Efficiency of beta-blockers in elderly patients with coronary heart disease complicated with chronic heart failure, with different titers of autoantibodies to β-adrenal receptors
Objective: to study the efficiency of beta-blocker therapy in patients with coronary heart disease complicated by heart failure, depending on the level of AABs to β-AR. Materials and methods: 70 patients aged 69.5±7.9 years were followed up, with coronary artery disease: stable angina of effort II-III EF, HF degree IIA, and hospitalized at the Cardiology Department of State Institution "Іnstitute of Gerontology named after D. Chebotarev of the NAMS of Ukraine". 10 healthy people aged 69.5±7.9 years served as controls. The period of follow-up was 12 months. Patients received a standard therapy including ACE inhibitors, BRAІІ, AK, diuretics, long-acting nitrates, beta-blockers if necessary. All patients have had high-resolution electrocardiography with registration of VLP, HRV, ECG, echocardiography, and a study of cardiotropic AABs using ELISA. Results. According to the results of determination of the level of AABs to β1-AR, all patients were divided into two groups. The first group consisted of patients with AABs to β1-AR, their amount representing 57.1%; the second group comprised patients with a negative amount of AABs to β1AR: 42.8%. According to the data obtained in patients with high titers of AABs to β1-AR, there was an increase in DAC, CRA, CSR, EDV and reduction of EF, UO, compared with patients who had normal titers of AABs to β1-AR, indicating more pronounced processes in this group of pathological LV remodeling. Based on HRV the ratio LF / HF in comparison groups in the active and passive period in the group with presence of AABs to β1-AR was 1.79±0.02 and 1.49±0.03, respectively; while in the group with normal titers of AABs to β1-AR, this indicator corresponded to 1.94±0.02 and 1.56±0.02. These findings suggest about decrease in sympathetic activity, which is an unfavorable prognostic marker and points out myocardial desensitization. There were no statistical differences in terms of electrical instability of the myocardium (disp.QT,VLP) in groups with and without AABs to β1-AR. According to results of beta-blocker therapy, in patients with high titers of AABs to β1-AR effi ciency of beta blockers was more pronounced, which manifested in an improvement of morphological and functional state of the myocardium: a decreased size of the cavities and increased LVEF. Conclusion. The article demonstrates the efficiency of beta-blocker therapy in patients with coronary heart disease complicated by heart failure, depending on the level of AABs to β-AR.