The Effectiveness of Phosphocreatine in Patients with Ischemic Heart Disease and Heart Failure after Surgical Revascularization

Abstract


Relevance In patients with multivessel and left main coronary artery coronary artery bypass grafting (CABG) is an effective treatment method. At the same time some patients after successful surgical revascularization in long term, after surgery developed symptomatic chronic heart failure (CHF). The purpose of the study To study the effectiveness of phosphocreatine (Neoton) in the treatment of CHF after CABG. Materials and methods We examined 32 patients with coronary artery disease and heart failure III / IV functional class (FC) in NYHA, which for 8 ± 2 years before the manifestation of heart failure, coronary artery bypass grafting was performed. Left ventricular ejection fraction in patients enrolled in the study was 34,1 ± 4%. 25 (78%) patients before treatment bypass angiography was performed, which after reviewing its results with our heart team, second surgical revascularization for various reasons, was considered inappropriate. Due to continuing low exercise tolerance, in addition to the basic treatment of CHF, exogenous phosphocreatine (Neoton) was prescribed intravenously at a daily dose of 3, ± 0,5 grams per 12 ± 2 days. Dose and duration of treatment of exogenous phosphocreatine was chosen depending on FC of heart failure. Results and their discussion Prescription of phosphocreatine in addition to basic therapy led to an increase in CHF FC in 17 of 32 (53%) patients included in the study. In 30% of patients responding to therapy phosphocreatine (Neoton) increased exercise tolerance after 1 course of treatment, in 70% of patients - after 2 courses. On the background of treatment with phosphocreatine (Neoton) in the whole group a significant increase of CHF FC from 3,4 ± 0,3 to 2,7 ± 0,6 (p <0.001) was observed. The greatest efficacy was seen in patients with FC III CHF. Side effects were observed in 3 (9%) patients and presented as development of moderate hypotension, mainly when 4 g. of drug was prescribed and which was stopped lowering the infusion rate of phosphocreatine (Neoton). Conclusion. Prescription of exogenous phosphocreatine (Neoton) in patients with III / IV CHF FC after a performed CABG allows more than 50% of patients to reduce the clinical manifestations of heart failure and improve exercise tolerance with good tolerability. We recommend including this drug in the complex treatment of CHF in patients with coronary artery disease after CABG and in which repeated revascularization it’s not appropriate. Key words Сoronary bypass grafting, chronic heart failure, phosphocreatine

Воронежский государственный медицинский университет им. Н.Н. Бурденко, ул. Студенческая, д. 10, Воронеж, 394036, Российская Федерация

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Email: admin@vestnik-surgery.com
д.м.н., проф., проф. кафедры госпитальной хирургии Воронежского государственного медицинского университета им. Н.Н. Бурденко, зав. кардиохирургическим центром Воронежской областной клинической больницы №1;

Воронежский государственный медицинский университет им. Н.Н. Бурденко, ул. Студенческая, д. 10, Воронеж, 394036, Российская Федерация

Email: admin@vestnik-surgery.com
 д.м.н., доц. кафедры терапии ИДПО Воронежского государственного медицинского университета им. Н.Н. Бурденко, зав. отделением медицинской реабилитации Воронежской городской клинической больницы №3.

Воронежский государственный медицинский университет им. Н.Н. Бурденко, ул. Студенческая, д. 10, Воронеж, 394036, Российская Федерация

Email: admin@vestnik-surgery.com

 д.м.н., доц. кафедры госпитальной терапии факультета лечебного дела и педиатрии 
Медицинского института Белгородского государственного национального исследовательского университета.

  1. Simakov A.A. et al. Est' li osnovaniya dlya naznacheniya metabolicheskoy terapii bol'nym s serdechnoy nedostatochnost'yu [Is there any reason to assign metabolic therapy in patients with heart failure]? Rossiiskie meditsinskie vesti , 2011; XVI: 1: 80-85 (in Russ.).
  2. Zhidkov I.L. et al. Intraoperatsionnaya zashchita miokarda vnekletochnymi kardioplegicheskimi rastvorami u patsientov s patologiey klapanov serdtsa [Intraoperative myocardal protection by extracellular cardiac solutions in patients with abnormal heart valves]. Anesteziologiia i reanimatologiia , 2007; 2: 38-42 (in Russ.).
  3. Iosseliani D.G., Koledinskii A.G., Kuchkina N.V. Mozhet intrakoronarnoe vvedenie fosfokreatina predupredit' reperfuzionnoe povrezhdenie miokarda v techenie angioplastiki infarkt-svyazannoy arterii pri ostrom infarkte miokarda [Can the introduction of intracoronary phosphocreatine to prevent reperfusion myocardial damage during angioplasty of the infarct-related artery in acute myocardial infarction]? Interventsionnaia kardiologiia , 2004; 6: 10-14 (in Russ.)
  4. Perepech N.B. Neoton (fosfokreatin): Mekhanizmy deistviia i klinicheskoe primenenie [Neoton (phosphocreatine): mechanisms of action and clinical applications. Ed. by V.A. Almazov]. Moscow, 2005; 94 (in Russ.).
  5. Perepech N.B., Nedoshivin A.O., Kutuzova A.E. Profilaktika i lechenie serdechnoy nedostatochnosti u bol'nykh infarktom miokarda s pomoshch'yu ekzogennogo fosfokreatina [Prevention and treatment of heart failure in patients with myocardial infarction using exogenous hosphocreatine]. Klinicheskaia meditsina , 1993; 1: 19-22 (in Russ.).
  6. Chambers D.J. et al. The addition of phosphocreatine (NEOTON) in the cardioplegic St. Thomas solution (Plegia). Eur. J. Cardiothorac. Surg., 1991; 5: 74-81.
  7. Mastroroberto P. et al. Phosphocreatine protection of the ischemic myocardium during cardiac surgery. Curr. Ther. Res., 1992; 51: 37-45.
  8. Pauletto P. et al. Prevention of arrhythmias and changes in the level of cardiac enzymes with phosphocreatine at patients with aorto-coronary shunting. Mol. Cell Cardiol., abstract No 100. 1993; 25: III: 538.
  9. Wang Y. et al. The therapeutic effect of phosphocreatine in the treatment of early diastolic dysfunction. Chin. J. Cardiovasc. Rehabil. Med., 2010; 19: 501-504.
  10. Ferraro S. et al. The effects of phosphocreatine at patients with congestive heart failure: a double-blind comparative study with placebo. Clin. Cardiol., 1996; 19: 699-703.
  11. Grazioli G., Strumia M., Strumia E. Evaluation of the
  12. phosphocreatine efficiency in chronic heart failure treatment. Curr. Ther. Res., 1992; 52: 2: 271-280.

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