Post-COVID-19 changes in the structure of the heart and the effectiveness of the vasodilator Sidnofarm (results of own research) | Ukrainian Medical Journal

The aim is to compare the changes in the structural and functional state of the left ventricular myocardium in patients after COVID-19 and to determine the antianginal and antiischemic activity of molsidomine (Sidnopharm) in this category of patients.

Object and methods of research. We examined 120 persons aged 58±8.23 years (48.4% of women and 51.6% of men), 60 of whom relapsed to COVID-19 and had complaints from the cardiovascular system, including cardialgia. All patients in the complex treatment of major diseases received statins, renin-angiotensin-aldosterone system blockers, antiplatelet agents and other prescribed therapy. Patients with COVID-19 were divided into two groups (30 individuals). Sidnopharm at a dose of 2 mg 2 times a day for 1 month was added in the treatment program of the 1st (main) group, the 2nd (comparison group) received any antianginal drugs, except for nitrates of prolonged action.

Results. Patients who underwent COVID-19 in the past 6 months were found to have relatively larger left heart volumes and left ventricular myocardial mass compared to those who did not become ill. They have relative hypersympathicotonia with a predominance of daytime arrhythmic activity. According to speckle-tracking echocardiography, patients with COVID-19 and long-term cardialgia have a decrease in local contractility of predominantly basal segments of the left ventricular wall due to subendocardial microvascular ischemia. Patients with post-COVID-19 cardialgia showed a significant reduction in both the severity of complaints and instrumental data of ischemia: the number of episodes of depression of the ST segment (according to Holter monitoring) and improved contractility of mainly basal and middle sections of the walls of the left ventricle (according to speckle-tracking echocardiography) due to the improvement of their blood supply on the background of treatment with Sidnopharm at a dose of 2 mg 2 times a day for 30 days.

Conclusion. Sidnopharm — coronary dilator, nitric oxide donor, endothelial protector, antianginal and anti-ischemic drug, which is used mainly in the treatment of coronary heart disease — can also be recommended to prescribe in the treatment of patients with post-COVID-19 syndrome.

References:

1. https://coronavirus.jhu.edu/map.html
2. Gladkac M.M., Maack Ch. (2020) The endothelium as Achilles’ heel in COVID-19 patients. Cardiovasc. Res., 116(14): e195–e197.
3. Nägele M.P., Haubner B., Tanner F.C. et al. (2020) Endothelial dysfunction in COVID-19: Current findings and therapeutic implications. Atherosclerosis, 314: 58–62. doi: 10.1016/j.atherosclerosis.2020.10.014.
4. Buja L.M., Wolf D.A., Zhao B. et al. (2020) The emerging spectrum of cardiopulmonary pathology of the coronavirus disease 2019 (COVID-19): Report of 3 autopsies from Houston, Texas, and review of autopsy findings from other United States cities. Cardiovasc. Pathol., 48: 107233.
5. Fox Sh.E., Akmatbekov A., Harbert J.L. et al. (2020) Pulmonary and cardiac pathology in African American patients with COVID-19: an autopsy series from New Orleans. Lancet, 8(7): P681–P686.
6. Bernard I., Limonta D., Mahal L.K., Hobman T.C. (2020) Endothelium Infection and Dysregulation by SARS-CoV-2: Evidence and Caveats in COVID-19. Viruses, 13(1): 29. doi: 10.3390/v13010029.
7. Libby P., Lüscher Th. (2020) COVID-19 is, in the end, an endothelial disease. Eur. Heart J., 41(32): 3038–3044. https://doi.org/10.1093/eurheartj/ehaa623.
8. Ngai J.C., Ko F.W., Ng S.S. et al. (2010) The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology, 15(3): 543–550. doi: 10.1111/j.1440-1843.2010.01720.x.
9. Tay M.Z., Poh Ch.M., Rénia L. et al. (2020) The trinity of COVID-19: immunity, inflammation and intervention. Nat. Rev. Immunol., 20(6): 363–374. doi: 10.1038/s41577-020-0311-8.
10. Yende S., Kellum J.A., Talisa V.B. et al. (2019) Long-term Host Immune Response Trajectories Among Hospitalized Patients With Sepsis. JAMA Netw. Open, 2(8): e198686. doi: 10.1001/jamanetworkopen.2019.8686.
11. Hartley C., Bavinger J.C., Kuthyar S. et al. (2020) Pathogenesis of Uveitis in Ebola Virus Disease Survivors: Evolving Understanding from Outbreaks to Animal Models. Microorganisms, 8(4): 594. doi: 10.3390/microorganisms8040594.
12. Wu F., Wang A., Liu M. et al. (2020) Neutralizing antibody responses to SARS-CoV-2 in a COVID-19 recovered patient cohort and their implications (https://www.medrxiv.org/content/10.1101/2020.03.30.20047365v2).
13. Gemelli Against COVID-19 Post-Acute Care Study Group (2020) Post-COVID-19 global health strategies: the need for an interdisciplinary approach. Aging Clin. Exp. Res., 11: 1–8.
14. Thornton J. (2020) Covid-19: the challenge of patient rehabilitation after intensive care. BMJ, 369: m1787.
15. O’Keefe J.B., Cellai M. (2020) Characterization of prolonged COVID-19 symptoms and patient comorbidities in an outpatient telemedicine cohort (https://www.medrxiv.org/content/10.1101/2020.07.05.20146886v1).
16. Cheng H., Wang Y., Wang G.Q. (2020) Organ‐protective Effect of Angiotensin‐converting Enzyme 2 and its Effect on the Prognosis of COVID‐19. J. Med. Virol., 92(7): 726–730.
17. Selyuk M.M., Kozachok M.M., Levkin I.M. et al. (2018) Influence of molsidomine (Sidnofarm) on central hemodynamic parameters and on exercise tolerance disorders in patients with stage II arterial hypertension. Fam. Med., 3(77): 67–73. (In Ukr.).
18. Choi J.O., Cho S.W., Song Y.B. et al. (2009) Longitudinal 2D strain at rest predicts the presence of left main and three vessel coronary artery disease in patients without regional wall motion abnormality. Eur. J. Echocardiogr., 10: 695–701.
19. Aggeli C., Felekos I., Tousoulis D. et al. (2013) Myocardial mechanics for the early detection of cardiac sarcoidosis. Int. J. Cardiol., 168(5): 4820–4821. https://doi.org/10.1016/j.ijcard.2013.07.010.
20. Biering-Sørensen T., Jensen J.S., Pedersen S.H., Galatius S. (2016) Regional Longitudinal Myocardial Deformation Provides Incremental Prognostic Information in Patients with ST-Segment Elevation Myocardial Infarction. PLoS ONE, 11(6): e0158280.