View on indicators of damage of cardiovascular system of patients with systemic sclerodermia

Abstract

Despite many years of scientific research, the final concept of the pathogenesis and treatment of systemic scleroderma (SSD) compared to other systemic rheumatic diseases has not been reached. The microcirculatory vasculature is also the main target in SSD. The purpose of the study is to evaluate the damage to the cardiovascular system in patients with systemic scleroderma. Materials and methods. Clinical research was conducted in 86 patients with a diffuse form of SSD, aged 18 to 50 years (average age 37.6±10.3 years), with an average disease duration of 10.7±7.9 years, were involved in the study. All patients involved in the study were divided into three groups according to the type of treatment: patients in 1st group (n-34) received conventional treatment according to the recommendations of the standard of care for SSD, 2nd group (n-29) received treatment according to the standard of care for patients in the 2nd group(n-29) statin (atorvastatin drug in the amount of 20- 40 mg for 6 months) in addition to traditional treatment, tocilizumab (8 mg/kg) according to the scheme (8 mg/kg) dose in the form of injection once every 4 weeks) was prescribed for 6 months. Results. According to the obtained results, when the changes in the systolic and diastolic volume of the left ventricle during the study were studied, the changes in the systolic volume of the left ventricle reliably increased in patients of 1st group compared to the beginning of the study, while in 2nd group, this indicator did not change, which is confirmed by the unreliable change of values in statistical analysis. Also, in the 3rd group, it was seen that the heart remodeling was shifted in a positive direction with a reliable decrease in end-systolic volume of left ventricular (ESVLV). Left ventricular fraction (LVF), which is the main gradient determining the functional state of the left ventricle, showed negative results in the 1st group of patients, decreasing in reliable values during our study. In the 2nd group of patients who received atorvastatin in addition to conventional treatment, this indicator changed unreliable, that is, the values shifted in one direction or another. The thickness of carotid arteries (TCA), which is considered a vascular component of cardiovascular system changes, changed as follows during six months of treatment in our research: in 1st group, the thickness of IMC showed a worsening of the process even though it was at less reliable (p<0.05) values. In 2nd group, the values did not change. In patients of 3rd group who received atorvastatin and tocilizumab drugs in addition to traditional treatment, the IMC thickness decreased reliably (p<0.01) after treatment and reflected positive results. Conclusion. In patients with systemic scleroderma, negative changes were detected in the cardiovascular system according to the results of ECG and EchoCG examination, in particular, left ventricular hypertrophy - in 43% of cases, coronary insufficiency - in 30%, and the end systolic volume of the left ventricle was found in 47% and increased myocardial mass by 66%. In patients with systemic scleroderma, pathological enlargement of the intima-media complex of the common carotid artery (>0.9 mm) was detected in 32.4% of cases, atherosclerotic plaques in 18.6% of patients.