Authors
Shumakov D.V.1, Dontsov V.V.1, Zybin D.I.1, Ivanov A.V.2, Popov M.A.1, Agafonov E.G.1, Pronina V.P.1, Zolotareva L.S.3, 4, Vzvarov S.A.1, Maslennikov R.A.1
1 Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy, Moscow
2 Institute of general pathology and pathophysiology, Moscow
3 Institute of Motherhood and Childhood, Pirogov Russian National Research Medical University, Moscow
4 O.M. Filatov City Clinical Hospital №15, Moscow
Abstract
The plasma pool of aminothiols, on the one hand, has a significant effect on the metabolism of glutathione in the tissues of blood vessels and the heart, and on the other hand, it may reflect its disorders. CABG, in turn, can be considered as a procedure that triggers stress and adaptive mechanisms that can significantly affect the metabolism of aminothiols. However, to date, data on this effect of CABG is fragmentary. To understand the processes occurring in the aminothiol system in coronary heart disease and CABG, it is important to detect not only shifts in the concentrations of these markers, but also to identify the presence or absence of their association with each other. Currently, there is still insufficient information about the features of the aminothiol system in patients with coronary heart disease and about changes in this system in the postoperative period after CABG.
Material and methods. The present study was performed on the basis of the M.F. Vladimirsky State Medical University of the Russian Academy of Sciences.
A prospective examination of 40 patients and 40 healthy volunteers was conducted: group 1 – patients (n = 40) with multivessel coronary artery disease who underwent complete myocardial revascularization at the M. F. Vladimirsky State Medical University in the period from January 2022 to January 2023; group 2 – healthy volunteers (n = 40), a control group for calculating the norms of the level of aminothiols in the blood.
Results. The level of glutathione before surgery, mmol/l (GSH, mkM) in the study group was statistically significantly lower than the level of glutathione in healthy volunteers (787.2±170.9 in the study group and 1019.9±106.4 in the group of healthy volunteers, p<0.001).
The groups did not significantly differ in the level of the oxidized form of glutathione (GSSG), mkmol/l (p = 0.665). The ratio of glutathione and glutathione disulfide was statistically significantly higher in healthy volunteers compared with patients from the main group (p<0.001).
The level of cysteine and glutathione in the study group decreased in dynamics (p<0.001).
The level of cysteine after surgery, mmol/l correlated with the amplitude of systolic movement of the mitral valve fibrous ring (MAPSE) (R = 0.380, p = 0.048).
The level of glutathione, mmol/l before surgery was negatively correlated with the level of glucose before surgery (R = -0.225, p = 0.044), iLP before surgery (R = -0.284, p = 0.011), E/A before surgery (R = -0.291, p = 0.009), Ve” (Latin) before surgery (R = -0.463, p = 0.003), positively correlated with MAPSE (R = 0.326, p = 0.003) and TAPSE (R = 0.479, p<0.001) before surgery.
The level of glutathione, mmol/l one year after surgery was negatively correlated with EF (R = -0.317, p = 0.046), positively correlated with TAPSE (R = 0.334, p = 0.035) before surgery, with CSR (R = 0.335, p = 0.035), IXO (R = 0.319, p = 0.045) in the long–term period, negatively – with glucose levels (R = -0.315, p = 0.048) and EF (R = -0.344, p = 0.030).
In the long term, one year after surgery, the quality of life of the patients in the study group was lower than the quality of life of healthy volunteers (4.5 (3; 7) and 0 (0;0), Mann-Whitney criterion, p<0.001).
Conclusion. In our article, we analyzed changes in two interrelated biochemical cycles, the S–adenosylmethionine cycle and the glutathione cycle, occurring in patients with cardiac surgery in response to surgery. In the postoperative period, we observed a decrease in blood glutathione levels in patients undergoing cardiac surgery (CABG).
In the course of our study, we observed the protective effects of S-adenosyl methionine, cysteine, and glutathione after coronary artery bypass surgery, and the high redox potential of aminothiols negatively correlates with the severity of the patients’ clinical condition, assessed using instrumental (echocardiography) and laboratory examination methods.
Keywords: coronary heart disease, glutathione, homocysteine, coronary bypass surgery.
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