Search

The aim of the study was to assess heart rate reduction for a acute decompensated heart failure in patients with reduced left ventricular systolic function and in patients with heart failure without significant reduction in ejection fraction. Were examined 79 patients with an ejection fraction less than 40%. 38 of them took If-channel blocker, ivabradine, 41 amounted to a control group. A group of patients with diastolic dysfunction was 48 patients (23 in the treatment of ivabradine and 25 subgroups of control). During the 14 days of observation it was found that the positive effect of reducing the sinus rate by ivabradine was observed in patients with diastolic dysfunction. In this group of patients on the background of decreasing heart rate, improves the passive diastolic properties of the left ventricle and an increase in the distance traveled by the patients during 6-minute walk test compared with the control group. The data obtained in our study support the use of ivabradine in patients with acute decompensated heart failure. The most significant changes in hemodynamic parameters and functional status were obtained in patients with diastolic dysfunction. Given the small sample, the results need to be further confirmed in larger clinical trials.

The investigation included 56 patients with MI of lower localization and acute left ventricle failure (ALVF). Group A included 33 patients with primary coronary balloon angioplasty (PCBAP), in group B there were 23 patients with MI and ALVF without revascularization. Group A was divided into 2 subgroups--A1 (patients with history of IM) and A2 (patients without previous MI). On the first and on the 14th days echocardiographic investigation was performed in all the patients. Ejection fraction (EF) of the LV in dynamics by the 14th day of the disease increased in group A from 32.8 +/- 1.8% to 36.1 +/- 1.6% (p0.05) at the expense of subgroup A2 (32.1 +/- 2.6% on the first day and 37.5% +/- 1.9 on the 14th day, p0.05), while in subgroup A1 there were no substantial changes of EF. In group B, on the contrary, there was decreased EF of the LV. Most of the group A patients had many injuries of the coronary bed vessels. After PCBAP of the right coronary artery (RCA) the increase of EF was followed by an improvement of the local contractility of the LV myocardium not only in the infarction zone, but also in the segments with ischemic dysfunction in which blood flows from the infarction-independent artery with its collateral filling from RCA.