Endothelial dysfunction in patients with ischemic heart disease complicated by chronic heart failure and possibilities of its correction with isosorbide-5-mononitrate

Aim. To study effect of isosorbide-5-mononitrate on vasoregulating function of endothelium in patients with ischemic heart disease complicated by chro nic heart failure. Material and methods. Isosorbide-5-mononitrate (40 mg o. d.) was given to 28 men with class II-III angina pectoris complicated by NY HA class If heart failure. Reaction of brachial artery to reactive hyperemi a and nitroglycerine was investigated noninvasively by ultrasonography. Vel oergometry and echocardiography were used for the study of working capacity and morphofunctional parameters of the heart, respectively. Efficacy and t olerability of the drug were also assessed. Results. After 12 weeks of trea tment mean brachial artery diameter and its increment during reactive hyper emia increased by 9.5% (p<0.05) and from 8.2+/-1.5 to 11.1+/-0.9% (p<0.05), respectively. Endothelium,independent reaction to nitroglycerine decreased from 15.4+/-3.5 to 11.9+/-1.5% (p<0.05). Number of anginal attacks per wee k and supplementary nitroglycerine consumption decreased by 59.3 and 63.7%, respectively. Antianginal effect was achieved in 85.7% of cases. After 12 weeks systolic and diastolic blood pressure lowered by 3.3 and 4.5%, respec tively, while heart rate rose by 1.6%.