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

Abstract

The aim of the work was to study the features of central and intracardiac hemodynamicsin patients with generalized atherosclerosis (GAS) and their dynamics under the influence of aselective inhibitor of phosphodiesterase 3 cilostazol. The condition of central hemodynamics wasstudied in patients of three study groups: 1 group consisted of 48 male GAS patients aged 65 to 83years with clinical manifestations of lesions of four vascular territories: coronary, cerebral, mesentericand femoral; Group 2 consisted of 23 patients with chronic coronary syndrome (CCS), postinfarctioncardiosclerosis without concomitant vascular pathology, males mean age 68.5 ± 6.5 years, with clinicalmanifestations of atherosclerotic lesions of the coronary artery only. The control group (CG) consistedof 18 almost healthy males, the mean age in the group was 62.5 ± 5.3 years. Patients in group 1 wererandomized into two subgroups. Patients of the first subgroup (GAS-C) in addition to basic therapyreceived cilostazol (C) at a dose of 100 mg twice a day, patients of the second subgroup - comparisonsubgroup (GAS-P) - received only basic therapy. The condition of central hemodynamics was assessedby echocardiography in M- and B-modes. The bioelectrical activity of the myocardium was assessedby the method of daily monitoring of the electrocardiogram.The obtained data showed significantly lower indicators of both inotropic and chronotropicmyocardial function in patients of the 1st group compared to the patient with CG (p <0.05), whichwas significantly lower in minute volume of blood circulation (p<0.01). The comparison of centralhemodynamics of patients of the 1st group with similar indicators of patients of the 2nd grouprevealed significantly lower values of heart rate (HR), left ventricular ejection fraction (EF), circularrate of myocardial fibers (Vcf), stroke volume (SV) and minute blood volume (MBV) in patients ofthe 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 significantlyincreased by 9.1% (p<0.05), end-systolic volume decreased by 6.2%, ejection fraction increased by5.2% (p<0.01), minute blood flow increased by 14.9% (p<0.01), and the rate of circular contraction ofmyocardial fibers increased by 4.7% (p<0, 05), compared with data before treatment. It is importantthat the increase in functional activity of the myocardium (chronotropic and inotropic), under theinfluence 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 ofphosphodiesterase-3 inhibitor C as a part of complex standard pharmacotherapy and leads to increasein minute volume of blood circulation. Importantly, the increase in myocardial functional activityin patients with GAS does not increase the manifestations of myocardial ischemia, but significantly(p<0.05) reduces the number of PEIM and PlEIM.