Iordanova N. Changes in amino acid profile in blood of patients with acute ST-elevation myocardial infarction under the influence of treatment and depends on the clinical course

The thesis presents the issue characteristic amino acid profile in blood (AAP) of patients (pts) with acute ST-elevation myocardial infarction (STEMI) without reperfusion therapy (RT) depending on the clinical course of hospital period. The AAP as an independent predictor of complicated course of STEMI was estimate. The effectiveness of metabolic cardioprotectors (MC), different in origin and chemical structure (quercetin and 2-ethyl-6-methyl-3-oxypyridine succinate), was compared. The laboratory criteria for predicting the effectiveness of MC in pts with STEMI without RT based on AAP were defined. The results of the studу were obtained by prospective examination of 116 pts with STEMI without RT. The development of resistant/late (during ten days of hospital period) systolic dysfunction of left ventricle (SDLV) were associated with the increased baseline level of proline independently on the presence of early SDLV (at the day of admission), as well as anamnestic risk factors and kidney dysfunction. In pts with early SDLV the increased baseline phenylalanine/tyrosine ratio was associated with resistant SDLV during ten day of hospital period. The increased baseline levels of methionine, glutamate, glycine and decreased Fisher's index are the independent risk factors of resistant/late heart failure (on the third day of hospital period or later) in pts with STEMI. The ischemic complications of STEMI (early postinfarction stenocardia and/or recurrent myocardial infarction) are associated with the decreased baseline value of glycine/serine ratio. The arrhythmic complications of STEMI (ventricular exstrasystoles III-V classes by Lown, ventricular tachycardia, ventricular fibrillation) are associated with the increased baseline level of aspartate. The efficacy of MC in pts with STEMI without RT also largely depends on the AAP, especially depends on the amino acids and their ratios, which involved in metabolism and cardioprotective actions of MC. The positive effect of quercetin is associated with lower baseline phenylalanine/tyrosine ratio, and the positive effect of 2-ethyl-6-methyl-3-oxypyridine succinate is associated with lower baseline homocysteine/methionine ratio.