Dynamics of vascular walls elastic properties and effort tolerance among CHD-patients: stable angina st. II-III FK after receiving bisoprolol therapy

Prasolov A.V., Moskaluk M.I., Knyazeva L.A., Knyazeva L.I., Valitsky I.S.
Kursk State Medical University
Internal diseases department №1 (head of department, Doctor of Medicine, Professor Knyazeva L.I.)

In recent years growth of incidence and death rate caused by fatal breach of blood circulatory system takes form of epidemic. Almost 10 million of working population in Russia suffer coronary heart disease, more than one third suffer stable angina. Coronary heart disease holds the 1st place for fatalities caused by cardiovascular pathologies and progressive atherosclerosis of cardiovascular beds.
Purpose:  Study of dynamics of vascular walls elastic properties and effort tolerance among coronary heart disease patients: stable angina st. II-III FK receiving bisoprolol therapy.

Materials and methods: There were 30 patients with coronary heart disease inspected:  stable angina st. II-III FK – 25 male (83%) and 5 female (27%). The average age was 49,2 ± 4,36 years. All patients received medication: aspirin, statin, bisoprolol dosed in 7,5  ± 2,5 mg twice a day within 8 weeks, nitroglycerine sublingually upon demand. Intake of other antianginal medication was excluded.
Quality control of conducted therapy was carried out on the basis of clinical semiology analysis: pain syndrome regression, lessening of nitroglycerine demand and alteration of effort tolerance while passing a treadmill-test.  
Vascular walls parameters were surveyed with the use of ambulatory blood pressure monitors manufactured by OOO “Petr Telegin” (Nizhny Novgorod) and software BPLab.
Research results. All the examined patients had clinical improvements while receiving bisoprolol what was evident as reliable decrease of anginal attacks (up to 52,6%), lessening of nitroglycerine demand (up to 76,7 %), treadmill-test results (increase of effort tolerance up to 26,6%). Against bisoprolol therapy stable angina patients experienced decrease of heart rate up to 44,3%  (58,6 ± 3,4 heartbeats per minute).
While being treated 10 patients with coronary heart disease experienced an increase of their level of effort tolerance to 7,0 and more MET to the 8th week of treatment; amount of patients performing physical exercises recommended for stable angina III FK decreased to 25% (p<0,001) – from 24 to 18 people as well.
The accomplished research showed that all the examined patients with angina of effort experienced alterations of indices determining vascular walls stiffness what was characterized by reliable value increase in comparison with control values of PTT – to 26,3% (p<0,05), dPdt – to 55,1 % (p<0,05), ASI – to 7,5 % (p<0,05), AIx increase – to 66,7 % (p<0,05), SAI – to 18,4% (p<0,05).
Against bisoprolol therapy there was detected a reliable increase of pulse transit time (PTT) to 15,1 % (p<0,05), decrease of arterial pressure rise (dPdt) to 26,2% (p<0,05). Also signified positive dynamics of augmentation index (AIx) determining vascular wall elasticity were detected – it increased to 72% (p<0,05).
During correlation analysis a reliable negative association between indices of vascular walls stiffness and level of effort tolerance on treadmill-test results was detected. A negative correlation dependence was defined between level of effort tolerance and AIx (r= - 0,88, p<0,05). There’s a direct correlation dependence between level of tolerable weight bearing and PTT (r= 0,58, p<0,05).

Conclusion: A reliable direct correlation dependence between PTT and level of effort tolerance and inverse relationship between augmentation index and level of effort tolerance are present for coronary heart disease patients: stable angina st. II-III FK. Bisoprolol therapy along with clinical effectiveness, effort tolerance increase causes decrease of vascular wall stiffness what is characterized by PTT increase, AIx index-decrease, decrease of arterial pressurerise (dPdt).