Effects of Bisoprolol and Carvedilol on Left Ventricular Remodeling in Patients with Chronic Heart Failure

T. A. Alieva¹; D.K.Avezov, PhD¹; U.K. Kamilova, PhD, ScD²

¹Tashkent Medical Academy; ²The Republican Specialized Scientific-Practical Medical Centre of Therapy and Medical Rehabilitation; Tashkent, Uzbekistan

*Corresponding author: Umida K. Kamilova, PhD, ScD. The Republican Specialized Scientific - Practical Medical Centre of Therapy and Medical Rehabilitation; Tashkent, Uzbekistan. E-mail: umida_kamilova@mail.ru

Abstract: 

The purpose of the present  research was to study the types of LV remodeling in post-MI patients with CHF and assess the impact of bisoprolol and carvedilol on LV remodeling.

Material and Methods: The study included 217 post-MI patients with CHF between the ages of 38 and 60 (mean age 50.6±6.8 yrs) who were treated at the cardiology department of Tashkent Medical Academy. NYHA functional class (FC) of CHF was determined by the 6-minute walk test (6MWT). All the patients were divided into two groups. Group 1 consisted of 107 post-MI patients with FC I-III, who received bisoprolol on the background of basic therapy during 6 months; Group 2 consisted of 110 post-MI patients with FC I-III, who received carvedilol on the background of basic therapy during 6 months. The mean daily dose of bisoprolol was 10 mg, and carvedilol. 25-50 mg. All patients underwent clinical examination, ECG, and echocardiography.

Result: Reverse remodeling and improvement in left ventricular function was observed in both groups, with a slight advantage in the bisoprolol group. There was a decrease in the number of patients with prognostically unfavorable types of remodeling (eccentric and concentric LVH) and restoration of normal LV geometry.

Keywords: 
chronic heart failure; left ventricular remodeling, bisoprolol; carvedilol.
References: 
  1. Arutyunov AG, Rylova AK, Arutyunov GP. Register of the hospitalized patients with circulatory insufficiency (Pavlov’s register). Post 1. Modern clinical characteristics of patients with circulatory insufficiency. Clinical phenotypes of patients. Serd Ned 2014; 4:135-141. [Article in Russian]
  2. Sitnikov MYu, Lyasnikova EA, Trukshina MA. Chronic heart failure: epidemiology and perspectives of management. Serd Ned 2012; 6:372-376. [Article in Russian].
  3. Hobbs FD, Roalfe AK, Davis RC, Davies MK, Hare R. Prognosis of all-cause heart failure and borderline left ventricular systolic dysfunction: 5 year mortality follow-up of the Echocardiographic Heart of England Screening Study (ECHOES). Eur Heart J 2007; 28(9):1128-34.     
  4. O'Connor CM, Abraham WT, Albert NM, Clare R, Gattis Stough W, Gheorghiade M, et al. Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J 2008;156(4):662–673.
  5. Arutyunov AG. Is there new approaches to emergency treatment of CHF decompensation? The complexity of the endpoints assessment. Serd Ned 2009; 5: 254-58. [Article in Russian].
  6. National guidelines for diagnosis and treatment of chronic heart failure (4th revision). Serd Ned 2013;81:4-64. [in Russian].
  7. Cleland JG, Pennell DJ, Ray SG, Coats AJ, Macfarlane PW, Murray GD, et al. Myocardial viability as a determinant of the ejection fraction response to carvedilol in patients with heart failure (CHRISTMAS trial): randomised controlled trial. Lancet 2003; 362:14–21.
  8. Gaasch WH, Delorey DE, St John Sutton MG, Zile MR. Patterns of structural and functional remodeling of the left ventricle in chronic heart failure. Am J Cardiol 2008; 102(4):459-62.
  9. Sirkin AL, Dobrovolsky AV. Place of bisoprolol in the treatment of diseases of the cardiovascular system. Rus Med Zh  2010; 18:1352-55. [Article in Russian].
  10. Colucci WS, Kolias TJ, Adams KF, Armstrong WF, Ghali JK, Gottlieb SS, et al. Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: The REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial. Circulation  2007;116(1):49-56. 
  11. Glaser MG, Astashkin EI Sokolova. The role of drugs with negative chronotropic effect in the treatment of patients with coronary artery disease and heart failure. Kardiovask Ter Profilactika 2013;5:81-6. [Article in Russian].
  12. Wikstrand J, Wedel H, Castagno D, McMurray JJ. The large-scale placebo-controlled beta-blocker studies in systolic heart failure revisited: results from CIBIS-II, COPERNICUS and SENIORS-SHF compared with stratified subsets from MERIT-HF. J Intern Med 2014;275(2):134–43.
  13. Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantification of the left ventricle by two-dimensional echocardiography: American Society of Echocardiography Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 1989; 2:358–367.
  14. Sahn DJ, Demaria A, Kisslo J, Weyman A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58:1072–1083.
  15. Devereux RB, Reichek N. Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1979; 70: 1308–1316.
  16. Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, Reichek N. Echocardiographic assessment of left ventricular hypertrophy: comparison with necropsy findings. Am J Cardiol 1986; 57: 450–458.

The fully formatted PDF version is available.

Download Article

IJBM 2014; 4(4) Suppl 1:S34-S37. © 2014 International Medical Research and Development Corporation. All rights reserved.