Dynamics of vector electrocardiography parameters in patients with chronic heart failure under optimal drug therapy

Objective. To compare vECG parameters in one-year follow-up of patients with CHF under optimal drug therapy including ARNI or ACEI. Material and methods. The study included 100 patients with CHF class II-IV and left ventricular ejection fraction (LVEF) ≤40% who received optimal drug therapy including ARNI/ACEI, beta-blockers, AMCRs (mineralocorticoid receptor antagonists), INGLT2 (sodium-glucose cotransporter type 2 inhibitors). Of these, 50 patients received ARNIs (valsartan+sacubitril) and 50 patients received ACEI (perindopril). The follow-up was 12 months. All patients underwent clinical examination, electrocardiography (ECG) in standard leads with vECG and analysis of serum NT-proBNP at baseline and at the end of the study. Results. Baseline vECG parameters were comparable in both groups. Median spatial QRS-T angle in patients taking ARNI decreased after 12 months from 152.02o [95; 177] to 140.3o [58; 166] (p=0.01), in patients taking ACEI — from 150.54o [96; 178] to 147.61o [95; 175] (p=0.016). Dynamics of QRS-T spatial angle was more significant under ARNI therapy compared to ACEI (p=0.009). At the end of follow-up, serum NT-proBNP was lower in the group of ARNI (0.027). There was weak positive (r=0.21) significant relationship between QRS-T spatial angle and NT-proBNP (p=0.048). Conclusion. ARNI in complex therapy of CHF with reduced LVEF has more significant effect on QRS-T spatial angle measured by VECG compared to ACEI. This can indicate higher effectiveness of these drugs.