The thesis is devoted to increasing the effectiveness of diagnostic and therapeutic approaches in patients with ischemic heart disease (IHD) after suffering from coronavirus disease (COVID-19) by studying clinical features, structural and functional changes in the heart, autonomic, anxiety-depressive, cognitive disorders, activity of markers of neurohumoral, metabolic dysregulation and dynamics under the influence of combined pharmacotherapy.
Scientific novelty of the results obtained. New scientific data on the negative consequences of COVID-19 coronavirus disease in patients with coronary artery disease have been obtained. It has been proven that in patients with coronary artery disease after COVID-19 coronavirus disease, significant changes in the structural, functional and energetic state of the heart are observed, which is confirmed by an increase in linear and volumetric indicators, the degree of LV myocardial hypertrophy, the frequency of registration of LV diastolic dysfunction against the background of an increase in MPAP, ESP, a decrease in global LV contractile function, an increase in the estimated indicators of the energy cost of heart work (SW, PE and PVZ) and a decrease in the rate of myocardial recovery in the Long-COVID period. It has been shown that the presence of a previous COVID-19 coronavirus disease in patients with coronary artery disease is associated with an increased risk of LV dilation by 5.6 times, LV myocardial hypertrophy by 3.05 times, LV diastolic dysfunction by 1.44 times, and an increase in energy expenditure during cardiac activity by 1.66 times, which indicates the negative consequences of the influence of SARS-CoV-2 on the state of cardiac remodeling in patients with coronary artery disease.
The clinical and neurovegetative features of patients with coronary artery disease after a previous COVID-19 coronavirus disease have been clarified. It has been established that in patients with coronary artery disease after suffering from COVID-19 coronavirus disease, there is an increase in the frequency and severity of anxiety-depressive, cognitive disorders, autonomic dysfunction with an increase in the tone of the sympathetic and parasympathetic divisions of the ANS during the day, an increase in the LF/HF ratio by 24.13% during the day, activation of slowly acting humoral regulatory mechanisms by 63.52% during the passive period, as well as an overstrain of the functional-adaptive state of the cardiovascular system with the dominance of the activity of central regulatory mechanisms over autonomous ones. Scientific data have been supplemented that the presence of a history of COVID-19 coronavirus disease in patients with coronary artery disease increases the relative risk of developing anxiety syndrome by 1.75 times, depressive syndrome by 1.35 times, cognitive deficit by 4.94 times, sympatho-parasympathetic imbalance by 1.23 times in the daytime and 1.16 times in the night periods, and is also associated with an increase in the SI stress index by 4.16 times in the active and 3.75 times in the passive periods. The idea of the presence of a wide range of correlations between the level of ADD, cognitive dysfunction and HRV indicators in patients with coronary artery disease after COVID-19 has been expanded.
New scientific data were obtained on an increase in the concentration of vasopressin by 70.23%, insulin by 52.16%, NOMA index by 60.00%, and a decrease in the level of active ghrelin by 45.71% (p<0.05) in patients with coronary artery disease in the Long-COVID period. In patients with coronary artery disease who have suffered from COVID-19, a wide range of correlations between hormonal and metabolic markers, neurovegetative disorders, and parameters characterizing the state of cardiac remodeling were found.
Practical significance of the results obtained. The feasibility of conducting a questionnaire using the HADS and MoCA scales to determine the severity of ADD and cognitive deficit in patients with coronary artery disease who have had COVID-19 is argued. It is recommended to determine the levels of insulin, active ghrelin and vasopressin in patients with coronary artery disease after COVID-19 as markers associated with cardiac remodeling and neurovegetative disorders. A method of treating patients with coronary artery disease after COVID-19 with the inclusion of phenibut and exogenous L-arginine in the basic therapy has been developed and implemented in practice in order to improve the structural-functional and energy state of the heart, HRV, cognitive status, and reduce ADD.
