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Efficacy and safety of carvedilol and losartan with various combinations of bronchodilators in patients with chronic heart failure due to coronary artery disease combined with COPD

Session Poster Session 4

Speaker Vladimir Evdokimov

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : V Evdokimov (Moscow,RU), A Evdokimova (Moscow,RU), E Kovalenko (Moscow,RU), E Yushchuk (Moscow,RU)

Authors:
V Evdokimov1 , A Evdokimova1 , E Kovalenko1 , E Yushchuk1 , 1State University of Medicine & Dentistry - Moscow - Russian Federation ,

Citation:

Purpose: to compare clinical efficacy and safety of carvedilol and losartan with various combinations of bronchodilators in complex therapy in patient with CHF due to CAD combined with COPD.
Methods: after enrollment in this trial 98 patients (70 men and 28 women), aged 64.1 ± 4.8 years, with CHF classes II to III (New York Heart Association) combined with moderate to severe COPD (GOLD-2015) with initial ejection fraction of the left ventricle (LVEF) less than 45%, were randomized into three groups – tiotropium (18 µg daily, n=36), indacaterol (150 µg daily, n=32) and tiotropium/indacaterol group (18/150 µg daily, n=30). Patients of all groups received the complex CHF treatment comprising carvedilol, losartan, diuretics, nitrates, cardiac glycosides (if necessary) and basic COPD therapy (inhalation corticosteroids). Echocardiography, exercise tolerance, 24-hour electrocardiography, respiratory function test were assessed at baseline and after 6 months of treatment. The quality of life was evaluated by MYHFQ, SGRQ and mMRC.
Results: after 6 months of therapy the improvement of clinical condition and quality of life were marked in all groups. In 1st, 2nd and 3rd group LVEF was increased by 20.9%, 18.3% and 22.5%, pulmonary hypertension decreased by 21.2%, 22.8% and 26.7%, episodes of silent myocardial ischemia decreased by 52.3%, 47.6% and 52.4%, respectively. Towards the end of the observation period, in all groups there was a confident and authentic increase of FEV1 witch made 10.4%, 7.8%, and 11.9% accordingly. Patients showed statistically significant and clinically meaningful reduction of SGRQ, MYHFQ scores and MMRC dyspnea grade (see table 1). All treatment regimens were well tolerated. 
Conclusions: the carvedilol and losartan with tiotropium and/or indacaterol administration in patients with CHF combined with COPD raises efficiency of treatment, improves quality of life, basic parameters of central hemodinamics and pulmonary function. Efficacy of long-acting inhaled anticholinergic agent (tiotropium) and long-acting ß-agonist (indacaterol) in patient with CHF due to CAD combined with COPD are similar. Combination of these drugs significantly enhances the positive effects of the therapy.

Group 1

tiotropium

(n=36)

Group 2

indacaterol

(n=32)

Group 3

tiotropium

+indacaterol

(n=30)

CHF class (NYHA)

-17,2*

-16,1*

-20,1*

mMRC

-20,1*

-23,2*

-27,5*

6 minute walk test

+18,2*

+21,4*

+24,4**

MLHFQ

-27*

-25*

-30,2*

SGRQ

-symptoms

-activities

-impact

-15,4*

-12,8*

-22,5*

-9,2

-18,6*

-10,6

-21,4*

-8,3

-24,4*

-14,1*

-26,4**

-13,7*

* - p<0,05, ** - p<0,01 compared to baseline


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