scholarly journals Hemodynamic and endothelium-protective effects of β-adrenoblockers in patients with coronary heart disease complicated by chronic heart failure and atrial fibrillation

2010 ◽  
Vol 1 (1) ◽  
pp. 65-69
Author(s):  
A. N Zakirova ◽  
E. R Abdyukova ◽  
N. E Zakirova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Adhesion Molecules ◽  
Cellular Adhesion ◽  
Clinical State ◽  
Term Therapy ◽  
Protective Effects ◽  
Metoprolol Tartrate

Aim. To elucidate effect of b-adrenoblockers on remodeling of myocardium and adhesive function of endothelium in with ischemic heart disease with chronic heart failure (CHF) and addition of atrial fibrillation (AF). Material and methods. We included into the study 77 patients with functional class II–III CHF and AF of ischemic genesis randomized in 2 groups, In group 1 were included 40 patients who during 24 weeks used carvedilol at the background of basic therapy, in group 2–37 patients receiving metoprolol tartrate. In the work we used clinico-instrumental (echocardiography, test with 60 minute walk), immunoenzymatic (soluble intercellular adhesion molecules (sVCAM, SE – selectin) methods of investigation. Results. Application of both BAB improved clinical state and physical working capacity of patients with CHF and AF. Carvedilol more significantly than metoprolol tartrate prevented remodeling of myocardium, inhibited expression of cellular adhesion molecules. Levels of sE-selectin and VCAM-1 decreased under action of carvedilol. Conclusion. Carvedilol in long term therapy of CHF with AF exerts substantial influence on adhesive function of endothelium and improves hemodynamics.

The clinical course of atrial fibrillation in patients with coronary heart disease

2016 ◽  
Vol 94 (8) ◽  
pp. 591-595 ◽  
Author(s):  
V. I. Podzolkov ◽  
Aida I. Tarzimanova ◽  
R. G. Gataulin
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Clinical Course ◽  
History Of ◽  
Group 2 ◽  
Group 1

The modern medical literature practically does not contain clinical publications reporting studies of factors responsible for progression of atrial fibrillation (AF) in patients with coronary heart disease (CHD). It accounts for the importance of investigations into evolution of the clinical course of AF in such patients.Aim. To elucidate evolution of the clinical course of AF in patients with CHD in a long-term prospective study.Materials and methods. The study included. 112 patient aged 57-74 (mean 67.44±3.3) years with CHD and paroxysmal form of AF carried outfrom 2011 to 2015. Evolution of the clinical course of AF was evaluated based on the number of arrhythmic attacks during the last 3 months. The appearance ofprolonged persistent AF episodes or permanent AF was regarded as progression of arrhythmia.Results. During the 4 year study, 64 (57,2%) patients (group 1) did not experiencea rise in the frequency and duration of AF attacks. Progression of arrhythmia was documented in 48 (42,8%) of the 112 (100%) patients (group 2). These patients more frequently had the history of myocardial infarction and chronic heart failure than patients of group 1. The latter had the mean values of left ventricular (LV) ejection fraction 61,23±6,24%, i.e. significantly higher than 48,47±8,4% in group 2.47 and 28 % of the patients in group 2and 1 respectively suffered mitral regurgitation (p<0,05). Patients of group 2 had significantly more akineticzones. Intake of nitroglycerin in group 1 resulted in positive dynamics of local LV contractility that did not change in patients of group 2. Conclusion. 42,8% of the patients with CHD and paroxysmal form of AF experienced progression of arrhythmia into a persistent or permanent form. Predictors of AF progression in patients with CHD are the history of myocardial infarction, chronic heart failure, mitral regurgitation, and irreversible changes in local myocardial LV contraction.

scholarly journals Treatment optimization of beta-blockers in chronic heart failure therapy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yirga Legesse Niriayo ◽  
Solomon Weldegebreal Asgedom ◽  
Gebre Teklemariam Demoz ◽  
Kidu Gidey
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Ischemic Heart Disease ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Evidence Based ◽  
Heart Failure Therapy ◽  
Evidence Based Guidelines

Abstract Although evidence based guidelines recommend optimal use of beta blockers in all patients with chronic heart failure unless contraindicated, they are often underutilized and/or prescribed below the recommended dosage in the majority of patients with heart failure. To our knowledge, however, the optimal use of beta-blockers in chronic heart failure is not investigated in Ethiopia. Therefore, the aim of our study was to investigate the utilization and optimization of beta blockers in the management of patients with chronic heart failure in Ethiopia. A prospective observational study was conducted among ambulatory patients with chronic heart failure in Ethiopia. We included adult patients with a diagnosis of heart failure with a baseline left ventricular ejection fraction < 40% who had been on follow-up for at least 6 months. Patients were recruited into the study during their appointment for medication refilling using simple random sampling technique. All patients were followed for at least 6 months to determine the optimal use of beta blockers. The optimal use of beta blockers was determined according to evidence based guidelines. After explaining the purpose of the study, we obtained written informed consent from all participants. Data were collected through patient interview and review of patients’ medical records. Binary logistic regression analysis was performed to identify factors associated with utilization of beta blockers. A total of 288 patients were included in the study. Out of the total, 67% of the patients were receiving beta blockers. Among the patients who received beta blockers, 34.2% were taking guideline recommended beta blockers while 65.8% were taking atenolol, which is not guideline recommended beta blocker. Among the patients who received guideline recommended beta blockers, only 3% were taking optimal dose. Prior hospitalization [Adjusted Odds ratio (AOR) 0.38, 95% confidence interval (CI) 0.19–0.76], dose of furosemide > 40 mg (AOR 0.39, 95% CI 0.20–0.76), ischemic heart disease (AOR 3.27, 95% CI 1.66–6.45), atrial fibrillation (AOR 4.41, 95% CI 1.38–14.13) were significantly associated with the utilization of beta-blockers. Despite proven benefit, beta blockers were not optimally used in most of the participants in this study. The presence of ischemic heart disease and atrial fibrillation were positively associated with the utilization of beta blockers while hospitalization and higher diuretic dose were negatively associated with the utilization of beta blockers. Clinicians should attempt to use evidence based beta blockers at guideline recommended target doses that have been shown to have morbidity and mortality benefit in chronic heart failure. Moreover, more effort needs to be done to minimize the potentially modifiable risk factors for underutilization of beta blocker in chronic heart failure therapy.

scholarly journals Clinical Efficacy of Carvedilol In Treatment of Patients With Ischemic Heart Disease and Chronic Heart Failure

1970 ◽  
Vol 1 (2) ◽  
pp. 207-215
Author(s):  
A Jahan ◽  
SM Ureevna ◽  
SE Vladimirovich
Keyword(s):  
Oxidative Stress ◽  
Heart Failure ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Diastolic Function ◽  
Clinical Efficacy ◽  
Standard Therapy ◽  
Chronic Stable Angina ◽  
Term Therapy ◽  
History Of

Background: In the pathogenesis of CHF neurohormonal changes, in particular, changes of activity of sympathetic nervous system (SNS) occupies an important position. For this reason, researchers concentrated on the use β-blockers in therapy of patients with CHF. They reduce heart rate, improve diastolic function of the myocardium, reduce secretion of renin and restore the sensitivity of β- adrenoreceptors to its regulatory influences. We studied the influence of the 3<sup>rd</sup>generation betaadrenoblocker – Carvedilol in patients with CHF- including clinical efficacy and reduction of oxidative stress. Methods: The study was conducted in Saint-Petersburg State Medical University, from January 2000 to June 2000. 37 patients (33 male and 4 female) with CHF class III or IV despite receiving standard therapy of heart failure were enrolled in the study for the treatment with Carvedilol. All of the patients received Carvedilol for 6 months at a dose of 12.5-50mg/day with standard therapy of Heart Failure, which was not changed during next 6 months. Results: The average age of the patients was 56.8±2.3 years. The cause of CHF was IHD. 34 patients had chronic stable angina (CCS class II-IV). The majority of the patients had a history of myocardial infarction (91.8%); of these 73.5% of the patients had a history of repeated MI. Hypertension stage 2 and 3 was associated in 32.4% patients.Long-term therapy with Carvedilol led to improvement of the clinical status of the patients. After 6 months therapy with Carvedilol frequency of hospitalization was significantly reduced (1.36±0.23 vs. 0.33±0.1; p<0,01). The patients were symptomatically improved after 6 months therapy with Carvedilol. There was a tendency of reduction of LV mass by 12.1% (214.0±11.1 gm/m<sup>2</sup> vs. 188.1±10.8 gm/m<sup>2</sup>, p<0.05). After treatment with Carvedilol there was significant increase in LVEF by 10% (30.0±1.5% to 33.0±0.1%; p<0.01) and increase in fractional shortening of LV by 22.2% (from 17.25±1.14 vs. 21.09±1.25; p<0.01). There was a significant reduction in plasma MDA, indicator of oxidative stress, in comparison with the baseline data. Conclusion: Carvedilol therapy in patients with Chronic heart failure improves clinical symptoms of patients with improvement in systolic & diastolic function of LV. Carvedilol also reduces oxidative stress in patients with heart failure. Keywords: Carvedilol, Heart failure, Ischaemic heart disease DOI: http://dx.doi.org/10.3329/cardio.v1i2.8240 Cardiovasc. j. 2009; 1(2): 207-215

scholarly journals THE ROLE OF VASODILATION FACTORS IN THE PATHOGENESIS OF CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN IN ATRIAL FIBRILLATION

2021 ◽  
Author(s):  
V. I. Denesiuk ◽  
O. I. Afanasiuk ◽  
O. V. Denesiuk ◽  
N. O. Muzyka
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Heart Function ◽  
Nyha Classification ◽  
Stable Coronary Heart Disease ◽  
Comparative Group

The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression.

scholarly journals Hemodynamic and endotheliym-protective effects of beta-blockers in patients with chronic heart failure and atrial fibrillation ischemic origin

2020 ◽  
Vol 11 (2) ◽  
pp. 6-15
Author(s):  
Aliara N. Zakirova ◽  
Elvina R. Abdiukova ◽  
Vitalii V. Viktorov ◽  
Nelli E. Zakirova ◽  
Dinara F. Nizamova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Left Ventricle ◽  
Left Atrium ◽  
Contractile Function ◽  
Intercellular Adhesion ◽  
Metoprolol Tartrate ◽  
Basic Therapy ◽  
Left Ventricle Remodeling

Aim.To evaluate the effect ofb-blockers (BB) on myocardial remodeling and endothelial adhesive function in patients with chronic heart failure (CHF) and atrial fibrillation (AF) of ischemic origin. Material and methods.The study included 77 patients with functional class IIIII CHF and AF who had previously suffered a large-focalQ-myocardial infarction. Patients were randomized into 2 groups, comparable in clinical and instrumental characteristics and homogeneous in basic therapy of CHF and AF. Group 1 included 40 patients who took carvedilol for 24 weeks as part of the basic therapy of CHF and AF, and group 2 included 37 patients who received metoprolol tartrate. We used clinical and instrumental (echocardiography, 6-minute walking test, clinical assessment scale) and enzyme immunoassay (analysis of the level of soluble molecules of intercellular adhesion sVCAM-1 and sE-selectin) research methods. Results.The use of carvedilol a non-cardioselective BB that performsa1,b1andb2-adrenoblockade, andb1-selective, short- acting BB metoprolol tartrate as part of basic therapy improved the clinical condition and physical performance of patients with CHF and AF. It was found that carvedilol more significantly than metoprolol affects the state of intracardiac hemodynamics, slows down the processes of remodeling of the left atrium and left ventricle, increases the contractile function of the myocardium. Carvedilol as part of basic therapy reduces endothelial adhesion and inhibits the overexpression of intercellular adhesion molecules sVCAM-1 and sE-selectin, and when using metoprolol tartrate, there is only a tendency to decrease these indicators. Conclusion.Carvedilol as part of the basic therapy of CHF and AF has significant endothelial-protective and clinical-hemodynamic effects, positively affects the adhesive function of the endothelium and the processes of left atrium and left ventricle remodeling.

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