Dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the candesartan and ramipril therapy in patients with heart failure with preserved ejection fraction after myocardial infarction on the background of arter

Abstract

Abstract. Chronic heart failure (CHF) is actual medical problem around the world and in Ukraine. Almost 50% of these patients have heart failure with preserved ejection fraction. CHF is the result of many complications and cardiovascular disease, such as coronary heart disease, including myocardial infarction and hypertension. Despite the prevalence of heart failure with preserved ejection fraction a common strategy for the treatment of this disease has not yet been developed. This is due to the limited number of controlled studies in these patients. One of the most effective drugs in the treatment of heart failure with preserved ejection fraction after myocardial infarction are candesartan and ramipril. Determining the dynamics of GDF 15 and NTproBNP along with those of echocardiography is promising for evaluating the effectiveness of treatment of patients with heart failure with preserved ejection fraction after myocardial infarction in the background of arterial hypertension.

The aim of research. To determine the dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the ramipril and candesartan therapy in patients with heart failure and preserved ejection fraction after myocardial infarction on the background of arterial hypertension.

Materials and methods. 38 patients with heart failure with preserved left ventricular ejection fraction (EF>45%) after myocardial infarction with comorbidity arterial hypertension were included into the study. Dynamics of structural and functional changes of the heart and the levels of GDF 15 and NTproBNP on the ramipril and candesartan therapy for 12 weeks (mean age 64,3 ± 1,3 years) were investigated. Prescription myocardial infarction ranged from 2 months to 3 years. Patients were divided into 2 groups. The first group in addition to the basic treatment received candesartan (KASARK "Arterium", Ukraine) at a mean dose 18,5 ± 2,1 mg daily. Patients of the second group received ramipril (RAMIMED, «Medochemie Ltd.», Iceland/Cyprus) at a mean dose 5,8±0,6 mg daily.

Results. In patients receiving candesartan was observed decreased hypertrophy with significant thinning left ventricular walls, decreased  left ventricular mass index (5,4%, p<0,05), MVA (11,0%, p<0,05), increase E' (12,5%, p<0,05), reduction ratio E/E' (10,9%, p<0,05) and decreased left atrium volume index (12,0%, p<0,05).  Patients with ramipril therapy have significant thinning posterior left ventricular wall (6,7%, p<0,05), decreased  left ventricular mass index (5,9%, p<0,05) and left atrium volume index (10,1%, p<0,05). On the candesartan therapy for 12 weeks was observed a significant reduction the levels of GDF 15 (Δ (%)=-27±4,65) and NTproBNP (Δ(%)=-22±12,7) in serum. Patients with ramipril therapy also contributed to a significant decrease levels of GDF 15 (Δ (%)=-25±3,48) and NTproBNP (Δ(%)=-16±12,6). On the background of candesartan therapy was a significant increased the distance of the 6-minute walking test (26,1%; p<0,05). Ramipril therapy also led to a significant increased the distance of the 6-minute walking test (13,1%; p<0,05).

Conclusion. Intaking of the candesartan and ramipril contributed to decreasing LV. On the background of candesartan therapy was observed more substantial improvement of LV diastolic function with decreasing E/E' compared with ramipril. Candesartan and ramipril therapy led to a lowering of GDF 15 and NTproBNP, while the dynamics of NTproBNP in patients receiving candesartan was more significant. Candesartan and ramipril therapy provided to improve the clinical condition of patients.