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Anti-remodeling efficiency of preparations such as perindopril, veroshpiron and bisoprol applied to patients...t
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1. Курбанов А. Б., Базарбаева Д. И. Состояние загрязненности окружающей среды и продуктов питания детей в Республике Ка-ракалпакстан//Материалы науч.-практич.конф. «Мониторинг гигиенического состояния окружающей среды и здоровья человека». - Ташкент, 2006. - С. 16-17.
2. Курбанов А. Б., Ешанов Т. Б., Ибрагимов М. Ю., Константинова Л. Г., Темирбеков О., Косназаров К. А. Гигиеническая оценка пестицидов, применяемых в Республике Каракалпакстан/Под ред. Н. Палагина. - Нукус: «Билим», 2002. - 76 с.
3. Курбанов А. Б., Мадреимов А., Мамбетуллаева С. М., Атаназаров К. М. Анализ распространенности острых кишечных инфекций в Республике Каракалпакстан: методич. разработка. - Нукус, 2005. - 19 с.
4. Кутлымуратов Р. С., Сафаров К. С. Выявляемость некоторых представителей семейства энтеробактерий из проб питьевой воды и водоёмов//Материалы междунар.науч.-практич.конф. «Проблемы рационального использования и охрана биологических ресурсов Южного Приаралья». - Нукус, 2006. - С. 81.
5. Мадреимов А. О санитарно-экологической обстановке и заболеваемости острыми диареями в Южном Приаралье/Материалы науч-практич.конф. «Актуальные проблемы экологии и гигиены в Узбекистане». - Ташкент, 2008. - С. 229-231.
6. Мадреимов А. О совершенствовании мер борьбы с острыми кишечными заболеваниями в Республике Каракалпакстан//Меди-цинские науки. - М., 2009. - № 1. - С. 17-19.
7. Мадреимов А., Абсаттарова В. К. О заболеваемости детей острыми диареями в Республике Каракалпакстан в условиях мало-водия и мерах профилактики//Материалы науч.-практич.конф. «Актуальные проблемы экологии и гигиены в Узбекистане». -Ташкент, 2008. - С. 227-229.
8. Мадреимов А., Маткаримов Б. Д. Некоторые эпидемиологические закономерности острых кишечных заболеваний в условиях Южного Приаралья//Проблемы биологии и медицины. - 2009. - № 3. - С. 30-35.
9. Мадреимов А., Нарымбетова Р. Ж., Ниязова Г. Т., Атаханова Д. О. О влиянии некоторых вредных факторов окружающей среды на здоровье людей в Республике Каракалпакстан//Материалы IX Респ.съезда гигиенистов и сан.врачей Узбекистана. - Ташкент, 2010. - Т. 2. - С. 107-108.
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13. СанПиН № 0182-05. «Гигиенические требования к качеству воды нецентрализованного водоснабжения и санитарная охрана источников в условиях Узбекистана».
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Atakhodzhaeva Gulchekhra Abdunabievna, PhD, the assistant of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan, E-mail: atakhodzhaeva@list.ru. Rakhimov Shukhrat Malicovich, PhD, professor of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan.
Anti-remodeling efficiency of preparations such as perindopril, veroshpiron and bisoprol applied to patients with chronic heart failure and metabolic syndrome
Abstract: The aim ofthis work is to study the anti-remodeling efficiency of complex pharmacotherapy of CHF by use of perindopril, veroshpiron and bisoprolol in patients with MS. The study involved 76 male patients with chronic heart failure (CHF) II-III FC, with post infarction cardiosclerosis. Depending on the components of MS the patients were divided into 3 groups: Ist group (n=27), patients without MS; Group II (n=24), patients with a combination of dyslipidemia (DLP) with abdominal obesity (AO) and arterial hypertension (AH); Group III (n=25), patients with a combination of AD, AH and DLP with diabetes 2 types. A three-month treatment with an implement of the Perindopril, Bisoprolol and Veroshpiron combination in patients suffering from CHF without MS promotes regression of non-adaptive remodeling of myocardium and improvement of systolic and diastolic function of the heart. The MS in patients with chronic heart failure reduces the anti-remodeling effectiveness of the combined application of Perindopril, Bisoprolol and Veroshpiron, which depends on the representation of its components. The most marked resistance against therapy exists, when there is a combination of AO, AH and DLP with diabetes of 2 types.
Keyworlds: chronic heart failure, metabolic syndrome, systolic and diastolic left ventricular dysfunction.
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Section 6. Medical science
Chronic heart failure (CHF) remains one of the most common diseases of the cardiovascular system [1; 2], keeping its tendency to further spread among the population. Despite the advances and success achieved in the treatment of this disease, the number of patients with severe forms of it is still increasing. This leads to the increase in the number of primary and repeated hospitalization during the year, causing enormous economic loss to many countries. [3] The survival rate of patients with CHF still remains low. This requires further study of various aspects of the disease.
A special importance is given to the development of heart failure in patients with metabolic syndrome (MS). This is associated with a high incidence of heart failure after myocardial infarction (MI) in patients with MS [4; 5], as well as the peculiarities of structural and functional changes of the heart. MS is characterized by formation of a distinctive hemodynamic and specific damage of target organs, which then act as an independent risk factor for cardiovascular complications [6; 7]. As shown in studies conducted in recent years, the peculiarities of heart disorders in MS are the development of left ventricular hypertrophy and the inadequate level of blood pressure [8]. Some researchers [9] believe that it is the obesity which plays the main role in the structural and morphological changes of the myocardium. Moreover, there was established a relationship between the character of hypertrophy of the LV and the type of obesity. The eccentric LVH is typical for glyuteofemoral type, while concentric LVH is typical for abdominal type of obesity. Structural modifications and remodeling of the heart are also associated with the other components of the MS, such as insulin resistance, dyslipidemia and hyperinsulinemia [10; 11]. Thus, in a pathological remodeling of the myocardium in CHF in patients with MS not only hemodynamic, but also metabolic factors are being involved.
The aim of this work is to study the anti-remodeling efficiency of complex pharmacotherapy of CHF by use of perindopril, vero-shpiron and bisoprolol in patients with MS.
Material and Methods
The study involved 76 male patients with chronic heart failure (CHF) II-III functional class (FC), with postinfarction cardiosclerosis. Prescription of myocardial infarction from 6 months to 5 years. Verification of the diagnosis carried out on the basis of the classification of the New York Heart Association (NYHA), six-minute walk test and due scale assessment scale of the clinical state. The average index six-minute walk testing was detected as 304.7±19,3m (274-338m). Depending on the components of MS the patients were divided into 3 groups: Ist group (n=27), patients without MS; Group II (n=24), patients with a combination of dyslipidemia (DLP) with abdominal obesity (AO) and hypertension (AH); Group III (n=25), patients with a combination of AD, AH and DLP with diabetes of 2 types.
While diagnosingthe MS, the diagnostic criteria of MS International Diabetes Federation (IDF, 2009) was used. Abdominal obesity (AO) (>94 cm for men); level of triglycerides (TG >1.7 mmol/l); the level oflipoprotein cholesterol with high density (HSLPVP <1.03 for men); blood pressure level (systolic blood pressure >130 mm Hg, diastolic blood pressure >85 mm Hg), glucose level on an empty stomach (>5.6 mmol/l) or the presence of diabetes mellitus of type 2 were considered as the main components of the syndrome.
The patients under survey were hospitalized in the cardiology department of the city hospital number 7 in Tashkent. Patients were examined on the basis of the contract with medical diagnostic centre of the Ministry of Health of the Republic of Uzbekistan. All examined patients underwent clinical, laboratory and instrumental methods of research. Echocardiography (EchoCG) was carried out on the
machine Mindray (China) by method of lyingin prone position and the left side ofM and B modes in accordance with the requirements of the American Association of Echocardiography (ASE). Wherein the followings were evaluated: the ultimate-diastolic dimension (UDD), the ultimate-systolic dimension (USD), the thickness of the posterior wall of the left ventricle (TPW), the width of the ventricular septal (TVS), the size of the left atrium (LA), ultimate-systolic volume, ultimate-diastolic volume. Concerning the left ventricular (LV) systolic function, the data was assessed due to the level of ejection fraction (EF), which was calculated by the formula Teicholz et al. [8], stroke volume (SV), which was defined as the difference between the UDV-USV, as well as by the degree of shortening of the anterior-posterior size of the left ventricle into systole (% AS). Concerning the left ventricular diastolic function, the data was assessed due to the maximum speed of the early peak of diastolic filling (VmaxPeak E, 0,62 m/s), the maximum speed of transmitral flow during systole of the left atrium (VmaxPeak A, 0,35 m/s) and the ratio of E/A (1.5-1.6), isovolemic LV relaxation time (IVRT), deceleration time of early diastolic filling (DT). The mass of the myocardium left ventricular (LVMM) was calculated by the formula Devereux RB [9]; index mass of the myocardium left ventricular (LVMMI) as a ratio to the area of the body; the left ventricular hypertrophy criteria was accepted as LVMMI >125 g/m 2 in men and >110 g/m 2 in women. The relative width of walls (RWW) was also calculated.
After a two-week washout period, all patients were taking Perindopril (Prestarium, Servier), Bisoprolol (Concor, Nycomed), as well as Veroshpiron (Gedeon Richter) 50 mg/day within the period of three months. Perindopril is titrated at a dose of 4 mg to 8 mg, Bisoprolol was titrated in a dose from 5 mg to 7.5 mg.
Statistical analysis of the received data was performed on a personal computer of IBM PC/AT type by using standard electronic program package «biostatic for Windows, version 6.0" The parameters were described as M±m. While distributing the values, the group comparisons of quantitative variables were performed by using the variational statistical test (t).
The results of the research
The results of echocardiography studies in patients with chronic heart failure, shown in table № 1, indicate the presence of features of structural and functional changes in the myocardium in patients with MS. All patients with heart failure show the signs of structural and functional changes in the left ventricle and left atrium of the heart, the severity of which depends on the presence and severity ofMS. The next stage of this work was to study the anti-remodeling efficiency of complex pharmacotherapy using the main set ofprepa-rations for the treatment of heart failure.
After 3 months of treatment with Perindopril, Bisoprolol and Veroshpiron applied to patients with chronic heart failure, the data obtained (Table № 1) shows a significant positive trend by indicators of echocardiography and Doppler Ehocardiography in patients without MS. The weak dynamics of the analyzed indicators was identified in patients with MS, especially of the third group. Despite the positive developments and progress in ultimate-systolic and ultimate-diastolic pressure and size of the left ventricle in patients of the 1st and 2nd groups, which showed statistical veracity, the decrease in TVS and TPWwas negligible. In the third group, the statistical veracity was observed in reduction ofonly USD and USV. Three-month treatment in 1st (p<0.01) and 2nd, 3rd (p<0.05) groups contributed to the reduction of LVMM (p<0.01). However, even if the data of the 2nd and 3rd groups approached each other and become nearly similar after the treatment, the indicators in the third group still remain significantly higher (p<0.01). A similar pattern also appears according to LVMMI.
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Anti-remodeling efficiency of preparations such as perindopril, veroshpiron and bisoprol applied to patients...t
Table 1. - Indicators of echocardiography and Dopler Echocardiography in patients with CHF II-INFC and without MS before and after treatment with Perindopril, Bisoprolol and Veroshpiron
Indicators Treatment periods 1st group (n=27) 2nd group (n=24) 3rd group (n=25)
LA, cm Before treatment 3,71±0,086 3,94±0,083 4,16±0,09
After 3 months 3,48±0,066° 3,71±0,081° 4,02±0,089
LVMM, g Before treatment 212,78±6,08 235,88±9,58 283,66±11,58
After 3 months 189,34±7,18°° 210,57±8,21° 249,14±10,65
LVMMI, g/m 2 Before treatment 128,58±4,57 130,93±6,23 163,0±6,67
After 3 months 114,52±4,89°° 116,53±4,58° 146,38±7,39°
TVS, cm Before treatment 1,09±0,028 1,14±0,027 1,22±0,03
After 3 months 1,04±0,021 1,09±0,026 1,16±0,026
TPW, cm Before treatment 1,04±0,021 1,08±0,022 1,12±0,025
After 3 months 1,02±0,021 1,07±0,024 1,08±0,021
UDD, cm Before treatment 4,73±0,071 4,82±0,068 5,15±0,083
After 3 months 4,51±0,078° 4,64±0,078 4,9±0,089
USD, cm Before treatment 2,95±0,056 3,11±0,057* 3,47±0,085
After 3 months 2,67±0,061°° 2,84±0,067°* 3,15±0,089°
UDV ml Before treatment 132,15±3,62 138,42±3,57 159,48±4,39
After 3 months 122,07±3,29° 126,21±3,81° 149,44±4,1
USV, ml Before treatment 61,78±2,28 68,5±2,22* 91,16±2,91
After 3 months 49,96±2,39°° 57,88±2,89° 79,68±2,91°
SV, ml Before treatment 70,37±3,89 69,92±3,28 68,32±2,71
After 3 months 72,11±1,94 68,33±2,47 69,76±2,05
EF,% Before treatment 52,56±2,02 50,2±1,53 42,72±1,11
After 3 months 59,4±1,13°° 54,39±1,55 46,90±1,10
Dt, mc Before treatment 189,67±8,5 215,08±8,91 230,83±9,52
After 3 months 166,78±6,88° 189,76±8,68 213,8±10,7
IVRT, mc Before treatment 85,2±2,05 89,28±2,81 95,29±2,75
After 3 months 78,15±2,51° 81,82±2,53 88,38±2,51
%AS,% Before treatment 37,16±1,73 35,19±1,34 32,47±1,53
After 3 months 40,18±1,88 38,49±1,45 35,66±1,42
РЕ, м/с Before treatment 0,59±0,018 0,57±0,019 0,54±0,021
After 3 months 0,65±0,018° 0,61±0,019 0,57±0,016
РА, м/с Before treatment 0,50±0,016 0,53±0,018 0,58±0,017
After 3 months 0,43±0,018° 0,46±0,019° 0,52±0,015°
Е/А Before treatment 1,18±0,042 1,08±0,054 0,93±0,027
After 3 months 1,51±0,045°° 1,33±0,041° 1,10±0,039°
Heart rate, bpm Before treatment 75,37±1,72 76,92±1,96 77,4±2,36
After 3 months 70,04±1,58° 73,29±1,37 74,72±1,99
Note: ° — р<0,05; °° — р<0,01 the accuracy of the performance differences before and after treatment.
As a result of the above-mentioned structural changes in patients without MS, a significant improvement of systolic function is observed after the treatment showed, which is evidenced by the increase of ejection fraction (p<0.01). The increase of this indicator is also observed in the 2nd and 3rd groups, which did not reach statistical veracity, and lags behind by 8.3% (p<0.05) and 21% (p<0.01) respectively, compared to the 1st group. Increasing of the degree of anterior-posterior size of the left ventricle into systole is a proof of improvement of its systolic function, which was most, expressed in the 1st group.
There is a difference between surveyed patients according to the results of the effect of the treatment related to the diastolic function of the left ventricular. A significant improvement of this function is observed in patients without MS, which is evident by statistically significant reduction in isovolemic relaxation time of LV, the deceleration time of early diastolic filling and maximum speed of atrial systole, as well as an increase of the maximum rate of early diastolic filling of LV and E/A ratio. However, in patients with MS, especially in the 3rd group, the decrease of Dt and IVRT, the increase of
PE were not very significant, and the difference in these indicators between the 1st and 3rd groups remained high, reaching up to 28.2% (p<0.01), 13.2% (p<0.05) and 12.3% (p<0.01), respectively. Along with this, in spite of the decrease in RA (p<0.05), it was higher by 20.9% (p<0.01) and in spite of the increase in the E/A, this ratio was lower by 27.2% (p<0.01) compared to the 1st group.
Discussion
There are different forms of MS exist depending on the number and combination of symptoms [14]. Besides the classic, there may be alternative options thereof[15]. Based on this, we have identified two groups of patients with MS. In the second group the manifestation ofMS was the combination ofAO and AH with DLP. Patients of 3rd group had more severe symptoms of MS, in addition to the above mentioned features; they had diabetes of 2 types as well. The currently available published data [16; 17; 18] points to the relationship between MS and the structural-functional changes of the heart.
Leading part in the treatment of patients with heart failure is taken by ACE inhibitors, ß-adrenoblockers and spironolactones [2]. Three-month treatment with an implement of Perindopril,
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Section 6. Medical science
Veroshpiron and Bisoprolol to patients without MS, is characterized by positive dynamics of structural and morphological parameters of LV (decrease in LVMM and LVMMI), left ventricular remodeling, and central hemodynamic (reducing of UDV and USV, increased ejection fraction). It was also detected a positive effect of the therapy on diastolic function of LV, which manifested as a decrease of IVRT and DT, as well as an improvementof transmitral spectrum (reduction of RA, increasing PE and E/A). A similar pattern, but with a little difference of indicators before and after treat-menthas been observed in patients with AO+AH+DLP. LVMM significantly exceeding the indicator of the 1st group, together with LVMMI approached to the level of the 1st group after treatment However, the dynamics of central hemodynamic parameters have considerably conceded. Despite a significant decline, the USD and USV remain statistically and authentically high, whereas ejection fraction stays low compared to the 1st group. After treatment, on the background of significant reduction of PA and increasing of E/A, and according to transmitral spectrum, it was proved that the 2nd group is much inferior to patients without MS. The results of the comparative analysis established that the more severe form of MS (AO+AH+DLP+Diabetes2) in patients with heart failure increasingly reduces the effectiveness of the combined application
of Perindopril, Bisoprolol and Veroshpiron. Statistically significant positive changes in these patients after treatment is retraced only according to LVMM, LVMMI, USV, PA, and E/A. Preservation of statistically significant difference according to UDD, USD and EF after treatment between the 1st and the 3rd group represents a significant deceleration of regression of pathological LV remodeling in latter one. This, in its turn, is reflected on the diastolic function of LV. Despite the positive dynamics of transmitral flow indicators, the current function in these patients' remains significantly lower compared to the patients without MS.
Conclusions:
1. A three-month treatment with an implement of the Perindopril, Bisoprolol and Veroshpiron combination in patients suffering from CHF without MS promotes regression of non-adaptive remodeling of myocardial and improvement of systolic and diastolic function of the heart.
2. The MS in patients with chronic heart failure reduces the anti-remodeling effectiveness of the combined application of Perindopril, Bisoprolol and Veroshpiron, which depends on the representation of its components. The most marked resistance against therapy exists, when there is a combination of AO, AH and DLP with diabetes of 2 types.
References:
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2. Gurevich M. A. The role of ACE inhibitors in the treatment of heart failure. Clinic Medicine 2004; 2: 4-9.
3. Belenkov Y. N. Chronic heart failure: medical and economic aspects of treatment. The Doctor 2002; 12: 3-7.
4. Zeller M., Steg P., Ravisy J. et al. Prevalence and impact of metabolic syndrome on hospital outcomes in acute myocardial infarc-tio//Arch. Intern. Med.2005; 10: 1192-1198.
5. Levantesi G., MaccHia A., Marfisi R. M. et al. Metabolic syndrome and risk of cardiovascular events after myocardial infarction//J. Am. Coll. Cardiol.2005; 2: 277-283.
6. De Simone G., Paganisi F., Contaldo F. Link of nonhemodynamic factors to hemodynamic determinants of left ventricular hypertrophy. Hipertention 2001; 38:13-18.
7. Conradi A. O., Zhukova A. V, Winnick T. A., Shlyakhto E. V. Structural and functional parameters of the myocardium in patients with hypertension, depending on body weight, such as obesity and the state of carbohydrate metabolism. Arter. Hyper. 2002; 8: 1: 12-17.
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14. Mamedov M. N. Metabolic syndrome. The features of diagnosing in clinical ambulatory conditions. Appendix to the magazine. The Treating Doctor 2000; 6: 11-14
15. Makolkin V. I., Podzolkov V. I., Napalkov D. A. Metabolic syndrome from the point of view of cardiologist: diagnostics, non-drug and drug treatments. Cardiology 2002; 12: 91-96.
16. Glebovskaya T. D., Burova N. N., Solovyov N, V, The role of the disturbance of diastolic myocardial function in heart failure in patients with metabolic syndrome, undergoing myocardial infarction-segment elevation ST//Hypertension 2010; 2170-174.
17. Vigdorchik V. I., Prokopenko V. D., Simonov, D. V. Diastolic function of the left ventricle in patients with hypertension associated with metabolic syndrome.//Vest.Nov.med.tehnol. 2004; 4: 57-59.
18. Mammadov M. N., Gorbunov V. M., Kiseleva N. V., Oganov R. G. Features of structural and functional changes in the myocardium and hemodynamic disturbances in patients with metabolic syndrome: the role of hypertension in the formation of the total coronary risk//Cardiology 2005; 11: 11-16.
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The role of metabolic syndrome in the nature of postinfarction remodeling of the heart in patients with chronic heart failure
21. Fuentes L., Brown A. L. et al. Metabolic syndrome IS associated WITH abnormal left ventricular diastolic function independent of LV mass//Eur.Heart J. 2007; 5: 553-559.
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Atakhodzhaeva Gulchekhra Abdunabievna, PhD, the assistant of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan, E-mail: atakhodzhaeva@list.ru. Rakhimov Shukhrat Malicovich, PhD, professor of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan.
Karimdjanova Guzal Akmaldjanovna, the assistant of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan Igamberdieva Ranokhon Shukhratkhodjaevna, the assistant of department of faculty therapy of Tashkent Pediatric Medical Institute, Uzbekistan.
The role of metabolic syndrome in the nature of postinfarction remodeling of the heart in patients with chronic heart failure
Abstract: The aim is to study of heart’s structure and hemodynamic indicators according to composition of metabolic syndrome components in the patient with chronic heart failure (CHF) functional class (FC) II-III. 62 men-patient with cardiosclerosis after heart attack were examined by the way of echocardiography on CHF FC II-III (NYHA). According to metabolic syndrome components they are devided into 3 groups: 1st group (n=20), patients without signs of metabolic syndrome; 2nd group (n=21) patients with combination of dyslipidemia (DLP), abdominal obesity (AO), arterial hypertension (AG) and hypertriglyceridemia; 3rd group (n=21) with different combination of dyslipoproteinemia, diabetes and obesity also AG and hypertriglyceridemia. in CHF passed with metabolic syndrome is seen a clear sign of heart’s systolic and diastolic.the presence of metabolic syndrome in CHF also its progressing is the subject to be hypertrophy of left ventricle, breaking the transmitral blood flow, also thickening of barier between ventricles and left ventricle back thickness.
Keywords: chronic heart failure, metabolic syndrome, echocardiography, hemodynamics.
Metabolic syndrome (MS) is currently one of the actual medical and social problems throughout the world. MS, which is characterized by a combination of insulin resistance (IR)/hyperinsu-linemia, hypertriglyceridemia, gipoalfaholesterinemia, infraction of glucose tolerance and other metabolic inflaction, and also arterial hypertension is a risk factor of cardiovascular disease [1]. By the opinoin of many experts on MS characteristic is the formation of a specific kind of hemodynamics and specific damage of organ-target, which further acts as an independent risk factor for cardiovascular complications [2; 3]. As shown in researches conducted in recent years, the peculiarities of heart disorders in MS is the development ofhypertrophy ofthe left ventricle (LV), inadequate blood pressure levels [4]. MHLV viewed as an independent marker of high risk of cardiovascular disease [5], including sudden death [6] and significantly affect the mechanism of formation of diastolic dysfunction (DD), left ventricular heart [7], which is important in the formation of heart failure (HF). Currently, there are few data on the nature of the development of heart failure in combination with various MS cardiovascular disease that poses the need for further research in this direction. For this reason in this study we set the goal to explore the nature of cardiac remodeling, promoting the development of heart failure in patients with myocardial infarction (MI) due to MS.
Material and Methods
The study involved 76 male patients with chronic heart failure (CHF) II-III functional class (FC), with postinfarction cardiosclerosis. Prescription of myocardial infarction from 6 months to 5 years. Verification of the diagnosis carried out on the basis of the classification ofthe NewYork Heart Association (NYHA), six-minute walk test and due scale assessment scale of the clinical state. The average index six minute walk testing was detected as 304.7±19,3m (274-338m). Depending on the components of MS the patients were divided into 3 groups: Ist group (n=27), patients without MS; Group II (n=24), patients with a combination of dyslipidemia (DLP) with abdominal obesity (AO) and hypertension (AH); Group III (n=25), patients with a combination ofAD, AH and DLP with diabetes of 2 types.
While diagnosing the MS, the diagnostic criteria of MS International Diabetes Federation (IDF, 2009) was used. Abdominal obesity (AO) (>94 cm for men); level of triglycerides (TG >1.7 mmol/l); the level oflipoprotein cholesterol with high density (HSLPVP <1.03 for men); blood pressure level (systolic blood pressure >130 mm Hg, diastolic blood pressure >85 mm Hg), glucose level on an empty stomach (>5.6 mmol/l) or the presence of diabetes mellitus of type 2 were considered as the main components of the syndrome.
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