Management of central hemodynamic and endothelial function disturbances in patients with myocardial infarction combined with metabolic syndrome.

Unlabelled: On a global scale, myocardial infarction (MI) remains one of the most important cardiological challenges of today due to persistent incidence of morbidity, disability and mortality.

Aim: The aim of study was to improve the treatment of MI combined with MS by adding a carnitine-arginine combination to the treatment protocol used in these patients.

Materials And Methods: The study included assessments of 56 patients who had acute coronary syndrome (ACS) with ST segment elevation and concomitant MS. The examined group included 38 patients, in whom a standard per-protocol treatment for ACS/MI was supplemented by a combination of L-arginine (4.2 g)/L-carnitine (2.0 g) supplied as solution for infusions. The combination was administered intravenously, 100 mL once a day for 5 days. The control group enrolled 18 patients who received standard per protocol treatment only. In addition to routine clinical tests and investigations, the patients had echocardiographic assessment for indices of cardiac remodeling and systolic-diastolic function of the left ventricle. The functional status of vascular endothelium was assessed based on plasma concentrations of endothelin-1 (ET-1) and concentrations of stable NO metabolites.

Results: In patients with ACS/MI combined with MS, baseline findings included pronounced disturbances of cardiac morpho-functional parameters, development of post-infarction ventricular remodeling with impaired systolic and diastolic heart function and developing clinical signs of cardiac insufficiency in the setting of endothelial vascular dysfunction. Already in 10 days of treatment, patients in the test group (who had additional treatment with L-arginine/L-carnitine) were noted to have increases in DT and EF and reductions in LVEDV and E/A ratio. On day 28 of treatment, there were significant increases in E and EF (by 13%) and reductions in IVRT, A and E/A, which suggested a gradual recovery of myocardial contractility and a reduction in diastolic dysfunction.

Conclusions: The pharmacotherapeutic combination with inclusion of Larginine and L-carnitine produced a significant improvement in parameters of central cardiac hemodynamics and restored endothelial vascular function. This was accompanied by a significant reduction in the incidence and severity of such complications as reperfusion arrhythmias and acute left ventricular failure.