ENDOTHELIAL DYSFUNCTION AND ITS MANAGEMENT IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION COMBINED WITH METABOLIC SYNDROME
Keywords:myocardial infarction, metabolic syndrome, endothelial dysfunction, L-arginine
Background. Oxidative stress, endothelial dysfunction, dyslipidemia and low-grade inflammation induce the disorders of energy metabolism and ischemic damage to cardiomyocytes. It is an essential issue in pathogenesis of acute coronary syndrome/myocardial infarction (ACS/MI).
Objective. The aim of the study was to improve the existing pharmacological therapy in patients with ACS/MI combined with metabolic syndrome (MS).
Methods. The study enrolled 95 patients with acute myocardial infarction. The patients were divided into 2 groups depending on concomitant metabolic syndrome. All groups were divided to subgroups, where patients received typical standard treatment according to the Ukrainian unified and modified treatment regimen with addition of L-arginine and L-carnitine.
Results. In 79.2% of patients with ACS/MI + MS the course of underlying disease was associated with various complications: pericarditis epistenocardica was diagnosed in 39.8% of patients; arrhythmias were present in 35.5% of patients of the main group; left ventricular aneurysm was present in 15.9% of patients. At the same time, significant changes in the indicators of vascular endothelial function in patients with ACS (MI) were revealed (the level of endothelin-1 in the blood plasma was in 2.1 times higher than the reference norm) that was the justification for inclusion of L-arginine and L-carnitine in the complex therapy of comorbid patients.
Conclusions. The multi-modality treatment with inclusion of L-arginine and L-carnitine facilitated restoration of energy supply of myocardial contractility, endothelial function of blood vessels, and antioxidant protection of the body and ultimately resulted in a more favorable course of this comorbid problem.
Batushkin VV. [Cytoprotection in acute myocardial infarction after the discovery of infarct-dependent artery: new horizons]. Liky Ukrainy. 2017;8(214):33–40. (In Ukrainian)
Thiele H, Desch S, de Waha S. Acute myocardial infarction in patients with ST-segment elevation myocardial infarction: ESC guidelines 2017. Herz. 2017 Dec 1;42(8):728-38.
Parkhomenko OM, Kozhukhov SN, Lutay YaM. [Rationale and design of multicenter randomized study PROTECT – study of the effectiveness and safety of quercetin in patients with acute myocardial infarction]. Ukrainian Journal of Cardiology. 2016;(3): 31–6. (In Ukrainian)
Selyuk MM, Kozachok MM, Levkin IM, Selyuk OV. Selection of the optimal combination of metabolic drugs for the treatment of patients with cardiovascular pathology. Family Medicine. 2017; 2(70):60–4. (In Ukrainian)
Acute coronary syndrome with ST segment elevation: Unified clinical protocol of emergency, primary, secondary and tertiary care. – Ministry of Health of Ukraine. 2017: 78. (In Ukrainian)
Shved MI, Tsuglevich LV, Geryak SM. Clinical efficacy of cardiocytoprotective therapy in patients with acute coronary syndrome (myocardial infarction), who underwent balloon angioplasty and coronary artery stenting. Archive of Clinical Medicine.2019;(1):31-7.
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 JJ, Lavie CJ, Fares H, Menezes AR, O'Keefe JH. L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. In Mayo Clinic Proceedings 2013 Jun 1 (Vol. 88, No. 6, pp. 544-551). Elsevier.
Celermajer DS. Endothelial dysfunction: does it matter? Is it reversible?. Journal of the American College of Cardiology. 1997 Aug;30(2):325-33.
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 Feb 1;139(2): s124-30.
Haynes WG, Webb DJ. Endothelin as a regulator of cardiovascular function in health and disease. Journal of Hypertension. 1998 Aug 1;16(8):1081-98.
George J, Shmuel SB, Roth A. L-arginine attenuates lymphocyte activation and antioxidized LDL antibody levels in patients undergoing angioplasty. Atherosclerosis. 2004;174: 323-327.
DOI: https://doi.org/10.1016/j.atherosclerosis. 2004.01.025
Ibanez B, James S, Agewall S. 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. Eur Heart J. 2018;2:119-177.
Opie LH. Role of carnitine in fatty acid metabolism of normal and ischemic myocardium. Am Heart J. 1997;97 (3):375-88.
DOI: https://doi.org/10.1016/0002-8703(79) 90440-X
Rizzon P, Biasko G, Biase MDi. High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. Eur Heart J.1989;10 (6):502-8.
Shug A, Thomsen J, Folts J. Changes in tissue levels of carnitine and other metabolites during myocardial ischemia and anoxia. Arch Biochem Biophys. 1998;187(1):25-33.
Hicks JJ, MontesCortes DH, Cruz-Dominguez MP. Antioxidants decrease reperfusion induced arrhythmias in myocardial infarction with ST-elevation. Frontiers in Bioscience. 2007;12:2029-37.
How to Cite
Copyright (c) 2021 International Journal of Medicine and Medical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who sent their manuscript to International Journal of Medicine and Medical Research agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY-NC that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).