Tsuglevich L. Optimization of early re-treatment of patients with myocardial ischemia and non-alcoholic fatty liver disease who underwent percutaneous coronary intervention

The dissertation is devoted to increasing the effectiveness of early rehabilitation treatment of patients with myocardial infarction and non-alcoholic steatohepatitis by correcting hemodynamic, autonomic-metabolic and endothelial disorders using an individualized rehabilitation program in combination with cytoprotective therapy. Оn the basis of studying the clinical and functional features of the combined course of myocardial infarction and steatohepatitis, pathogenetic mechanisms of mutually aggravating morpho-functional damage of liver and heart in these comorbid patients was established. Excessive activation of the systemic inflammatory response in the clinical, structural-functional and laboratory features of the acute coronary syndrome (myocardial infarction) on the background of structural-functional changes in the liver due to non-alcoholic steatohepatitis was proved. In patients with myocardial infarction in combination with non-alcoholic steatohepatitis on the background of circulatory and tissue hypoxia caused by disorders of cardiohemodynamics there is a pronounced redox imbalance (significant increase of MDA on the background of reduced activity of SOD, SH-groups, catalase, ceruloplasmin) and endothelial dysfunction leads to progressive liver damage. It is proved that the severity of disorders of redox balance and endothelial dysfunction directly correlates with the degree of hemodynamic changes and clinical and laboratory manifestations of functional disorders of the liver and manifested by steatohepatitis. It was found that standard basic therapy was effective in patients with ACS (myocardial infarction), who underwent percutaneous coronary intervention within the allowable time interval and who were not diagnosed with liver dysfunction, but such treatment showed insufficient therapeutic effect on the clinical course of myocardial infarction and the severity of clinical laboratory syndromes of liver damage, endothelial dysfunction, systemic inflammatory process, functional state of free radical oxidation of lipids, which ultimately did not reduce the number of MI complications. For the first time, differentiated inclusion of L-arginine and L-carnitine in complex therapy in patients with myocardial infarction in combination with non-alcoholic steatohepatitis was substantiated to achieve improvement of the clinical course of the underlying disease and elimination of liver dysfunction by correction of endothelial dysfunction, reduction of systemic inflammatory process and functioning of free radical oxidation lipids system.