RU2364401C1 - Method of vascular remodelling correction in patients suffering from chronic ischemic cardiac insufficiency - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to cardiology, and concerns vascular remodelling correction in patients suffering from chronic ischemic cardiac insufficiency. It is ensured by conventional pharmacotherapy involving ACE inhibitors, beta-blocker, aspirin and statin combined with introduction of Ivabradine in a daily dose 5-15 mg two-intake a day, within 6 months.

EFFECT: method provides effective vascular remodelling ensured by reduced vessel wall stiffness.

2 ex, 1 tbl

Description

The invention relates to medicine, namely to cardiology and can be used to correct vascular remodeling in patients with chronic heart failure (CHF) of ischemic etiology.

There are various methods for the correction of vascular remodeling in patients with chronic heart failure of ischemic etiology using various pharmacological effects (angiotensin converting enzyme inhibitors (ACE inhibitors), diuretics, beta-blockers, angiotensin II receptor antagonists, calcium antagonists, statins, etc.) (V. Lopatin. , Ilyukhin OV Vascular stiffness control. Clinical significance and correction methods. // Heart - 2007, Volume 6, No. 3 (35), pp. 128-132).

Disadvantages: lack of effectiveness.

Effect: increasing the efficiency of treatment of patients with chronic heart failure of ischemic etiology.

The task is achieved through the use of ivabradine in the treatment of chronic heart failure of ischemic etiology.

Ivabradine (Coraxan, Servier, France) is a new antianginal and anti-ischemic drug that affects heart rate by inhibiting the I _f channels of the sinus node cells. This drug has not previously been used to correct vascular remodeling.

The method is as follows. Patients with stable angina pectoris II-III functional class (FC), complicated by CHF II-III FC with standard drug therapy, including ACE inhibitors perindopril 4-8 mg per day, beta-blocker bisoprolol 2.5-5 mg per day, aspirin 75 mg per day and simvastatin 20-40 mg per day, ivabradine is additionally prescribed in a daily dose of 5-15 mg (6.21 ± 2.05 mg) in 2 doses, taking into account the initial heart rate (HR) and subsequent dose titration in accordance with with the dynamics of heart rate. The duration of ivabradine therapy is 6 months.

Before and after treatment, all patients underwent sphygmoplethysmography on a VaSera VS-1000 instrument (Fucuda Denshi, Japan). The device measures and automatically detects blood pressure by the oscillometric method, which has a high correlation with the Doppler measurement technique; plethysmograms on 4 limbs (using cuffs); ECG and FCG. The informativeness and clinical significance of the following indicators were evaluated: pulse wave propagation velocity (SRWP) on the right and left (R-PWV, L-PWV); cardio-ankle-vascular index (CAVI1); PWV - PWV of the aorta; gain index of systolic blood pressure (R-AI - an indicator of brachial plethysmogram).

The novelty of the method lies in the use of ivabradine in a daily dose of 5-15 mg (6.21 ± 2.05 mg) in 2 divided doses daily against standard therapy for 6 months to correct vascular remodeling in patients with chronic heart failure of ischemic etiology.

The drug ivabradine for the correction of vascular remodeling has not been previously used.

Examples of specific application.

Example 1

Patient S.L.A., 65 years old, diagnosis: IHD. PEAKS (1988). Angina pectoris III FC. CHF IIA / III FC.

Before treatment with sphygmoplethysmography, the following data were obtained: R-PWV - 16.3 m / s, L-PWV - 16.5 m / s, CAVI1 - 13.9, which exceeds the age norm; R-AI - 1.18. On the background of complex therapy, including perindopril 8 mg per day, bisoprolol 5 mg per day, aspirin 75 mg per day, simvastatin 20 mg per day, in combination with ivabradine 5 mg 2 times a day after 6 months, the following results were obtained: R- PWV and L-PWV returned to normal and amounted to 13.3 m / s and 13.5 m / s, respectively, the true stiffness of the arteries decreased by 51% and amounted to CAVI1 - 6.8, R-AI was 1.08. In addition, against the background of complex therapy in combination with ivabradine, the patient noted a reduction in angina attacks and increased exercise tolerance.

Example 2

Patient S.M.V., 60 years old, diagnosis: IHD. Angina pectoris II FC. CHF IIA / II FC.

Before treatment with sphygmoplethysmography, the following data were obtained: R-PWV - 14.7 m / s, L-PWV - 14.7 m / s, CAVI1 - 10.5, PWV of the aorta - 9.6 m / s, which exceeds age norm, R-AI - 1.57. After 6 months of treatment with ivabradine (dose 5 mg 2 times a day) on the background of standard therapy, including perindopril 8 mg per day, bisoprolol 2.5 mg per day, aspirin 75 mg per day, simvastatin 20 mg per day, the following results were obtained: R-PWV and L-PWV returned to normal and amounted to 13.1 m / s and 13.5 m / s, respectively, the true stiffness of the arteries (CAVI1) decreased to 8.3, PWV of the aorta decreased by 50% and amounted to 4.7 m / s, R-AI was 1.16. In addition, against the background of complex therapy with ivabradine, the patient noted a reduction in angina attacks and increased exercise tolerance.

The observation of 17 patients with chronic heart failure of ischemic etiology during a 6-month treatment with ivabradine in complex therapy showed that when taking the drug there was a significant positive dynamics in the clinical manifestations of heart failure, an improvement in the stiffness of the arterial wall was noted.

Table 1 The dynamics of arterial wall stiffness during treatment with ivabradine (n = 15).

Indicator Originally After treatment R R-PWV, m / s 13.87 ± 1.71 12.64 ± 1.6 0,03 L-PWV, m / s 13.88 ± 1.79 12.5 ± 1.96 0,03 CAVI1 9.26 ± 1.95 7.59 ± 1.18 0.005 PWV of the aorta, m / s 8.18 ± 3.63 4.74 ± 1.27 0.003 R-AI 1.26 ± 0.21 1.01 ± 0.23 0.001

The positive effect of using the proposed method is manifested in the correction of vascular remodeling in patients with CHF of ischemic etiology and an increase in the effectiveness of treatment of CHF.

Claims (1)

A method for the correction of vascular remodeling in patients with chronic heart failure of ischemic etiology using standard drug therapy consisting of ACE inhibitors, beta-blocker, aspirin and statin, characterized in that the patient is additionally prescribed ivabradine in a daily dose of 5-15 mg in 2 doses daily, for 6 month