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administered dobutamine did not respond (irreversible dysfunction). Irreversible dysfunction was detected in 2,2 ± 0,1 segments (atorvastatin 20 mg/dayand 1,6 ± 0,1 segments in Group 2 segments (atorvastatin 80 mg/ day). Number of dobutamine responsive segments (segments with reversible dysfunction) in patients group 2were higher than in thegroup 1 (p < 0,05). Wall motion abnormality index (WMAl) during LDSE significantly decreased to 1,25 ± 0,03 and 1,17 ± 0,03
(p < 0,01) in the groups land 2, respectively. Significant reduction of WMAI noted in patients treated with atorvastatin 80 mg/day (p < 0,05).
Conclusion. Using of high doses of atorvastatin (80mg/day) in patients with AMI+ST helps to limit myocardial necrosisby decreasing ischemic and reperfusion injury of the myocardium and affects the formation of stunned myocardium, which is reversible dysfunction and improved LV regional contractility.
FUNCTIONAL STATE OF LEFT VENTRICULAR IN DIFFERENT METHODS OF RESTORATION OF CORONARY BLOOD FLOW IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH COMPLICATED ACUTE INSUFFICIENCY WITH INSUFFICIENCY
KoYIRov A.K.1, KENJAEV S.R.1, KHAITOV S.SH.1, GANIEV U.SH.1, MIRMAKSUDOV M.S.2
Republican research center of emergency medicine, Tashkent, Uzbekistan1; Tashkent medical academy, Tashkent. Uzbekistan2
Relevance. Over the past decade it has increased the share of endovascular treatment of coronary heart disease (CHD) in the world. The choice of this treatment strategy of CHD, to counterbalance the surgical treatment in combination with conservative therapy caused the immediate efficacy and safety of the endovascular procedure to achieve adequate restoration of coronary blood flow in the majority of cases. Primary endovascular restoration of coronary blood flow has several advantages over thrombolytic therapy. There is evidence that reperfusion of the myocardium using the endovascular procedure is more than 95 % of patients with acute ST-segment elevation myocardial infarction (STEMI), then thrombolytic therapy restoration of blood flow is achieved only 7075 %.
Endovascular method promotes effective limitation of the size of the damaged myocardium in the early stages of the onset of the disease, prevents the development of residual stenosis in the infarct-related artery (IRA) and pathological remodeling of the left ventricle (LV) and as a result, leads to a reduction not only in-hospital mortality, but and improved survival of patients in distant periods.
After the restoration of blood flow in some way in the area of the IRA is a change in contractility parameters, the geometry of the myocardium and central hemodynamics in general, which in turn determine the future course of the disease and the tactics of treatment. Today, in connection with the development and widespread use of modern methods of restoring coronary blood flow in AMIST, great attention is paid to the prevention of early pathological LV remodeling, which allows to influence the prognosis and survival of patients.
Introduction (goals/objectives): The goal of the study is to compare the indices of contractility and diastolic myocardial dysfunction in patients with acute myocardial infarction complicated by acute cardiac
failure after endovascular intervention and thrombolytic therapy.
Material and methods: The study included 48 patients with acute myocardial infarction with ST-segment elevation (AMPST) up to 6 hours from onset of the disease. The mean age of patients was 48.9 ± 2 years. All patients are divided into 2 groups: Group I included 26 patients with STEMI and ST who underwent initial endovascular procedure (angioplasty and stenting) during the first 6 hours; the second group included 22 patients with AMPST who received thrombolytic therapy in the first 6 hours from the onset of a myocardial infarction with a positive effect. All patients underwent echocardiographic and doppler echocardiographic examinations on the 1st and 7th day of the course of acute myocardial infarction.
Results: On the first day of the course of acute myocardial infarction, the most favorable type of left ventricular diastolic dysfunction developed in the first and second groups of patients was the slowing down of relaxation (group E/AI 0,9 ± 0,05, E/AI group 1 ± 0,05 ). Then, on the 7th day of the study, the pseudonormalization of the diastolic filling of the left ventricle (E/AI of the group 1,4 ± 0,08, (p1 < 0,001) is recorded in the I group of patients. However, already by 1 day of myocardial infarction, more pronounced violation of segmental contractility of the left ventricle is recorded in II group of patients: The index of disturbance of segmental contractility of the myocardium (INSSM) of the I group is 1,2 ± 0,04 (p1 = 0,001), group II INSSM 1,6 ± 0,04 (p2 < 0,001)).
Conclusion: Patients with effective thrombolytic therapy, in contrast to patients with primary endovascular intervention, have an unfavorable prognosis in the development of early pathological left ventricular remodeling and heart failure, which is confirmed by a high index of disturbance of segmental contractility of the left ventricular myocardium and the formation of a restrictive type of diastolic left ventricular dysfunction.
