M.M. Dolzhenko, Yu.O. Luchinska, S.M. MymrenkoDynamics of duplex scanning of extracranial vessels after coronary artery bypass grafting in patients receiving angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

The aim – to study the changes of duplex scanning of extracranial vessels parameters in patients receiving angiotensinconverting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARB), to prevent graft stenosis related to the biochemical blood parameters. Material and methods. The study included 170 patients with coronary artery disease and post-infarction cardiosclerosis after coronary artery bypass grafting (CABG). They were divided into 2 groups: 105 patients received standard therapy and ACE inhibitor enalapril or lisinopril (20–40 mg daily), and 65 patients intolerant to ACE inhibitors received ARB valsartan at a dose of 160–320 mg daily. All patients underwent duplex scanning of extracranial vessels, contrast multispiral computer tomography (MSCT) of coronary vessels and biochemical blood tests. Results. After 12 months of observation patients receiving ARB had significantly less intima-media thickness than those treated with ACE inhibitors (0.80±0.01 compared to 0.90±0.02 mm; Р=0.001). After 12 months of follow CRP level was statistically higher in ACE inhibitors group (Р=0.02). Compared to the immediate post-surgery period, at 12 months after CABG we observed a significant decrease in total cholesterol, low-density lipoproteins and atherogenic index in both groups. Yet, the level of atherogenic cholesterol fractions remained high. During MSCT it was found that in the group treated with ACE inhibitors, compared to ARB, there was a significantly higher number of patients with graft stenosis (17 and 4 patients (23 % and 8 %, respectively, Р=0.03), but the difference in number of patients with the development of new stenosis was not found (28 patients in the ACE inhibitor group and 12 in ARB, 38 % and 23 %, respectively, Р=0.08). Conclusions. One year after CABG surgery ARB treatment was associated with significantly less intima-media thickness, lower CRP level and lower number of patients with graft stenosis. These results allow to recommend ARB valsartan as an effective means of graft stenosis prevention after CABG. This drug has a pronounced anti-inflammatory effect, affects endothelial function and intima proliferation.

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