Hemodynamic and endotheliym-protective effects of beta-blockers in patients with chronic heart failure and atrial fibrillation ischemic origin

Abstract

Aim.To evaluate the effect ofb-blockers (BB) on myocardial remodeling and endothelial adhesive function in patients with chronic heart failure (CHF) and atrial fibrillation (AF) of ischemic origin.
 Material and methods.The study included 77 patients with functional class IIIII CHF and AF who had previously suffered a large-focalQ-myocardial infarction. Patients were randomized into 2 groups, comparable in clinical and instrumental characteristics and homogeneous in basic therapy of CHF and AF. Group 1 included 40 patients who took carvedilol for 24 weeks as part of the basic therapy of CHF and AF, and group 2 included 37 patients who received metoprolol tartrate. We used clinical and instrumental (echocardiography, 6-minute walking test, clinical assessment scale) and enzyme immunoassay (analysis of the level of soluble molecules of intercellular adhesion sVCAM-1 and sE-selectin) research methods.
 Results.The use of carvedilol a non-cardioselective BB that performsa1,b1andb2-adrenoblockade, andb1-selective, short- acting BB metoprolol tartrate as part of basic therapy improved the clinical condition and physical performance of patients with CHF and AF. It was found that carvedilol more significantly than metoprolol affects the state of intracardiac hemodynamics, slows down the processes of remodeling of the left atrium and left ventricle, increases the contractile function of the myocardium. Carvedilol as part of basic therapy reduces endothelial adhesion and inhibits the overexpression of intercellular adhesion molecules sVCAM-1 and sE-selectin, and when using metoprolol tartrate, there is only a tendency to decrease these indicators.
 Conclusion.Carvedilol as part of the basic therapy of CHF and AF has significant endothelial-protective and clinical-hemodynamic effects, positively affects the adhesive function of the endothelium and the processes of left atrium and left ventricle remodeling.