Evaluation of Short Term Effect of Atorvastatin on Myocardial Performance and Its Pleiotropic Effects on Ischemic Heart Failure

Abstract

Background: statins are used routinely in patients with coronary artery disease for their lipid lowering effects. Some clinical studies have found that statins do not affect clinical outcomes in patients with chronic heart failure (CHF), while others have found that statins have many beneficial effects. The aim of this study was to evaluate the pleiotropic effects of atorvastatin on patients with chronic heart failure of ischemic etiology (IHF) using conventional echocardiography and tissue doppler imaging. Patient & Methods: Forty­eight patients with (CHF) were divided randomly into two equal groups; Atorvastatin group (received conventional therapy of HF plus atorvastatin 20 mg/d orally) and Original Research Article El-Sisi et al.; BJPR, 6(5): 343-357, 2015; Article no.BJPR.2015.076 344 Control group (received conventional therapy only) for 3 months. Patients were examined both before and after treatment for biochemical tests; serum tumor necrosis factor α (TNF­α), serum high sensetive c reactive protein (hs­CRP), oxidized low density lipoprotein (ox­ LDL), noradrenaline, adrenaline, renin, brain naturetic peptide (BNP­32), Troponin­I, total lipid profile and malondialdehyde. Conventional Echocardiography including left ventricle (LV) dimensions & wall thickness, ejection fraction (EF), E/A ratio, and tissue Doppler imaging (TDI) including Isovolumic contraction (IC), mitral annulus systolic velocity(S­peak), early (E) and late (A) diastolic peak velocities and Tei index were performed. Results: Atorvastatin group showed statistically significant decreased in TNF­ α, hs­CRP, ox­LDL, BNP­32 and noradrenaline compared to their baseline values before the study. Conventional echo failed to detect significant changes in each group except for significant increase in E/A ratio in atorvastatin group. DTI demonstrated that atorvastatin group showed significant improvement in systolic function [significant increase in S wave & isovolumic contraction (IC) peak velocities and better diastolic function [E peak velocity increased & E/E' ratio decreased significantly]. Tei index and heart rate improved significantly in atorvastatin group. Conclusion: Atorvastatin improved cardiac function, decreased inflammatory and oxidative stress parameters as well as modulated the neurohormonal imbalance in CHF patients.