sST 2 AS A MARKER OF THE TREATMENT OF PATIENTS AFTER MYOCARDIAL INFARCTION WITH ACCOMPANYING ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH MELDONIUM AND FOLIC ACID
Authors: Volynskyi D.A. , Vakalyuk I.P. , Denina R.V. , Zvonar P.P. , Volynska N.M. 
Published: December 2023

Coronary artery disease (CAD) is one of the leading reason of mortality in Ukraine and all over the world. Arterial hypertension (AH) is the most common manageable factor in cardiovascular morbidity. Every third Ukrainian suffers from this disease. The presence of AH in a patient often becomes the reason for the further development of stable coronary artery disease (SCAD) due to the close pathogenetic connection of both pathologies. sST2 is a modern marker of cardiac fibrosis, which can help to evaluate the effectiveness of the underlying treatment for the patients with SCAD and concomitant AH.

The aim. To study the possibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying arterial hypertension on the background of treatment with meldonium and folic acid.

Materials and methods. During our study we observed 40 patients with SCAD FC II-III and concomitant AH stage III, who had an acute myocardial infarction and underwent percutaneous coronary intervention with balloon angioplasty and stenting. All examined were divided into 2 groups of 20 patients each. The first group received standard treatment. The second group in addition to standard treatment, received a combination of folic acid and meldonium. In the course of the work, a detailed analysis of the results of general clinical, laboratory and instrumental examination methods was carried out. Laboratory study of sST2 levels in blood plasma was carried out by quantitative enzyme immunoassay.

Results. We observed improvement of all Echocardiography parameters in patients of both groups. Somewhat more significant changes were recorded in the analysis of end systolic diameter of left ventricle. So, if in the first group the decrease in this indicator occurred gradually and amounted to an average of 7-8% after 6 months of treatment, then in the group of combined application of meldonium and folic acid against the background of traditional therapy, a significant reduction in ESD by 10.5% was recorded. The indicator decreased from 4.2 cm to 3.8 cm (p<0.05). Also there was a different trend regarding the dynamics of thickness of the posterior wall during systole. In the first group the reduction of this indicator at the end of the study was 5.7% (p>0.05). In the second group this indicator decreased from 1.13 cm to 1.11 cm after 1 month of treatment and to 0.89 cm after 6 months. That is, the decrease in the first stage was only 1.8% (p>0.05), and then 26.9% (p<0.05). In the course of the study, an increase in LVEF was found among patients with SCAD with concomitant AH. The increase in this indicator after 6 months was 3-4% among all the examined, regardless of the applied drug therapy.

We observed the decrease in the concentration of sST2 in both groups of patients. However, it was reliable only among patients to whom, in addition to standard treatment, we added a combination of meldonium and folic acid. In the group of patients on SCAD with concomitant hypertension, a weak direct correlation between the level of ST2 and LVMI was established. The correlation coefficient in this case was r=0.1033 (p>0.05).

Conclusions. In the course of our study, the feasibility of using sST2 as a marker of the effectiveness of treatment of patients after a myocardial infarction with accompanying AH against the background of treatment with meldonium and folic acid was established. Application of myocardial cytoprotectors reliably reduced the concentration of a sST2, which makes their use in the complex treatment of patients after MI with concomitant AH reasonable.