FEATURES OF THE USE OF BETA-BLOCKERS IN PATIENTS WITH HEART FAILURE AND LOW TRIIODOTHYRONINE SYNDROME WHO HAD CORONAVIRUS INFECTION (literature review and own data)

Abstract

This study focuses on investigating the specific application of β-blockers (BB) in cases of heart failure (HF) combined with a history of coronavirus infection, which significantly affects the cardiovascular system. The sharp increase in mortality during the COVID-19 pandemic demonstrated that HF is a poor prognostic factor in patients with COVID-19. Additionally, the risk of death for patients with COVID-19 and low free triiodothyronine (FT3) levels is 33% higher compared to individuals with normal FT3 levels. More than 25% of patients with COVID-19 were diagnosed with low triiodothyronine syndrome (LT3S). LT3S can be considered an indicator of poor prognosis in patients with HF. To identify the relationship between the risk of rehospitalization in patients with HF and reduced left ventricular ejection fraction (LVEF) and the duration of bisoprolol titration up to 5 mg per day, a ROC analysis was conducted. It was found that the frequency of rehospitalization in the group of patients with HF without LT3S is predictably higher at bisoprolol doses of 1.25-5.0 mg compared to BB doses over 5 mg. Furthermore, the use of bisoprolol at a daily dose of >5 mg in patients with reduced LVEF and concomitant LT3S does not improve the course of HF and does not lead to a reduction in rehospitalization frequency due to the increased risk of HF decompensation. Thus, the effect of bisoprolol in LT3S is the opposite: the risk of rehospitalization increases with the daily dose of BB over 5 mg, accompanied by a further decrease in serum FT3 levels. It is likely that in patients with HF and LT3S, titrating the bisoprolol dose above 5 mg is inadvisable, and the titration duration should not be less than 63 days. A literature search was conducted using the databases Web of Science, Scopus, The Cochrane Library, MedLine, EMBASE, Global Health, etc.