Double Blockade of Aldosterone Receptors as a Method of Elimination Negative Effects of Non-Steroidal Anti-Inflammatory Drugs in Chronic Heart Failure

The article deals with the dynamics of echocardioscopy indices during 1.5 years in a patient who underwent an acute myocardial infarction (MI). Two months after the MI left ventricular (LV) end-diastolic size and LV volume were 61 mm and 190 ml, respectively; LV ejection fraction (EF) was 42%. At the background of maximal possible doses of ramipril, bisoprolol, and selective antagonist of aldosterone receptors eplerenone, and after revascularization, within eight months LV end-diastolic size decreased down to 57 mm, LV volume - to 158 ml, and LVEF increased up to 51 %. There was no change of potassium and creatinine blood serum levels. The situation changed dramatically after addition to ongoing therapy because of exacerbation of chronic osteochondrosis of ketoprofen 100, meloxicam 15 and tolperisone (Mydocalm) 450 mg / day. The patient noted an increase in dyspnea during walking, a decrease in exercise tolerance. LVEF fell to 36%, LV size increased up to values registered in 2 months after MI. There were no signs of overt fluid retention (no gain of weight, lower limbs edema, lung congestion on X-ray, hepatomegaly at ultrasound examination). In 4 months after addition to therapy of a loop diuretic torasemide (5 mg) the cardio-hemodynamic parameters almost returned to values prior to administration of anti-inflammatory drugs. Conclusion. Loop diuretic (such as torasemide) can be recommended for elimination of negative consequences of the use of nonsteroidal anti-inflammatory drugs in patients with chronic heart failure.

постинфарктный кардиосклероз, хроническая сердечная недостаточность, нестероидные противовоспалительные препараты, торасемид, эплеренон, ischemic dilated cardiomyopathy, nonsteroidal anti-inflammatory drugs, torasemide, eplerenone, chronic heart failure

1. Каратеев А. Е., Алексеева Л. И., Филатова Е. Г. и др. Обезболивающие препараты в терапевтической практике. М: ИМАПРЕСС 2013: 134 с.

2. Lanas A., Tornero J., Zamorano J. L. Assessment of gastrointestinal and cardiovascular risk in patients with osteoarthritis who require NSAIDs: the LOGICA study. Ann Rheum Dis 2010;69 (8):1453-1458. DOI:10.1136/ard. 2009.123166

3. McGettigan P., Henry D. Cardiovascular risk with nonsteroidal anti-inflammatory drugs: systematic review of population-based controlled observational studies. PLoS Med 2011;8 (9):e1001098. DOI:10.1371 /journal. p med. 1001098.

4. Trelle S., Reichenbach S., Wandel S. et al. Cardiovascular safety of non-steroidal anti- inflammatory drugs: network meta-analysis. BMJ 2011;342:7086. DOI:10.1136.

5. Arfe A., Scotti L., Varas-Lorenzo C. et al. Non-steroidal antiinflammatory drugs and risk of heart fail-ure in four European countries: nested case-control study. BMJ 2016;354: i4857. DOI:10.1136/bmj. i4857 (Published 28 September 2016)

6. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure/^e Task Forcefor the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiol-ogy (ESC). Eur Heart J. 2016;37 (27):2129-2120.

7. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недостаточность 2013;14 (7):65-70, 422-425.

8. Fang L., Murphy A.J., Dart A. M. A clinical perspective of anti-fibrotic therapies for cardiovascular disease. Frontiers in Pharmacology 2017;8:186. DOI: 10.3389/fphar. 2017.00186

9. Lopez B., Querejeta R., Gonzalez A. et al. Effects of loop diuretics on myocardial fibrosis and collagen type I. turnover in chronic heart failure. J. Am Coll Cardiol 2004;43 (11):2028-2035. DOI: 10.1016/j. jacc. 2003.12.052

10. Lopez B., Gonzalez A., Beaumont J. et al. Identification of a potential cardiac antifibrotic mechanism of torasemide in patients with chronic heart failure. J. Am Coll Cardiol 2007;50 (9):859-867. DOI:10.1016/j.jacc. 2007.04.080Get rights and content

11. Lopez B., Querejeta R., Gonzalez A. et al. Impact of treatment on myocardial lysyl oxidase expression and collagen cross-linking in patients with heart failure. Hypertension 2009;53:236-242. DOI: 10.1161/НYPERTENSIONAHA. 108.12527

12. Buggey J., Mentz R.J., Pitt B. et al. A reappraisal of loop diuretic choice in heart failure patients. Am Heart J. 2015;169:323-333. DOI: 10.1016/j.ahj. 2014.12.009.