ANTIISCHEMIC AND ANTIARRHYTHMIC EFFECTS OF SIMVASTATIN IN PATIENTS WITH DIASTOLIC HEART FAILURE

Aim. To assess the dynamics of antiischemic and antiarrhythmic effects of the 6-month simvastatin therapy (20 mg/d) in patients with ischemic chronic heart failure (CHF), arterial hypertension, and preserved left ventricular (LV) ejection fraction. 

Material and methods. The study included 125 patients with diastolic dysfunction (impaired relaxation and pseudonormalisation): 66 patients receiving standard CHF treatment and simvastatin (the main group), plus 59 patients receiving only standard CHF treatment (the control group). Within the main group, antiischemic and antiarrhythmic effects of simvastatin were compared by the type of diastolicLVdysfunction. At baseline and after 6 months of the treatment, all participants underwent 24-hour electrocardiography monitoring. 

Results. According to the analyses of qualitative and quantitative parameters of transient myocardial ischemia, the main group demonstrated a reduction in the ischemia duration (–32,7%; p<0,001), the ST segment displacement area (–35,7%; p<0,001), and the number of ischemic episodes (–30,3%; p<0,001). Within the main group, a significant dynamics of these parameters was observed only among patients with impaired relaxation (–44,5%, —43,9%, and –36,2%, respectively; p<0,001). QTDc significantly decreased in the main group (–17,9%; p<0,05), with a non-significant tendency towards reduction in the control group (–13,3%; p>0,05). In patients with Type I and Type II diastolic heart failure (DHF), the QTDc reduction was similar (p<0,05). The number of supraventricular and ventricular extrasystoles significantly decreased in the main group (–24,5% and –27,9%, respectively; p<0,05), exclusively among patients with Type I DHF, in contrast to the control group. Pathologic values of heart rate turbulence (HRT) were observed in one-third of the patients from both groups. The simvastatin therapy was associated with a significant decrease (–20%) in the number of patients with pathologic HRT values, irrespectively of the DHF type. The TWA index significantly decreased only in the main group (–25,9%; p<0.05), with no marked difference by the DHF type. In the main group, parasympathetic parameters of heart rate variability significantly increased, while in the control group, these parameters significantly decreased. 

Conclusion. Simvastatin therapy was associated with a significant improvement of the key qualitative and quantitative parameters of transient myocardial ischemia, as well as with a marked antiarrhythmic effect.

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