Dynamics of microcirculation indices in patients with chronic ischemic diseases of the central nervous and cardiovascular systems


DOI: https://dx.doi.org/10.18565/therapy.2021.8.84-92

Heylo T.S., Danilogorskaya Yu.A., Nazarenko G.B., Gladysheva E.G.

1) Therapeutic Ophthalmology Center LLC, Moscow; 2) I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Healthcare of Russia
Abstract. Cerebral microangiopathy is the most common cause of cognitive impairment in patients with cardiovascular disease.
Purpose: to assess the effect of meldonium (Mildronate®) on microcirculation parameters, the degree of cognitive impairment and health status in general therapeutic patients with arterial hypertension (AH) and chronic ischemic diseases of the central nervous and cardiovascular system.
Material and methods. The study included 31 patients with AH in combination with chronic cerebral ischemia; 71% of patients suffered from coronary artery disease (angina pectoris 1–2 FC). In addition to standard antihypertensive therapy, 21 patients received Mildronate® (1000 mg/day) for 6 weeks. All patients twice (before the beginning and after 6 weeks of therapy) underwent: capillaroscopy of the bulbar conjunctiva and the limbus of the eye using an ophthalmic capillaroscope «OKO» with the determination of quantitative and qualitative indicators of microcirculation; static perimetry (SP), during which the boundaries of the patient’s field of vision and the area of the loss of a part of the field of view (scotomas) were established; assessment of the level of cognitive impairment on the MoCA scale and quality of life using the EQ-5D questionnaire.
Results and conclusion. After 6 weeks of therapy with meldonium, a significant improvement in the quantitative indicators of capillaroscopy was noted: an acceleration of the blood flow rate both in arterioles (by 12%) and venules (by 5%). Qualitative characteristics also showed positive dynamics: the severity of erythrocyte sludge (p <0,05), focal stasis (p <0,05), arterio-venous shunts (p <0,05) significantly decreased. The change in microcirculation indices was accompanied by a significant increase in the number of objects perceived by patients during SP from 156 (137; 168) to 163 (148; 178; p <0,05), which indicated an expansion of the visual field during therapy with Mildronate®. According to the MoCA scale and the EQ-5D questionnaire, the patients’ cognitive functions and quality of life also significantly improved: the score on the MoCA test increased from 21 (19; 22) to 25 (22; 26; p <0,05), and the health assessment by the patient himself – from 75 (70; 80) to 85% (80; 85) (p <0,05).
Keywords: microcirculation disorder, capillaroscopy, meldonium, chronic cerebral ischemia, endothelial dysfunction, hypertension, coronary artery disease
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About the Autors

Tatyana S. Heylo, ophthalmologist, Chief physician of Therapeutic Ophthalmology Center LLC. Address: 117218, Moscow, 18/2 Krzhizhanovskogo Str. Tel.: +7 (985) 769-73-50. E-mail: cto96@mail.ru. ORCID: 0000-0002-8374-2645
Yulia A. Danilogorskaya, PhD, assistant of the Department of hospital therapy No.1 of N.V. Sklifosovsky Institute of clinical medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Healthcare of Russia. Address: 119021, Moscow, 11/2 Rossolimo Str. Tel.: +7 (916) 612-98-14. E-mail: julia_dan@mail.ru. ORCID: 0000-0002-4994-8500
Georgy B. Nazarenko, PhD, ophthalmologist of Therapeutic Ophthalmology Center LLC. Address: 117218, Moscow, 18/2 Krzhizhanovskogo Str. Tel.: +7 (499) 125-13-77. E-mail: cto96@mail.ru. ORCID: 0000-0003-3567-821X
Ekaterina G. Gladysheva, PhD, assistant of the Department of hospital therapy No.1 of N.V. Sklifosovsky Institute of clinical medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University) of the Ministry of Healthcare of Russia. Address: 119021, Moscow, 11/2 Rossolimo Str. Tel.: +7 (903) 670-69-81. E-mail: Eglad8@mail.ru. ORCID: 0000-0002-4079-7689


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