Cytoprotective and metabolic therapy for patients with prior Q-QS wave or non-Q wave myocardial infarction complicated by decompensated heart failure on the background of graded exercises

Abstract

The objective of the research — to determine the efficacy of rehabilitation treatment of the patients with decompensated heart failure (HF) in the early and late post-infarction period using succinic acid and arginine preparations, as well as to assess their effect on exercise tolerance. Material and methods. There were examined 120 patients with Q-QS wave or non-Q wave myocardial infarction (MI), stage II A-B decompensated chronic HF according to the classification by Vasylenko V. Kh. and Strazhesko M. D., the New York Heart Association (NYHA) functional class (FC) III–IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups. All the patients underwent the six-minute walk test (6 MWT) in a quiet 30–50-m long hospital corridor in the morning. Before performing the 6 MWT, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and the standard 12-lead electrocardiogram (ECG) was recorded. Criteria for immediate stopping the test included chest pain, severe shortness of breath, limb cramps, dizziness, unsteady gait, sweating, severe pallor, SpO2 < 86%. Results. When assessing the appearance of clinical signs during physical activity in the patients with prior Q wave MI, the signs such as chest pain, heart rhythm disorders and dizziness were found to increase in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and their combination contributed to a significant reduction in clinical signs of graded exercise inadequacy. Thus, chest pain that accompanied physical activity in 60%, 73.3%, 66.7% of the patients at the beginning of treatment, was observed in one-third of the patients — 20%, 26.7%, 13.3%, respectively, 2 months after the beginning of treatment. Similar tendency was observed when assessing a dynamic of dizziness and cyanosis/pallor cases. When analyzing a dynamic of clinical signs during physical activity in the patients with prior non-Q wave MI, an insignificant reduction in the signs such as chest pain, shortness of breath, heart rhythm disorders and dizziness was observed in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and especially their combination significantly reduced clinical signs of inadequate response to physical exercises. The patients of group 4, who walked (174.87±1.92) m before treatment, walked a distance of (369.00±4.71) m after two months of treatment (p<0.05). Similar tendency was observed when analyzing the indicators of the metabolic equivalent of task (MET) and O2 consumption. During a course of treatment of the patients with non-Q wave MI complicated by decompensated HF, a gradual increase in exercise tolerance and motor activity was observed in all the groups. According to the 6 MWT, in all the groups, there was observed a significant increase (p<0.05) in distance walked over a span of 6 minutes both one month and two months after the beginning of treatment. In addition, during the first and especially the second month of treatment, the 6 MWT was accompanied by a significantly less reduction in HR before and after the test. At the same time, despite the one-sidedness of probable dynamics of the characteristics indicated by the 6 MWT in case of standard treatment, a favorable dynamic was less significant. Similar tendency in HR response to physical activity was observed during the process of treating the patients of other groups. In general, a gradual reduction in resting HR and a significantly less increase in peak HR were observed. According to the dynamics of both SBP and DBP, the formation of favorable hemodynamic support of physical activity in the patients of all the groups was observed as well. Similar tendency was observed when analyzing the indicators of the MET and O2 consumption. These indicators were found to be significantly higher in the dynamics of treatment in all groups of the patients. Positive dynamics in the MET and O2 consumption indicators in the patients who, in addition to standard therapy, received a preparation of succinic acid and arginine preparations deserved special attention. Conclusions. In the patients with decompensated heart failure secondary to acute myocardial infarction, basic therapy including arginine and succinic acid preparations contributes to the improvement of the 6 minutes walk test indicators, its individual perception. Succinic acid and arginine preparations in combination with standard therapy for the patients with MI and decompensated HF allows improving clinical signs of performing physical activity there by improving functional class of heart failure.