The thesis presents a clinical and pathogenetic substantiation and a new solution to the current problem - improving the effectiveness of treatment of chronic coronary syndromes in patients with COVID-19, taking into account the factors of unfavourable prognosis based on the study of the characteristics of the disease course, structural and functional state of the heart and immune response.
In patients with COVID-19 against the background of CCS, there are structural and functional changes in the heart, manifested by larger LV dimensions (OR = 3.653; 95% CI [1.350 - 9.886]), higher values of EDD (OR = 4.129; 95% CI [1.679 - 10.154]), ESD (OR = 2.774; 95% CI [1.268 - 1.506]), EDV (OR = 1.036; 95% CI [1.018 - 1.055]), ESV (OR = 1.073; 95% CI [1.041 - 1.107]) with higher IMMR (OR = 1.032; 95% CI [1.009 - 1.055]) and lower LVEF (OR = 0.834; 95% CI [0.766 - 0.909]).
Immunological changes in patients with COVID-19 in the setting of CCS were characterized by a lower level of the SIRI index (OR = 0.803; 95% CI [0.645 - 1.000]), a lower level of the NLR index (OR = 0.902; 95% CI [0.818 - 0.994]), lower SII (OR = 0.999; 95% CI [0.999 - 1.000]), lower PLR (OR = 0.995; 95% CI [0.999 - 1.000]) and lower AISI (OR = 0.999; 95% CI [0.998 - 1.000]).
The analysis of fatal and non-fatal events showed a higher number of such events in the group with concomitant CCS. Survival rates in both groups did not differ due to an increase in the number of hospitalizations in the CCS group.
The addition of trimetazidine and quercetin to the treatment regimen in patients with COVID-19 with a background of CCS significantly reduced the activity of the inflammatory process. This was evidenced by a faster normalization of the number of neutrophils (by 18.79%), monocytes (by 29.41%), ESR (by 39.22%), inflammatory indices SIRI (by 44.59%), AISI (by 39.35%), a decrease in IL-6 (by 31.88%), soluble ACE-2 (by 20.79%) and β-HOB (by 32.93%). The combination of quercetin and trimetazidine more clearly reduced the size of the RV by 14.62% and the RV/LV index by 24.54%, IMMR (by 7.68%), and increased LVEF (by 2.29%), and improved quality of life (by 15.41%).
The knowledge that COVID-19 coronavirus disease with concomitant chronic coronary syndromes is characterised by a more severe course in older people, frequent development of chronic heart failure and atrial fibrillation, and a higher body mass index has been supplemented, more pronounced subjectification of symptoms, higher systolic blood pressure at hospitalisation, impaired lipid metabolism, in particular, higher levels of cholesterol, lower platelet count, higher levels of soluble ACE-2, and worse quality of life.
It has been shown that the most significant factors of unfavourable prognosis in patients with COVID-19 in the setting of CCS are: concomitant HF, which causes an increase in hospital mortality; increased CRP/L index, β-HOB, ferritin and soluble ACE-2 levels, which contribute to a higher risk of destabilisation of coronary atherosclerosis; increased D-dimer content, which is associated with a high risk of thromboembolic complications.
For the first time, it has been shown that during hospitalisation for COVID-19-associated pneumonia in patients with CCS, an increase in IL-6 levels >12.62 pg/mL, ferritin >443.1 ng/mL, soluble ACE-2 >1.932 ng/mL and β-HOB >0, 841 mmol/l is associated with severe disease, and an increase in IL-6 levels >54.8 pg/mL, D-dimer >750 ng/mL, soluble ACE-2 >2.193 ng/mL and β-HOB >1.21 mmol/l is associated with a higher risk of mortality.
It was noted that in patients with COVID-19 against the background of CCS there are structural and functional changes in the heart, which are manifested by larger LV dimensions, higher values of EDD, ESD, EDV, ESV, and IMMR, as well as lower LV EF.
For the first time, it was shown that the presence of concomitant CCS in patients with COVID-19-associated pneumonia leads to distinct changes in the immune response: lower levels of the SIRI index, NLR index, SII index, PLR index, and AISI index.
It has been proven that the addition of trimetazidine and quercetin to the treatment regimen in patients with COVID-19-associated pneumonia on the background of CCS reduces the activity of the inflammatory process, as evidenced by a faster normalisation of the count of neutrophils, monocytes, ESR, inflammatory indices SIRI, AISI, and a decrease in the levels of IL-6, soluble ACE-2, and β-HOB. Complex therapy with the inclusion of quercetin and trimetazidine has a more pronounced effect on the structural and functional state of the myocardium and improves quality of life.
Key words: coronary heart disease, chronic coronary syndromes, pneumonia, angina pectoris, coronavirus disease, pathogenesis, interleukin-6, ferritin, inflammation, angiotensin-converting enzyme, COVID-19, cardiovascular risk, comorbidity, quercetin, trimetazidine. Branch-Medicina.
