PREVENTION OF LEFT VENTRICLE SYSTOLIC DYSFUNCTION IN PATIENTS WITH ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION AFTER CARDIAC REVASCULARIZATION

Aim. To study effects of bioflavonoid quercetin (corvitin) on left ventricle (LV) systolic dysfunction in patients with acute coronary syndrome with ST segment elevation (ACS+ST) after cardiac revascularization.Material and methods. 60 patients with ACS+ST (44,2±1,3 y.o.) were examined. Patients were admitted to hospital within 6 hours after complaints beginning. Patients were randomized in two groups. 30 patients of group A had standard therapy and cardiac revascularization. 30 patients of group B received corvitin additionally to standard therapy before cardiac revascularization. Echocardiography initially and stress-echocardiography with dobutamine after status stabilization (at 8-10 days of disease) were performed.Results. Dobutamine test (with low and high doses) showed myocardial viability in patients of group B. Patients of group A had irreversible LV systolic dysfunction in 32 % of segments. Corvitin slowed down LV dilatation progression in patients with ACS+ST. It resulted in the end-diastolic and end-systolic indexes did not change within 10 days. The LV ejection fraction was more increased in patients of group B in comparison with patients of group A.Conclusion. The early corvitin prescribing has positive effects on LV systolic function and prevents post-reperfusion complications. </p

Left ventricular remodelling in patients with reversible ischemic dysfunction before and after myocardial revascularization

Aim. To study the dynamics of left ventricular (LV) remodelling in patients with myocardial infarction (MI) and reversible ischemic dysfunction, before and after myocardial revascularization. Material and methods. The study included 69 patients after MI. All participants underwent two-dimensional echocardiography (EchoCG), within 24 hours after hospital admission and one month after revascularization. After three-four days of treatment and clinical stabilization, the patients underwent stress EchoCG with dobutamine, to assess myocardial viability. Results. Complete or partial recovery of all asynergic myocardial segments was observed in 22 (Group I) and 19 (Group II) patients, respectively, while in 28 (Group III), LV aneurysm was detected. In most patients from each group, transluminal balloon angioplasty (TLBAP) with stent implantation was performed. The proportion of conservatively treated patients was maximal in Group III. Despite revascularization, in coronary patients with impaired myocardial viability (Group III), the increase in ejection fraction and reduction in end-systolic volume was significantly lower than in patients with viable myocardium. Sphericity index, relative wall thickness index, and myocardial stress parameters were increased in each group, although this increase was non-significant in Group III. After revascularization, a significant reduction in end-systolic volume, and a tendency towards enddiastolic LV volume reduction were observed in each group, being maximal in Group I. Conclusion. In MI patients with viable myocardium in dyskineticLV zones, revascularization surgery should be considered

Clopidogrel therapy effects on cell hemostasis in acute coronary syndrome

The study was aimed at investigating cell hemostasis parameters in acute coronary syndrome (ACS), and comparing the effects of various antiaggregant medications (clopidogrel, aspirin, or their combination) on platelet (PL) and red blood cell (RBC) aggregation activity. In total, 98 ACS patients were divided into groups, according to the antiaggregant therapy received. At Days 3-4 and 6-7, PL aggregation activity and RBC morphology and function were assessed. Antiaggregant therapy was highly effective among those receiving combined treatment, with minimal PL aggregation and maximal RBC morphology improvement (high prevalence of discocytes and reversibly deformed RBC) observed as early as Day 3 and further increasing by Day 7. All three variants of antiaggregant therapy were significantly effective, but Clopidogrel, especially in combination with aspirin, demonstrated the best effect. Combined therapy (clopidogrel and aspirin) improved cell hemostasis parameters, which could be linked to better aggregation inhibition due to different therapeutic targets for these two agents

Phospholipid metabolism and effectiveness of a glycoprotein IIb/IIIa receptor blocker tirofiban in patients with acute coronary syndrome without ST segment elevation

Aim. To study the effects of tirofiban, a glycoprotein IIb/IIIa receptor blocker, on platelet (PL) phospholipids (PhL) in patients with acute coronary syndrome (ACS).Material and methods. The study included 55 ACS patients without ST segment elevation (↓ST), receiving standard therapy; 26 participants were administered tirofiban. The control group included 23 healthy volunteers, with­out any cardiovascular disease. In all participants, PL PhL characteristics were assessed at baseline, at Day 3 and Days 7-10.Results. In ACS patients, both qualitative and quantitative changes in PL PhL metabolism were observed, which could result in disturbed PL hemostasis. The main manifestation of these disturbances was increased lysophosphatidyl choline (LFS) level in PL membranes. Disturbed PL PhL metabolism was observed in all ACS patients, being maximally manifested at baseline.Conclusion. Tirofiban therapy, as a part of standard ACS↓ST treatment, improved PhL composition of PL membranes and beneficially affected PL hemostasis

Clinical role of the “symptom-balloon” time in endovascular treatment of acute coronary syndrome with ST segment elevation

Aim. To investigate the clinical effectiveness of endovascular revascularization of the infarct-related coronary artery (IRCA) in regard to the “symptom-balloon” time, analyzing retrospective data on patients with acute coronary syndrome (ACS) and ST segment elevation (STE-ACS). Material and methods. The study included 164 patients with STE-ACS, who underwent selective coronary angiography (CAG) and transluminal balloon angioplasty (TLBAP) with coronary stenting. Based on the “symptom-balloon” time, all patients were divided into two groups. In Group I (n=78), the “symptom-balloon” time was &lt;6 hours, while in Group II (n=86), it was 6–24 hours. Echocardiography (EchoCG) was performed at Day 1, 7, and 30. Results. The EchoCG data demonstrated a reduction in left ventricular (LV) systolic function. In Group I, LV systolic function significantly improved by Day 7: LV ejection fraction (EF) increased from 48,2% to 51,6% (p=0,0013). At Day 30, LV EF was 54,7% (p=0,001). In Group II, the increase in LV EF was not statistically significant (from 46,1% to 47,2%; p=0,2197).Conclusion. Urgent coronary revascularization in STE-ACS improved localLV contractility, due to the restriction of stunned myocardium areas. The speed of theLV contractility improvement after IRCA TLBAP/coronary stenting was strongly associated with the “symptom-balloon” time