THE INFLUENCE OF CYTOPROTECTIVE AND METABOLIC THERAPY ON THE DYNAMICS OF QUALITY OF LIFE INDICATORS IN PATIENTS WITH STEMI THAT DEVELOPED AGAINST THE BACKGROUND OF TYPE 2 DIABETES
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i1.13734Keywords:
acute coronary syndrome, STEMI, type 2 diabetes, diagnostics, complication, treatment, L-carnitine, dapagliflozin, quality of lifeAbstract
SUMMARY. The presence of type 2 diabetes in patients with acute coronary syndrome (ACS) limits the possibility of using early invasive coronary interventions and determines the tactics of drug preparation for surgical interventions and prevention of complications. The severity of the clinical and psychoemotional state of such patients substantiates the importance and feasibility of assessing the integral indicator of "quality of life" as criterion of effectiveness and expediency of carried out medical measures.
The aim – to evaluate the dynamics of quality of life indicators using the Euroqol Group EQ-5D-5L questionnaire in patients with ACS (STEMI) on the background of type 2 diabetes and a high risk of developing cardiac complications at the inpatient stage of treatment under the influence of metabolic (SGLT2 inhibitor dapagliflozin) and cytoprotective (L-carnitine) therapy.
Material and Methods. 75 patients with ACS (STEMI) on the background of T2DM were examined: 38 patients of the main group, who underwent urgent balloon angioplasty and stenting of the infarct-related coronary artery, additionally received L-carnitine and dapagliflozin. 37 patients of the comparison group received only standard protocol treatment. The control group consisted of 28 patients with STEMI without comorbid pathology, who also underwent urgent coronary angioplasty, stenting, and protocol drug treatment. In addition to general clinical, laboratory, and instrumental methods, patients were additionally monitored by ECG, transthoracic echocardiography, and CAG to assess the severity of VA damage, and quality of life was determined using the EQ-5D-5L questionnaire.
Results. In the initial state, the severity of the clinical condition in patients of both groups did not differ significantly and was caused by typical manifestations of ACS and T2DM. In patients of the main group, the additional use of L-carnitine and dapagliflozin against the background of protocol treatment led to 100 % elimination of anginal syndrome and decrease in FC GOS to I-II. In the patients of the comparison group, after 5 days, chest discomfort was observed (in 53.1 %) and GOS Killip class II–III in 50.0 % of patients. The dynamics of troponin and creatine phosphokinase indicators in patients of both studied groups indicated the cessation of cardiomyocyte necrosis already in the first days of treatment. But in patients of the comparison group, their levels did not reach the reference norm even on the fifth day. It was also established that the clinical effectiveness of the complex treatment was significantly higher in relation to reperfusion rhythm disturbances and manifestations of acute heart failure, which were registered respectively in 13.3 % of patients in the main group versus 32.1 % in the control group, and ventricular tachycardia and ventricular fibrillation developed in them 3 times less often
At baseline, patients of both studied groups rated their quality of life with a relatively low score (25.83±10.37) points and (26.24±10.18) points. In the process of carrying out a standard treatment program, patients with ACS in combination with T2DM experienced a significant improvement in well-being, the quality of life index increased by 70.2 % in general. At the same time, we note a significantly higher assessment of the quality of life in patients after a course of complex treatment with the inclusion of L-carnitine and dapagliflozin. Their quality of life index improved by an average of 238.6 % and reached the level of (87.5±9.4) units. With the additional use of L-carnitine and dapagliflozin, the best results were obtained in terms of patient ratings of reduced chest pain/discomfort and feelings of anxiety/depression and slightly lower motor activity scores. At the same time, the use of standard treatment was accompanied by a reliable regression of only the pain syndrome indicator, but the severe general clinical condition of the patients in this group contributed to the increase in signs of anxiety and depressive behavior at the end of the inpatient course of treatment.
Conclusions. The use of a course of complex medical therapy with the inclusion of L-carnitine and dapagliflozin in the pre- and postoperative periods in patients with ACS in combination with T2DM led to an improvement in the clinical condition, restoration of central and peripheral cardiohemodynamic parameters, and a significant reduction in the frequency of reperfusion arrhythmias and left ventricular failure. At the same time, the patients of this group obtained the best results in terms of their assessment of the reduction of chest pain/discomfort and the feeling of anxiety/depression and slightly lower in terms of motor activity, and the use of standard treatment was accompanied by only a reliable regression of the pain syndrome index, but the severe general clinical condition of the patients contributed to the increase of symptoms anxiety and depressive behavior.
References
Gandziuk, V.A., Dyachuk, D.D., & Kondratyuk, N.U. (2017). Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect). Bulletin of Biology and Medicine, 2(136), 319-322. Retrieved from: http://nbuv.gov.ua/UJRN/Vpbm_2017_2_72.
Ivanyuk, А.V., & Orlova, N.M. (2020). Ischemic heart disease among the population of working age in Kyiv region: statistical analysis of the modern epidemiological situation. Reports of Vinnytsia National Medical University [Internet], 24(4), 694-699. DOI: 10.31393/reports-vnmedical-2020-24(4)-24.
Kovalenko, V.M., & Kornatskyi, V.M. (2019). Aktualni problemy zdorovya ta minimizatsiya yikh v umovakh zbroynoho konfliktu v Ukrayini [Actual health problems and their minimization in the conditions of armed conflict in Ukraine]. Kyiv: Natsionalnyy naukovyy tsentr instytut kardiolohiyi im. akad. M. D. Strazheska [in Ukrainian].
Brogan, R.A., Alabas, O., & Almudarra, S. (2019). Relative survival and excess mortality following primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur. Heart J. Acute Cardiovasc. Care, 8(1), 68-77.
Dalal, J.J., Digrajkar, A., & Das, B. (2018). ST2 elevation in heart failure, predictive of a high early mortality. Indian Heart Journal, 70(6), 822-827.
Shved, M.I., & Levytska, L.V. (2018). Suchasni tekhnolohiyi vidnovnoho likuvannya khvorykh iz hostrym koronarnym syndromom [Modern technologies of restorative treatment of patients with acute coronary syndrome]. Kyiv: Vydavn. dim Medknyha [in Ukrainian].
Ibanez, B., James, S., Agewall, S., & Antunes, M. (2018). 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., 2, 119-177. DOI: 10.1093/eurheartj/ehx393.
Petrie, J.R., Guzik, T.J., & Touyz, R.M. (2018). Diabetes, Hypertension, and Cardiovascular Disease: Clinical Insights and Vascular Mechanisms. Can. J. Cardiol., 34(5), 575-584. DOI: 10.1016/j.cjca.2017.12.005.
Leon, B.M., & Maddox, T.M. (2015) Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World J. Diabetes, 6(13), 1246-1258. DOI: 10.4239/wjd.v6.i13.1246.
Daryabor, G., Atashzar, M., & Kabelitz, D. (2020). The Effects of Type 2 Diabetes Mellitus on Organ Metabolism and the Immune System. Front. Immunol., 11, 1582-1595.
Solomenchuk, T.M., & Besh, D.I. (2004). Infarkt miokarda u molodykh: ksenobiotyky yak etiolohichnyy stymul rozvytku [Myocardial infarction in young people: xenobiotics as an etiological stimulus for development]. Praktychna medytsyna – Practical Medicine, 1, 79-82 [in Ukrainian].
Stuart, R.M., Khan, O., & Abeysuriya, R. (2020). Diabetes care cascade in Ukraine: an analysis of breakpoints and opportunities for improved diabetes outcomes. BMC Health Serv. Res., 20(1), 409. DOI: 10.1186/s12913-020-05261-y.
WHO (2016). Diabetes fact sheet. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/diabetes.
Shved, M.I., Tsuglevich, L.V., & Kyrychok, I.B. (2017). Features of cardiorehabilitation and correction of impaired systolic-diastolic function and heart rate variability in patients with acute coronary syndrome with revascularization of coronary arteries.Georgian Medical News, 4 (265), 46-53 [in Ukrainian].
Shved, M.I., & Pelyo, M.P. (2018). The effect of cardioprotective metabolic therapy on the occurrence of rhythm and conduction disorders in patients with myocardial infarction with metabolic syndrome. Arithmology, 2(26), 53-55 [in Ukrainian].
Ministry of Health of Ukraine (2014). Acute coronary syndrome with ST segment elevation: Unified clinical protocol of emergency, primary, secondary and tertiary care.
Shved, M.I., Tsuglevich, L.V., & Geryak, S.M. (2019). 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, 1, 31-37.
Pogosova, N.V., Baichorov, I. Kh., Yufereva, Yu. M., & Koltunov, I. E. (2015). Kachestvo zhizni bolnykh s serdechno-sosudistymi zabolevaniyami: sovremennoye sostoyaniye problemy [Quality of life of patients with cardiovascular diseases: current state of problems]. Kardiologiya – Cardiology, 50(4), 66-78 [in Russian].
Yagenskyi, A.V., Hofer, I.M., Sichkaruk, N., & Oldridge, N. (2018). Otsinka yakosti zhyttya u patsiyentiv z ishemichnoyu khvoroboyu sertsya: rezultaty validyzatsiyi ukrayinomovnoyi versiyi opytuvalnyka MacNewHeartDiseaseHealth-related Quality of Life [Assessment of the quality of life in patients with coronary heart disease: validation results of the Ukrainian version of the questionnaire MacNewHeartDiseaseHealth-related Quality of Life]. Ukrayinskyi kardiolohichnyi zhurnal – Ukrainian Journal of Cardiology, 3, 22-28 [in Ukrainian].
EuroqolGroup (1990). Euroqol – a new facility for the measurement of health-related quality of life. Health.Policy, 16, 199-208.
Ministry of Health of Ukraine (2018). Unifikovanyy klinichnyy protokol ekstrenoyi, pervynnoyi, vtorynnoyi ta tretynnoyi medychnoyi dopomohy «Hostryy koronarnyy syndrom z elevatsiyeyu sehmenta ST» – Unified clinical protocol of emergency, primary, secondary and tertiary medical care "Acute coronary syndrome with ST segment elevation" [in Ukrainian].
Gonskyi, Y.I. (2001). Biolohichna khimiya: laboratornyy praktykum [Biological chemistry: labora-tory practice]. Ternopil: Ukrmedknyha [in Ukrainian].
Haines, D.E., Lai, W.W., & Manning, W.J. (2011). ACCF/ASE/AHA/ASNC/HFSA/HRS/SCAI/SCCM/SCCT/SCMR 2011 appropriate use criteria for echocardiography. J. Am Soc. Echocardiogr., 24(3), 229-267. DOI: 10.1016/j.echo.2010.12.008.
Papadopoulos, K., Lekakis, I., & Nicolaides, E. (2017). The predictive value of the syntax score in patients with chronic coronary artery disease under going percutaneous coronary intervention or coronary artery by pass grafting: a pilotstudy. Open Cardiovasc. Med. J., 11, 28-32. DOI: 10.2174/1874192401711010028.
GUSTO investigators (1993). An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The New England Journal of Medicine, 329(10), 673-682. DOI: 10.1056/NEJM199309023291001.
Astashkin, E.I., & Glezer, M.G. (2012). Role of L-carnitine in energy metabolism cardiomyocytes and treatment of diseases of cardiovascular system. Cardiology and Cardiovascular Surgery, 6(2), 58-65.
DiNicolantonio, J., Lavie, C. & Fares, H. (2013). L-carnitine in the secondary prevention of cardiovascular disease: Systematic revien and meta-analysis. MayoClin. Proc., 1-8.
Hicks, J.J., MontesCortes, D.H., & Cruz-Dominguez, M.P. (2007). Antioxidants decrease reperfusion induced arrhythmias in myocardial infarction with ST-elevation. Frontiers in Bioscience, 12, 2029-2037.
Rizzon, P., & Biasko, G. (1989). High doses of L-carnitine in acute myocardial infarction: metabolic and antiarrhythmic effects. Eur. Heart J., 10(6), 502-508.
Di Pino, A., & DeFronzo, R. (2019). Insulin Resistance and Atherosclerosis: Implications for Insulin-Sensitizing Agents. Endocr. Rev., 40(6), 1447-1467. DOI: 10.1210/er.2018-00141.
Sinning, C., Makarova, N., & Völzke, H. (2021). Association of glycated hemoglobin A1c levels with cardiovascular outcomes in the general population: results from the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium. Cardiovasc. Diabetol., 20(1), 223-231 DOI: 10.1186/s12933-021-01413-4.
Radchenko, O., & Korolyuk, O. (2021). Glycated hemoglobin: mechanisms of formation and clinical significance (literature review and own researches). International journal of endocrinology (Ukraine), 16(1), 69-75. DOI: 10. 22141/2224-0721.16.1.2020.199131.
Ganesan, K., Rana, M.B.M., & Sultan, S. (2022). Oral Hypoglycemic Medications. Treasure Island (FL): StatPearls Publishing.
Berg, D.D., Jhund, P.S., & Docherty, K.F. (2021) Time to Clinical Benefit of Dapagliflozin and Significance of Prior Heart Failure Hospitalization in Patients With Heart Failure With Reduced Ejection Fraction. JAMA Cardiol., 6(5), 499-507. DOI: 10.1001/jamacardio.2020.7585.
