Patients after myocardial infarction with chronic heart failure with preserved left ventricular ejection fraction: the issue of prescribing beta blockers. The results of a 2-year prospective study

Aim. To study a 2-year catamnesis in patients with myocardial infarction (MI) with heart failure (HF) with preserved LVEF who received/did not receive beta-blockers (ВВ).

Materials and methods. 127 MI patients aged 53 (48; 60) years with preserved LVEF were included. On the 4th-9th day of MI, after 12 and 24 months, echocardiography with assessment of global longitudinal deformation (GLS), multi-day monitoring of the electrocardiogram (MMECG), the level of N-terminal propeptide of natriuretic hormone was determined, and a 6-minute walking test was performed. The end point was considered to be the progression of HF over the next 2 years.

Results. 29 (23%) patients did not receive BB due to hypotension and bradycardia – the "without BB" group, the other 98 (77%) who received BB formed the "BB" group.  In the "BB" group, by the 2nd year of the post-infarction period, there was an increase in indexed indices of final diastolic and systolic volumes, a decrease in LVEF by 3.1% (p=0.00077) and GLS by 2.4% (p=0.0002), in the "without BB" group, these parameters remained stable.

In patients of the BB group, a decrease in chronotropic load on the myocardium and an increase in the circadian index were recorded while maintaining its rigid level. In the group of patients "without BB", an increase in chronotropic load and normalization of the circadian rhythm profile were noted by 12 months after MI.

The number of patients with progressive HF over 2 years of follow-up in the "BB"/"without BB" groups did not differ: in 21% and 24%, respectively (RR=0.659 (95% 0.35-1.243)

Conclusion. In the group of patients with HF with preserved LVEF who did not take BB, a more stable state of the volume and deformation characteristics of the myocardium was noted for 2 years after MI, normalization of the circadian heart rhythm profile was observed, and no significant differences in the frequency of HF progression were found.