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ESTIMATE THE INFLUENCE OF TRIMETAZIDINE ON THE QUALITY OF LIFE OF PATIENTS WITH CHD WITH CHRONIC
HEART FAILURE
1 2 Agababyan I.R. , Kobilova NA.
1Agababyan Irina Rubenovna - Candidate of Medical Sciences, Associate Professor, Head of the
Department;
2Kobilova Nigina Akmalovna - Assistant, DEPARTMENT OF THERAPY, FACULTY OF POSTGRADUATE EDUCATION, SAMARKAND STATE MEDICAL INSTITUTE, SAMARKAND, REPUBLIC OF UZBEKISTAN
Abstract: the main cause of the development of chronic heart failure (CHF) is ischemic heart disease (CHD), in particular, acute myocardial infarction (AMI). Postinfarction remodeling leads to impaired LV systolic function, CHF and a decrease in the quality of life in patients with MI [2,5]. The leading role in the development of CHF after myocardial infarction belongs to structural and functional changes in the myocardium, leading to remodeling of the left ventricle with impaired contractile function [3,5]. Recently, the morphofunctional state of the ischemic myocardium and the forms of its reversible dysfunction have been actively studied [5]. Of particular interest are cardiomyocytes, which do not actively contract, but maintain minimal oxygen consumption and the main components of cellular metabolism [1]. Such a myocardium is characterized by the terms stunned myocardium ("stunned" myocardium) and hibernation myocardium ("dormant" myocardium). Certain prospects in terms of CHF treatment may be associated with the complete restoration of the functions of the "stunned" or "dormant" myocardium not by performing surgical revascularization or balloon coronary angioplasty, but by influencing the most important energy and metabolic processes in cardiomyocytes [4]. One of the drugs of metabolic action is the myocardial cytoprotector trimetazidine, an inhibitor of mitochondrial long-chain 3-ketoacyl-CoA thiolase. Cytoprotection is achieved by providing a sufficient amount of energy, which allows maintaining the normal contractile function of cardiomyocytes and the myocardium as a whole. 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%). 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 [6]. It was found that the addition of trimetazidine to traditional therapy of chronic heart failure in patients with coronary heart disease leads to a significant improvement in myocardial contractile function and to a significant decrease in the functional class of chronic heart failure.
Keywords: trimetazidine, ischemic heart disease, chronic heart failure, myocardial infarction.
Target: Evaluate the effect of trimetazidine on the quality of life of patients with coronary artery disease who have had myocardial infarction with chronic heart failure.
Materials and methods: We examined 53 patients with coronary artery disease who underwent myocardial infarction [men - 36 (67.9%), women - 17 (32.1%)]. The median age was 63.4±1.3 years old. All patients underwent examination: interview and examination; general clinical and biochemical studies, ECG. Assessment of the manifestations of CHF in patients of both groups was carried out according to the New York classification according to the results of the 6-minute walk test. The assessment of the quality of life of patients in points was carried out according to the adapted Minnesota questionnaire (LWHF index:0 points for excellent quality of life. 100 points - the worst quality of life) patients with CHF.
The patients were divided into 2 groups. The first group included 34 (64%) patients [men - 22 (64%), women - 12 (35.3%)], who along with basic therapy received trimetazidine (predizin, Gedeon Richter, Hungary) at a dose of 35 mg 2 once a day for 3 months. The second group (control group) included 19 (35.8%) patients [men - 14 (74%), women - 5 (26%)] who received only basic therapy (beta-blockers, ACE inhibitors, anticoagulants, antianginal drugs). In the first grouppatients with bad habits accounted for 9 (26.5%), obese patients - 16 (47.1%). Of the concomitant pathology, the majority of patients with hypertension - 10 (29.4%), In the second group (control group), patients with bad habits - 8 (42.1%), obese patients - 6 (31.6%). Of the concomitant pathologies, the majority of patients with HD are 9 (47.4%). These main clinical indicators in both groups did not differ significantly.
Table 1. These main clinical indicators in both groups
Parameters Trimetazidine group n = 34 Control group n = 19
Men 22 (64%) 14 (74%)
Women 12 (35.3%) 5 (26%)
Average age 63.4±1,3
GB 10 (29.4%) 9 (47.4%)
Obesity 16 (47.1%) 6 (31.6%)
Bad habits (smoking and alcohol) 9 (26.5%) 8 (42.1%)
Distribution by classes of CHFat the time of inclusion of patients in the study was observed in group 1 in 16 (47.1%) patients: FC I in 4 (25%), FC II - 5 (31.25%), FC III - 4 (25%) and IV FC - 3 (18.75%). In group 2, 14 (73.7%) patients: FC I in 4 (28.6%), FC II -3 (21.4%), FC III - 3 (21.4%) and FC IV - 4 (28.6%) patients. According to the Minnesota questionnaire in the 1st group of patients, the indicators of the quality of life (mean value in points) were 63.1 ± 1.6 points (p <0.05). Group 2 had 60.4 ± 1.4 points (p <0.05).
Results. On the background of the treatment, the quality of life of the patients improved. This was reflected in the positive dynamics in the distribution of patients by FC and in the assessment of the occurrence of CHF, there was a positive trend: in the group taking predizin - the number of patients with FC II CHF increased from 5 (31.25%) to 7 (43.75%), FC I CHF from 4 (25%) to 5 (31.25%) patients compared to the initial data, the number of patients with FC III CHF decreased to 2 (12.5%) and FC IV CHF to 2 (12.5%) patients, and
in the control group there was a slight negative dynamics (III and IV FC up to 2 (14.28%) and 4 (28.6%), respectively).
Table 2. The data are presented
Criterion Trimetazidine group n = 34. CHF = 16 Control group n = 19. CHF = 14
Before treatment After treatment Before treatment After treatment
I FC, 4 (25%) 5 (31.25%) 4 (28.6%) 4 (28.6%)
II FC 5 (31.25%) 7 (43.75%) 3 (21.4%) 4 (28.6%)
III FC 4 (25%) 2 (12.5%) 3 (21.4%) 2 (14.28%)
IV FC 3 (18.75%) 2 (12.5%) 4 (28.6%) 4 (28.6%)
The study noted a positive trend in indicators reflecting the quality of life according to the Minnesota questionnaire. In the 1st group of patients, the indicators of the quality of life (mean value in points) improved from 63.1 ± 1.6 to 35.3 ± 0.78 points (p <0.05). In the 2nd group with 60.4 ± 1.4 to 52.6 ± 1.5 points (p <0.05).
Table 3. Minnesota Questionnaire data
Group Initially In 6 months P
1 st group (n = 34) 63.1 ± 1.6 35.3 ± 0.78 p <0.05
2nd group (n = 19) 60.4 ± 1.4 52.6 ± 1.5 p <0.05
When analyzing biochemical parameters in group 1 (who received additional predizin) before treatment, cholesterol was 6.6±0.7 mmol / L, and after treatment 6.0±0.2 mmol / L. In the second group, before treatment, cholesterol was 6.8±0.5 mmol / L, and after treatment 6.3±0.5 mmol / L.
Conclusions. Cardioprotectors and, in particular, trimetazidine have a positive effect on hemodynamics in patients with coronary artery disease complicated by chronic heart failure. Currently, trimetazidine is also recommended as an antianginal drug for angina pectoris. Therefore, the drug can be included in the treatment of patients with ischemic heart disease and postinfarction cardiosclerosis.
References
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2021. Т. 48. № 7. Р. 137-142.
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ПУТИ КОРРЕКЦИИ ЭНДОТОКСИКОЗА ПРИ ОСТРОМ ПЕРИТОНИТЕ (ОБЗОР ЛИТЕРАТУРЫ) Саттаров Ш.Х.1, Рузибаев С.А.2
1Саттаров Шокир Хасанович - соискатель; 2Рузибаев Санжар Абдусаломович - доктор медицинских наук, доцент, кафедра хирургических болезней и урологии, Самаркандский государственный медицинский институт, г. Самарканд, Республика Узбекистан
Аннотация: проведенный обзор литературы показал, что перитонит, несмотря на современные достижения в ургентной абдоминальной хирургии, продолжает оставаться актуальной проблемой. Это обусловлено тем, что патогенетические механизмы, которые развиваются во время перитонита, являются чрезвычайно сложными и не полностью изученными, а возникающие острые септические осложнения продолжают обусловливать высокий уровень летальности при данной патологии.
Ключевые слова: острый перитонит, эндотоксикоза, санация.
Введение. Важным и очень актуальным остается вопрос коррекции эндотоксикоза при перитонитах. На современном этапе при критических состояниях применение эфферентных методов лечения является общепринятым. Ни один из методов
