Effects Of Phosphocreatine On Cardiac Reserve Function Evaluated By Exercise Cardiac Contractility Monitor

BackgroundPhosphocreatine is a kind of high-energy phosphate compounds. Studies have shown that intravenous phosphocreatine could improve myocardial energy reserve, stabilize phospholipid membrane of myocardial cells, protect myocardial cells against oxygen free radical damage and improve cardiac function as well as coronary circulation. The current international methods of assessing cardiac function, such as electrocardiogram(ECG), echocardiography and cardiac catheterization. have all kinds of shortcomings as one-sided, invasive, difficult to operate, not being able to monitor dynamically and so on. In the heart sounds diagram,which is formed from energy conversion of heart beat, the first heart sound amplitude size is positively related with myocardial contractility. Based on this theory. The "Exercise cardiac contractility monitor " was invented to monitor myocardial contractility and cardiac reserve which is objective, simple, non-invasive and non-invasively. so it can be widely used in hospitals all aroud the world. In this study we used this exercise cardiac contractility monitor to evaluate the improvement of cardiac reserve by phosphocreatine therapy.Objective1.To observe the clinical efficacy of phosphocreatine to patients with heart failure, acute coronary syndrome and arrhythmia disease;2.To discuss the value of exercise cardiac contractility monitor in evaluating cardiac reserve function and application prospect;3.To study the changes and rules of cardiac reserve indicators influenced by 4.phosphocreatine via exercise cardiac contractility monitor.MethodIn this study,80individuals were evolved, including46men and34women with a mean age of (61.54±15.6) years old. All cases were divided into three groups based on their clinical diagnoses:acute coronary syndrome group (36cases), heart failure group (26cases) and arrhythmia group (18cases). Patients demographic data and comorbidities were recorded and all investigators were treated with intravenous phosphocreatine for a course which was0.9%normal saline100ml+phosphocreatine1g ivdrip bid*7days, on the basis of standard treatment of acute coronary syndrome, heart failure, or arrhythmia for each group. and the monitor was used to measure the cardiac functional reserve of patients at resting state before and after this therapy course. The main indicators consisted of the heart rate (HR), the first heat sound (S1), the second heart sound (S2)and the ratio of them (S1/S2), the diastole time (D), the systole time (S) and the ratio of diastole and systole(D/S).Results1. All cases after treatment of phosphocreatine compared with before:the heart rate HR slowed down, diastole time D, systole time S and the ratio of them D/S increased, they were all statistically significant (P<0.05); the amplitude ratio of first heart sound and second heart sound S1/S2increased, but there was no statistically significant difference (P=0.226).2. Cases in each group after treatment of phosphocreatine compared with before: in all these three groups of patients, heart rate HR slowed down, diastole and systole time ratio D/S and diastole time D increased, heart sound amplitude ratio S1/S2in heart failure group increased, all the above were statistically significant (P<0.05); in acute coronary syndrome group and arrhythmia group, systole time S increased with a statistically significant difference (P<0.05), heart sound amplitude ratio S1/S2reduced without a statistically significant difference (the values of P were0.830and0.575). 3. Difference of indicators of cases among three groups before and after the therapy:the heart rates HR in the acute coronary syndrome group before and after treatment of phosphocreatine were both smaller than that of the heart failure and arrhythmia group; the diastole and systole time frame D/S in acute coronary syndrome group before treatment was larger compared with heart failure group. the diastole time D and systole time S of acute coronary syndrome group before and after treatment were both larger compared with those of arrhythmia group, all the indicators above had statistically significant differences (P<0.05); the indicators before and after treatment between arrhythmias group and heart failure group had no statistically significant difference (P>0.05). Besides, the age and gender factor made no significant differences mong the three groups before and after treatment of phosphocreatine (P>0.05).4. D/S、D and S had a negative correlation with heart rate HR in all cases.(r value before and after treatment Successively was-0.855、-0.826,-0.640、-0.649,-0.456、-0.460, P<0.01)Conclusions1. Exercise cardiac contractility monitor could objectively and precisely evaluate cardiac function and cardiac reserve which made a great value in application.2. Creatine phosphate could comprehensively improve cardiac reserve function by increasing the heart rate reserve, diastolic function reserve and cardiac contractility reserve.3. Changes of cardiac contractility reserve in patients with acute coronary syndrome and arrhythmia was not obvious, changes of heart rate reserve and diastolic reserve in those patients came up earlier.4. Cardiac contractility compensatory increased at first and then gradually reduced with the reduction of heart function. Since heart failure patients possessed reduced cardiac contractility, the improved performance of cardiac contractility reserves by phosphocreatine was shown in the increase of cardiac contractility.5. Heart rate reserve in patients with acute coronary syndrome was larger than that in patients with heart failure and arrhythmia.6. D/S、D and S all had a negative correlation with heart rate HR.7. The shortcomings of this study is that the cases were relatively less and some groups came up with no statistically significant conclusions, which still needed to expand the cases and clinical research.