Положительное влияние периндоприла на сосуды микроциркуляторного русла у больных с хронической сердечной недостаточностью

Цель    Оценка влияния 12‑месячной терапии периндоприлом на структурно-функциональное состояние сосудов микроциркуляторного русла (МЦР) у пациентов с хронической сердечной недостаточностью с сохранной (СНсФВ) и промежуточной (СНпФВ) фракцией выброса левого желудочка.

Материал и методы  Обследованы 30 пациентов с СНсФВ и СНпФВ. Всем был назначен периндоприл в максимально переносимой дозе на срок 12 мес. Проводилась оценка структурно-функциональных изменений сосудов МЦР при помощи фотоплетизмографии и капилляроскопии до начала терапии периндоприлом и через 12 мес, т. е. после ее окончания.

Результаты   На фоне 12‑месячной терапии периндоприлом отмечалось улучшение функции эндотелия в виде прироста индекса окклюзии (ИО) и сдвига фаз (СФ). ИО увеличился с 1,45 [1,3; 1,6] до 1,8 [1,6; 2,2] (p=0,00004). СФ увеличился с 7,1 мс [4,8; 10,2] до 9,2 мс [6,7; 13,2]) (p=0,0003). Обнаружено уменьшение жесткости крупных сосудов мышечного типа. Индекс жесткости (aSI) уменьшился с 8,8 [6,6; 11,0] до 7,45 [6,5; 9,4] м / с (р=0,01). На фоне терапии произошло увеличение плотности капиллярной сети в покое (р=0,008), при пробах с венозной окклюзией (р=0,003) и реактивной гиперемией (р=0,0003).

Заключение     По результатам исследования выявлено улучшение функции эндотелия на фоне терапии периндоприлом в течение 12 мес у пациентов с СНсФВ и СНпФВ.

1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M et al. The Global Health and Economic Burden of Hospitalizations for Heart Failure. Journal of the American College of Cardiology. 2014;63(12):1123–33. DOI: 10.1016/j.jacc.2013.11.053

2. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics – 2019 Update: A Report From the American Heart Association. Circulation. 2019;139(10):e56–528. DOI: 10.1161/CIR.0000000000000659

3. Polyakov D.S., Fomin I.V., Vaysberg A.R. EPOCHA-D-CHF: gender differences in the prognosis of patients with CHF af-ter acute decompensation (part 2). Kardiologiia. 2019;59(4S):33–43. DOI: 10.18087/cardio.2654

4. Hsu JJ, Ziaeian B, Fonarow GC. Heart Failure With Mid-Range (Borderline) Ejection Fraction. Clinical Implications and Future Directions. JACC: Heart Failure. 2017;5(11):763–71. DOI: 10.1016/j.jchf.2017.06.013

5. Kanorskii S.G., Borisenko Yu. V. Chronic Heart Failure With Preserved Ejection Fraction: Effective Treatment Possible? Kardiologiia. 2018;58(6):85–9. DOI: 10.18087/cardio.2018.6.10154

6. Kireeva V.V., Koch N.V., Lifschitz G.I., Apartsin K.A. Endothelial dysfunction as cornerstone of cardiovascular events: molecular and pharmaceutic aspects. Russian journal of Cardiology. 2015;19(10):64–8. DOI: 10.15829/1560-4071-2014-10-64-68

7. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. Journal of the American College of Cardiology. 2013;62(4):263–71. DOI: 10.1016/j.jacc.2013.02.092

8. Franssen C, Chen S, Unger A, Korkmaz HI, De Keulenaer GW, Tschöpe C et al. Myocardial microvascular inflammatory endothelial activation in heart failure with preserved ejection fraction. JACC. Heart failure. 2016;4(4):312–24. DOI: 10.1016/j.jchf.2015.10.007

9. Nakamura M, Sugawara S, Arakawa N, Nagano M, Shizuka T, Shimoda Y et al. Reduced vascular compliance is associated with impaired endothelium-dependent dilatation in the brachial artery of patients with congestive heart failure. Journal of Cardiac Failure. 2004;10(1):36–42. DOI: 10.1016/S1071-9164(03)00585-2

10. Nauta JF, Hummel YM, van Melle JP, van der Meer P, Lam CSP, Ponikowski P et al. What have we learned about heart failure with mid-range ejection fraction one year after its introduction? European Journal of Heart Failure. 2017;19(12):1569–73. DOI: 10.1002/ejhf.1058

11. Belenkov Yu.N., Shchendrygina A.A., Privalova E.V., Kuznetsov A.P., Kuznetsov M.I. Method for assessing the state of the vascular bed in healthy individuals with cardiovascular risk factors and in cardiovascular patients. RU 2508900 C1. Zayavka 2012156011/14 from 24.12.2012. 2012. https://yandex.ru/patents/doc/RU2508900C1_20140310]

12. Rubinshtein R, Kuvin JT, Soffler M, Lennon RJ, Lavi S, Nelson RE et al. Assessment of endothelial function by non-invasive peripheral arterial tonometry predicts late cardiovascular adverse events. European Heart Journal. 2010;31(9):1142–8. DOI: 10.1093/eurheartj/ehq010

13. Kuvin JT, Patel AR, Sliney KA, Pandian NG, Sheffy J, Schnall RP et al. Assessment of peripheral vascular endothelial function with finger arterial pulse wave amplitude. American Heart Journal. 2003;146(1):168–74. DOI: 10.1016/S0002-8703(03)00094-2

14. Weisrock F, Fritschka M, Beckmann S, Litmeier S, Wagner J, Tahirovic E et al. Reliability of peripheral arterial tonometry in patients with heart failure, diabetic nephropathy and arterial hypertension. Vascular Medicine. 2017;22(4):292–300. DOI: 10.1177/1358863X17706752

15. Fujisue K, Sugiyama S, Matsuzawa Y, Akiyama E, Sugamura K, Matsubara J et al. Prognostic Significance of Peripheral Microvascular Endothelial Dysfunction in Heart Failure With Reduced Left Ventricular Ejection Fraction. Circulation Journal. 2015;79(12):2623–31. DOI: 10.1253/circj.CJ-15-0671

16. Shantsila E, Wrigley BJ, Blann AD, Gill PS, Lip GYH. A contemporary view on endothelial function in heart failure. European Journal of Heart Failure. 2012;14(8):873–81. DOI: 10.1093/eurjhf/hfs066

17. Giannitsi S, Maria B, Bechlioulis A, Naka K. Endothelial dysfunction and heart failure: A review of the existing bibliography with emphasis on flow mediated dilation. JRSM Cardiovascular Disease. 2019;8:204800401984304. DOI: 10.1177/2048004019843047

18. Premer C, Kanelidis AJ, Hare JM, Schulman IH. Rethinking Endothelial Dysfunction as a Crucial Target in Fighting Heart Failure. Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2019;3(1):1– 13. DOI: 10.1016/j.mayocpiqo.2018.12.006

19. Ghiadoni L, Magagna A, Versari D, Kardasz I, Huang Y, Taddei S et al. Different Effect of Antihypertensive Drugs on Conduit Artery Endothelial Function. Hypertension. 2003;41(6):1281–6. DOI: 10.1161/01.HYP.0000070956.57418.22

20. Ceconi C, Fox K, Remme W, Simoons M, Bertrand M, Parrinello G et al. ACE inhibition with perindopril and endothelial function. Results of a substudy of the EUROPA study: PERTINENT. Cardiovascular Research. 2007;73(1):237–46. DOI: 10.1016/j.cardiores.2006.10.021

21. Bots ML, Remme WJ, Lüscher TF, Fox KM, Bertrand M, Ferrari R et al. ACE Inhibition and Endothelial Function: Main Findings of PERFECT, a Sub-Study of the EUROPA Trial. Cardiovascular Drugs and Therapy. 2007;21(4):269–79. DOI: 10.1007/s10557-007-6041-3

22. Brasier AR, Recinos A, Eledrisi MS. Vascular Inflammation and the Renin-Angiotensin System. Arteriosclerosis, Thrombosis, and Vascular Biology. 2002;22(8):1257–66. DOI: 10.1161/01. ATV.0000021412.56621.A2

23. Marketou ME, Zacharis EA, Koukouraki S, Stathaki MI, Arfanakis DA, Kochiadakis GE et al. Effect of angiotensin-converting enzyme inhibitors on systemic inflammation and myocardial sympathetic innervation in normotensive patients with type 2 diabetes mellitus. Journal of Human Hypertension. 2008;22(3):191–6. DOI: 10.1038/sj.jhh.1002310

24. Tousoulis D, Kourtellaris P, Antoniades C, Vasiliadou C, Papageorgiou N, Tentolouris C et al. Effects of irbesartan and perindopril on forearm reactive hyperemia and inflammatory process, in normotensive patientswith coronary artery disease. International Journal of Cardiology. 2008;124(1):127–9. DOI: 10.1016/j.ijcard.2006.11.206

25. Danilogorskaya Yu.A., Zheleznykh E.A., Privalova E.V., Shchendrygina A.A., Belenkov Yu.N., Ilgisonis I.S. et al. Influence of the combination drug Prestans (perindopril A, amlodipine) on morpho-functional parameters of arterial bed in essential hypertension. Russian Journal of Cardiology. 2017;22(12):113–9. DOI: 10.15829/1560-4071-2017-12-113-119