EFFICACY ANALYSIS OF DIFFERENT ANTIANGINAL REGIMENS IN ISCHEMIC HEART DISEASE WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Aim. Assessment of effectiveness of different treatment regimens application for angina in coronary heart disease patients (CHD) with frequent exacerbations of chronic obstructive pulmonary disease (COPD).

Material and methods. Totally, 60 patients included, with CHD and COPD, with frequent exacerbations (2 and more per year). All patients received ivabradine, the I f -channels inhibitor (Coraxan). Taken the second antianginal drug, patients were selected into 2 groups: 1st group consisted of 30 patients, receiving together with basic CHD and COPD therapy Coraxan with trimetazidine (Preductal MB), 2nd group — 30 patients with inclusion of prolonged nitrates. All patients were monitored for clinical picture of CHD, Holter ECG, echocardiography and laboratory studies. Follow-up period — 6 months.

Results. After comparatory analysis, there was demonstrated significantly more prominent decrease of anginal attacks per day and times of short nitrates be taken (p<0,05), improvement of functional class (FC) of angina in patients receiving Coraxan with Preductal MB. By the end of follow-up, in the 1st group 20% of patients had I FC of angina, 53,3% — II FC, 26,7% — III FC. Patients from 2nd group had I GC in 6,7% cases, II FC — 33,3%, III — 60%. Holter monitoring analysis revealed the decrease 4,7 times the quantity of ventricular and 4,5 times supraventricular extrasystoles at the background of long-term intake of Coraxan and Preductal MB, significantly less prominent dynamics was shown in the 2nd group. Only in the group of Coraxan with Preductal MB, there was improvement of systolic and diastolic function of the left ventricle.

Conclusion. In CHD and COPD patients with common exacerbations it is feasible to apply antianginal therapy that includes Coraxan and Preductal MB, and that not only facilitates prominent decrease of clinical symptoms, improvement of life quality, but also helps to reduce heart rhythm disorders, improves systolic and diastolic left ventricle function, hence preventing cardiovascular complications.

1. Shal’nova SA, Konradi AO, Karpov JuA, et al. Analysis of mortality from cardiovascular disease in 12 regions of the Russian Federation participating in the study, “Epidemiology of cardiovascular disease in various regions of Russia.” Russ J Cardiol 2012; 5(97): 6-12. Russian (Шальнова С.А., Конради А.О., Карпов Ю.А. и др. Анализ смертности от сердечно-сосудистых заболеваний в 12 регионах Российской Федерации, участвующих в исследовании “Эпидемиология сердечно-сосудистых заболеваний в различных регионах России”. Российский кардиологический журнал 2012; 5(97): 6-12).

2. Global strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease (revision 2011). Ed. Belevsky AS. M.: Russian Respiratory Society 2012: р. 86. Russian (Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2011 г). Пер. с англ. под ред. А.С. Белевского. М.: Российское респираторное общество 2012: р. 86).

3. Flynn BC, Vernick WJ, Ellis JE. β-Blockade in the perioperative management of the patient with cardiac disease undergoing non-cardiac surgery. Br. J. Anaesth. 2011; 107: 113-5.

4. Fleischmann KE, Beckman JA, Buller CE, et al. 2009 ACCF/AHA focused update on perioperative beta blockade: a report of the American college of cardiology foundation/American heart association task force on practice guidelines. Circulation. 200924;120(21):21-3.

5. Onay-Besikci A, zkan SA. Trimetazidine Revisited: A Comprehensive Review of the Pharmacological Effects and Analytical Techniques for the Determination of Trimetazidine. Cardiovascular Therapeutics. 2008; 26(2): 147-65.

6. Global strategy for the diagnosis, treatment and prevention of chronic obstructive pulmonary disease (revision 2014). Ed. Belevsky AS. M.: Russian Respiratory Society 2014: р. 92. Russian (Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2014 г). Пер. с англ. под ред. А.С. Белевского. М.: Российское респираторное общество 2014: р. 92).

7. Astashkin EI. Correction of the energy metabolism in the myocardium — a new trend in the treatment of cardiovascular diseases. Heart and metabolism. 2008; 21: 1-3. Russian (Асташкин Е.И. Коррекция энергетического обмена в миокарде — новое направление в лечении сердечно-сосудистых заболеваний. Сердце и метаболизм. 2008; 21: 1-3.)

8. Shilov AM, Osija AO, Eremina IV, et al. The possibility of using drugs with metabolic oriented (trimetazidine) in the treatment of chronic heart failure. RMJ. 2010; 25: 1493-9. Russian (Шилов А.М.,Осия А.О.,Еремина И.В.и др. Возможности применения препаратов с метаболической направленностью (триметазидин) при лечении хронической сердечной недостаточности. РМЖ. 2010; 25: 1493-9.)

9. Hu B, Li W, Xu T, et al. Evaluation of Trimetazidine in Angina Pectoris by Echocardiography and Radionuclide Angiography: A Meta-Analysis of Randomized, Controlled Trials. Clin. Cardiol. 2011; 34 (6): 395-400.

10. Fang Y, Debunne M, Vercauteren M, et al. Heart rate reduction induced by the if current inhibitor ivabradine improves diastolic function and attenuates cardiac tissue hypoxia. J Cardiovasc Pharmacol. 2012;59(3):260-7.