rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2009-5-3-31-35rpcardio-659Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯEFFICACY OF IVABRADINE AND VERAPAMIL IN PATIENTS WITH DIASTOLIC HEART FAILURE CAUSED BY LEFT VENTRICLE IMPAIRED RELAXATIONСРАВНИТЕЛЬНАЯ ЭФФЕКТИВНОСТЬ ИВАБРАДИНА И ВЕРАПАМИЛА У БОЛЬНЫХ С ДИАСТОЛИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ВСЛЕДСТВИЕ НАРУШЕННОЙ РЕЛАКСАЦИИ ЛЕВОГО ЖЕЛУДОЧКААдамянК. Г.AdamyanK. G.

Ереван 0044, ул. П.Севака, 5

ul. P. Sevaka 5, Erevan 0044

ЧилингарянА. Л.ChilingarianA. L.

Ереван 0044, ул. П.Севака, 5

ul. P. Sevaka 5, Erevan 0044

aramchil@gmail.comНаучно-исследовательский институт кардиологииАрменияResearch Institute for CardiologyArmenia200910012016533135Copyright © Adamyan K.G., Chilingarian A.L., 20162016Адамян К.Г., Чилингарян А.Л.Adamyan K.G., Chilingarian A.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/659Aim

Aim. To compare ivabradine (IB) and verapamil (VP) effects on left ventricle (LV) diastolic function in patients with diastolic heart failure (DHF) caused by left ventricle impaired relaxation.

Methods

Methods. It was comparative randomized study. 238 patients (190 men, 48 women; aged 63±10 y.o.) with DHF were randomized in two groups to receive IB (7,5 mg bid, n=119) or VP (240 mg o.d., n=119). Echocardiography (EchoCG) indices, total ischemic burden (TIB) and N-terminal fragment of pro-brain natriuretic peptide (NT-pro-BNP) were evaluated initially and after 1, 3, 6 and 12 months of therapy.

Results

Results. After 3 months of therapy some EchoCG parameters (E/A, transmitral E wave deceleration time [EDT]) as well as TIB improved more significantly in IB group. After 6 months in IB group in comparison with VP group additional differences appeared (midwall fractional shortening; E/Em of lateral mitral annulus – 8,6±4,7 and 12,3±4,7, respectively, p<0,05; NT-pro-BNP – 91,7±4,3 pg/ml and 128±7,6 pg/ml, respectively, p<0.01) or became stronger (TIB, E/A and EDT). The differences persisted after 12 months of follow up. Besides a number of patients required hospitalization were less in IB group in comparison with VP group (11 vs 19, respectively, p<0.05).

Conclusion

Conclusion. Both IB and VP improved diastolic function and reduced heart rate, ischemia time, NT-pro-BNP levels and hospitalization rate in patients with DHF. However, IB compared with VP has more prominent effect on these parameters. 

Цель

Цель. Сравнить влияние ивабрадина (ИБ) и верапамила (ВП) на диастолическую функцию левого желудочка (ЛЖ) у пациентов с диастолической сердечной недостаточностью (ДСН).

Материал и методы

Материал и методы. Обследовано 238 пациентов (190 мужчин и 48 женщин; средний возраст 63±10 лет) с ДСН и фракцией выброса (ФВ) ЛЖ ≥ 50%. Пациенты рандомизированы в группы приема ИБ (7,5 мг дважды в день) и ВП (240 мг/день). Исходно и через 1, 3, 6 и 12 мес оценивали эхокардиографические параметры, а также общее ишемическое время (ОИВ) и уровень N-терминального фрагмента мозгового натрийуретического пептида (NT-pro-BNP).

Результаты

Результаты. На фоне терапии отмечено достоверное улучшение диастолической функции ЛЖ (увеличение Е/А, уменьшение времени спада волны Е [ВСЕ]), ОИВ, а также улучшение сократимости ЛЖ (увеличение фракции укорочения свободной стенки, снижение Е/Еm и уровней NT-pro-BNP). У пациентов, принимавших ИБ, динамика показателей была выражена в большей степени. Через 12 мес наблюдения сохранялась достоверная разница в изучаемых показателях, однако отмечено увеличение разницы в параметрах диастолического расслабления в пользу ИБ: ВСЕ - 262±11 и 282±15 мс, время изоволюметрического расслабления ЛЖ - 75±5 и 84±7 мс, Е/А 1,0 и 0,55 (р<0,01), соответственно, при лечении ИБ и ВП. Меньшая частота госпитализаций была в группе ИБ (11 больных против 19 больных при лечении ВП, р<0,05).

Заключение

Заключение. ИБ и ВП улучшают диастолическую функцию ЛЖ, урежают частоту сердечных сокращений, уменьшают время ишемии миокарда и уровни NT-pro-BNP у пациентов с ДСН. ИБ в сравнении с ВП эффективнее действует на вышеуказанные параметры.

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The authors declare that there are no conflicts of interest present.