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

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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.

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Гемодинамические и эндотелийпротективные эффекты b-адреноблокаторов у больных ишемической болезнью сердца, осложненной хронической сердечной недостаточностью и фибрилляцией предсердий

About the authors

A. N Zakirova

Bashkir State Medical University, Russian Agency for Health Care

Email: a.n.zakirova@yandex.ru

E. R Abdyukova

Bashkir State Medical University, Russian Agency for Health Care

N. E Zakirova

Bashkir State Medical University, Russian Agency for Health Care


  1. Беленков Ю.Н. ИБС как основная причина сердечной недостаточности. Сердеч. недостат. 2004; 5 (2): 77–8.
  2. Cleland J.G., Khand A, Clark A. The heart failure epidemic: exactly how big is it? Eur Heart J 2001; 22 (8): 623–6.
  3. Раков А.А., Хохлов А.Л., Федоров В.Н. и др. Фармакоэпидемиология хронической сердечной недостаточности у амбулаторных больных. Качеств. клин. практика. 2003; 2: 40–3.
  4. Komajda M., Lapuerta P, Hermans N et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 2005; 26 (16): 1653–9.
  5. Беленков Ю.Н., Мареев В.Ю. Лечение сердечной недостаточности в XXI веке: достижения, вопросы и уроки доказательной медицины. Кардиология. 2008; 2: 6–16.
  6. Ferrari R, Ceconi C, Curello S, Visioli O. The neuroendocrine and sympathetic nervous system in congestive heart failure. Eur Heart J 1998; 19 (Suppl. F): 45–51.
  7. Patten R.D., Udelson J.E., Konstam M.A. Ventricular remodeling and its prevention in the treatment of heart failure. Curr Opin Cardiol 1998; 13 (3): 162–7.
  8. Communal C, Singh K, Pimentel D.R., Colucci W.S. Noreperinephrine stimulates apoptosis in adult rat ventricular myocytes by activation of the beta - adrenergic pathways. Circulation 1988; 98 (13): 1329–34.
  9. Cannon R.O. Role of nitric oxide in cardiovascular disease: focus on the endothelium. Clin Chem 1998; 44: 1809–19.
  10. Vanhoutte P.M. Endothelial control of vasomotor function: from health to coronari disease. Circ J 2003; 67: 572–5.
  11. Oliveira G.H. Novel serologic markers of cardiovascular risk. Curr Atheroscler Rep 2005; 7: 148–54.
  12. Nakamura M. Peripheral vascular remodeling in chronic heart failure: clinical relevance and new conceptualization of its mechanisms. J Card Fail 1999; 5 (2): 127–38.
  13. Brevetti G et al. High levels of adhesion molecules are associated with impaired endothelium dependent vasodilation in patients with peripheral arterial disease. Thromb Haemost 2001; 85 (1): 63–6.
  14. Hoffmeister H.M., Buttcher E, Kozmaier S. Activation of inflammatory pathways in acute coronary syndromes. Eur Heart J 2000; 21: 650–6.
  15. Кушаковский М.С. Фибрилляция предсердий (причины, механизмы, клинические формы, лечение и профилактика). Спб.: ИКФ «Фолиант», 1999.
  16. Heinrich P. Mattle Long- Term Outcome after stroke due to Atrial Fibrillation. Cerebrovask Dis 2003; 6 (Suppl.): 3–8.
  17. Packer M, Coats A.J., Fowler M.B. et al. Effect of carvedilol on survival in severe heart failure. N Eng J Med 2001; 344 (22): 1651–8.
  18. Effect of carvedilol on outcome after myocardial infarction in patients with left - ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357: 1385–90.
  19. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT- HF). Lancet 1999; 353: 2001–7.
  20. Poole-Wilson P.A., Swedberg K, Cleland J.G. et al. Comparison of carvedilol and metoprolol in clinical outcomes in patients with chronic heart failure. Carvedilol or Metoprolol European Trial (COMET) randomized controllied trial. Lancet 2003; 362: 7–13.
  21. Закирова А.Н., Закирова Н.Э., Карамова И.М. и др. Влияние b-адреноблокаторов на ремоделирование миокарда, иммуновоспалительные реакции и дисфункцию эндотелия у больных ишемической болезнью сердца с хронической сердечной недостаточностью. Рационал. фармакотер. и кардиол. 2007; 4: 19–24.
  22. Лунева Е.Б., Никитин Н.П., Татарский Б.А., Clark A.L., Cleland J.G. Анатомические и функциональные изменения левого предсердия у пациентов с хронической сердечной недостаточностью и развившейся фибрилляцией предсердий. Вестн. аритмол. 2006; 46: 25–8.
  23. Dittrich H.C., Pearce L.A., Asinger R.W. et al. Left atrial diameter in nonvalvular atrial fibrillation: an echocardiographic study. Am Heart J 1999; 137: 494–9.
  24. Schotten U, Neuberger H.R., Allessie M.A. The role of atrial dilatation in the domestication of atrial fibrillation – Progress in Biophysics & Molecular Biology 2003; 82: 151–62.
  25. [Алмазов B.A.], Беркович О.А., Ситникова М.Ю. и др. Ишемическая болезнь сердца. Эндотелиальная дисфункция у больных с дебютом ишемической болезни сердца в разном возрасте. Кардиология. 2001; 5: 1–5.
  26. Лутай М.И. Разрыв атеросклеротической бляшки и его клинические последствия. Можно ли предотвратить коронарную катастрофу? Укр. кардiол. журн. 2002; 5: 45–9.
  27. Marui N, Offermann M.K., Swerlick R et al. Vascular cell adhesion molecule -1 (VCAM-1) gene transcription and exprission age regulated through an antioxidant – sensive mechanism in human vascular endothelial cells. J Clin Invest 1993; 92: 1866–74.
  28. Закирова Н.Э., Оганов Р.Г., Закирова А.Н. и др. Дисфункция эндотелия при ишемической болезни сердца. Рационал. фармакол. и кардиол. 2008; 4: 23–7.
  29. Hasper D, Hummel M, Kleber E.X. et al. Systemic inflammation in patients with heart failure. Eur Heart J 1998; 19: 761–5.

Copyright (c) 2010 Zakirova A.N., Abdyukova E.R., Zakirova N.E.

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