The aim of this work is to study the effect of cilostazol on regional hemodynamics, serotonin levels and functional activity of the brain, heart, lower extremities in patients with generalized atherosclerosis. A 12-week open-label, randomized, placebo-controlled study included 52 males with generalized atherosclerosis and 26 males with chronic coronary syndrome (comparison group). Patients in the generalized atherosclerosis group were randomized into two subgroups: 26 males in addition to basic therapy received cilostazol at a dose of 100 mg twice daily, and 26 patients who received additional placebo. Patients with generalized atherosclerosis had injury of four vascular territories: cerebral, coronary, mesenteric and lower extremities. It was found that in patients with generalized atherosclerosis, the level of serotonin in plasma exceeded this comparison group by 7.8 times, and a number of indicators were lower - in particular, indicators of volumetric blood flow (p<0,001), cognitive function, painless walking distance. Under the influence of treatment with the addition of cilostazol for 12 weeks before baseline therapy, the condition improved: plasma serotonin levels decreased 2,9 times (p<0,001), significantly (p<0,001) increased volumetric bold flow in all studied vascular territories, which contributed to a decrease in the number of both painful and painless episodes of myocardial ischemia (according to daily electrocardiographic monitoring), increased painless and maximum walking distance, and improved cognitive function of the brain. In the generalized atherosclerosis group, who was taking placebo, under the influence of treatment, the changes were not significant. Our data indicate a positive effect of cilostazol as an addition to basic therapy in patients with generalized atherosclerosis and the need for further research in this area.
The aim of the work was to study the features of central and intracardiac hemodynamics in patients with generalized atherosclerosis (GAS) and their dynamics under the influence of a selective inhibitor of phosphodiesterase 3 cilostazol. The condition of central hemodynamics was studied in patients of three study groups: 1 group consisted of 48 male GAS patients aged 65 to 83 years with clinical manifestations of lesions of four vascular territories: coronary, cerebral, mesenteric and femoral; Group 2 consisted of 23 patients with chronic coronary syndrome (CCS), postinfarction cardiosclerosis without concomitant vascular pathology, males mean age 68.5 ± 6.5 years, with clinical manifestations of atherosclerotic lesions of the coronary artery only. The control group (CG) consisted of 18 almost healthy males, the mean age in the group was 62.5 ± 5.3 years. Patients in group 1 were randomized into two subgroups. Patients of the first subgroup (GAS-C) in addition to basic therapy received cilostazol (C) at a dose of 100 mg twice a day, patients of the second subgroup - comparison subgroup (GAS-P) - received only basic therapy. The condition of central hemodynamics was assessed by echocardiography in M- and B-modes. The bioelectrical activity of the myocardium was assessed by the method of daily monitoring of the electrocardiogram. The obtained data showed significantly lower indicators of both inotropic and chronotropic myocardial function in patients of the 1st group compared to the patient with CG (p <0.05), which was significantly lower in minute volume of blood circulation (p<0.01). The comparison of central hemodynamics of patients of the 1st group with similar indicators of patients of the 2nd group revealed significantly lower values of heart rate (HR), left ventricular ejection fraction (EF), circular rate of myocardial fibers (Vcf), stroke volume (SV) and minute blood volume (MBV) in patients of the 1st group (p<0.05). After the addition of cilostazol (C) to the complex standard pharmacotherapy, an increase in inotropic and chronotropic cardiac function was observed: heart rate significantly increased by 9.1% (p<0.05), end-systolic volume decreased by 6.2%, ejection fraction increased by 5.2% (p<0.01), minute blood flow increased by 14.9% (p<0.01), and the rate of circular contraction of myocardial fibers increased by 4.7% (p<0, 05), compared with data before treatment. It is important that the increase in functional activity of the myocardium (chronotropic and inotropic), under the influence of C, was simultaneously with a decrease in the manifestations of myocardial ischemia. The number of painful (РEIM) and painless episodes of myocardial ischemia (PlEIM) probably decreased - by 24.0% and 20.6%, respectively (p<0.05). Thus, our data showed that in patients with generalized atherosclerosis with myocardial infarction, ischemic stroke with intermittent claudication and stenosis of the mesenteric arteries, the use of phosphodiesterase-3 inhibitor C as a part of complex standard pharmacotherapy and leads to increase in minute volume of blood circulation. Importantly, the increase in myocardial functional activity in patients with GAS does not increase the manifestations of myocardial ischemia, but significantly (p<0.05) reduces the number of PEIM and PlEIM.
THE INFLUENCE OF CILOSTAZOL ON CLINICAL-HEMODYNAMIC AND RELATED HUMORAL FACTORS IN PATIENTS WITH COMPLICATED ARTERIAL HYPERTENSION
The aim of the study is to investigate the effectiveness of cilostazol in patients with generalized atherosclerosis (GAS).A comprehensive examination of 65 male patients with proved GAS was performed (lesions of the lower extremities, carotid, mesenteric, coronary, cerebral arteries) and 28 healthy males (comparison group - CG) aged over 60 years. Patients with GAS consisted of 2 groups: GAS1 - patients in addition to basic therapy received cilostazol (C; 100 mg 2 times per day); GAS2 - placebo. Patients with GAS showed a significant deterioration in blood flow (decrease in its volumetric blood flow - FV, increase in peak systolic velocity - PSV) in all studied arteries, episodes of myocardial ischemia according to daily ECG monitoring, decreased cognitive function (CF). In patients with GAS1 on the background of taking C observed improvement (p<0,001) blood flow in the studied arteries (increase in FV and decrease in PSV), decrease in the number and duration of episodes of myocardial ischemia (p<0,01 and p<0,05, respectively), increase distances of painless and maximum walking distance (p<0,01), improvement of CF. The data obtained indicate the effectiveness of C as part of complex therapy in patients with GAS and expediency of further research in this direction to clarify the criteria for its appointment to such patients.
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