Experience of drug therapy in hypertrophic cardiomyopathy

Abstract

Aim. To assess the impact of drug therapy on the clinical course of hypertrophic cardiomyopathy in long term. Methods. 90 patients with hypertrophic cardiomyopathy (males - 55, females - 35, mean age 42,0±1,52 years) were observed for a long period of time. Non-obstructive form of the disease was diagnosed in 72 (80%) patients, obstructive - in 18 (20%) patients. Average follow-up duration was 15,0±0,73 years. Drug therapy was received by 54 patients, 21 patients were treated with beta-blockers, 16 patients - with verapamil. Research methods included a resting ECG, 24-hour ECG monitoring, echocardiography according to the standard protocol. Results. The treatment was initially started in primarily in more severe patients with severe clinical picture. Verapamil intake reduced complains on palpitations beta-blockers reduced clinical signs of angina. Beta-blockers have objectively reduced the number of ventricular extrasystoles. Significant differences were obtained in average grades of ventricular extrasystoles (2.40±0.54 in patients receiving beta-blockers, 1.05±0.22 in patients not receiving beta-blockers, p <0.01), in ventricular extrasystole number per day (708±327 and 87.3±58.4, p <0.05). No significant effect of treatment on the structural and functional parameters were identified, verapamil reduced the pressure gradient at the pulmonary artery, but increased the obstruction gradient. No effects of drug therapy on the sudden death incidence in the study group were found. Conclusion. Medical treatment for hypertrophic cardiomyopathy is advisable to patients with severe clinical picture because of the possible (in some patients) positive impact on the clinical signs. No significant positive effects of treatment with beta-blockers and verapamil on structural and functional parameters were observed.

Keywords

hypertrophic cardiomyopathy / treatment / long-term follow-up

References

[1] Абдуллаев Т.А., Аллаберганов О.Х., Марданов Б.У. Клинико-гемодинамические эффекты карведилола у больных гипертрофической кардиомиопатией // Кардиоваскулярн. терап. и профил. - 2011. - Т. 10, №8. - С. 57-62.

[2] Джанашия П.Х., Маркелова И.В., Крылова Н.С. и др. Сравнительная оценка эффективности ивабрадина и атенолола у больных гипертрофической кардиомиопатией // Рос. кардиол. ж. - 2010. - №1. - С. 59-64.

[3] Комиссарова С.М., Чакова Н.Н., Ниязова С.С. и др. Избирательная эффективность валсартана у больных с гипертрофической кардиомиопатией // Кардиология в Беларуси. - 2011. - №4. - С. 117-127.

[4] Комиссарова С.М. Гипертрофическая кардиомиопатия: эффективность и безопасность применения бета-адреноблокатора Конкора // Мед. новости. - 2008. - №1. - С. 59-62.

[5] Тихомирова Е.А., Куприянова О.О., Басаргина Е.Н. и др. Динамика показателей сердечно-сосудистой системы на фоне применения бета-адреноблокаторов у детей с обструктивной формой гипертрофической кардиомиопатии // Педиатр. фармакол. - 2007. - №5. - С. 64-68.

[6] Шапошник И.И., Богданов Д.В. Гипертрофическая кардиомиопатия. - М.: Медпрактика-М, 2008. - 128 с.

[7] Ashrafian H., McKenna W.J., Watkins H. Disease pathways and novel therapeutic targets in hypertrophic cardiomyopathy // Circ. Res. - 2011. - Vol. 109,N 1. - Р. 86-96.

[8] Gersh B.J., Maron B.J., Bonow R.O. et al. 2011 ACCF/ AHA Guideline for the Diagnosis and Treatment of Hypertrophic Cardiomyopathy // Circulation. - 2011. - Vol. 124. - P. 2761-2796.

[9] Maron B.J., Casey S.A., Haas T.S. et al. Hypertrophic cardiomyopathy with longevity to 90 years or older // Am. J. Cardiol. - 2012. - Vol. 109,N 9. - P. 1341-1347.

RIGHTS & PERMISSIONS

Shaposhnik I.I., Bogdanov D.V.