Dynamics of structural, functional and vegetative changes of heart under the influence of combined therapy with the use of ursodeoxycholic acid and L-arginine in patients with coronary heart disease associated with nonalcoholic fatty liver disease

摘要

Objective: to study the effect of the ursodeoxycholic acid and L-arginine combination on the background of basic therapy on the structural and functional state of the heart and indicators of the autonomic nervous system in patients with coronary heart disease combined with the non-alcoholic fatty liver disease.Methods: The study involved 56 patients with coronary heart disease (CHD) and nonalcoholic fatty liver disease (NAFLD). Patients were randomized into two groups. Patients in the 1st group (n = 30) received only basic therapy of coronary heart disease, patients in the 2nd group (n = 26) in addition to basic therapy were prescribed with UDCA and L-arginine. All patients underwent daily ECG monitoring and two-dimensional echocardiography. Statistical data processing was carried out using the program package Statistica 10.0.Results: In the 2nd group after 3 months of treatment there were observed decrease in indicators: myocardial stiffness index by 45 %, Va by 7.4 %, mean heart rate in both the active (11.72 %) and the passive (8 %) periods, the number (80 %) and duration (85 %) of tachycardia episodes, total number of ventricular (84 %) and supraventricular (63 %) extrasystoles per day, duration of the ST depression (by 55 %) and the duration of its maximum episode (by 75 %) and LF/HF ratio to 24 % in the active and 27 % in the passive period along with an increase of indicators: Ve by 7.4 %, SDNNi in both active (18 %) and passive (20 %) periods (p < 0.05).Conclusions: The positive effects of adding UDCA and L-arginine to basic therapy in patients with coronary artery disease and NAFLD include improved diastolic function, decreased myocardial ischemia, decreased myocardial stiffness and the number of ventricular and supraventricular extrasystoles, as well as increased total VPS, normalization of the sympathetic-parasympathetic balance by increasing the parasympathetic component of the cardiovascular system.