Dynamics of structural, functional and vegetative changes of heart under the influence of combined therapy with the use of ursodeoxycholic acid and L-arginine in patients with coronary heart disease associated with nonalcoholic fatty liver disease
DOI:
https://doi.org/10.14739/2310-1237.2017.2.109268Keywords:
coronary artery disease, nonalcoholic fatty liver disease, hemodynamics, autonomic nervous system, ursodeoxycholic acid, arginineAbstract
Objective: to study the effect of the ursodeoxycholic acid and L-arginine combination on the background of basic therapy on the structural and functional state of the heart and indicators of the autonomic nervous system in patients with coronary heart disease combined with the non-alcoholic fatty liver disease.
Methods: The study involved 56 patients with coronary heart disease (CHD) and nonalcoholic fatty liver disease (NAFLD). Patients were randomized into two groups. Patients in the 1st group (n = 30) received only basic therapy of coronary heart disease, patients in the 2nd group (n = 26) in addition to basic therapy were prescribed with UDCA and L-arginine. All patients underwent daily ECG monitoring and two-dimensional echocardiography. Statistical data processing was carried out using the program package Statistica 10.0.
Results: In the 2nd group after 3 months of treatment there were observed decrease in indicators: myocardial stiffness index by 45 %, Va by 7.4 %, mean heart rate in both the active (11.72 %) and the passive (8 %) periods, the number (80 %) and duration (85 %) of tachycardia episodes, total number of ventricular (84 %) and supraventricular (63 %) extrasystoles per day, duration of the ST depression (by 55 %) and the duration of its maximum episode (by 75 %) and LF/HF ratio to 24 % in the active and 27 % in the passive period along with an increase of indicators: Ve by 7.4 %, SDNNi in both active (18 %) and passive (20 %) periods (p < 0.05).
Conclusions: The positive effects of adding UDCA and L-arginine to basic therapy in patients with coronary artery disease and NAFLD include improved diastolic function, decreased myocardial ischemia, decreased myocardial stiffness and the number of ventricular and supraventricular extrasystoles, as well as increased total VPS, normalization of the sympathetic-parasympathetic balance by increasing the parasympathetic component of the cardiovascular system.
References
Kovalenko, V. M., & Kornatskyi, V. M. (2016). Problemy zdorovia i medychnoi dopomohy ta model pokrashchennia v suchasnykh umovakh [Problems of health and medical care and the model of improvement in modern conditions]. Kyiv. [in Ukrainian].
Babak, O. Ya., Kolesnikova, Ye. V., Shut, I. V., Kurinnaya, Ye. G., & Sytnic, K. A. (2013). Vliyanie geneticheskogo polimorfizma na formirovanie nealkogol'noj zhirovoj bolezni pecheni [Effect of genetic polymorphism on the formation of non-alcoholic fatty liver disease]. Hastroenterolohiia, 1(47), 54–59. [in Russian].
Kolesnikova, O. V. (2014). Sovremennyj paciyent s zabolevaniem i patologiej serdechno-sosudistoj sistemy: kakoj vybor sdelat'? [The modern patient with liver disease and pathology of cardiovascular system: what choice to make?]. Suchasna hastroenterolohiia, 2(76), 85–94. [in Russian].
Zaitzev, D. N., & Govorin, A. V. (2013). Vegetativnaya disfunkciya u bol'nykh khronicheskim prostatitom [Vegetative dysfunction in patients with chronic prostatitis]. Vestnik Volgogradskogo gosudarstvennogo medicinskogo universiteta, 1(45), 80–83. [in Russian].
Krahmalova, E. O., & Kozlov, A. P. (2010). Nealkogolʹnaya zhyrovaya boleznʹ pecheni i serdechno- sosudistaya patologiya. Sovremennyj vzglyad na problemu [Non alcoholic fatty liver disease and cardiovascular pathology. The modern view on the problem]. Ukrainskyi terapevtychnyi zhurnal, 4, 82–85. [in Russian].
Mykhailovska, N. S., & Miniailenko, L. E. (2016). Osoblyvosti remodeliuvannia miokarda u khvorykh na ishemichnu khvorobu sertsia, komorbidnu z nealkoholnoiu zhyrovoiu khvoroboiu pechinky [Myocardial remodeling features in patients with coronary heart disease comorbid with nonalcoholic fatty liver disease]. ScienceRise: MedicalScience, 2/3(19), 9–14. [in Ukrainian]. doi: 10.15587/2313-8416.2016.60797.
Vejn, A. M. (2003). Vegetativnye rasstrojstva. Klinika, diagnostika, lechenie [Autonomic dysfunction. Clinic, diagnosis, treatment]. Moscow: MIA. [in Russian].
Radchenko, O. M. (2012) Nealkoholna zhyrova khvoroba pechinky: problemy likuvannia [Non-alcoholic fatty liver disease: treatment problems]. Racional'naya farmakoterapiya, 3, 9–13. [in Ukrainian].
Lee, C., Li, D., Channon, K., & Paterson, D. (2009). L-arginine supplementation reduces cardiac noradrenergic neurotransmission in spontaneously hypertensive rats. Journal of Molecular and Cellular Cardiology, 47(1), 149–155. doi: 10.1016/j.yjmcc.2009.03.023.
Lorin, J., Zeller, M., Guilland, J., Cottin, Y., Vergely, C., & Rochette, L. (2014). Arginine and nitric oxide synthase: Regulatory mechanisms and cardiovascular aspects. Molecular Nutrition & Food Research, 58(1), 101–116. doi: 10.1002/mnfr.201300033.
Khara, M. R., & Golovach, N. A. (2013). Vplyv L-arhininu na biokhimichni protsesy v miokardi shchuriv riznoi stati pry streptozototsynovomu tsukrovomu diabeti [Effect of l-arginine on biochemical processes in the myocardium of rats of different gender in streptozotocininduced diabetes mellitus]. Klinichna ta eksperymentalna patolohiia, 1(43), 161–165. [in Ukrainian].
Mykhailovska, N. S., & Kulynych, T. O. (2017). Vplyv ekzohennoho L-arhininu na stan kardiohemodynamiky ta variabelnist sertsevoho rytmu u khvorykh na ishemichnu khvorobu sertsia pislia perenesenoi nehospitalnoi pnevmonii [Influence of exogenous L-arginine on the state of cardioghemodynamics and heart rate variability in patients with coronary heart disease after postpartum pneumonia]. ScienceRise: MedicalScience, 3(11), 27–34. [in Ukrainian]. doi: 10.15587/2519-4798.2017.97083.
Smuglov, Ye. P., Kuznecov, N. S., Shadchneva, N. A., & Sakhaltuev, A. D. (2015). Klinicheskie aspekty ispol'zovaniya L-arginina v kompleksnoj terapii stabil'noj IBS [Clinical aspects of the use of L-arginine in the integrated therapy of stable coronary heart disease]. Krymskij zhurnal e´ksperimental'noj i klinicheskoj mediciny, 5, 2(18), 60–64. [in Russian].
Bazylevych, A. Ya.,& Potashev, S. V. (2011). Vplyv ursodezoksykholevoi kysloty na stan tsentralnoi hemodynamiky, miokardialnoi funktsii ta remodeliuvannia livoho shlunochka u khvorykh iz postinfarktnym kardiosklerozom kombinovanym iz nealkoholnoiu zhyrovoiu khvoroboiu pechinky [Effect of ursodeoxycholic acid on the state of central hemodynamics, myocardial function and remodeling of the left ventricle in patients with postinfarction cardiosclerosis combined with nonalcoholic fatty liver disease]. Klinichna farmatsiia, farmakoterapiia ta medychna standartyzatsiia, 1–2, 47–56. [in Ukrainian].
Kielar, M., Myrcha, P., & Pleban, E. (2004). New possibilities in treatment of atherosclerosis--increase of nitric oxide synthesis by L-arginine supplementation. Polski Merkuriusz Lekarski, 17(102), 656–660.
Kraidashenko, O. V., & Shalmina, M. A. (2012). E´ndotelij oposredovannyj antiishemicheskij e´ffekt tivortina v bol'nykh s ishemicheskoj bolezn'yu serdca pozhilogo i starcheskogo vozrasta [Endothelium derived antiischemic effect of tyvortin in elderly patients with ischemic heart disease]. Visnyk problem biolohii i medytsyny, 2(2), 105–109. [in Russian].
Treschinskaya, M. A. (2012). Antie´jdzhingovyj e´ffekt L-arginina [Anti-aging Effect of L-arginine]. Medicina neotlozhnyh sostoyanij, 3(42), 50–54. [in Russian].
Miragoli, M., Kadir, S., Sheppard, M., Salvarani, N., Virta, M., Wells, S., et al. (2011). A protective antiarrhythmic role of ursodeoxycholic acid in an in vitro rat model of the cholestatic fetal heart. Hepatology, 54(4), 1282–1292. doi: 10.1002/hep.24492.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
