The influence of Mexidol on the quality of life and the functional status of patients with chronic ischemia of the brain and chronic heart failure with a low emission fraction

Authors:
V.V. TOLKACHEVA¹, E.R. KAZAKHMEDOV¹, J.D. KOBALAVA¹, S.A. GALOCHKIN¹, A.V. SHCHULKIN²

¹Peoples' Friendship University of Russia, Moscow, Russia;
²Ryazan State Medical University named after Academician I.P. Pavlov of the Ministry of Health of the Russian Federation, Ryazan, Russia

Place of publication:
CARDIOLOGY AND CARDIOVASCULAR SURGERY, 2021, Vol. 14, No. 1

Abstract:
Objective. To study the effect of Mexidol on the functional state of the myocardium, the level of brain natriuretic peptide (NT-proBNP), exercise tolerance, quality of life, the severity of oxidative stress, inflammatory response and endothelial dysfunction in patients with chronic cerebral ischemia (CCI) and chronic heart failure (CHF) II-III functional class (FC) according to the NYHA classification with sequential intravenous and oral administration of Mexidol for 13 weeks against the background of standard basic therapy. Material and methods. The study included 44 patients with CCI and CHF II-III FC according to NYHA. The average age was 65.5±11.8 years (75% men); 21 patients were in the basic therapy group for CHF with additional prescription of Mexidol, 23 patients were in the basic therapy group. At baseline, on day 7 and at week 13, echocardiographic parameters, NT-proBNP level, exercise tolerance (6-minute walk test, 6MWT), assessment of the patient’s clinical condition using the SHOKS scale (modified by V.Yu. Mareev), oxidative stress parameters (malondialdehyde (MDA) level and superoxide dismutase (SOD) activity), inflammatory response (C-reactive protein (CRP) level, tumor necrosis factor (TNF-α) level), as well as homocysteine ​​content and cystatin C level were assessed. At baseline and at the end of the study, quality of life was assessed using the Minnesota Living With Heart Failure Questionnaire (MLHFQ) and the Kansas City Cardiomyopathy Questionnaire (KCCQ). Results. Patients in the Mexidol + basic therapy group demonstrated a more pronounced improvement in quality of life indicators, a higher increase in the 6MH T results, a more pronounced improvement in the clinical condition according to the SHOKS scale, a significant decrease in the end-diastolic and end-systolic dimensions of the LV, as well as a significantly more pronounced decrease in the NT-proBNP level on the 7th day and after 13 weeks of therapy compared with the basic therapy group. The use of Mexidol in addition to basic therapy led to a decrease in the MDA concentration and an increase in SOD activity on the 7th day and after 13 weeks of observation. A significant decrease in the CRP and TNF-α levels was revealed both on the 7th day and after 13 weeks of observation against the background of additional use of Mexidol. A slower increase in homocysteine ​​was found in the Mexidol therapy group. No significant differences in cystatin C indicators were found between the groups. Conclusion. Mexidol, when added to the basic therapy of patients with chronic cerebral ischemia and CHF II-III functional classes, has a beneficial effect on quality of life, functional status, improves clinical condition and intracardiac hemodynamic parameters, exhibits reliable antioxidant activity, reduces the severity of the inflammatory response, slows the increase in homocysteine ​​levels, and has no effect on renal function (cystatin C). Key words: chronic cerebral ischemia, heart failure, quality of life, cognitive status, ethylmethylhydroxypyridine succinate, Mexidol, oxidative stress, inflammation, endothelial dysfunction.