РОЛЬ ФАКТОРІВ ВАЗОДИЛАТАЦІЇ В ПАТОГЕНЕЗІ ХРОНІЧНОЇ СЕРЦЕВОЇ НЕДОСТАТНОСТІ ІШЕМІЧНОГО ПОХОДЖЕННЯ ПРИ ФІБРИЛЯЦІЇ ПЕРЕДСЕРДЬ

The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression.The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression

Вплив базисної комплексної дворічної терапії на показники пізнього ремоделювання лівого шлуночка та профілактику виникнення кардіоваскулярних подій у хворих після перенесеної нестабільної стенокардії в поєднанні з артеріальною гіпертензією

 The purpose of the study was to determine the effect of basic complex biennial treatment on the parameters of late remodeling of the left ventricle (LV) and cardiovascular events in patients after unstable angina (UA) in combination with arterial hypertension (AH).Materials and methods. A total of 144 patients with unstable angina in combination with arterial hypertension, at the age of 41–67 years, who were treated in the infarct department of City Clinical Hospital № 1 in Vinnytsya, who had a history of myocardial infarction in 59.7 % of cases, were examined. The duration of hypertension was 9.3 years on average, chronic CHD – 6.4 years; systolic blood pressure – 163.2 ± 1.50 mm Hg, diastolic blood pressure – 101.1 ± 0.67 mm Hg. The patients underwent general clinical examination, ECG, echocardiography in M- and B-regimens, lipid blood spectrum and troponin I. The examinations were carried out before treatment, after 6, 12 and 24 months. Basic complex treatment was carried out for two years with perindopril 5–10 mg/day, bisoprolol 5–10 mg/day, atorvastatin 20 mg/day and acetylsalicylic acid 75 mg/day.Results. In the examined patients after thе UA in combination with hypertension before the treatment concentric left ventricular hypertrophy (LVH) according to A. Genau was determined in 40.3 %, eccentric – in 58.3 %, concentric remodeling – in 1.4 %. After conducting the basic comprehensive treatment, the concentric LVH decreased and the eccentric increased.In patients after UA in combination with hypertension before treatment I (initial) degree of LVH was determined in 6.3 %, II (moderate) – 26.4 %, III (significant) –in 66.7 %. After the basic comprehensive treatment, the third (significant) level of LVH significantly decreased due to the gradual transition to the second and the first stage of late remodeling of the LV. While studying the development of cardiovascular events it was found, that two years mortality was 2.1 %, recurrent not fatal myocardial infarction was registered in 10.4 % of cases.Conclusions. In patients after the UA in combination with hypertension conducted two-year basic complex antiremodeling treatment was accompanied in a number of cases by the transition of concentric remodeling of LV to the eccentric one and a reducеion in risk of cardiovascular events development. Цель работы – определить влияние базисного комплексного двухлетнего лечения на показатели позднего ремоделирования левого желудочка (ЛЖ) и кардиоваскулярные события у больных после перенесенной нестабильной стенокардии (НС) на фоне артериальной гипертензии (АГ).Материалы и методы. Обследовали 144 больных, перенесших эпизод острого коронарного синдрома (ОКС) на фоне АГ, в возрасте 41–67 лет. Пациенты находились на лечении в инфарктном отделении ГКБ № 1 г. Винницы. Среди включенных в исследование больных с НС в 59,7 % случав в анамнезе был инфаркт миокарда (ИМ). Продолжительность АГ составляла 9,3 года, хронической ИБС – 6,4 года; систолическое АД – 163,2 ± 1,50 мм рт. ст., диастолическое АД – 101,1 ± 0,67 мм рт. ст. Больным проводили общее клиническое обследование, ЭКГ, ЭхоКГ, в М и В режимах, определение липидного спектра крови и тропонина I для исключения инфаркта миокарда. Обследование выполняли до лечения, через 6, 12, и 24 месяцев. Базисное комплексное лечение проводили в течение 2 лет, оно предусматривало прием периндоприла в дозе 5–10 мг/сут., бисопролола 5–10 мг/сут., аторвастатина 20 мг/сут., ацетилсалициловой кислоты – 75 мг/сут.Результаты. У больных, перенесших НС на фоне АГ, до лечения концентрическая гипертрофия левого желудочка (ГЛШ) по Genau отмечена в 40,3 % случаев, эксцентрическая – в 58,3 %; концентрическое ремоделирование – в 1,4 % случаев. После проведенного базисного комплексного лечения удельный вес больных с концентрической ГЛЖ уменьшился, а с эксцентрической ГЛЖ увеличился.У больных, перенесших НС на фоне АГ, до лечения І (начальная) степень ГЛЖ установлена в 6,3 %, II (умеренная) – в 26,4 %, III (значительная) – в 66,7 % случаев. После базисного комплексного лечения III (значительная) степень ГЛЖ существенно уменьшилась за счет перехода во II и даже I степень позднего ремоделирования ЛЖ. При изучении кардиоваскулярных событий в течение 2 лет установлено, что смертность составила 2,1 %, повторный нефатальный ИМ зарегистрирован в 10,4 % случаев.Выводы. У больных, перенесших НС на фоне АГ, базисное двухлетнее комплексное антиремоделирующее лечение приводит к переходу в ряде случаев концентрического в эксцентрическое позднее ремоделирование ЛЖ и уменьшению развития кардиоваскулярных событий.  Мета роботи – визначити вплив базисного комплексного дворічного лікування на показники пізнього ремоделювання лівого шлуночка (ЛШ) і кардіоваскулярні події у хворих після перенесеної нестабільної стенокардії (НС) у поєднанні з артеріальною гіпертензією (АГ).Матеріали та методи. Обстежили 144 хворих, які перенесли епізод гострого коронарного синдрому (ГКС) на тлі артеріальної гіпертензії (АГ), віком 41–67 років. Хворі перебували на лікуванні в інфарктному відділені МКЛ № 1 м. Вінниці. Серед залучених у дослідження хворих на НС в 59,7 % випадків в анамнезі був інфаркт міокарда (ІМ). Тривалість АГ становила в середньому 9,3 року, хронічної ІХС – 6,4 року; систолічний АТ – 163,2 ±1,50 мм рт. ст., діастолічний АТ – 101,1 ± 0,67 мм рт. ст. Хворим здійснили загальноклінічне обстеження, ЕКГ, ЕхоКГ в М і В режимах, визначили ліпідний спектр крові і тропонін I для виключення інфаркту міокарда. Обстеження виконали до лікування, через 6, 12 і 24 місяці. Базисне комплексне лікування проводили впродовж 2 років, включало периндоприл у дозі 5–10 мг/добу, бісопролол 5–10 мг/добу, аторвастатин 20 мг/добу, ацетилсаліцилову кислоту 75 мг/добу.Результати. У обстежених хворих, які перенесли НС на тлі АГ, до лікування концентричну гіпертрофію лівого шлуночка (ГЛШ) за Genau визначали в 40,3 % випадків, ексцентричну – в 58,3 %, концентричне ремоделювання – в 1,4 %. Через 2 роки спостереження питома вага концентричної ГЛШ зменшилась, а ексцентричної збільшилася.У хворих, які перенесли НС на тлі АГ, до лікування І (початковий) ступінь ГЛШ встановили в 6,3 % випадків, ІІ (помірний) – у 26,4 %, ІІІ (значний) – в 66,7 %. У результаті здійсненого дворічного базисного комплексного лікування відсоток хворих з ІІІ (значним) ступенем ГЛШ суттєво зменшився внаслідок поступового переходу в ІІ (помірний) та І (початковий) ступінь пізнього ремоделювання ЛШ. Аналізуючи частоту кардіоваскулярних подій, встановили: дворічна смертність становила 2,1 %, повторний нефатальний ІМ зареєстровано в 10,4 % випадків.Висновки. У хворих, які перенесли НС на тлі АГ, дворічне базисне комплексне антиремоделювальне лікування супроводжувалося переходом у низці випадків концентричного в ексцентричне ремоделювання ЛШ і зменшенням ризику розвитку кардіоваскулярних подій

The Role of Vasodilation Factors in the Pathogenesis of Chronic Heart Failure of Ischemic Origin in Atrial Fibrillation

The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression

Results of Artery Stenting in Patients with Acute Myocardial Infarction with Comorbid Hypertension

Introduction. The study of the effectiveness of treatment of acute myocardial infarction (AMI) with comorbide arterial hypertension (AH) is an actual problem of the modern cardiology. According to the statistics of 2010, 8.6 million of Ukraine’s population suffer from the coronary heart disease (CHD), the AMI occurs in 50 thousand of these patients annually. Hypertension affects more than 12 million people. The question of the effectiveness of coronary stenting in patients with AMI and comorbide AH is insufficiently studied. Aim. To analyze the results of the effectiveness of coronary stenting in patients with AMI with comorbide AH. Material and methods. The inclusion criteria in the study were patients with Q–IM, Q–IM and comorbide hypertension, complicated by lesions of the organs of the circulatory system. The exclusion criterion was the age over 80 years, heart failure (HF) of the functional class IV, neoplasms, severe kidney and liver diseases. Results and discussion. A retrospective analysis of the medical records of 105 patients with AMI with comorbide hypertension who were undergoing treatment in the cardiology Department N 1 of the clinical hospital N 1 in Vinnytsia from 2011 to 2014. Acute Q–IM with elevate ST-segment was observed in 84,8 % of patients, acute not Q–IM with elevate ST-segment – in 15.2 %, acute anterior Q–IM – in 39.0 %, inferior Q–IM – in 42.9 %. Repeated myocardial infarction in the anamnesis was observed in 14.2 % of patients. The average age of patients was 56.7 ± 0.80 years. Patients got into the infarction department up to 3 hours after the occurrence of AMI in 39,0 % of cases; in 4–6 hours – in 18.1 %; in 7–24 hours – in 20.0 %; in more then 24 hours – in 22.9 %. The duration of AH in anamnesis was 9.0 ± 0,45 years, chronic CHD – 2.8 ± 0.25 years. In examined patients the values of systolic blood pressure was 138.0 ± 2.15 mm Hg, diastolic – 89.4 ± 1.27 mm Hg. The examined patients underwent the general blood analysis, determination of the lipid spectrum of blood, troponin I and T, ECG. Angiographic examination was performed using the Siemens Axiom Artis (Germany) for 2-3 hours after hospitalization of the patients. In the unit of resuscitation and intensive care cardiology Department N 1 for patients with AMI and comorbide AH was administered pain medication, were prescribed dual antiplatelet therapy, beta-blocker bisoprolol at a dose of 5.0–10.0 mg/day, ACE inhibitor perindopril at a dose of 5.0–10.0 mg/day and lipid-lowering therapy with atorvastatin at a dose of 20 mg/day. Examined patients with AMI with comorbid hypertension often experience such cardiovascular complications: heart failure of І-III NYHA functional classes – in 100 %, acute left ventricular insufficiency of І–III of classes according to the classification of T. Killip, J. Kimbal occurs in 19.0 %, arterial fibrillation in 7.6 %, ventricular extrasystoles II–V grades in Launam – in 7.0 %, ventricular fibrillation – in 3.8 %, cardiogenic shock – in 2.9 percent. One-vascular lesions of the coronary arteries (VA) was observed in 26.7 % of patients, 2-vascular – in 28.5 %, 3-vascular – in 44.8 %, subclause and occlusion – in 57,1 % of patients. Patients with comorbid hypertension were installed one stent in 86.3 % of cases; two stents – in 13.7 %. Restoration of blood flow in the anterior mishloach VA occurred in 58.1 %, the right VA – in 26.7 %, in the envelope VA – in 12.4 %. Failure to restore the coronary blood flow was observed in 2.9 % of patients. Clinical efficacy of restoring coronary flow in patients with AMI with comorbid AH according to the results of the TIMI: TIMI 1 (partial) – 0.9 %, TIMI 2 (significant) – in 20.0 %, TIMI 3 (complete, normal) – in 76.2 %, TIMI 0 (not restarted) – in 2.9 % of patients. Conclusions. 1. Сoronary blood flow in patients with AMI with comorbid AH was renewed in the front interventricular VA in 58.1 % of the patients, in the right VA – in 26.7 %, in the envelope VA – 12.4 %, failed to restore coronary blood flow in right VA – in 2.9 % of cases. 2. Reparation of coronary blood flow in patients with AMI with comorbid AH took place according to the criteria of TIMI 1 (partial) in 0.9 %, TIMI 2 (significant) – at 20.0 %, TIMI 3 (normal) – 76,2 %, TIMI 0 (did not happen) – 2.9 % of cases, which shows the effectiveness of the interventional treatment