EARLY EFFECTS OF THE DRUG THERAPY OF LEFT VENTRICULAR SYSTOLIC DISFUNCTION IN PATIENTS WITH CHRONIC ARTERY DISEASE

Purpose: To compare the effects of the same resting heart rate using as a combination of ivabradine and bisoprolol (BS) and uptitration Bs on exercise tolerance, its chronotropic support of LV systolic function and NT proBNP in patients with chronic ischemic heart disease with moderate heart failure and systolic dysfunction of the left ventricle (LV). Methods: In this blind, parallel-group study included 52 patients aged <60 years (54 ± 2,3) with sinus rhythm> 70 beats per minute with coronary artery disease (stable angina CCS class I- II), to document infarction> 3 months mild hypertension and approximate 38-45% of the PV taking ACE inhibitors and BB 2.5 mg / d. In group 1 (n = 40) was dotitrovan BS to 5 mg / d and Iv was added (5 mg to 7 5 mg twice, 12,4 ± 0.49 mg / day), Group 2 (n = 38) BS titrated to 10 mg / d (9,1 ± 0.35 mg / d). At the beginning of the study (M0) and 2-months (M2), the patients underwent treadmill- test ? TT (Bruce protocol) was measured by ejection fraction, the velocity of the mitral annulus, the ratio of the flow rate to the speed of the ring (were rated E / E ‘) of using TDI and plasma NT proBNP was measured by ELISA. Results. Resting heart rate and systolic blood pressure were similar in both groups at M0 (78,6 ± 3,59 versus 81,4± ± 3,7 beats and 135,4 ± 5,8 versus 132,4 ± 5,8 mm Hg. In.) and M2 (66,4 ± 2,93 64,9 ± 2,91 against and beats against 124,2 ± 5,4 125,2 ± 5,7 mm Hg, p> 0, 05) . Fatigue and / or shortness of breath dominated the reasons for stopping the TT both groups at M0 (55% vs. 47.5%) and M2 (68.6% vs. 60%). Conclusions: In patients <60 years with coronary heart disease and moderately reduced vWF equivalent control heart rate at rest after 2 months, treatment with the combination of ivabradine and bisoprolol, compared with monotherapy with bisoprolol was associated with an improvement in exercise tolerance, despite the increase in chronotropic reserve and and improved systolic function in terms of tissue Doppler and decreased plasma NT proBNP in the absence of significant changes in ejection fraction.