Bevziuk L. Clinical and pathogenetic validation for spironolactone and trimetazidine use in the treatment of patients with atrial fibrillation and comorbid age-dependent pathology

The thesis was aimed to optimize the treatment of patients with atrial fibrillation (AF) with comorbid type 2 diabetes mellitus (DM) and / or chronic kidney disease (CKD) by additional use of spironolactone and trimetazidine. 140 elderly hypertensive pts: 60 pts with persistent AF (persAF), 60 pts with permanent AF (permAF) and 20 pts uncomplicated essential hypertension (EH) as control group were included. DM was noticed in 28 % persAF and in 40 % permAF, CKD - 82 % and 89 %, respectively. The dynamics of symptoms, structural and functional parameters of the heart were studied under 12-month treatment in three parallel groups: 1) stable base therapy; 2) therapy with the addition of spironolactone; 3) therapy with the addition of trimetazidine. In AF pts as compared control group there was the increase of daily systolic blood pressure (SBP) and the decrease of SBP index. The same incidence of concentric LVH (70 %) was register in AF and EH groups whereas the frequency of the eccentric LVH in AF was increased (23 %). The growth of LVH was associated with an enlargement of left atrium (LA) and diastolic dysfunction worsening. Systolic arterial pressure in pulmonary artery (SAPpa) raised in AF pts; the incidence of pulmonary hypertension increased and its severity grew up when AF combined with DM. The observed in AF pts worsening of myocardium electrical heterogeneity occurred in parallel with the increase of LVH and was accompanied by the increase both incidence and severity of ventricular rhythm disturbances. Pharmacotherapy with addition of spironolactone and trimetazidine more pronouncedly reduced systolic and pulse BP, slowed the speed of morning BP surge, increased degree of BP night-time reduction and increased proportion of pts with a dipper profile of daily BP. The most pronounced positive dynamics of daily blood pressure was established in AF pts with comorbid DM. Only under the influence of spironolactone, irrespectively DM and CKD presence, the myocardium electrical inhomogeneity, the daily number of single and pairs ventricular extrasystoles decreased. Trimetazidine treatment reduced by 2 fold the daily number of single ventricular extrabeats.