Cardiac volume load and heart failure prognosis in patients with uncomplicated myocardial infarction

То predict heart failure (HF) in 192 patients with Q-wave myocardial infarction (Q-MI), a brief cardiac volume load (VI) test was performed at MI Day 3. Group I included 50 patients with Q-MI and HF II (Killip) (n=50), Group II- 108 patients with Q-MI and no HF (left ventricular ejection fraction, IVEF >40 %), Group III - 34patients with Q-MI, no HF (IVEF>40 %), but with pathologic VI test reaction. These participants received alpha-blocking beta-blocker carvedilol instead ofmetoprolol. The control group included 20 healthy people. In controls, VI test was associated with improved IV systolic and diastolic functions (SF, DF); IV form became more ellipsoid (normal VI reaction). In Group I, VL test was associated with disturbances in SF and IV filling structure; IF form became more spheroid (pathologic reaction). In Group II, normal reaction was observed in 40 %, pathologic reaction - in 60 %. During one-year follow-up period, HF developed only in patients with pathologic VI reaction (28,1 %). long-term carvedilol therapy reduced HF incidence inpatients with uncomplicated Q-MI and pathologic VI reaction, from 28,1 % to 11,8 % (p<0,05)

Effectiveness of preJhospital betaJblocker therapy in patients with acute coronary syndrome

To assess the effectiveness of pre-hospital beta-blocker therapy in patients with acute coronary syndrome (ACS), 76 individuals with Q-wave myocardial infarction (Q-MI), and 62 persons with non-Q wave MI (non-Q-MI) were examined. Q-IM patients received aspirin, streptokinase, heparin, beta-blocker, and enalapril. They were divided into two groups, according to reperfusion status after thrombolysis (TL): Group I (reperfusion), Group II (no reperfusion). Each group was divided into subgroups, by the time of beta-blocker administration: subgroups Ia and IIa – pre-hospital administration, Ib and IIb – hospital treatment. Patients with non-Q-IM (Group III) were also divided into subgroups: IIIa – pre-hospital beta-blocker administration, IIIb – hospital beta-blocker treatment. Early (pre-hospital) beta-blocker therapy was associated with reduced area of myocardial necrosis, improved systolic and diastolic function, left ventricular geometry and clinical prognosis in MI patients

LEFT VENTRICLE DIASTOLIC DYSFUNCTION IN PATIENTS WITH ANTERIOR WALL MYOCARDIAL INFARCTION AND DRUG PREVENTION OF CONGESTIVE HEART FAILURE (A LONG-TERM OBSERVATION)

The aim of this study was to evaluate LV diastolic reserve (DR) and possibilities of long>term prevention of congestive heart failure with long>term administration of Captopril and Carvedilol in patients with anterior wall MI and silent LV diastolic dysfunction. DR was measured in patients with MI by means of volume stress, and accordingly the patients were divided into 2 groups: 1st (n=20) with preserved LV DR treated by Streptokinase, aspirin, heparin, captopril and atenolol, 2nd (n=43) with decreased LV DR. Patients with decreased LV DR were divided into groups: A – treatment identical to the 1st group, B – atenolol substituted for carvediolol. The results of the study have shown that severe types of LV DD – congestive HF – developed only in patients with decreased LV DR, whereas long>term (6 months) combined administration of Captopril and Carvedilol reliably decreases the incidence of congestive HF in patients with MI

Left ventricular remodeling in patients with right ventricular myocardial infarction

Aim. To study left ventricular (LV) remodeling, interventricular and intraventricular asynchrony in isolated inferior LV myocardial infarction (MI) or combined inferior LV MI with right ventricular (RV) MI.Material and methods. 57 patients with inferior LV MI with or without RV MI (n=57) were included in a 6-month prospective study. The patients were divided into 2 groups: Group 1 - patients with inferior LV MI (n=30); Group 2 - patients with inferior LV MI in combination with RV MI (n=27). Electrocardiography and echocardiography were performed in all patients at admission, on days 3, 30 and 180 after MI.Results. Significant signs of diastolic dysfunction (RV end-diastolic area 29.21±2.0 cm2) were found in group 2 on the third day after MI. A significant increase in the LV volume indices and diastolic sphericity index (from 0.54±0.02 to 0.59±0.03 units) and an increase in interventricular asynchrony (from 37.4±4.2 to 44.6±4.2 ms) were found in group 2 in 30 days after MI. Increasing tendency towards intraventricular and interventricular asynchrony, despite the absence of pathological LV remodeling, occurred in group 2 in 6 months after MI.Conclusion. Patients with RV MI have more pronounced maladaptive LV remodeling, intraventricular and interventricular asynchrony and greater LV diastolic dysfunction

Left ventricular remodeling in patients with right ventricular myocardial infarction

Aim. To study left ventricular (LV) remodeling, interventricular and intraventricular asynchrony in isolated inferior LV myocardial infarction (MI) or combined inferior LV MI with right ventricular (RV) MI.Material and methods. 57 patients with inferior LV MI with or without RV MI (n=57) were included in a 6-month prospective study. The patients were divided into 2 groups: Group 1 - patients with inferior LV MI (n=30); Group 2 - patients with inferior LV MI in combination with RV MI (n=27). Electrocardiography and echocardiography were performed in all patients at admission, on days 3, 30 and 180 after MI.Results. Significant signs of diastolic dysfunction (RV end-diastolic area 29.21±2.0 cm2) were found in group 2 on the third day after MI. A significant increase in the LV volume indices and diastolic sphericity index (from 0.54±0.02 to 0.59±0.03 units) and an increase in interventricular asynchrony (from 37.4±4.2 to 44.6±4.2 ms) were found in group 2 in 30 days after MI. Increasing tendency towards intraventricular and interventricular asynchrony, despite the absence of pathological LV remodeling, occurred in group 2 in 6 months after MI.Conclusion. Patients with RV MI have more pronounced maladaptive LV remodeling, intraventricular and interventricular asynchrony and greater LV diastolic dysfunction.</p

PLACE OF VOLUMETRIC LOAD IN ASSESSMENT OF DIASTOLIC RESERVE OF THE LEFT VENTRICLE AND IN PREDICTION OF HEART FAILURE DEVELOPMENT FOR MYOCARDIAL INFARCTION PATIENTS

Aim. To study the role of volumetric load in assessment of diastolic reserve of the left ventricle (LV) and to reveal informative predictors of transmitral diastolic flow for heart failure development in myocardial infarction patients without systolic LV dysfunction.Material and methods. Totally, 40 males studied with primary Q-wave myocardial infarction without clinical signs of heart failure with the baseline LV ejection fraction 50-55%. Statistical analysis was performed via Excel 5.0. Standard methods of variational statistics were applied: mean values, standard deviation. Significance of differences was assessed with t-criteria by Student.Results. In patients with myocardial infarction at volume load there were 2 types of transmitral diastolic flow. 1 group — patients, who had ipsidirectional changes of transmitral diastolic flow, as the healthy: significantly increased Е and А (p&lt;0,05), not changed Е/А, shortened IVRT of LV and Tdec (p&lt;0,002). 2 group — patients, who at the load did not develop increase of Е (p&gt;0,05), had significantly increased А by 12% (p&lt;0,002) and hence decreased Е/А (p&lt;0,05), and significantly prolonged IVRT of LV and Tdec (p&lt;0,05); changes did not return to baseline by 5 minutes of recovery period.Conclusion. 1) load test of VDLT is safe and informative method for DR of LV estimation and for revealing of high risk congestive HF in MI. 2) in patients with decreased DR of LV in VL there is decrease of E, significant increase of A, decrease of E/A and prolongation of IVRT and Tdec, during postinfarction period in 27,3% cases congestive HF does develop. 3) in patients with MI and remaining DR of LV during postinfarction period the congestive HF does not develop