Laba O. Prognostic value of the heart rate control on the clinic progress of the acute coronary syndrome

The thesis is devoted to the issue of raising the efficiency of treatment of the acute coronary syndrome (non-stable angina pectoris and myocardial infarction without ST segment elevation) by adding ivabradine in addition to the basic therapy at non-sufficient heart rate control. In case of intolerance to beta - blockers, dose escalation limitation or insufficient heart rate control when using the maximum dose, it is reasonable to supplement the standard therapy acute coronary syndrome with ivabradine, which promotes the re-duction of duration of pain syndrome, ischemia, necessity in nitrates and frequency of complications in remote terms. Ivabradine has a positive impact on the cardiac remodeling after acute coronary syndrome within 6 months, namely reduces the enddiastolic dimensions of the left ventricle (by 0,2 cm) and facilitates the ejection fraction increase (by 0,6 %). The connection between heart rate and clinical implications of the ac^ite coronary syndrome and complications progression in hospital period (course or recurrence of myocardial infarction, acute left ventricle deficiency, acute heart aneurism, ventricles fibrillary contractions) has been established. Insufficient heart rate control at acute coronary syndrome (60 beats/minute and less) stipulated by use inappropriate doses of beta blockers, availability of contrindications for their use or factors limiting the dose buildup possibility (hypotension, heart failure, chronic obstructive lungs disease, inefficiency of the maximum dose). Heart rate during hospitalization is independent factor which influences the progress of illness, postinfarction cardiac remodeling and risk of progression of the following myocardial infarction within 6 months. The association of the heightened level of brain natriuretic peptide (NT - pro - BNP) (its increase over 400 pg/ml) with higher heart rate at the moment of hospitalization and the risk of complications progression both during permanent (acute left ventricle deficiency and congestive pneumonia (p=0,04)), and re-mote period (6 months) as well at patients with non-stable angina pectoris (repeat hospitalization (p=0,04)), which makes it possible to distinguish them as independent factors of unfavourable prognosis at patients with acute coronary syndrome.