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Section 8. Medical science
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19. Xie H., Chen X., Chen N., Zhou Q Sudden Death in a Male Infant Due to Histiocytoid Cardiomyopathy: An Autopsy Case and Review of the Literature.//Am J. Forensic Med. Pathol. - 2016. - Dec.30. doi:10.1097/PAF.0000000000000289.
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22. Sarquella-Brugada G., Campuzano O., Cesar S., Iglesias A., Fernandez A., Brugada J, et al. Sudden infant death syndrome caused by cardiac arrhythmias: Only a matter of genes encoding ion channels? Int. J. Legal. Med. - 2016. - 130:415-420. - doi: 10.1007/s00414-016-1330-7.
23. Gilbert J., Sheppard M. N., Byard R. W. Sudden Infant and Early Childhood Death and Sinus of Valsalva Pseudoaneurysms.//J. Forensic. Sci. - 2016. - No. 16. - doi:10.1111/1556-4029.13293.
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25. McDonald F. B., Chandrasekharan K., Wilson R. J., Hasan S. U. Cardiorespiratory control and cytokine profile in response to heat stress, hypoxia, and lipopolysaccharide (LPS) exposure during early neonatal period.//Physiol Rep. - 2016. - Feb; 4 (2). pii: e12688. - doi: 10.14814/phy2.12688.
DOI: http://dx.doi.org/10.20534/ESR-17-1.2-70-71
Kilichev Anvar Akramovich, Kurbanov Ravshanbek Davletovich Republican Specialized Center of Cardiology, Uzbekistan E-mail: [email protected]
Study of diastolic function in patients with Q-wave myocardial infarction
Abstract: The article presents data on the study of diastolic function in patients with Q-wave myocardial infarction. It has been found that the progression of left ventricular diastolic dysfunction in patients with Q-wave myocardial infarction is associated with a longer course of coronary heart disease and hypertension.
Keywords: diastolic dysfunction, myocardial infarction, heart rate variability.
Prediction of adverse remodeling of the left ventricle (LV) after acute myocardial infarction is an actual problem of modern cardiology. The necessity of studying left ventricular remodeling in patients with myocardial infarction due to the fact that this process is the basis of the formation and progression of heart failure, occurrence of threatening ventricular arrhythmias and sudden death [1; 2; 3]. Studies in recent years have shown that the presence of left ventricular diastolic dysfunction (LVDD) as one and/or more abnormal Doppler echocardiography indices have significant prognostic value in patients with cardiovascular disease, which increases with the degree LVDD [4; 5].
The aim of this study was to evaluate left ventricular diastolic function in patients with acute myocardial infarction
Materials and methods.We examined 131 male patients with primary Qwave myocardial infarction, aged from 30 to 69 years (51.9 ± 9.13 years). The steady phase of acute myocardial infarction, treatment was carried out in accordance with recommendations for management of patients with myocardial infarction with ST-segment elevation and included thrombolytic therapy if indicated, early administration of beta-blockers, antiaggregants, anticoagulants, nitrates, lipid-lowering agents, ACE inhibitors, loop diuretics. Against the background of conducted therapy for acute myocardial infarction on the 10th -14th day, all patients underwent clinical examination, including casual examination, medical history, ECG in 12 standard leads, echocardiography. Echocardiography and
Doppler studies were performed on the machine «Sonoline Versa Pro» according to the standard procedure using the recommendations of the American Society of echocardiography.
The data were processed using the computer program Microsoft Excel, STATISTICA 6 and Biostat. The odds ratio (OR) and 95% confidence intervals (95% CIs) were calculated using logistic regression. The significance of differences was assessed using indicators of non-parametric ^2 test (Pearson's test). Quantitative indicators are presented as M ± SD. Correlation relationship was investigated by regression analysis and Spearman's rank correlation coefficient. Differences between groups were considered statistically significant at P <0.05.
Results and discussion. Undoubtedly, with the progression of coronary heart disease character of diastole indicators, its function undergo complex changes associated with worsening of diastolic disorders, and development of adaptive hemodynamic reactions, acting through the increase in pressure in the left atrium and/or end-diastolic pressure of left ventricle and lead to the formation of different types of diastolic dysfunction: inadequate relaxation, pseudonormal and restrictive [6; 7; 8]. To assess the relationship of violations of left ventricular contractile function and LVDD the patients were divided into 2 groups (Table 1.): group with preserved left ventricular systolic function (ejection fraction >50%) and group with reduced ejection fraction (<50%).
Study of diastolic function in patients with Q-wave myocardial infarction
Analysis of the prevalence of LVDD of various types showed and restrictive types were significantly more frequent in patients that severe diastolic dysfunctions ofleft ventricle — pseudonormal with reduced left ventricular systolic function.
Table 1. - Prevalence of LVDD in groups of patients with different left ventricular contractility
Diastolic dysfunction LVEF> 50% LVEF<50% P
Inadequate relaxation 33/73 (45.2%) 40/73 (54.8%) 0.25
Pseudonormal 12/35 (34.3%) 23/35 (65.7%) 0.014
Restrictive 4/23 (17.4%) 19/23 (82.6%) 0.00001
All patients depending on the severity of LVDD were divided into 3 groups: I (n = 73) - with inadequate relaxation, II (n = 35) - with pseudonormal type, III (n = 23) - with restrictive type of filling.
AHaAH3Analysis of clinical and anamnestic indicators showed (Table 2.) that patients with severe LVDD were more likely to have anterior localization of MI (73.9% vs 39.7% and 65.7%, respectively, groups I and II). Hypertension history with almost the same frequency was found in all groups being compared, but it should be noted that its remoteness was significantly higher in
* - P <0.05 between groups I and II ** - P <0.05 between groups II and III *** - P <0.05 between groups I and III
Identification and analysis of options for LVDD have important clinical value as indicate the severity of diastolic dysfunctions contributing to the formation of CHF [9.10].
the groups with type III LVDD. Diabetes mellitus with reliable frequency prevailed in the group of patients with the restrictive type of LVDD (8.2%, 8.8% vs. 13%). The similar trend can be seen in relation to remoteness of coronary heart disease before MI. Thus, in the group with severe LVDD, it was 10.5 years versus 5.2 and 6.4 years in group I and II, respectively (p<0.05). As worsening diastolic dysfunction it observed pronounced inhibition of left ventricular systolic function, characterized by reduced indicator of ejection fraction (EF) to 37.2 ± 10.14% in patients with restrictive type of LVDD.
Thus, progression of LVDD in patients with Q-wave myocardial infarction is associated with longer duration of ischemic heart disease and hypertension. As worsening diastolic dysfunction it observes expressed depression of left ventricular systolic function.
Table 2. - Comparative characteristics of groups with different types of LVDD
Indicators Group I (n = 73) Group II (n = 35) Group III (n = 23)
Anterior 29/39.7% 23 23/65.7% * 17/73.9% **
Posterior 44/60.3% 12/34.3% * 6/26.1% **
GB 68/90.4% 26/74.2% 20/82.6%
DM 6/8.2% 3/8.8% 3/13% **, ***
EF,% 49,3 ± 10,27 44,3 ± 8,56 37,2 ± 10,14 **, ***
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5. Moller, J. E. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction/J. E. Moller, G. A. Whalley, F. L. Dini et al.//Circulation. - 2008. - Vol. 117. - P. 2591-2598.
6. EAE/ASE recommendations. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography//Eu-ropean Journal of Echocardiography - 2009. - 10, 165-193.
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8. Somaratne J. B., Whalley G. A., Poppe K. K., Gamble G. D., Doughty R. N. Pseudonormal mitral filling is associated with similarly poor prognosis as restrictive filling in patients with heart failure and coronary heart disease: a systematic review and meta-analysis of prospective studies. J Am Soc Echocardiogr. - 2009. - 22: 494-498.
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