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LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH AND WITHOUT ST SEGMENT ELEVATION

https://doi.org/10.20996/1819-6446-2016-12-2-154-159

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Abstract

Aim. To study the remodeling of the left ventricle (LV) in patients with ST segment elevation (STEMI) and non-ST segment elevation (non-STEMI) myocardial infarction (MI). Materials and methods. Patients (n=99) with acute MI (48 – with STEMI, 51 – with non-STEMI) were examined. Diagnosis of MI was set on the basis of the dynamics of myocardial damage markers, data of clinical and electrocardiogram examination. The comparison group consisted of 33 patients with stable angina functional class 2. The control group included 35 healthy men. Structural and functional state of the LV myocardium and types of its remodeling were assessed by echocardiography.
Results. It was found that the LV eccentric hypertrophy was the predominated type of LV remodeling in patients with STEMI. Besides, these patients demonstrated disorders of the LV contractile function (LV ejection fraction 40.2±5.49% vs. 61.4±3.91% in control; p<0.05), the LV dilatation (end-systolic volume index 54.1±5.27 vs. 25.2±2.22 ml/m2 in the control; p<0.05), the lowest LV wall thickness (relative wall thickness 0.36±0.01 vs. 0.44±0.01 in control; p<0.05), increase in the LV myocardial stress (168.3±20.17 vs. 108.6±9.82 dynes/cm2 in control; p<0.05), and LV spherification. The majority of patients with non-STEMI revealed combination of concentric and eccentric types of LV remodeling. Their hemodynamic parameters were comparable to those in patients with stable angina, but exceed the control data.
Conclusion. In patients with acute MI severity of the LV remodeling correlated with the depth and vastness of myocardial damage. The most significant hemodynamic changes were observed in STEMI.

About the Authors

N. E. Zakirova
Bashkir State Medical University, Ufa
Russian Federation


Z. A. Kazieva
Bashkir State Medical University, Ufa


A. N. Zakirova
Bashkir State Medical University, Ufa


References

1. Mc Manus D.D., Gore J., Varzebski J. et al. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Аm. J Med 2011; 124 (1): 40-7.

2. Belenkov YN Coronary artery disease as the main cause of heart failure. Serdechnaya Nedostatochnost' 2004; 5 (2): 77-85. In Russian (Беленков Ю.Н. ИБС как основная причина сердечной недостаточности. Сердечная Недостаточность 2004; 5(2): 77-85).

3. Opie L.H., Commerford F.J., Gerch B.J., Pfeffer M.A. Controversies in ventricular remodeling. Lancet 2006; 367 (9507): 356-67.

4. Belov YV, Varaksin VA. Structural and geometric changes of the myocardium and features central hemodynamics in the post-infarction left ventricular remodeling. Kardiologiia 2003; 1: 19-23. In Russian (Белов Ю.В., Вараксин В.А. Структурно-геометрические изменения миокарда и особенности центральной гемодинамики при постинфарктном ремоделировании левого желудочка. Кардиология 2003; 1:19-23).

5. Bolognese L., Cerisano G. Early predictors of left ventricular remodeling after acute myocardial infarction. Am Heart J 1999; 138; 2:79-83.

6. Kapelko VI. The evolution of the concept and the metabolic basis of ischemic myocardial dysfunction. Kardiologiia 2005; 9: 55-61. In Russian (Капелько В.И. Эволюция концепции и метаболическая основа ишемической дисфункции миокарда. Кардиология 2005; 9:55-61).

7. Tsyplenkova VG. Critical notes on the paradigm of "hibernating and stunned myocardium". Kardiologiia 2005; 9: 43-6. In Russian (Цыпленкова В.Г. Критические заметки по поводу парадигмы «гибернирующий и оглушенный миокард». Кардиология 2005; 9: 43-6).

8. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: Summary Article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2003; 108(9): 146-62.

9. Lang R., Biering M., Devereux R.B. et al. Recommendations of chambers guantibication. Eur.J Echocardiog 2006; 7(2): 79-108.

10. Canau A., Devereux R.B., Roman M. J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol 1992; 19(7):1550-8.

11. Smart S.C., Knickelbine T., Malik E., Sagar K.B. Dobutamine-atropine stress echocardiography fort the detection of coronary artery disease in patients with left ventricular hypertrophy, importance of chamber size and systolic wall stress. Circulation 2000; 101(3): 258-63.

12. Pfeffer M.A., Braunwald E. Ventricular remodeling after myocardial infarction. Experimental observations and clinical implication. Circulation 1990; 81(4): 77-8.

13. Martynov AI, Vasyuk YA, Kopeleva MV, Krikunov PV. Postinfarction remodeling of the left ventricle: the possibility of β-blockers. Kardiologiia 2001; (3): 79-82. In Russian (Мартынов А.И., Васюк Ю.А., Копелева М.В., Крикунов П.В. Постинфарктное ремоделирование левого желудочка: возможности β-адреноблокаторов. Кардиология 2001; (3): 79-82).

14. Kloner R.A., Arime R.B., Kay G.L. et al. Evidence for stunned myocardial in humane: a 2001 update. Coron Artery Dis 2001; 12(5): 349-56.

15. Zakirova AN, Oganov RG, Zakirova NE et al. Remodeling of the myocardium in patients with coronary heart disease. Rational Pharmacotherapy in Cardiology 2009; (1): 42-5. In Russian (Закирова А.Н., Оганов Р.Г., Закирова Н.Э. и др. Ремоделирование миокарда при ишемической болезни сердца. Рациональная Фармакотерапия в Кардиологии 2009; (1):42-5).

16. Kloner R.A., Jennings R.B Consequences of brief ischemia: stunning, preconditioning and thear clinical implications: part 1. Circulation 2001; 104(24): 2981-9.

17. Verma S., Fedakk P.W.M, Weisel R. et al. Fundamentals of reperfusion injury for the clinical cardiologist. Circulation 2002; 105:2332-8.

18. Dutka D.P., Camici P.G. Hibernation and congestive heart failure. Heart Fail Rew 2003; 8: 167-73.

19. Rinaldi C.A., Hall R.J. Myocardial stunning and hibernation in clinical practice. Int J Pract 2000; 54: 569-604.

20. Carden D.L. Grander D.N. Pathorhisiology of ischemia – reperfusion injury. J. Pathol 2000; 190:255-66.

21. Zakirova NE, Zakirova AN. The role of the immune and inflammatory responses of endothelial dysfunction in myocardial remodeling and progression of coronary heart disease. Rational Pharmacotherapy in Cardiology 2014; 10 (5): 487-93. In Russian (Закирова Н.Э., Закирова А.Н. Роль иммуновоспалительных реакций и дисфункции эндотелия в ремоделировании миокарда и прогрессировании ишемической болезни сердца. Рациональная Фармакотерапия в Кардиологии 2014; 10(5): 487-93).


Review

For citations:


Zakirova N.E., Kazieva Z.A., Zakirova A.N. LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH AND WITHOUT ST SEGMENT ELEVATION. Rational Pharmacotherapy in Cardiology. 2016;12(2):154-159. (In Russ.) https://doi.org/10.20996/1819-6446-2016-12-2-154-159

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