Abstract
<jats:p>Coronary revascularization reduces ischemic burden in patients with chronic coronary syndromes, yet a substantial proportion of individuals with heart failure and mildly reduced ejection fraction may continue to exhibit adverse myocardial remodeling and residual systemic inflammation, both linked to recurrent events and functional decline. Magnesium plays a key role in energy metabolism, electrophysiology and inflammatory signaling, therefore magnesium support might be clinically meaningful after revascularization. This study evaluated whether adding magnesium orotate to guideline-directed standard therapy influences echocardiographic remodeling, stress/fibrosis biomarkers and integrated inflammatory indices in post-revascularization patients with chronic coronary syndromes and HFmrEF. Sixty-two patients were enrolled and randomized to a control group receiving standard therapy (n=29) or to an intervention group receiving standard therapy plus magnesium orotate 500 mg twice daily for 6 months (n=33). Transthoracic echocardiography was performed at baseline, 3 months and 6 months. Serum soluble ST2, galectin-3, NT-proBNP and C-reactive protein were measured, while complete blood count and lipid parameters were used to calculate SII, NLR, PLR, SIRI, AISI, the triglyceride-glucose index, the hsCRP/HDL-c ratio and the atherogenic index of plasma. Baseline demographic and clinical characteristics were comparable between groups. Over 6 months, the magnesium orotate group demonstrated a more pronounced improvement in systolic performance, with a greater increase in left ventricular ejection fraction, along with a significant reduction in interventricular septal and posterior wall thickness in systole, suggesting attenuation of hypertrophic remodeling. Favorable trends in cavity dimensions and pulmonary artery pressure were also observed. Biomarker dynamics supported these findings: galectin-3, NT-proBNP and C-reactive protein decreased significantly, with between-group differences at 6 months for several markers, consistent with reduced fibrotic signaling and lower inflammatory activity. Soluble ST2 showed a downward direction in both groups. Integrated hematologic indices of inflammation (SII, NLR, PLR, SIRI and AISI) declined steadily, and the magnitude of reduction was greater with magnesium orotate, indicating more effective modulation of residual inflammatory milieu. Metabolic atherogenic surrogates (TyG index, hsCRP/HDL-c ratio and AIP) also improved in the intervention group, supporting a broader cardiometabolic benefit. In conclusion, in patients after myocardial revascularization with chronic coronary syndromes and HFmrEF, adjunctive magnesium orotate for 6 months was associated with more favorable echocardiographic remodeling and a more consistent decrease in fibrosis- and inflammation-related biomarkers and composite inflammatory indices. These results justify further larger studies to clarify clinical outcome effects and to define the optimal duration and target populations for magnesium-based support in contemporary secondary prevention.</jats:p>