Abstract:

Background: Beta-blockers are commonly used to improve endothelial function in patients with chronic heart failure (CHF), however, comparative effectiveness of bisoprolol and carvedilol remains to be clarified. Objective: The purpose of this study was to evaluate the functional state of endothelium in patients with chronic heart failure and the comparative effectiveness of long-term treatment with bisoprolol and carvedilol. Methods: In 100 patients, men (age: 38-60) with myocardial infarction history, complicated by chronic heart failure, we determined vasomotor endothelial function of the brachial artery by as-sessing endothelium dependant and independent vasodilation, von Willebrand factor (vWf) level. Patients were assigned in two groups both against the background of standard therapy: 1 – 51 receiving bisoprolol, 2 – 49 receiving carvedilol. Results: Against the background of standard therapy with bisoprolol and carvedilol after 6 months, endothelium dependant vasodilation increased significantly, in NYHA Class I by 18,3 and 38,8%; in Class II by 11,1 and 35,7%; in Class III by 34 and 60%, in the 1st and 2nd groups, respectively. Von Willebrand factor levels were depressed by 4,1 and 10% in NYHA Class I, by 15,3 and 23,3% in Class İİ. Analyzing vWf level in Class III patients, we observed increased this index by 3,2 with bisoprolol and 25,8% by carvedilol. Conclusion: Depending on the NYHA Classes, endothelial dysfunction exaggerates: reduces endo-thelium dependant vasodilation, speed characteristics of blood flow, vascular tone and sensitivity of the brachial artery to the shear stress, increases the secretion of von Willebrand factor. In patients with expressed heart failure signs, NYHA Class III, carvedilol demonstrated high efficacy, markedly improving the functional state of the endothelium, positively affecting the functional and humoral markers of endothelial dysfunction.

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