Rosemarie Thiele

Selensubstitution bei akutem Myokrdinfarkt

BACKGROUND Previous examinations have demonstrated decreased selenium levels in serum and full blood in patients with myocardial infarction. PATIENTS AND METHOD 28 patients received a selenium treatment additional to the usual treatment of myocardial infarction. 19 patients with myocardial infarction with no supplementary selenium treatment served as a control group. Selenium levels in serum, full blood and urine were measured and the complications of the myocardial infarction documanted. RESULTS There was a significant increase of serum and full blood selenium and glutathione peroxidase levels under i.v. selenium therapy in the acute phase of myocardial infarction (first to third day). Left heart failure more rarely occurred in the selenium group (20%) than in control patients (57%). Acute tachycardial cardiac rhythm disturbances such as ventricular extrasystoles and couplets diminished in both groups; ventricular extrasystoles decreased in the selenium group. CONCLUSIONS Selen should be substituted in patients with acute myocardial infarction and decreased selen levels. It would be useful to carry out a prospective double-blind study.Summary□Background: Previous examinations have demonstrated decreased selenium levels in serum and full blood in patients with myocardial infarction.□Patients and Method: 28 patients received a selenium treatment additional to the usual treatment of myocardial infarction. 19 patients with myocardial infarction with no supplementary selenium treatment served as a control group. Selenium levels in serum, full blood and urine were measured and the complications of the myocardial infarction documanted.□Results: There was a significant increase of serum and full blood selenium and glutathione peroxidase levels under i. v. selenium therapy in the acute phase of myocardial infarction (first to third day). Left heart failure more rarely occured in the selenium group (20%) than in control patients (57%). Acute tachycardial cardiac rhythm disturbances such as ventricular extrasystoles and couplets diminished in both groups; ventricular extrasystoles decreased in the selenium group.□Conclusions: Selen should be substituted in patients with acute myocardial infarction and decreased selen levels. It would be useful to carry out a prospective double-blind study.

Einfluß der Substitution von Selen und Vitamin E auf Herzinsuffizienz und ventrikuläre Herzrhythmusstörungen bei Patienten mit akutem Myokardinfarkt

PATIENTS AND METHOD Patients with acute myocardial infarction were treated with selenium and vitamin E as antioxidants in addition to the standard therapy. They were compared to a reference group which received no additional therapy. It was to be investigated whether selenium and vitamin E are able to positively influence the course of the infarction, measured by way of the insufficiency symptoms, ventricular cardiac arrhythmia in long-term ECG and the ejection fraction determined by echocardiography. The concentrations of selenium, malonic dialdehyde (TBARS), glutathione peroxidase and vitamin E were measured at various points in time. RESULTS During the course of the in-patient treatment, significant percentage increases in selenium, glutathione peroxidase and vitamin E were detected. Group differences were similarly significant. It was not possible to detect differences in the clinical parameters. Possible explanations to be discussed are the duration of the treatment, the times of the examinations and the different proportions of patients treated thrombolytically in the 2 groups.Zusammenfassung□Patienten und Methode: Patienten mit akutem Myokardinfarkt wurden zusätzlich zur Standardtherapie mit Selen und Vitamin E als Antioxidanzien behandelt. Verglichen wurde mit einer Referenzgruppe, die keine Zusatztherapie erhielt. Es sollte untersucht werden, ob Selen und Vitamin E den Infarktverlauf, gemessen an Insuffizienzsymptomen, ventrikulären Herzrhythmusstörungen im Langzeit-EKG und der echokardiographisch ermittelten Ejektionsfraktion, günstig beeinflussen können. Die Konzentrationen von Selen, Malondialdehyd (TBARS), Glutathionperoxidase und Vitamin E wurden zu verschiedenen Zeitpunkten ermittelt.□Ergebnisse: Im Verlauf des stationären Aufenthalts war ein signifikanter prozentualer Anstieg von Selen, Glutathionperoxidase und Vitamin E in der behandelten Gruppe nachweisbar; Gruppenunterschiede waren ebenfalls signifikant. Unterschiede der klinischen Parameter konnten nicht nachgewiesen werden. Als mögliche Erklärung sind die Dauer der Behandlung, die Zeitpunkte der Untersuchungen und die verschiedenen Anteile thrombolytisch behandelter Patienten in beiden Gruppen zu diskutieren.Abstract□Patients and Method: Patients with acute myocardial infarction were treated with selenium and vitamin E as antioxidants in addition to the standard therapy. They were compared to a reference group which received no additional therapy. It was to be investigated whether selenium and vitamin E are able to positively influence the course of the infarction, measured by way of the insufficiency symptoms, ventricular cardiac arrhythmia in long-term ECG and the ejection fraction determined by echocardiography. The concentrations of selenium, malonic dialdehyde (TBARS), glutathione peroxidase and vitamin E were measured at various points in time.□Results: During the course of the in-patient treatment, significant percentage increases in selenium, glutathione peroxidase and vitamin E were detected. Group differences were similarly significant. It was not possible to detect differences in the clinical parameters. Possible explanations to be discussed are the duration of the treatment, the times of the examinations and the different proportions of patients treated thrombolytically in the 2 groups.

Koronarangiographie und Veränderung des antioxidativen Status

Zusammenfassung□Patienten und Methodik: In einer prospektiven Untersuchung wurde bei Patienten (n=53) mit einer stabilen Angina-pectoris-Symptomatik vor und vier bis sechs Stunden nach der Koronarangiographie der Redoxstatus (Glutathionperoxidase, Glutathion, Superoxiddismutase, Malondialdehyd, Selen in Serum und Vollblut) bestimmt. Die Patientengruppe wurde nach dem Ergebnis der Koronarangiographie in eine mit „schweren“ (n=16) und in eine solche mit „leichteren“ koronaren Veränderungen eingeteilt.□Ergebnisse: Sowohl in der Gesamtgruppe als auch in beiden Untergruppen kam es zu einer signifikanten Senkung des Selens im Serum und Vollblut. Die Enzyme Glutathionperoxidase und Superoxiddismutase wie auch Glutathion und Malondialdehyd verringerten sich nicht signifikant.□Schlußfolgerung: Wir werten diese Ergebnisse als Zunahme der Radikalbildung bei der koronaren Reperfusion (PTCA und Stentimplantation in der Gruppe mit „schweren“ koronaren Veränderungen), aber auch als Ausdruck der Radikalbildung durch die Methode selbst (Gruppe der Patienten mit „leichten“ koronaren Veränderungen). Weitere Untersuchungen sollten sich anschließen. Daneben sollte überlegt werden, vor der Koronarangiographie, PTCA und Stentimplantation den Redoxstatus des Organismus durch Radikalfänger (Zufuhr Vitamin E, A, C oder Selen) zu verbessern.Abstract□Patients and Methods: In a prospective study in 53 patients with stable angina pectoris symptoms the antioxidant status (glutathione peroxidase, glutathione, superoxid dismutase, malondialdehyde and selenium in serum and whole blood) was determined before and 4 to 6 hours after coronary angiography. According to the results of the coronary angiography the patients were classified in a group with „severe“ (n=16) and another with „moderate“ coronary alterations.□Results: In both groups there was a significant reduction of selenium in serum and whole blood. The enzymes glutathione peroxidase and superoxide dismutase as well as glutathione and malondialdehyde changed only slightly.□Conclusion: These results can be the cause of an increase of the formation of free radicals during coronary reperfusion (PTCA, implantation of stents in the group with “severe” coronary alterations) but could also be seen as a sign of formation of radicals by the method itself (in patients with “moderate” coronary alterations). Further investigations are indicated. Furthermore the amelioration of the antioxidant status of the organism by scavenger substances (vitamins A, B, C and selenium) should be discussed.