2016


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2016/№1

Additional possibilities in treatment of ischemic heart disease complicated by chronic heart failure with low left ventricular ejection fraction

Ryabikhin E. A., Mozheyko M. E., Krasilnikova Yu. A., Savicheva S. V., Potanina M. V.
State Budgetary Institution of Yaroslavl Region Health Care, “Yaroslavl Regional Clinical Hospital for Military Veterans, the International Center for Issues of Seniors “Healthy Longevity”, Uglichskaya 40, Yaroslavl 150047

Keywords: IHD, treatment, CHF

DOI: 10.18087/rhfj.2016.1.2177

Background. IHD is often associated with impaired LV function. The proven effect of HF on prediction for IHD patients warrants evaluating effects of antianginal drugs with vasodilating activity on remodeling and prognostically important CHF parameters, such as LV systolic and diastolic dysfunction. Aim. To evaluate safety and efficacy of nicorandil therapy administered concurrently with optimum drug therapy for LV remodeling and function in patients with stable IHD complicated by CHF with low LV EF (HF-lEF). Materials and methods. The 48-week double blind, randomized, placebo-controlled study included 39 patients with FC III stable angina and HF-lEF (LV EF <45%). Patients were divided into two comparable groups of nicorandil and placebo treatment consisting of 19 and 20 patients, respectively. Patients of both groups received first-line drugs for stable IHD. EchoCG was performed using the ultrasound apparatus Toshiba Aplio 80 for all patients. Results. In the nicorandil treatment group, the number of angina attacks decreased starting from week 2 of therapy to 8.2±7.5 vs. 15.6±7.3 in the placebo group (р<0.0001). This difference remained until the end of study (week 48) –8.5±6.8 vs. 13.8±7.4, respectively (р<0.0001). At the end of study, requirement for short-acting nitrates was 3.9±2.4 in the nicorandil treatment group vs. 5.8±3.9 in the placebo group (р<0.05). By week 48 in the nicorandil group, LV ESV decreased by 12.3 % (р<0.05), LV EF increased by 14.5 % (р<0.05), and LV EDV and left atrial (LA) dimension showed a tendency to decrease. In the placebo group, no significant changes were observed, and tendencies of the above-mentioned EchoCG parameters were opposite. In addition, in the nicorandil group, the ratio of transmitral diastolic flow peak velocities, Е / А changed by 12.5 % (р<0.05); significant changes were absent in the placebo group. For 12 months of the study, requirement for hospitalization for decompensated CHF was 2 (10 %) cases in the placebo group while in the nicorandil group, there were no hospitalizations for decompensated CHF. Administration of nicorandil was not associated with serious adverse events in any of the patients. Conclusion. In patients with stable IHD complicated by HF-lEF, addition of nicorandil to first-line drugs reduced the number of angina attacks and requirement for short-acting nitrates, and exerted a beneficial effect on prognostically important EchoCG parameters – increased LV EF and reduced LV remodeling.
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Ryabikhin E. A., Mozheyko M. E., Krasilnikova Yu. A., Savicheva S. V., Potanina M. V. Additional possibilities in treatment of ischemic heart disease complicated by chronic heart failure with low left ventricular ejection fraction. Russian Heart Failure Journal. 2016;17 (1):3–9

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