ЖУРНАЛ КАРДИОРЕСПИРАТОРНЫХ ИССЛЕДОВАНИЙ | JOURNAL OF CARDIORESPIRATORY RESEARCH
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31
УДК 616.127-005.8:615.45
Кобилова Нигина Акмаловна
ассистент кафедры терапии ФПДО
Самаркандский государственный медицинский институт, Самарканд, Узбекистан
ТРИМЕТАЗИДИН В КОМБИНИРОВАННОЙ ТЕРАПИИ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА, ПЕРЕНЕСШИХ
ИНФАРКТ МИОКАРДА
For citation:
Kobilova N.A.
Trimetazidine in combined therapy of ischemic heart disease with myocardial infarction. Journal of cardiorespiratory
research. 2021, vol. 2, issue 4, pp.31-33
http://dx.doi.org/10.26739/2181-0974-2021-4-6
АННОТАЦИЯ
Несмотря на постоянное совершенствование методов обследования и лечения, уровень смертности от ИБС сохраняется высоким, в
связи с чем ведутся поиски и разработки новых подходов к ведению больных ИБС. Эпидемиологические исследования, проведенные
среди населения Узбекистана, показали, что более 26% лиц в возрасте старше 40 лет страдают артериальной гипертонией (АГ), которая
является причиной мозгового инсульта, острого инфаркта миокарда, сердечной недостаточности; около 11% страдают различными
формами ИБС. В Узбекистане ежегодно регистрируется 8000 случаев острого инфаркта миокарда, около 60% пациентов умирают на
догоспитальном этапе. Поэтому, это является актуальной проблемой не только клинической, но и научной медицины. Появление в
клинической практике препаратов метаболического действия стало выдающимся событием в кардиологии.
Ключевые слова:
сердечно-сосудистая система, ишемическая болезнь сердца, инфаркт миокарда.
Kobilova Nigina Akmalovna
Assistant of the Department of Internal
Medicine, Faculty of Postgraduate Education,
Samarkand State Medical Institute, Samarkand, Uzbekistan
TRIMETAZIDINE IN COMBINED THERAPY OF ISCHEMIC HEART DISEASE WITH MYOCARDIAL INFARCTION
ANNOTATION
Despite the constant improvement of methods of examination and treatment, the mortality rate from coronary artery disease remains high, and
therefore the search and development of new approaches to the management of patients with coronary artery disease are underway. Epidemiological
studies carried out among the population of Uzbekistan have shown that more than 26% of people over the age of 40 suffer from arterial hypertension
(AH), which is the cause of cerebral stroke, acute myocardial infarction, heart failure; about 11% suffer from various forms of ischemic heart
disease. In Uzbekistan, 8000 cases of acute myocardial infarction are registered annually, about 60% of patients die at the pre-hospital stage [3].
Therefore, this is an urgent problem not only in clinical, but also in scientific medicine. The appearance of metabolic drugs in clinical practice has
become an outstanding event in cardiology
.
Key words
: CVS (cardiovascular system), ischemic heart disease, myocardial infarction.
Kobilova Nigina Akmalovna
Diplomdan keying ta`lim fakulteti terapiya kafedrasi assistenti
Samarqand Davlat Tibbiyot Instituti, Samarqand, O’zbekiston
MIOKARD INFARKTI O`TKAZGAN YURAK ISHEMIK KASLLIGI BOR BEMORLARDA TRIMETAZIDINNING
KOMBINIRLANGAN TERAPIYASI
ANNOTATSIYA
Tekshiruv va davolash usullarining doimiy takomillashtirilishiga qaramay, yurak-qon tomir kasalliklaridan o'lim darajasi yuqoriligicha
qolmoqda va shuning uchun yurak ishemik kasalligi bilan og'rigan bemorlarni davolashning yangi yondashuvlarini izlash va ishlab chiqish davom
etmoqda. O‘zbekiston aholisi o‘rtasida olib borilgan epidemiologik tadqiqotlar shuni ko‘rsatdiki, 40 yoshdan oshgan aholining 26% dan ortig‘i
miya insultlari, o‘tkir miokard infarkti, yurak yetishmovchiligining sababi bo‘lgan arterial gipertenziya (AG); taxminan 11% yurak ishemik
kasalligining turli shakllaridan aziyat chekadi. O‘zbekistonda har yili 8000 ga yaqin o‘tkir miokard infarkti qayd etiladi, bemorlarning 60 foizga
ЖУРНАЛ КАРДИОРЕСПИРАТОРНЫХ ИССЛЕДОВАНИЙ | JOURNAL OF CARDIORESPIRATORY RESEARCH
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yaqini kasalxonaga yotqizishdan oldingi bosqichda vafot etadi. Shuning uchun bu nafaqat klinik, balki ilmiy tibbiyotda ham dolzarb muammodir.
Metabolik dorilarning klinik amaliyotda paydo bo'lishi kardiologiyada ajoyib voqea bo'ldi.
Kalit so’zi:
Yurak qon-tomir tizimi,
yurak ishemik kasalligi
,
miokard infarkti.
Cardiovascular diseases (CVD) are the leading cause of nonviolent
death in the world. Among them, ischemic heart disease is in the lead -
in 2020 it affects 126 million people worldwide, this is 16% of all deaths
[4]. Men are susceptible to coronary artery disease more often than
women [4]. Clinical manifestations of coronary artery disease include
asymptomatic myocardial ischemia, angina pectoris, acute coronary
syndromes (unstable angina pectoris, myocardial infarction) and sudden
cardiac death [5]. Despite the constant improvement of examination and
treatment methods, the mortality rate from coronary artery disease
remains high, and therefore the search and development of new
approaches to the management of patients with coronary artery disease
are underway. Currently, coronary heart disease is one of the major
causes of death in the world. Very often leads to myocardial infarction,
remodeling of the heart, and ultimately to chronic heart failure. Chronic
heart failure ends in the death of the patient. In recent years, more
antianginal drugs have appeared for the treatment of stable and unstable
forms of coronary artery disease, these are nitrates, β-blockers, calcium
antagonists, ranolazine, nicorandil, allopurinol. Trimetazidine is also
now included in the treatment of acute pain - acute coronary syndrome
and unstable angina due to its action on cardiomyocytes. This once
again indicates the need for the use of trimetazidine in patients with past
covid-19 who are currently at the Long-covid stage and need long-term
rehabilitation. [2,8] In recent decades, the incidence of ischemic heart
disease has become significantly younger. Already at the age of 30,
ischemic heart disease is the main cause of morbidity and disability, and
from 40 years of age, premature death [6]. Therefore, this is an urgent
problem not only in clinical, but also in scientific medicine. The
appearance of metabolic drugs in clinical practice has become an
outstanding event in cardiology. Microcirculatory dysfunction and
metabolic disorders emerge as important concomitant pathogenetic
mechanisms in CAD. In addition, the limited impact of
revascularization procedures on the patient's prognosis, as well as
persistent angina pectoris in many patients after the elimination of
stenosing atherosclerotic plaques in the coronary arteries, support this
hypothesis [4, 5]. Therefore, in patients with CAD and stable angina, a
combined therapeutic approach is required, including metabolic agents
(such as trimetazidine, TMZ) in addition to standard therapy [7]. One of
the highly effective metabolic drugs is the myocardial cytoprotector
trimetazidine, an inhibitor of mitochondrial long-chain 3-ketoacyl-CoA
thiolase. Cytoprotection is achieved by providing enough energy, which
allows maintaining the normal contractile function of cardiomyocytes
and the myocardium as a whole. [9] Metabolic agents improve energy
production efficiency, reduce oxygen debt, and protect myocardial cells
from the effects of ischemia [11, 14,15]. Metabolic processes in the
heart are supported by energy, which is formed during the breakdown
of two main substrates: free fatty acids (70%) and glucose (15%). With
a deficiency of oxygen, the breakdown of fatty acids is disrupted, and
this leads to a number of biochemical changes: to inhibition of aerobic
glycolysis, to a decrease in the rate of ATP synthesis, to an increase in
the rate of formation of free radicals, to damage to cell membranes, to
the accumulation of Ca2 + cations and to the development of
intracellular acidosis, the consequence of which is a decrease in the
contractile function of the heart [1,12, 13]. Trimetazidine contributes to
the conservation of energy potential by optimizing the use of oxygen by
the myocardium under ischemic conditions by increasing aerobic
glycolysis and reducing the rate of fatty acid oxidation [10].
Target
: To evaluate the clinical efficacy of trimetazidine and its
effect on the functional state of the CVS in patients with coronary artery
disease who have had myocardial infarction.
Materials and methods
: The study was conducted in the
therapeutic departments of the Samarkand Regional Multidisciplinary
Medical Center. A total of 52 patients with coronary artery disease who
had undergone myocardial infarction (men - 36 (69%), women - 16
(31%)) were examined. All patients underwent examination: interview
and examination; general clinical and biochemical studies, ECG,
echocardiography (EchoCG). The study included patients with an LV
ejection fraction of less than 50%... The patients were divided into 2
groups. The first group (comparison group) included 19 (36%) patients
(men - 14 (74%), women - 5 (26%)) who received only basic therapy
(beta-blockers, ACE inhibitors, anticoagulants, antianginal drugs) ...
The second group included 33 (63%) patients (men - 22 (67%), women
- 11 (33%)) who, along with basic therapy, received trimetazidine
(predizin, Gedeon Richter, Hungary) at a dose of 35 mg 2 times day for
3 months. In the first grouppatients with bad habits accounted for 9
(47.3%), obese patients - 6 (31.6%). Of the concomitant pathology,
most patients with AH - 9 (47.4%), with diseases of the gastrointestinal
tract - 2 (10.5%), with heart failure FC IV- 5 (26.5%), with a disease of
the nervous system -5 (26.5%), with atrial fibrillation were 5 (26.3%).
In the second group (control group), patients with bad habits - 8
(24.2%), obese patients - 16 (48.5%). Of the concomitant pathologies,
most patients with AH are 10 (30.3%), with diseases of the
gastrointestinal tract - 3 (9.1%), with heart failure FC IV - 6 (18.2%),
with diseases of the nervous system - 11 (33.3%), atrial fibrillation were
6 (18.2%). These main clinical indicators were not significantly
different in both groups. The effectiveness of the therapy was assessed
by LV remodeling in patients with coronary artery disease after
myocardial infarction. The structural and functional state of the left
ventricle was studied using a MindrayDC-7 echocardiograph according
to the standard technique. Echocardiography was performed before and
after treatment. Evaluated the following indicators: end systolic size
(ESV), end diastolic size (EDV), end diastolic volume (EDV), end
systolic volume (ESV), stroke volume (SV), left ventricular ejection
fraction (LVEF).
Results.
When analyzing the dynamics of symptoms of heart failure against
the background of the therapy, it was revealed that in both groups there
was a significant decrease in the functional class (FC) in the studied
patients. Thus, in patients of group 1, FC decreased from 2.52 + 0.08 to
1.85 + 0.09 (p <0.001), and in patients of group 2, FC decreased from
2.40 ± 0.09 to 1.47 ± 0.12 (p <0.001). However, in patients of the 2nd
group, the decrease in FC was more pronounced than in the 1st group
(38.8% and 26.6%, respectively). When comparing the mean FC values
of patients between the 1st and 2nd groups after three months of therapy,
it was revealed that in the 2nd group of patients the average FC was less
by 25.8% (p = 0.008). None of the 52 patients included in the study
experienced a worsening of their condition during the three-month
therapy, and all patients successfully completed the study program.
When analyzing biochemical parameters in group 1 before
treatment, cholesterol was 6.8±0.5 mmol / L, and after treatment 6.3±0.5
mmol / L. In the second group (who received additionally predizin),
cholesterol was 6.6±0.7 mmol / L, and after treatment 6.0±0.2 mmol /
L. When analyzing the echocardiography parameters in group 1 before
treatment, the end diastolic volume (EDV) was 159 ± 1.84 mm / m2,
and after treatment - 154.4 ± 1.58 mm / m2 L; the final systolic volume
(CSV) before treatment - 86.84 ± 5.11 mm / m2, after - 78.67 ± 2.28
mm / m2; left ventricular ejection fraction (LVEF) before treatment –45
± 0.62%, after - 50.2 ± 1.26%. Left ventricular stroke volume (LVOL)
- before treatment was 63.57 ± 4.33, after treatment - 72.72 ± 2.48. In
group 2, before treatment, the end diastolic volume (EDV) was 146 ±
2.35 mm / m2, and after treatment —114.03 ± 5.32 mm / m2; the final
systolic volume (CSV) before treatment - 84.65 ± 1.64 mm / m2, after -
42.82 ± 2.18 mm / m2; left ventricular ejection fraction (LVEF) - before
treatment - 43.6 ± 1.45%, after - 56 ± 2.25%. Stroke volume of the left
ventricle (LVOL) - before treatment - 58.74 ± 1.43 after - 71.88 ± 3.18.
From The analyzes carried out after the treatment of patients showed a
tendency
towards
the
normalization
of
cholesterol
and
echocardiography. These indicators were most pronounced in the
second group (p≤0.05).
Output.
There was a significant difference and a better treatment
effect in the control group. Thus, the addition of predizin to the complex
therapy leads to a more pronounced improvement in the general
condition of patients and the normalization of echocardiography.
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