Nebivolol effects on myocardial remodelling, inflammation markers and endothelial dysfunction in chronic heart failure patients with or without Type 2 diabetes mellitus
Abstract
In patients with chronic heart failure (CHF), persistent neuro-humoral activation of sympatho-adrenal system and hyperglycaemia facilitate the activation of pro-cytokine inflammation component, as one of the pathophysiological mechanisms of endothelial dysfunction (ED).
Aim. To study nebivolol effects on clinical and functional status, left ventricular (LV) myocardial remodelling, inflammation markers, and ED in CHF patients with or without Type 2 diabetes mellitus (DM-2).
Material and methods. The study included 65 patients with functional class (FC) I-III CHF (NYHA classification) of ischemic origin and LV ejection fraction (EF) <50%. Mean age was 61,2±7,4 years; 35 participants were
diagnosed with DM-2.
Results. Additional beneficial effects of nebivolol, such as endogenous NO synthesis modulation and immune inflammation reduction, could explain its clinical effectiveness and prognosis improvement in patients with CHF and DM-2, as well as in CHF patients with normal carbohydrate metabolism.
Conclusion. Hyperglycaemia has an important negative effect on anti-inflammatory defence mechanisms, CHF clinical course, and prognosis, which was demonstrated by high baseline levels of all clinical and hemodynamic parameters, inflammation markers, and ED in patients with CHF and DM-2.
About the Authors
Yu. N. Belenkov
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
E. V. Privalova
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
I. S. Chekneva
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
L. V. Knyazeva
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
N. S. Suleymanova
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
I. V. Vasilyeva
I.M. Sechenov First Moscow State Medical Institute
Russian Federation
Moscow
Russian Federation
Moscow
References
1. Czuriga I. Chronic heart failure — the epidemic of the 21st century. Orv Hetil 2005; 146 (20 Suppl): 1075-87.
2. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. Circulation 2009;119: e391-479.
3. Какорин С.В., Карамышев Д.В., Мкртумян А.М. острый инфаркт миокарда у больных сахарным диабетом 2 типа. Сердце 2010; 52(2): 97-101.
4. Carg R, Yusuf S. Overview of randomized trials of angiotensinconverting enzyme inhibitors on mortality and morbidity in patients with heart failure. JAMA 1995; 273: 1450-6.
5. Иванов С.Г., Ситникова М.Ю., Шляхто Е.В. Роль оксидативного стресса в развитии и прогрессировании хронической сердечной недостаточности: актуальность и возможность его коррекции. Кардиология СНГ 2006; 4: 267-70.
6. Pye M, Rae AP, Cobbe SM. Study of serum C-reactive protein concentration in cardiac failure. Br Heart J 1990; 63: 228-30.
7. Keith M, Geranmayegan A, Sole M, et al. Increased oxidative stress in patients with congestive heart failure. JACC 1998; 31: 1352-6.
8. Беленков Ю.Н., Агеев Ф.Т., Мареев В.Ю. Нейрогормоны и цитокины при сердечной недостаточности: новая теория старого заболевания? Серд недостат 2000; 4: 16-21.
9. Dzau VJ, Antman EM, Black HR, et al. The cardiovascular disease continuum validated: clinical evidence of improved patient outcomes: part I: Pathophysiology and clinical trial evidence (risk factors through stable coronary artery disease). Circulation 2006; 114(25): 2850-70.
10. Torre-Amione G. Immune activation in chronic heart failure. Am J Cardiol 2005; 95 (11A): 38C-40.
11. Агеев Ф.Т., Арутюнов Г.П., Беленков Ю.Н. идр. Хроническая сердечная недостаточность. Москва “ГЕОТАР-МЕДИА” 2010; 331 с.
12. Carswell EA, Old LJ, Kassel RL, et al. An endotoxin-indused serum factor that causes necrosis of tumor. Proc Natl Acad Sci USA 1975; 72: 3666-70.
13. Levine B, Kalman J, Mayer L, et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med 1990; 323: 236-41.
14. Teasta M, Yeh M, Lee P, et al. Circulating levels of cytokines and their endogenous modulators in patients with mild to severe congestive heart failure due to coronary artery disease or hypertension. JACC 1996; 28: 964-71.
15. Torre-Amione G, Kapadia S, Benedict C, et al. Proinflammatory cytokine levels in patients with depressed left ventricular ejection fraction: a report from of SOLVD. JACC 1996; 27: 1201-6.
16. Anker SD, Haehling S. Inflammatory mediators in chronic heart failure: an overview. Heart 2004; 90: 464-70.
17. Арутюнов Г.П., Былова Н.А., Дзидзария М.И. Синдром инсулинорезистентности и ХСН — нерешенная проблема. Серд недостат 2009; 53 (3):177-82.
18. Галактионов В. Г. Иммунология 2004. Москва “Академия” 2004; 520 с.
19. Fichtlscherer S, Breuer S, Heeschen C, et al. Interleukin-10 serum levels and systemic endothelial vasoreactivity in patients with coronary artery disease. JACC 2004; 44: 44-9.
20. Лутай М.И., Голикова И.П., Деяк С.И. и др. Взаимосвязь фактора Виллебранда с сосудодвигательной функцией эндотелия у больных с разной степенью выраженности атеросклероза венечных артерий. Институт кардиологии им. Н.Д. Стражеско АМН Украины. Киев 2003.
21. Закирова А.Н., Габидуллин Р.Р., Закирова Н.Э. Клиникогемодинамические эффекты карведилола, влияние на перикисное окисление липидов и маркеры воспаления у больных ИБС и ХСН. Серд недостат 2006; 1(7):14-6.
Review
For citations:
Belenkov Yu.N., Privalova E.V., Chekneva I.S., Knyazeva L.V., Suleymanova N.S., Vasilyeva I.V. Nebivolol effects on myocardial remodelling, inflammation markers and endothelial dysfunction in chronic heart failure patients with or without Type 2 diabetes mellitus. Cardiovascular Therapy and Prevention. 2011;10(1):66-72. (In Russ.)
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