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Cardiologia CROATICA In our poster presentation we present two cases of patients with severe advanced heart failure. The patients were sent to echocardiography assessment with a history of several week’s of progressive dyspnoea and left bundle block on ECG. Patient 1: Man, born 1958, smoker, negative family history. 5/2009 two month progressive dyspnoea; NYHA III/IV; on ECG: LBBB; echocardiography: EF 25%, diffuse hypokinesis. 6/2009 CABG (RIA LIMA, RMS); NYHA III. 11/2009 Implantation BIV ICD; NYHA II/III. Th: furosemid 40 mg, atoravastatin 20 mg, aspirin 100 mg, carvediol 2x12,5 mg, ramipril 5 mg, spironolactone 25 mg daily. 11/2010 start with ivabradine therapy 2x5 mg daily. 03/2011 echocardiography: improvement diameter of LA, LV, EF 40%, NYHA II. Patient 2: Man, born 1954, smoker, businessman. Two month worsening of dyspnoea, NYHA IV at the time of addmission. Echocardiography: EF 20%; ECG: LBBB; BP 160/110, P 98. SCG: nonsignificant changes of coronary arteries. Th: furosemid 40mg, perindopril 5mg, atorvastatin 20 mg, aspirin 100 mg, carvediol 2x6,25 mg (fatigue after higher doses of carvediol). 6/2011 echocardiography: EF 35%; NYHA III. 8/2011 adding ivabradine 2x5 mg daily. Last control echocardiography: EF 40-45%; NYHA II. Conclusion: The central role of careful echocardiography follow up of heart failure patients is essential for optimal pharmacology therapy managment, including ivabradine addition to the therapy. Our case results correlate with ECHO substudy conclusion of SHIFT study. We show schematically in diagrams the significant improvement of echocardiography parameters after ivabradine addition. The good clinical status correlates with lowering of level NT pro BNP too.

The patients with severe heart failure: central role of echocardiography in indication of optimal treatment — two cases