THE FEATURES OF CENTRAL HEMODYNAMICS IN PATIENTS  WITH CHRONIC CORONARY SYNDROME ON THE BACKGROUND OF GENERALIZED  ATHEROSCLEROSIS UNDER THE INFLUECE OF CILOSTAZOL

Tatiana Motsak

doi:10.32345/USMYJ.4(119).2020.56-65

Tatiana Motsak Bogomolets National Medical University

DOI: https://doi.org/10.32345/USMYJ.4(119).2020.56-65

Keywords: central hemodynamics, generalized atherosclerosis, cilostazol, myocardial ischemia.

Abstract

The aim of the work was to study the features of central and intracardiac hemodynamics in patients with generalized atherosclerosis (GAS) and their dynamics under the influence of a selective inhibitor of phosphodiesterase 3 cilostazol. The condition of central hemodynamics was studied in patients of three study groups: 1 group consisted of 48 male GAS patients aged 65 to 83 years with clinical manifestations of lesions of four vascular territories: coronary, cerebral, mesenteric and femoral; Group 2 consisted of 23 patients with chronic coronary syndrome (CCS), postinfarction cardiosclerosis without concomitant vascular pathology, males mean age 68.5 ± 6.5 years, with clinical manifestations of atherosclerotic lesions of the coronary artery only. The control group (CG) consisted of 18 almost healthy males, the mean age in the group was 62.5 ± 5.3 years. Patients in group 1 were randomized into two subgroups. Patients of the first subgroup (GAS-C) in addition to basic therapy received cilostazol (C) at a dose of 100 mg twice a day, patients of the second subgroup - comparison subgroup (GAS-P) - received only basic therapy. The condition of central hemodynamics was assessed by echocardiography in M- and B-modes. The bioelectrical activity of the myocardium was assessed by the method of daily monitoring of the electrocardiogram.

The obtained data showed significantly lower indicators of both inotropic and chronotropic myocardial function in patients of the 1st group compared to the patient with CG (p <0.05), which was significantly lower in minute volume of blood circulation (p<0.01). The comparison of central hemodynamics of patients of the 1st group with similar indicators of patients of the 2nd group revealed significantly lower values of heart rate (HR), left ventricular ejection fraction (EF), circular rate of myocardial fibers (Vcf), stroke volume (SV) and minute blood volume (MBV) in patients of the 1st group (p<0.05). After the addition of cilostazol (C) to the complex standard pharmacotherapy, an increase in inotropic and chronotropic cardiac function was observed: heart rate significantly increased by 9.1% (p<0.05), end-systolic volume decreased by 6.2%, ejection fraction increased by 5.2% (p<0.01), minute blood flow increased by 14.9% (p<0.01), and the rate of circular contraction of myocardial fibers increased by 4.7% (p<0, 05), compared with data before treatment. It is important that the increase in functional activity of the myocardium (chronotropic and inotropic), under the influence of C, was simultaneously with a decrease in the manifestations of myocardial ischemia. The number of painful (РEIM) and painless episodes of myocardial ischemia (PlEIM) probably decreased - by 24.0% and 20.6%, respectively (p<0.05).

Thus, our data showed that in patients with generalized atherosclerosis with myocardial infarction, ischemic stroke with intermittent claudication and stenosis of the mesenteric arteries, the use of phosphodiesterase-3 inhibitor C as a part of complex standard pharmacotherapy and leads to increase in minute volume of blood circulation. Importantly, the increase in myocardial functional activity in patients with GAS does not increase the manifestations of myocardial ischemia, but significantly (p<0.05) reduces the number of PEIM and PlEIM.

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