Keywords
obesity
treatment
prognosis
metoprolol succinate
genetic polymorphism
quality of life
cardiac rhythm variability
hemodynamics
How to Cite
Abstract
A prospective, randomized, dynamic study was conducted for one year among 127 patients with obesity and chronic heart failure II–III stages 1–4th FC by NYHA at the age of 32–87 (61 [57; 65] years), 93 men and 34 women. The key factors of progression of cardiac decompensation and the principles of using metoprolol succinate, taking into account pharmacogenetic aspects in the complex treatment of this comorbidity were determined. The survey included determination of tolerance to physical activity, quality of life, central hemodynamics, heart rate variability, serum insulin levels and NT-proBNP, G1846A polymorphism of the CYP2D6 gene. Metoprolol succinate was administered according to a standard titration schedule every 2 weeks from 12.5 100–200 mg. It is shown, that the prognostic protocol developed with the use of Wald's sequential analysis provides new possibilities for predicting the effectiveness of metoprolol succinate in patients with obesity and chronic heart failure. The discriminant models developed allow to objectivize the criteria for determining the dose of metoprolol succinate in obese patients and chronic heart failure - the maximum initial, maximal endpoint, as well as the feasibility of further incremental dose increases.
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