M. Shved, R. Ovsiychuk

Ivan Horbachevsky Ternopil National Medical University

Introduction.Patients with type 2 diabetes mellitus (T2DM) have a 2-fold increased risk of coronary heart disease, and the risk of death from it is 2-4 times higher than in patients without carbohydrate metabolism disorders. The reason for such negative trends is considered to be the development of metabolic stress in conditions of hyperglycemia and insulin resistance, which are the basis of impaired energy metabolism and ischemic damage to cardiomyocytes, which implies the possibility of drug influence on these pathological processes.

The aim of the study. To find out the features of the course and the effectiveness of complex treatment using L-carnitine and dapagliflozin in patients with ST-segment elevation myocardial infarction and type 2 diabetes mellitus.

Materials and methods. The research group consisted of 38 patients (16.0% of women and 84.0% of men aged 42 to 65) with myocardial infarction with ST elevation (STEMI) on the background of T2DM, who, in addition to percutaneous coronary intervention (PCI), were additionally prescribed L-carnitine and the SGLT2 inhibitor dapagliflozin. The comparison group included 37 patients (13.5% of women and 86.5% of men aged 45 to 70) with STEMI and T2DM who received only standard protocol treatment after PCI. The control group consisted of 24 practically healthy individuals of similar gender and age.

In addition to general clinical and electrocardiography (ECG) examinations, an echocardiogram was performed to determine the global and local contractile activity of the myocardium according to the J. Simpson method, and the blood plasma levels of glucose, insulin, insulin resistance according to the Homeostatic Model Assessment index and the degree of its severity according to the F.Caro coefficient were determined.

All patients of the experimental and comparison groups before the occurrence of ACS (STEMI) were treated with hypoglycemic drugs of the metformin group.

The effectiveness of the treatment of patients was evaluated for 10 days.

Statistical processing of the obtained results was carried out using the package of statistical programs “Statistica 10.0” and the program “Microsoft Excel-2013”. Non-parametric methods of statistics were used to evaluate the obtained indicators – H. B. Mann-D. R. Whitney U-test for comparing indicators in two groups (p<0.05).

Results. Patients with STEMI on the background of T2DM after PCI most often developed reperfusion syndrome with manifestations of left ventricular failure and rhythm disturbances. The significant clinical and functional improvement was noted under the influence of standard medical treatment, but post-infarction remodeling progressed with impaired systolic and diastolic heart function with the development of heart failure syndrome and treatment-resistant paroxysms of atrial fibrillation, ventricular fibrillation, supraventricular and ventricular extrasystoles and blockades persisted peduncle of the W. His bundle.

The significant decrease in the frequency of rhythm and conduction disturbances was noted in the patients of the research group with STEMI on the background of T2DM under the influence of complex medical treatment including L-carnitine and the sodium-glucose cotransporter (SGLT2) inhibitor dapagliflozin already on the second day of observation, as well as a decrease in the manifestations of post-infarction remodeling of the left ventricle (LV), which in the final result showed a significant improvement in myocardial contractility (ejection fraction (EF) increased by 6.7%) and a decrease in diastolic dysfunction. A significant decrease in the frequency and severity of reperfusion arrhythmias was also noted, which was achieved precisely due to the cardiometabolic effect of L-carnitine and the SGLT2 inhibitor dapagliflozin.

Conclusions. The inclusion of L-carnitine and sodium-glucose cotransporter inhibitor dapagliflozin in complex medical treatment is effective and lead to a significant improvement in the parameters of central cardiohemodynamics and compensation of hyperglycemia with a decrease in insulin resistance (p<0.05), which is accompanied by a significant decrease in the frequency of occurrence and severity such complications of acute coronary syndrome as reperfusion arrhythmias and acute left ventricular failure.

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