Possibility of cardiac encephalopathy medicinal correction by the metabolic action drug
M.E. Mozheyko, E.V. Bushueva, M.V. Potanina, E.A. Riabikhin
Yaroslavl Regional Clinical Hospital of War Veterans — International Center for Elderly Problems Zdorovoe Dolgoletie
Metabolic imbalance is one of the important mechanisms of chronic heart failure (CHF) development and progression and cardiac encephalopathy occurrence in patients with coronary heart disease (CHD). The possibility of improving myocardial metabolism and ATP replenishment with levocarnitine prescription during ischemia can be considered as a real method of treatment alongside the main drugs in this cohort of patients.
Aim: to study the efficacy and safety of the metabolic drug levocarnitine, which is used to correct the morphological and functional parameters of the heart and cerebral blood flow in cardiac encephalopathy in patients with CHD and CHF.
Patients and Methods: an open comparative study involved 60 patients with stable angina pectoris of II–III functional class (FC), having CHF with a preserved ejection fraction of II FC. They were divided into two groups comparable in age and sex. Patients were prescribed Elcar®, 100 mg/ml solution for intravenous and intramuscular administration, manufactured by PIC-PHARMA, Russian Federation. Mini-mental State Examination (MMSE) was used for evaluation of cognitive indicators.
Results: the group treated with levocarnitine had a significant improvement in cognitive performance compared to the control group — there was a positive therapeutic effect on left ventricular diastolic function.
Conclusion: levocarnitine addition to standard therapy can improve the cognitive functions of patients with CHD, and it has a positive effect on the left ventricular diastolic function as well. Thus, it can be considered as a cardiovascular disease risk reduction.
Keywords: CHD, CHF, cardiac encephalopathy, cognitive function, life quality, levocarnitine.
For citation: Mozheyko M.E., Bushueva E.V., Potanina M.V., Riabikhin E.A. Possibility of cardiac encephalopathy medicinal correction by the metabolic action drug. RMJ. Medical Review. 2019;4(II):49–53.
References
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17. Асташкин Е.И., Глезер М.Г., Орехова Н.С. и др. Влияние L-карнитина на образование радикалов кислорода фагоцитами крови пациентов с постинфарктным кардиосклерозом. Кардиоваскулярная терапия и профилактика. 2016;15(5):28–32. [Astashkin E.I., Glezer M.G., Orekhova N.S. et al. Effect of L-carnitine on the formation of oxygen radicals by blood phagocytes in patients with post-infarction cardiosclerosis. Cardiovascular therapy and prevention. 2016;15(5):28–32 (in Russ.)].
18. Головкин В., Зуев А., Привалова М. и др. Когнитивные нарушения и кардиореспираторная дисфункция при дисциркуляторной энцефалопатии с кардиоцеребральным синдромом. Врач. 2018;29(4):51–53. [Golovkin V., Zuev A., Privalova M. et al. Cognitive impairment and cardiorespiratory dysfunction in dyscirculatory encephalopathy with cardiocerebral syndrome. Doctor. 2018;29(4):51–53 (in Russ.)].
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21. Orlandi A., Francesconi A., Ferlosio A. et al. Propionyl-Lcarnitine prevents age-related myocardial remodeling in the rabbit. Journal of Cardiovascular Pharmacology. 2007;50(2):168–175.
22. Dzugkoev S.G., Mozhaeva I.V., Otiev M.A. et al. Effect of L-carnitine, afobazole and their combination with L-arginine on biochemical and histological indices of endothelial dysfunctions in cobalt intoxication in rats. Patologicheskaia fiziologiia i eksperimental’naia terapiia. 2015;59(2):70–75.
23. Роль ацетил-L-карнитина в лечении симптомов депрессии: систематический обзор и метаанализ (реферат). РМЖ. 2018;4(2):69–73. [The role of acetyl-L-carnitine in the treatment of symptoms of depression: a systematic review and meta-analysis (abstract). RMJ. 2018;4(2):69–73(in Russ.)].
24. Метаанализ применения ацетил-L-карнитина при диабетической периферической нейропатии (реферат). РМЖ. 2017;9:637–641. [Meta-analysis of the use of acetyl-L-carnitine in diabetic peripheral neuropathy (abstract). RMJ. 2017;9:637–641 (in Russ.)].
25. Кузин В.М. Карнитина хлорид (25 лет в клинической практике). РМЖ. 2003;10:609. [Kuzin V.M. Carnitine chloride (25 years in clinical practice). RMJ.2003;10:609 (in Russ.)].
26. Трошина А.А. Дезагрегантная терапия — вторичная профилактика ишемической болезни сердца. РМЖ. 2018;11(1):54–58. [Troshina A.A. Disaggregant therapy — secondary prevention of coronary heart disease. RMJ. 2018;11(1):54–58 (in Russ.)].
27. Дроботя Н.В., Калтыкова В.В., Пироженко А.А. Современные взгляды на патогенетически обоснованную терапию ХСН: у кардиологов есть повод для оптимизма. РМЖ. 2017;20:1435–1439. [Drobota N.V., Kaltykova V.V., Pirozhenko A.A. Modern views on pathogenetically substantiated therapy for heart failure: cardiologists have reason for optimism. RMJ. 2017;20:1435–1439 (in Russ.)].
28. Сизова Ж.М., Ших Е.В., Махова А.А. Применение L-карнитина в общей врачебной практике. Терапевтический архив. 2019;91(1):114–120. [Sizov J.M., Shih E.V., Makhova A.A. The use of L-carnitine in general medical practice. Therapeutic Archive. 2019;91(1):114–120 (in Russ.)].
2. Леонтьева И.В., Сухоруков В.С. Значение метаболических нарушений в генезе кардиомиопатий и возможности применения L-карнитина для терапевтической коррекции. Вестник педиатрической фармакологии и нутрициологии. 2006;2:12–14. [Leontyeva I.V., Sukhorukov V.S. The value of metabolic disorders in the genesis of cardiomyopathy and the possibility of using L-carnitine for therapeutic correction. Bulletin of Pediatric Pharmacology and Nutrition. 2006;2:12–14 (in Russ.)].
3. Yoshihisa A., Watanabe S., Yokokawa T. et al. Associations between acylcarnitine to free carnitine ratio and adverse prognosis in heart failure patients with reduced or preserved ejection fraction. ESC Heart Fail. 2017;4(3):360–364.
4. Helton E., Darragh R., Francis P. et al. Metabolic aspects of myocardial disease and a role for L-carnitine in the treatment of childhood cardiomyopathy. Pediatrics. 2001;105:1260–1270.
5. Lango R., Smolenski R., Narkiewicz M. et al. Influence of L-carnitine and its derivatives on myocardial metabolism and function in ischemic heart disease and during cardiopulmonary bypass. Cardiovasc Res. 2001;51:21–29.
6. Асташкин Е.И., Глезер М.Г. Роль L-карнитина в энергетическом обмене кардиомиоцитов и лечении заболеваний сердечно-сосудистой системы. Кардиология и сердечно-сосудистая хирургия. 2012;2:58–65. [Astashkin E.I., Glezer M.G. The role of L-carnitine in the energy metabolism of cardiomyocytes and the treatment of diseases of the cardiovascular system. Cardiology and cardiovascular surgery. 2012;2:58–65 (in Russ.)].
7. Семиголовский Н.Ю., Верцинский Е.К., Азанов Б.А., Иванова Е.В. Положительные инотропные свойства левокарнитина при синдроме малого выброса у больных острым инфарктом миокарда. Кардиология и сердечно-сосудистая хирургия. 2013;3:43–46. [Semigolovsky N.Yu., Vertsinsky E.K., Azanov B.A., Ivanova E.V. Positive inotropic properties of levocarnitine in low discharge syndrome in patients with acute myocardial infarction. Cardiology and cardiovascular surgery. 2013;3:43–46 (in Russ.)].
8. Семиголовский Н.Ю. Применение левокарнитина при синдроме малого выброса у больных острым инфарктом миокарда. Российский семейный врач. 2013;1:45–49. [Semigolovskiy N.Yu. The use of levocarnitine in low discharge syndrome in patients with acute myocardial infarction. Russian family doctor. 2013;1:45–49 (in Russ.)].
9. Асташкин Е.И., Глезер М.Г. Влияние L-карнитина на оксидативный стресс при сердечно-сосудистых заболеваниях. Медицинский совет. 2016;10:104–110. [Astashkin E.I., Glezer M.G. The effect of L-carnitine on oxidative stress in cardiovascular diseases. Medical Council. 2016;10:104–110 (in Russ.)].
10. Ferrari R., Merli E., Cicchitelli G. et al. Therapeutic effects of Lcarnitineand propionyl-L-carnitine on cardiovascular diseases: a review. Ann N Y Acad Sci. 2004;1033:79–91.
11. Аронов Д.М. Реалии и перспективы применения L-карнитина в кардиологии. Российский кардиологический журнал. 2013;5:73–80. [Aronov D.M. The realities and prospects of the use of L-carnitine in cardiology. Russian Journal of Cardiology. 2013;5:73–80 (in Russ.)].
12. Пасечник И.Н., Скобелев Е.И. Перспективы метаболической терапии критических состояний. Доктор. Ру. 2015;8–9:22–27. [Pasechnik I.N., Skobelev E.I. Prospects for metabolic therapy of critical conditions. Doctor. Ru. 2015;8–9:22–27 (in Russ.)].
13. Sharifi M.H., Eftekhari M.H., Ostovan M.A., Rezaianazadeh A. Effects of a therapeutic lifestyle change diet and supplementation with Q10 plus L-carnitine on quality of life in patients with myocardial infarction: A randomized clinical trial. J Cardiovasc Thorac Res. 2017;9(1):21–28.
14. Song X., Qu H., Yang Z. et al. Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2017:6274854. DOI: 10.1155/2017/6274854.
15. Katz A.M. Is the failing heart energy depleted? Cardiology Clinics. 1998;16(4):633–644.
16. Serati A.R., Motamedi M.R., Emami S. et al. L-carnitine treatment in patients with mild diastolic heart failure is associated with improvement in diastolic function and symptoms. Cardiology. 2010;116(3):178–182.
17. Асташкин Е.И., Глезер М.Г., Орехова Н.С. и др. Влияние L-карнитина на образование радикалов кислорода фагоцитами крови пациентов с постинфарктным кардиосклерозом. Кардиоваскулярная терапия и профилактика. 2016;15(5):28–32. [Astashkin E.I., Glezer M.G., Orekhova N.S. et al. Effect of L-carnitine on the formation of oxygen radicals by blood phagocytes in patients with post-infarction cardiosclerosis. Cardiovascular therapy and prevention. 2016;15(5):28–32 (in Russ.)].
18. Головкин В., Зуев А., Привалова М. и др. Когнитивные нарушения и кардиореспираторная дисфункция при дисциркуляторной энцефалопатии с кардиоцеребральным синдромом. Врач. 2018;29(4):51–53. [Golovkin V., Zuev A., Privalova M. et al. Cognitive impairment and cardiorespiratory dysfunction in dyscirculatory encephalopathy with cardiocerebral syndrome. Doctor. 2018;29(4):51–53 (in Russ.)].
19. Flanagan J.L., Simmons P.A., Vehige J. et al. Role of carnitine in disease. Nutrition and Metabolism. 2010;7:30.
20. Koc A., Ozkan T., Karabay A.Z. et al. Effect of L-carnitine on the synthesis of nitric oxide in RAW 264 7 murine macrophage cell line. Cell Biochemistry and Function. 2011;29(8):679–685.
21. Orlandi A., Francesconi A., Ferlosio A. et al. Propionyl-Lcarnitine prevents age-related myocardial remodeling in the rabbit. Journal of Cardiovascular Pharmacology. 2007;50(2):168–175.
22. Dzugkoev S.G., Mozhaeva I.V., Otiev M.A. et al. Effect of L-carnitine, afobazole and their combination with L-arginine on biochemical and histological indices of endothelial dysfunctions in cobalt intoxication in rats. Patologicheskaia fiziologiia i eksperimental’naia terapiia. 2015;59(2):70–75.
23. Роль ацетил-L-карнитина в лечении симптомов депрессии: систематический обзор и метаанализ (реферат). РМЖ. 2018;4(2):69–73. [The role of acetyl-L-carnitine in the treatment of symptoms of depression: a systematic review and meta-analysis (abstract). RMJ. 2018;4(2):69–73(in Russ.)].
24. Метаанализ применения ацетил-L-карнитина при диабетической периферической нейропатии (реферат). РМЖ. 2017;9:637–641. [Meta-analysis of the use of acetyl-L-carnitine in diabetic peripheral neuropathy (abstract). RMJ. 2017;9:637–641 (in Russ.)].
25. Кузин В.М. Карнитина хлорид (25 лет в клинической практике). РМЖ. 2003;10:609. [Kuzin V.M. Carnitine chloride (25 years in clinical practice). RMJ.2003;10:609 (in Russ.)].
26. Трошина А.А. Дезагрегантная терапия — вторичная профилактика ишемической болезни сердца. РМЖ. 2018;11(1):54–58. [Troshina A.A. Disaggregant therapy — secondary prevention of coronary heart disease. RMJ. 2018;11(1):54–58 (in Russ.)].
27. Дроботя Н.В., Калтыкова В.В., Пироженко А.А. Современные взгляды на патогенетически обоснованную терапию ХСН: у кардиологов есть повод для оптимизма. РМЖ. 2017;20:1435–1439. [Drobota N.V., Kaltykova V.V., Pirozhenko A.A. Modern views on pathogenetically substantiated therapy for heart failure: cardiologists have reason for optimism. RMJ. 2017;20:1435–1439 (in Russ.)].
28. Сизова Ж.М., Ших Е.В., Махова А.А. Применение L-карнитина в общей врачебной практике. Терапевтический архив. 2019;91(1):114–120. [Sizov J.M., Shih E.V., Makhova A.A. The use of L-carnitine in general medical practice. Therapeutic Archive. 2019;91(1):114–120 (in Russ.)].
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