Influence of L-Arginine on the Clinical Course and Hemodynamic Parameters in Patients with Coronary Artery Disease on the Background of Anemic Syndrome in Middle-Aged and Older Patients

Abstract

The purpose of the study was to evaluate hemodynamic changes in middle-aged and older patients with coronary artery disease and anemia, against the background of standard therapy, as well as in combination with L-arginine. Materials and methods. 53 patients (35 women and 18 men) with stable ischemic heart disease and mild to moderate anemia (mean age 73.1 ± 1.2 years old) were examined. Among them, there were 24 (45.3%) patients with HF I, 21 (39.6%) patients with HF 2A, and 8 (15.1%) patients with HF 2B. The control subgroup (subgroup 1) consisted of 24 patients who received standard therapy for coronary artery disease and anemia. The remaining 29 people, in addition to standard therapy, additionally received L-arginine according to the scheme and made up the 2nd subgroup of the study. The follow-up period for patients was 6 months. An anamnesis was collected from all patients, the clinical picture of the disease was assessed, blood pressure and heart rate were measured, clinical and biochemical blood tests were studied, ECG and ECHO-CG were recorded. The effect of treatment with iron preparations was assessed by the dynamics of iron metabolism parameters. In the course of the ECHO-CG study, the main structural-geometric and functional parameters of the left ventricle were determined. Results and discussion. Under the influence of standard therapy and an increase in hemoglobin levels to normal levels (from 114.8 ± 1.4 g/l to 131.9 ± 1.1 g/l in the first subgroup; from 112.3 ± 2.1 g/l to 140.0 ± 1.3 g/l in the second subgroup (p<0.001 between subgroups after treatment) [17], complaints of general weakness, shortness of breath and palpitations decreased and the general condition of patients improved (blood pressure, heart rate, respiratory rate parameters normalized; there was a decrease or elimination of edema) in both clinical groups. But in patients who additionally received L-arginine, the intensity of manifestations of general weakness and palpitations were significantly less (p<0.001 and p<0.05 between subgroups). Against the background of standard therapy, symptoms such as dyspnea, edema, and pain in the heart area also decreased in both subgroups, but the effect of L-arginine on these symptoms was more noticeable. According to the results of the ECHO-CG study, in patients with coronary artery disease and anemia, a statistically significant recovery of structural and geometric parameters of the myocardium was observed: a decrease in end-diastolic and end-systolic volume and an increase in myocardial contractility in both subgroups, however, against the background of additional intake of L-arginine, the dynamics of indicators was more expressed; regression of signs of left ventricle hypertrophy. Conclusion. The results of the study showed the positive effect of L-arginine on cardiac remodeling and the clinical condition of middle-aged and older patients. Treatment with L-arginine did not cause side effects and did not require discontinuation of the drug