Assessment of the impact of pharmacotherapy on the structural and functional heart indices in patients with chronic heart failure with middle range ejection fraction taking into account comorbid pathology


DOI: https://dx.doi.org/10.18565/therapy.2021.1.39-46

Gosteva E.V., Vasilieva L.V., Osipova O.A., Starodubtseva I. A., Suslova E.Yu.

1) N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of Russia; 2) Belgorod State National Research University
Abstract. The aim of the study was to identify the features of structural and functional remodeling of the myocardium in patients with chronic heart failure with middle ranger ejection fraction (CHF) depending on the presence of comorbid pathology and their correction based on long-term (12 months) pharmacotherapy.
Material and methods. The material for the study was a survey of 86 patients with ischemic heart failure, with an average age of 59,3±4,7 years. Depending on the presence of comorbid pathology (CP) they were divided into groups: Group 1 – ischemic CHF without CP (n=32 people); Group 2 – CHF of ischemic origin in the presence of CP (n=54 people). For 12 months, patients received basic pharmacotherapy of ischemic CHF, in accordance with the guidelines for the diagnosis and treatment of CHF (2017).
Results. In patients with CHF with comorbid pathology the degree of hypertrophy of the left ventricle (LV) increased, the mass of the myocardium increased by 10% (p <0,05), the thickness of the posterior LV wall increased by 15% (p <0,05), the interventricular septum increased by 14% (p <0,05), the relative thickness of the LV walls increased by 13% (p <0,05), the LV volume/mass index decreased by 10% (p <0,05), which indicates concentric remodeling left ventricle. The most pronounced dysfunction of the right ventricle (RV) was in patients with comorbid pathology. Improvement in the diastolic function of the pancreas was noted only against the background of combination therapy with nebivolol and eplerenone in the group of patients without CP. In the group of patients without CP who took a combination of nebivolol and eplerenone, the transition of all patients to the category of CHF with a preserved LV ejection fraction was noted.
Conclusion. The presence of comorbid pathology is an aggravating factor in patients with ischemic CHF. The most effective therapy was observed in patients without comorbid pathology in combination therapy with nebivolol and eplerenone.
Keywords: chronic heart failure, middle range ejection fraction, comorbid pathology
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About the Autors

Elena V. Gosteva, PhD, associate professor of the Department of propedeutics of internal medicine, N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of Russia. Address: 394036, Voronezh, 10 Studencheskaya Str. E- mail: yanavrn@yandex.ru. ORCID: 0000-0002-8771-2558
Lyudmila V. Vasilieva, MD, professor, head of the Department of propedeutics of internal medicine, N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of Russia. Address: 394036, Voronezh, 10 Studencheskaya Str. E-mail: ludmilvasil@mail.ru. ORCID: 0000-0002-9900-556X
Olga A. Osipova, MD, professor of the Department of Department of hospital therapy, Belgorod State National Research University. Address: 308015, Belgorod, 85 Pobedy Str. E-mail: osipova@bsu.cdu.ru. ORCID: 0000-0002-7321-6529
Irina A. Starodubtseva, MD, associate professor of the Department of propedeutics of internal medicine, N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of Russia. Address: 394036, Voronezh, 10 Studencheskaya Str. E-mail: starodubtsevairina1@gmail.com. ORCID: 0000-0002-4665-2966
Ekaterina Yu. Suslova, PhD, associate professor of the Department of propedeutics of internal medicine, N.N. Burdenko Voronezh State Medical University of the Ministry of Healthcare of Russia. Address: 394036, Voronezh, 10 Studencheskaya Str. E-mail: suslova_ekaterina2502@mail.ru. ORCID: 0000-002-5407-0384

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