Factors related to the improvement of the right ventricular function in patients with pulmonary embolism at short-term follow-up

Abstract. Background. The purpose was to study the possible influence of Tivorel on the improvement of the right ventricular (RV) function in patients with acute pulmonary embolism (PE).

Materials and methods. The study was conducted between September 1, 2019 and December 31, 2020 at the premises of the Municipal Non-Profit Enterprise “City Clinical Hospital 8” of Kharkiv City Council. The analysis included 59 patients with RV dysfunction and PE, their average age was 66.34 ± 13.48 years. Twenty-nine (49.2 %) patients were at high risk and 30 (50.8 %) at moderate-tohigh risk. All individuals with PE were treated with anticoagulants according to 2019 European Society of Cardiology guidelines. Patients were divided into 2 groups using the envelope method. Group 1 (29 people) were prescribed Tivorel (42 mg of arginine hydrochloride and 20 mg of levocarnitine) manufactured by Yuria-Pharm company – 100 ml intravenously during the first five days of hospital stay, in addition to the standard therapy. Group 2 (30 patients) received the standard PE treatment.

Results. According to the cardiac ultrasound results, patients with PE had an improvement of right ventricular function parameters: a significant decrease in right atrial size and volume index, RV size and mean pulmonary artery pressure (р < 0.05). By the end of the observation period, the number of patients in group I whose RV size became < 3.0 cm was 23 (79.3 %) that was significantly higher than in group II – 17 (56.7 %) people, p = 0.01.

Conclusions. 43.3 % of patients at high and moderate-to-high risk of PE have ultrasonic signs of RV dysfunction after 14–21 days of standard anticoagulation therapy. According to the multivariate regression logistic analysis results, independent factors related to the normalization of RV function in patients with high and moderate-to-high risk of PE after 14–21 days are: mean pulmonary artery pressure, right atrial size and prescription of Tivorel infusions in addition to the standard therapy (p < 0.05).

Keywords: pulmonary embolism; arginine; short-term prognosis; anticoagulant therapy.

Authors:

V.Y. Tseluyko1, L.M. Yakovleva1, S.M. Sukhova2, O.V. Radchenko1

1V.N. Karazin Kharkiv National University, Kharkiv, Ukraine

2MNPE “City Clinical Hospital 8” of KhCC, Kharkiv, Ukraine