Abstract
The aim. Study the effect of combined lipid-lowering therapy (statins+ezetimibe+Inclisiran) for left ventricular (LV) myocardial cell perfusion in patients with severe lipid metabolism disorders according to single-photon emission computed tomography (SPECT) of the myocardium with 99mTc-MIBI.
Material and methods. The study included 54 patients with severe lipid metabolism disorders. 30 patients were prescribed therapy with the Inclisiran in addition to oral lipid–lowering therapy, 24 patients in the control group were on only oral lipid-lowering therapy. Left ventricular myocardial perfusion SPECT was performed with simultaneous assessment of systolic and diastolic function parameters before and after 9 months. Standard quantitative perfusion indicators were calculated: the prevalence (extent) of perfusion defects at rest (rest), after loading (stress) and reversible defects (reversible), the sum of the Summed Rest Score (SRS), Summed Stress Score (SSS) and Summed Difference Score (SDS), as well as the parameters of diffuse irregularity of myocardial perfusion LV (σт and σн), reflecting the severity of disorders at the microcirculation level.
Results. In the group of patients on combined lipid-lowering therapy, including Inclusiran, positive dynamics was noted during 9 months of follow-up according to the results of laboratory tests – a decrease in total cholesterol, low-density lipoprotein cholesterol (LDL cholesterol), and achievement of target levels of LDL cholesterol in 72.5% of patients. Improvement of myocardial perfusion in the form of a decrease in the area of reversible perfusion defects, as well as a decrease in the severity of initially existing diffuse disorders at the microcirculation level was noted in 70% of patients.
Conclusion. Intensive lipid-lowering therapy leads not only to achieving the target level of LDL cholesterol in most cases, but also to improving myocardial perfusion at the microcirculation level.
Keywords. atherosclerosis, Inclusiran, lipid metabolism disorders, severe hypercholesterolemia, coronary microcirculation, myocardial perfusion, single-photon emission tomography of the myocardium.
Material and methods. The study included 54 patients with severe lipid metabolism disorders. 30 patients were prescribed therapy with the Inclisiran in addition to oral lipid–lowering therapy, 24 patients in the control group were on only oral lipid-lowering therapy. Left ventricular myocardial perfusion SPECT was performed with simultaneous assessment of systolic and diastolic function parameters before and after 9 months. Standard quantitative perfusion indicators were calculated: the prevalence (extent) of perfusion defects at rest (rest), after loading (stress) and reversible defects (reversible), the sum of the Summed Rest Score (SRS), Summed Stress Score (SSS) and Summed Difference Score (SDS), as well as the parameters of diffuse irregularity of myocardial perfusion LV (σт and σн), reflecting the severity of disorders at the microcirculation level.
Results. In the group of patients on combined lipid-lowering therapy, including Inclusiran, positive dynamics was noted during 9 months of follow-up according to the results of laboratory tests – a decrease in total cholesterol, low-density lipoprotein cholesterol (LDL cholesterol), and achievement of target levels of LDL cholesterol in 72.5% of patients. Improvement of myocardial perfusion in the form of a decrease in the area of reversible perfusion defects, as well as a decrease in the severity of initially existing diffuse disorders at the microcirculation level was noted in 70% of patients.
Conclusion. Intensive lipid-lowering therapy leads not only to achieving the target level of LDL cholesterol in most cases, but also to improving myocardial perfusion at the microcirculation level.
Keywords. atherosclerosis, Inclusiran, lipid metabolism disorders, severe hypercholesterolemia, coronary microcirculation, myocardial perfusion, single-photon emission tomography of the myocardium.
For citation:Kurochkina N.S., Prus Yu.A., Nozadze D.N., Zubareva M.Yu., Ansheles A.A., Sergienko V.B., Kordzaya E.L., Sapina A.I., Vasileva E.Yu., Sergienko I.V., Ezhov M.V. The effect of combined lipid-lowering therapy on myocardial perfusion in patients with severe lipid metabolism disorders. Clinical review for general practice. 2025; 6 (3): 13–22 (In Russ.). DOI: 10.47407/kr2024.6.3.00578
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