Effects Of Trimetazidine Combined With Cardiac Rehabilitation On Ventricular Remodeling、Living Quality And Monocyte NLRP3 Expression In Patients With AMI

Objective:.To investigate the effects of Trimetazidine（TMZ）combined with Cardiac Rehabilitation（CR）on ventricular remodeling and Quality Of Life（QOL）at different stages after Percutaneous Coronary Intervention（PCI）in patients with AMI.The expression of NLRP3（Nod-Like Receptor Protein 3）in peripheral blood monocytes at different time periods after the onset of AMI and the effect of TMZ combined with CR on the expression of NLRP3 were observed.Methods:The study included 89 patients,and they are all AMI patients from Second Affiliated Hospital of Dalian Medical University,since October 2018 to January 2020.All patients underwent PCI in the emergency department or within 2 days of admission.Patients were treated with di-antibody,heparin,and statins,and eitherβ-receptor antagonists or CCB or RAS system antagonists were given depending on the patient’s blood pressure and heart rate.According to patients have no intention of rehabilitation and compliance level,we divided the subjects into two groups,one group was named the rehabilitation group,the other group was named the control group.The control group included 44 patients,they were treated with the above treatment,without any combination of other treatments.The rehabilitation group included 44 patients,they were treated with standard treatment combined with TMZ and CR.The rehabilitation group started the cardiac rehabilitation procedure as appropriate from the second day after PCI,and was given trimetazidine hydrochloride on the seventh day after PCI,35mg each time,twice a day,and swallowed with warm water after meal for 1 year（52±2 weeks）.All enrolled AMI patients had their peripheral blood samples taken on the morning of admission to detect blood routine,c Tn I,blood lipid,blood glucose,liver biochemistry,renal function and A1c.BNP levels were measured at 24-36 hour,week 1,week 4,week12,and week 52±2 after onset.Echocardiography was performed at 1 week of onset,4weeks of onset,12 weeks of onset and 52±2 weeks of onset,and the related cardiac function indexes（LVEDd and LVEF）were recorded.At 1 week of onset,and 52±2 weeks of onset,the Quality of Life Rating Scale（SF-12）,the Generalized Anxiety Scale（GAD-7）were recorded.Peak VO₂/kg,VO₂/kg@AT,and Mets@AT were recorded by cardioputrophic exercise tests.The expression of NLRP3 in peripheral blood monocytes of patients 24-36 hours after onset,1 week after onset,4 weeks after onset,12 weeks after onset,and 52±2 weeks after onset was detected.SPSS 24.0 statistical software was used to analyze the above data.Results:1.During the 1-year follow-up,the level of BNP decreased gradually in both groups.At 4 and 12 weeks of onset,the BNP level in the rehabilitation group was significantly lower than that in the control group.The LVEDd value of the rehabilitation group was significantly lower than that of the control group at 1 year of onset.The value of LVEF in the rehabilitation group was higher than that in the control group at 12 weeks and 1 year.2.At 1 year of onset,the SF-12 scale score of the rehabilitation group was significantly higher than that of the control group,and the GAD-7 scale score of the rehabilitation group was significantly lower than that of the control group.Meanwhile peak VO₂/kg,VO₂/kg@AT,Mets@AT of cardiopulmonary exercise test related indexes in the rehabilitation group were significantly higher than those in the control group.3.During the 1-year follow-up,the level of NLRP3 in the peripheral blood monocytes of both groups showed a decreasing trend and peaked at 24-36 hours after onset.We compared the levels of NLRP3 in peripheral blood monocytes between the two groups,the results showed that at 4 and 12 weeks,the rehabilitation group was lower.Conclusion:1.TMZ combined with CR significantly improved ventricular remodeling,exercise endurance and quality of life in AMI patients,and the effect was the best at 1year after PCI,with the patients benefiting the most.2.TMZ combined with CR can significantly reduce the level of NLRP3 in peripheral blood monocytes of AMI patients,and the effect is most obvious at 3 months after PCI.