HEART RATE CONTROL AND DIASTOLIC FUNCTION IN PATIENTS WITH PRESERVED SYSTOLIC FUNCTION OF THE LEFT VENTRICLE AFTER SURGICAL REVASCULARIZATION

Maharramova L. I.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Despite the use of conservative, invasive and surgical treatment methods, the inability to effectively manage the course of cardiovascular diseases (CVD) is still an urgent problem of modern medicine. Aim. To study the effect of heart rate control and surgical revascularization on diastolic function in patients with type 2 diabetes with preserved left ventricular systolic function. Methods. The study included 122 patients diagnosed with coronary artery disease who received comprehensive treatment. The diagnosis of coronary artery disease was confirmed on the basis of anamnesis, complaints, objective and instrumental methods of research. Among the instrumental methods of research selective coronarography occupied the main role. All patients underwent coronary artery bypass grafting (CABG). The studied patients were divided into two groups: 1st group 1 – 52 patients with coronary artery disease CHD without diabetes; 2nd group – 70 patients with coronary artery disease CHD and type 2 diabetes. From the 52 patients without diabetes, 29 patients received β-blockers (metoprolol 12.5-25 mg twice a day) and 23 patients a specific selective If-channel inhibitor – ivabradine (5-7.5 mg twice a day). From the 70 patients with diabetes, 32 patients received β-blockers (metoprolol 12.5-25 mg twice a day) аnd 38 patients ivabradine (5-7.5 mg twice a day). Results. Left ventricular diastolic dysfunction (LVDD) (85.7%) are more common in patients with type 2 diabetes than in patients without diabetes (65.3%). The results of echocardiographic studies performed at different stages of surgical revascularization showed that LVDD was partially reversible in both groups. Conclusion. Revascularization leads to a decrease in the degree of DD, to reduce the number of patients with LVDD and does not depend on the drugs selected for heart rate control.

cardiovascular diseases, heart rate, diastolic function, type 2 diabetes, ivabradine, β-blockers, surgical revascularization.

1. Bell D, Goncalves E. Heart failure in the patient with diabetes: Epidemiology, aetiology, prognosis, therapy and the effect of glucose-lowering medications. Diabetes Obes Metab. 2019;21(6):1277-90. DOI: 10.1111/dom.13652
2. Giugliano D, Meier J, Esposito K. Heart failure and type 2 diabetes: From cardiovascular outcome trials, with hope. Diabetes Obes Metab. 2019;21(5):1081-7. DOI: 10.1111/dom.13629
3. Rawshani A, Rawshani A, Franzén S, Sattar N, Eliasson B, Svensson AM, et al. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2018;379:633-44. DOI: 10.1056/NEJMoa1800256
4. Boyer JK, Thanigaraj S, Schechtman KB, Peґrez JE. Prevalence of Ventricular Diastolic Dysfunction in Asymptomatic, Normotensive Patients With Diabetes Mellitus. Am J Cardiol. 2004;93:870-5.
5. Shal’nova SA, Deev AD, Oganov RG. Chastota pul’sa i smertnost’ ot serdechno-sosudistyh zabolevanij u rossijskih muzhchin i zhenshhin. Rezul’taty jepidemiologicheskogo issledovanija. Kardiologija. 2005;10:45-50. [in Russian].
6. Petite S, Bishop B, Mauro V. Role of the Funny Current Inhibitor Ivabradine in Cardiac Pharmacotherapy: A Systematic Review. Am J Ther. 2018;25(2):e247-e266. DOI: 10.1097/MJT.0000000000000388
7. Palatini P, Benetos A, Grassi G, Julius S, Kjeldsen SE, Mancia G, et al. Identification and management of the hypertensive patient with elevated heart rate: statement of European Society of Hypertension Consensus Meeting. J Hypertens. 2006 Apr;24(4):603-10.
8. Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur Heart J. 2007 Oct;28(19):2375-414.
9. Karpov JuA, Deev AD. Programma AL’’TERNATIVA – issledovanie antianginal’noj jeffektivnosti i perenosimosti koraksana (ivabradina) i ocenka kachestva zhizni pacientov so stabil’noj stenokardiej: rezul’taty jepidemiologicheskogo jetapa. Kardiologija. 2008;5:30-5. [in Russian].
10. Fischer-Rasokat U, Honold J, Lochmann D, Wolter S, Liebetrau C, Fichtlscherer S, et al. β-Blockers and ivabradine differentially affect cardiopulmonary function and left ventricular filling index. Clin Res Cardiol. 2016;105(6):527-34. DOI: 10.1007/s00392-015-0950-0
11. Nawarskas J, Bowman B, Anderson J. Ivabradine: a unique and intriguing medication for treating cardiovascular disease. Cardiol Rev. 2015;23(4):201-11. DOI: 10.1097/CRD.0000000000000070
12. Tardif J, Ponikowski P, Kahan T. ASSOCIATE Investigators. Effects of ivabradine in patients with stable angina receiving β-blockers according to baseline heart rate: an analysis of the ASSOCIATE study. Int J Cardiol. 2013;168(2):789-94. DOI: 10.1016/j.ijcard.2012.10.011
13. Aboyans V, Frank M, Nubret K, Lacroix P, Laskar M. Heart rate and pulse pressure at rest are major prognostic markers of early postoperative complications after coronary bypass surgery. European Journal of Cardio-Thoracic Surgery. 2008;33(6):971-6. Available from: https:doi. org/10.1016/j.ejcts.2008.01.065
14. Barry A, Koshman S, Norris C, Ross D, Pearson G. Evaluation of Preventive Cardiovascular Pharmacotherapy after Coronary Artery Bypass Graft Surgery. Pharmacotherapy. 2014;34(5):464-72. DOI: 10.1002/phar.1380
15. Daci A, Bozalija A, Cavolli R, Alaj R, Beretta G, Krasniqi S. Pharmacotherapy Evaluation and Utilization in Coronary Artery Bypass Grafting Patients in Kosovo during the Period 2016-2017. Open Access Maced J Med Sci. 2018;6(3):498-505.

«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 151-155 pages, index UDK 616.12-005

10.29254/2077-4214-2020-1-155-151-155