Clinical efficacy in correction of vessels' endothelial dysfunction sn the peri- and postoperative period in patients with acute coronary syndrome in combination with obliterating atherosclerosis of the lower extremities
DOI:
https://doi.org/10.11603/2414-4533.2021.1.12016Keywords:
reperfusion complications, arginine-carnitine complexAbstract
The aim of the work: to study the effectiveness of interventional and drug treatment of patients with acute coronary syndrome without ST segment elevation in combination with obliterating atherosclerosis of the main vessels at the stage of critical lower extremity ischemia and high risk of cardiac complications at the inpatient stage.
Materials and Methods. The study included 54 patients with acute coronary syndrome without ST elevation in combination with obliterating atherosclerosis stage III–IV of chronic ischemia according to the classification of B. V. Pokrovsky or Fontaine, which corresponds to critical ischemia of the 4th, 5th or 6th categories (grade II–III) according to Rutherford (ESC, 2017). According to the chosen treatment tactics all patients were divided into 2 groups: 34 patients of the main experimental group in addition to standard corticosteroid treatment, received an additional intravenous 4.2 g of L-arginine and 2.0 g of L-carnitine in the form of a solution for infusion of 100 ml once a day for 7 days. One infusion of the drug was performed before the intervention. The control group included 20 patients who also underwent emergency balloon angioplasty and stenting of the infarct-dependent coronary artery, but patients in this group received only standard protocol treatment.
In addition to general clinical, instrumental and laboratory methods (general blood test, MB fraction of creatine phosphokinase (CPK-MB), troponin T, arterial blood oxygen saturation (SpO2), ECG in 12 standard leads, etc.), the functional state of vascular endothelium was determined by endothelin-1 concentration (ET-1) in blood plasma (using an enzyme-linked immunosorbent assay from Amersham Pharmacia Biotech) and the content of stable NO metabolites, which were determined by reaction with Gris reagent.
Results and Discussion. In the initial state in patients with ACS without ST segment elevation in combination with obliterating atherosclerosis of the lower extremity vessels was found the severe disorders of microcirculation and endothelial function and their additional aggravation in the peri- and postoperative periods after percutaneous coronary intervention. It was accompanied by the development of reperfusion syndrome with varying duration and severity of the left ventricular failure and arrhythmias. In patients of the control group under the influence of standard drug treatment was noted the presence of treatment-resistant supraventricular and ventricular extrasystoles. At the same time in patients of the experimental group with ACS without ST segment elevation in combination with obliterating atherosclerosis of the lower extremity vessels under the influence of complex drug treatment with the inclusion of L-arginine and L-carnitine from the second day of observation was a significant decrease of the frequency of rhythm and conduction disorders. At the end of treatment in comorbid patients of the experimental group the frequency of arrhythmias and conduction decreased by 53.1 % and manifestations of acute heart failure – by 44.2 %.
The obtained result substantiates the expediency of introducing the proposed cytoprotective antioxidant therapy in the preoperative period to prevent the manifestations of reperfusion syndrome and its continuation in the postoperative period to stabilize the clinical condition of patients and secondary prevention of complications.
References
Handziuk, V.A., Diachuk, D.D., & Kondratiuk, N.Yu. (2017). Dynamika zakhvoriuvanosti i smertnosti vnaslidok khvorob systemy kovoobihu v Ukraini (rehionalnyi aspekt) [Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect)]. Visnyk problem biol. i med. – Bulletin of Problems of Biology and Medicine, 2 (136), 319-322 [in Ukrainian].
Genyk, S.M., & Simchich, A.V. (2016). Reperfuziinyi syndrom pislia revaskuliaryzatsii ishemii nyzhnikh kintsivok [Reperfusion syndrome after revascularization of the ischemic lower limbs]. Sertse i sudyny – Heart and Vessels, 3, 104-108 [in Ukrainian].
Horobets, N.M. (2015). Novi stratehichni pidkhody do korektsii endotelialnoi dysfunktsii [New strategic approaches to the correction of endothelial dysfunction]. Liky Ukrainy – Medicine of Ukraine, 2 (188), 20-24 [in Ukrainian].
Grigoryev, A.M. (2014). Faktory riska neblagopriyatnykh iskhodov koronarnogo shuntirovaniya u patsiyentov s izolirovannym i multifokalnym aterosklerozom [Risk factors for adverse outcomes of coronary bypass grafting in patients with isolated and multifocal atherosclerosis]. Extended abstract of Candidate’s thesis. Kemerovo [in Russian].
Kovalenko, V.M. (2015). Kardiolohiia v Ukraini: vchora, siohodni i v maibutniomu [Cardiology in Ukraine: yesterday, today and in the future]. Ukr. kardiol. zhurnal – Ukrainian Journal of Cardiology, 2, 9-16 [in Ukrainian].
Kondakov, I.L., & Yakovenko, A.F. (2000). Sposoby morfo-funktsionalnoho doslidzhennia stanu endoteliiu: metod. rek. [Methods of morpho-functional study of the endothelium: guidelines]. Kharkiv [in Ukrainian].
Shved, M.I., Tsuglevich, L.V., Kirichok, I.B., Levitskaya, L.V., Boyko, T.V., & Kitsak, Ya.M. (2017). Osobennosti kardioreabilitatsii i korrektsii narusheniy sistolo-diastolicheskoy funktsii i variabelnosti ritma serdtsa u bolnykh ostrym koronarnym sindromom s revaskulyarizatsiyey koronarnykh arteriy [Cardioreabilitation peculiarities and correction of violations of systolic, diastolic function and heart ratevariability in patients with acute coronary sundrome and coronary artery revascularization]. Georgian Med. News, 4 (265), 46-53 [in Russian].
Barbarash, O.L., Zykov, M.V., Kashtalap, V.V., & Barbarash, L.S. (2011). Rasprostranennost i klinicheskaya znachimost multifokalnogo ateroskleroza u patsiyentov s ishemicheskoy boleznyu serdtsa [The prevalence and clinical significance of multifocal atherosclerosis in patients with ischemic heart disease]. Kardiologiya – Cardiology, 51, 8, 66-71 [in Russian].
Astashkin, E.I., & Glezer, M.G. (2012). Role of L-carnitine in energy metabolism cardiomyocytes and treatment of diseases of cardiovascular system. Cardiol. Cardiovasc. Surg., 6 (2), 58-65.
Conte, M.S., Moll, F.L., Verhaar, M.C., & Teraa, M. (2016). Critical limb ischemia: current trends and future directions. J. Am. Heart Assoc., 5, e002938.
DiNicolantonio, J., Lavie, C., & Fares, H. (2013). L-carnitine in the secondary prevention of cardiovascular disease: Systematic revien and meta-analysis. Mayo Clin. Proc., 88 (6), 544-551.
Fakhry, F., Spronk, S., & van der Laan, L. (2015). Endovascular revascularization and supervised exercise for peripheral artery disease and intermittent claudication: a randomized clinical trial. JAMA, 314, 1936-1944.
George, J., Shmuel, S.B., Roth, A., Herz, I., Izraelov, S., Deutsch, V., …, & Miller, H. (2004). L-arginine attenuates lymphocyte activation and antioxidized LDL antibody levels in patients undergoing angioplasty. Atherosclerosis, 174 (2), 323-327.
Sabatine, M.S., Giugliano, R.P., Keech, A.C., Honarpour, N., Wiviott, S.D., Murphy, S.A., …, & Pedersen, T.R. (2017). Evolocumab and clinical outcomes in patients with cardiovascular disease. N. Engl. J. Med., 376 (18), 1713-1722.
Levi, F., Luccbini, F., Negri, E., & La Veccbia, C. (2002). Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart, 88, 2, 119-124.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Hospital Surgery. Journal named by L.Ya. Kovalchuk
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish their work in Hospital Surgery. Journal by L. Ya. Kovalchuk agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are 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 acknowledgement of its initial publication in this journal.
- 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)
