Clinical Effectiveness of Cardiocytoprotective Therapy in Patients with Acute Coronar Syndrome (ACS) – Myocardial Infarction (MI), Who Were Performed Balloon Angioplasty and Coronary Artery Stenting
The aim of the study was to increase the efficiency of restorative treatment of patients with Acute Coronary Syndrome (Miocardial Infarction) by incorporating the protocol therapy for the course of parenteral use of L-arginine and L-carnitine (Tivorel).
It has been determined that patients with ACS (MI) after percutaneous coronary intervention often develop reperfusion syndrome with manifestations of left ventricular insufficiency and rhythm disturbances. Substantial clinical and functional improvement was noted under the influence of standard medical treatment in patients of control group. At the same time postinfarction remodeling with systolic and diastolic function of the heart, with the development of heart failure syndrome and endothelial dysfunction of blood vessels, and also remained resistant to extrasystole therapy, progressed.
Patients in the experimental group under the influence of complex medical treatment with the inclusion of L-arginine and L-carnitine marked a significant decrease in the frequency of violations of rhythm and conduction for the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of LV, which ultimately manifested a significant improvement in myocardial contractility (EF increased by 13%) and decreased diastolic dysfunction. Improvement of the inotropic function of the heart and a significant reduction in the frequency and severity of reperfusion arrhythmias was achieved precisely due to cardiometabolic effects of L-carnitine. In addition, in patients undergoing additional treatment with L-arginine and L-carnitine after 10 days of treatment, the activity of ET-1 was significantly lowered and the concentration of nitrogen oxide metabolites in the blood plasma increased and reach the level of healthy subjects (p>0.05). So, they recovered the endothelial function of the vessels.
Abdullaev RYa, Latoguz IK, Vlasenko MA. Principles of echocardiographic evaluation of the left ventricular diastolic function. Experimental and Clinical Medicine. 2001; 4: 59-62 .
Unified clinical protocol for emergency, primary, secondary and tertiary care "Acute coronary syndrome with elevation of segment ST". Ministry of Health of Ukraine. 2014; 78.
Batushkin VV. Cytoprotection in acute myocardial infarction after the discovery of a heart attack-dependent artery: new horizons. Liky Ukrayiny. 2017;8(214):33-40.
Kovalenko VM, Kornatsky VM. Actual problems of health and minimize them in conditions of armed conflict in Ukraine. Kiev: NSC "Institute of Cardiology named after MD. Strazhesko". 2018; 215.
Kondakov IL, Yakovenko AF. Methods of morpho-functional study of the state of the endothelium. Kharkiv. 2000; 18.
Seliuk MM, Kozachok MM, Lovkin IM, Seliuk OV. The choice of the optimal combination of metabolic drugs for the treatment of patients with cardiovascular pathology. Semeynaya meditsyna. 2017; 2(70): 60-64.
Shved MI, Levytska LV. Modern technologies of restorative treatment of patients with acute coronary syndrome. Ukrmedknyha. 2018; 176.
8. Shved MI, Levytska LV, Klantsa AI, Tsuglevych LV. Rehabilitation of patients with myocardial infarction and acute coronary syndrome after percutaneous coronary intervention. Khmelnitsky. 2018; 40.
Astashkin EI, Glezer MG. Role of L-carnitine in energy metabolism cardiomyocytes and treatment of diseases of cardiovascular system. Cardiology and cardiovascular surgery. 2012; 6 (2): 58-65.
DiNicolantonio J, Lavie C, Fares H, Menezes A, O'Keefe J. L-Carnitine in the Secondary Prevention of Cardiovascular Disease: Systematic Review and Meta-analysis. Mayo Clinic Proceedings. 2013; 88(6): 544-551. DOI: https://doi.org/10.1016/j.mayocp.2013.02.007 [PMid:23597877]
Celermajer D. S. Endothelial dysfunction: does it matter? Is it relevant? J. Am. Coll. Cardiol. 1997; 30: 325-333. DOI: https://doi.org/10.1016/S0735-1097(97)00189-7
Colonna P, Iliceto S. Myocardial infarction and left ventricular remodeling: Results of the CEDIM trial. American Heart Journal. 2000; 139(2): 124-130. DOI: https://doi.org/10.1067/mhj.2000.103918
Haynes W, Webb D. Endothelin as a regulator of cardiovascular function in health and disease. Journal of Hypertension. 1998; 16(8): 1081-1098. DOI: https://doi.org/10.1097/00004872-199816080-00001 [PMid:9794709]
George J, Shmuel S, Roth A, Herz I, Izraelov S, Deutsch V, et al. L-Arginine attenuates lymphocyte activation and anti-oxidized LDL antibody levels in patients undergoing angioplasty. Atherosclerosis. 2004; 174(2): 323-327. DOI: https://doi.org/10.1016/j.atherosclerosis.2004.01.025 [PMid:15136062]
2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Russian Journal of Cardiology. 2018; (5): 103-158. DOI: https://doi.org/10.1093/eurheartj/ehx393 [PMid:28886621]
Opie L. Role of carnitine in fatty acid metabolism of normal and ischemic myocardium. American Heart Journal. 1979; 97(3): 375-388. DOI: https://doi.org/10.1016/0002-8703(79)90440-X
Rizzon P, Biasco G, Di Biase M, Boscia F, Rizzo U, Minafra F, et al. High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. European Heart Journal. 1989; 10(6): 502-508. DOI: https://doi.org/10.1093/oxfordjournals.eurheartj.a059519 [PMid:2668006]
Shug A, Thomsen J, Folts J, Bittar N, Klein M, Koke J, et al. Changes in tissue levels of carnitine and other metabolites during myocardial ischemia and anoxia. Archives of Biochemistry and Biophysics. 1978; 187(1): 25-33. DOI: https://doi.org/10.1016/0003-9861(78)90003-6
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