, improve LV systolic and diastolic function, and reduce the risk for adverse coronary events and CHF progression. Conclusion. Long-term, systematic lisinopril and carvedilol treatment of patients who have had UA at rest reduces the risk for further unfavorable development of UA, repeated acute disorders of coronary circulation, CHF progression, and fatal outcomes.
  1. Hamm CW, Braunwald E. A classification of unstable angina revi­sited. Circulation. 2000 Jul 4;102 (1):118–22.
  2. Оганов Р. Г., Агапов А. А., Акчурин Р. С., Алекян Б. Г., Беленков Ю. Н., Волкова Э. Г. и др. Национальные рекомендации по лечению острого коронарного синдрома без стойкого подъема ST на ЭКГ. Кардиоваскулярная терапия и профилактика. 2006;5 (Прил. 1):411–40.
  3. Агмадова З. М., Каллаева А. Н. Особенности прогрессирования ремоделирования миокарда у больных с различными формами нестабильной стенокардии. Кардиология. 2014;54 (7):9–16.
  4. Bugiardini R, Pozzati A, Borghi A, Morgagni GL, Ottani F, Muzi A, Puddu P. Angiographic morphology in unstable angina and its relation to transient myocardial ischemia and hospital outcome. Am J Cardiol. 1991 Mar 1;67 (6):460–4.
  5. Закирова А. Н., Оганов Р. Г., Закирова Н. Э., Клочкова Г. Р., Мусина Ф. С. Ремоделирование миокарда при ишемической болезни сердца. Рациональная фармакотерапия в кардиологии. 2009;5 (1):42–5.
  6. Бузиашвили Ю. И., Ключников И. В., Мелконян А. М., Иноземцева Е. В., Коваленко О. А., Мамаев Х. К. Ишемическое ремоделирование левого желудочка (определение, патогенез, диагностика, медикаментозная и хирургическая коррекция). Кардиология. 2002;42 (10):88–94.
  7. Васюк Ю. А., Козина А. А., Ющук Е. Н., Нестерова Е. А., Садулаева И. А., Мартынов А. И. Особенности диастолической функции и ремоделирования левого желудочка у больных артериальной гипертензией и ишемической болезнью сердца. Журнал Сердечная Недостаточность. 2003;4 (4):190–2.
  8. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS et al. ACC / AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Unstable Angina). J Am Coll Cardiol. 2000 Sep;36 (3):970–1062.
  9. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure: US Carvedilol Heart Failure Study Group. N Engl J Med. 1996 May 23;334 (21):1349–55.
  10. Cleland JG, Pennell DJ, Ray SG, Coats AJ, Macfarlane PW, Murray GD et al. Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial. Lancet. 2003 Jul 5;362 (9377):14–21.
  11. Katus HA, Tendera M, Mohacsi P Rouleau JL, Fowler MB, Coats AJ et al. Effect of carvedilol on major clinical events in patients with severe heart failure and an extremely depressed ejection fraction: results of the COPERNICUS study J Am Coll Cardiol. 2002; 39 (s1):155–155.
  12. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001 May 5;357 (9266):1385–90.
  13. Krum H, Roecker EB, Mohacsi P, Rouleau JL, Tendera M, Coats AJ et al. Effects of initiating carvedilol in patients with severe heart failure: results from the COPERNICUS study. JAMA. 2003 Feb 12;289 (6):712–8.
  14. Yamamoto K, Origasa H, Hori M. Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese Diastolic Heart Failure Study (J-DHF). Eur J Heart Fail. 2013 Jan;15 (1):110–8.
  15. Струтынский А. В., Глазунов А. Б., Бакаев Р. Г., Банзелюк Е. Н., Ряузова Е. Г., Рейснер А. А. и др. Возможности многополюсного поверхностного ЭКГ-картирования сердца в выявлении электрической негомогенности миокарда у больных с желудочковыми аритмиями. Сердце. 2008;7 (5):294–8.
  16. Струтынский А. В., Глазунов А. Б., Банзелюк Е. Н. Современные методы электрокардиографической диагностики электрической нестабильности и негомогенности миокарда. Сердце. 2010;9 (6):377–83.
  17. Струтынский А. В., Глазунов А. Б., Банзелюк Е. Н., Воронина М. А., Горбачёва Е. В., Серова И. Н., Трушина И. Ю. ЭКГ. Роль и место в XXI веке. Диагностика нарушений перфузии миокарда. Сердце. 2011;10 (1):43–52.
  18. Беленков Ю. Н. Ремоделирование левого желудочка: комплексный подход. Журнал Сердечная Недостаточность. 2002;4 (14):161–3.
  19. Журавлева М. В. Карведилол – эффективное средство терапии сердечной недостаточности. Фарматека. 2004;2 (81):16–26.
  20. Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance: are they interchangeable? Eur Heart J. 2000 Aug;21 (16):1387–96.
Strutynsky A. V., Kallaeva A. N., Banzelyuk E. N., Gazieva P. A., Glazunov A. B., Baranov A. P. et al. Effect of long-term treatment with lisinopril and carvedilol on patients after unstable angina at rest. Russian Heart Failure Journal. 2015;16 (4):224–233

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