EVALUATION OF EFFECTS OF AZILSARTAN MEDOXOMIL AND EPLERENONE ON CLINICAL-HEMODYNAMIC AND SOME NEUROHUMORAL FACTORS IN TREATMENT OF DIFFERENT HEMODYNAMIC PHENOTYPES OF CHRONIC HEART FAILURE

Qurbonov ?. ?.*, Gadayev ?. G., Nurillaeva N. M. and Turakulov R. I.

ABSTRACT

The aim of the study was to evaluate effects of angiotensin (АТ) II АТ1 – receptor antagonist representative azilsartan medoxomil and mineralocorticoid receptor antagonist eplerenone to clinical-hemodynamic indexes and serum levels of gelectin-3 and aldosterone in different hemodynamic phenotypes of chronic heart failure patients. The study involved 108 CHF patients: the 1st group consisted of 36 patients with reduced LVEF (LVEF<40%), the 2nd group - 34 patients with intermediate LVEF (LVEF 41 – 49%) and the 3rd group consisted of 38 CHF patients with preserved LVEF (LVEF>50%). Referent serum levels of fibrosis biomarkers were as following: G-3 - 8,6 [3,7;11,7] ng/ml, aldosterone - 86,8 [47,8;199,1] pg/ml. They were administered 40-80mg of azilsartan medoxomil and 25-50mg of eplerenone as a basis therapy for six months. In CHF patients serum levels of G-3 and aldosterone were initially higher compared to control group. Particularly, they were respectively 2,1 and 5,1 times higher in the 1st group patients; 2,2 and 6,2 times in the 2nd; 2,6 and 6,6 times in the 3rd group. After six months of basis treatment, consisting of azilsartan medoxomil and eplerenone combination there was reliable decrease in serum levels of G-3 and aldosterone. In the first group decrease was respectively 9, 1% and 14,2%, in the 2nd 12,4% and 18,6%, in the 3rd group 16,1% and 22,5%. This in turn led to regression of LV remodeling and TBF indexes: in the 1st group LV EDV decreased by 7,4%, ESV by 13,5%, while LVEF increased by 8,5%. In the 2nd group LV EDV decreased by 10%, ESV by 16,6%, while LVEF increased by 7,6%. In the 3rd group decreased by %, ESV decreased by 5,3%, while LVEF increased by 4,1% LV EDV by 1,5%. In patients of the 2nd and 3rd groups LVRWT and LVMI reliably decreased respectively by 4,6% and 2,0%; 6,5% and 3,8% after the treatment. In CHF patients with intermediate and preserved LVEF statistically significant increase of fibrosis markers such as G-3 and aldosterone compared to CHF patients with reduced LVEF, as well as finding of concentric remodeling and hypertrophy of LV indicates increased accumulation of excess collagen in extracellular matrix, myocardial stiffening and intensiveness of fibrosis processes. Concordance between decrease of fibrosis markers and regression of LV remodeling and TBF measurements, and improvement of clinical condition and life quality of and tolerance to physical stress of the patients indicates diminished amount of fibrosis in myocardim. which in turn suggests that combined use of azilsartan medoxomil and eplerenone in treatment of CHF patients would be more prudent.

Keywords: chronic heart failure, galectin – 3, aldosterone, fibrosis markers, azilsartan medoxomil, eplerenone [email protected].