Kolomytseva I. Functional class of chronic heart failure and supportive drug therapy in patients with implanted pacemakers.

This thesis is devoted to establish the characteristics of changes in the functional classes of chronic heart failure (FC CHF) and their importance in pharmacological support of patients with permanent pacemakers. Before implantation of pacemakers, in the early postoperative period, after 6 months and 1 year were examined 162 patients (89 men and 73 women) aged 69 ± 10 years. According to the Classification of the New York Heart Association (NYHA) were allocated to 4 FC CHF. Among patients implanted with pacemakers in the early postoperative period, I FC CHF is found in 12% of patients, II FC CHF - 50%, III FC CHF - 33 %, IV FC CHF - 5 %, which are associated with myocardial infarction (17 %), stable angina (35 %), arterial hypertension (AH) (88 %), diabetes mellitus (DM) (16 %), atrial fibrillation (AF) (34 %), IIA and IIB stage of CHF (86 %). It was noted that patients with higher FC CHF after implantation of pacemakers required increasing frequency assignment and dose of anticoagulants and blockers of ?-adrenergic receptors and increasing the dose of ACE inhibitors and frequency assignment diuretics, blockers of the renin-angiotensin II and inhibitors of hydroxymethylglutaryl coenzyme A-reductase. At the annual stage of hardware and drug optimization after implantation of pacemaker was noted decrease of frequencies of occurrence higher FC and stages of CHF, FC of stable angina, grades and stages of AH by switching to lower FC CHF. Prognostically significant parameters of medical support in patients after implantation of pacemaker in group I FC CHF were heart rate (HR), diastolic blood pressure (DBP), end-systolic volume of the left ventricle (ESV LV) and stage of AH, in groups II and III FC CHF - systolic BP (SBP), DBP, ESV LV, end-diastolic volume (EDV) LV, stage and degree of AH, in the group IV FC CHF - HR, ESV LV, EDV LV.