Influence of the primary coronary artery stenting in patients with acute myocardial infarction with ST segment elevation at diastolic dysfunction of the left ventricular in the hospital period
- 1Communal nonprofit enterprise «Clinical Hospital of ambulance services of Lviv»
- 2Lviv National Medical University named after Danylo Halytsky
Summary. Aim — to establish the predictive effect of primary coronary artery stenting (PCI) on the clinical course and features of left ventricular (LV) remodelling in patients with acute myocardial infarction with ST segment elevation (STEMI) and diastolic dysfunction (DD) in the hospital period. Objects and research methods. The study included patients with STEMI: 80 (1st group), who had undergone PCI, and 20 (2nd group) without PCI. During the hospitalization period, the coronary angiography data were analyzed, the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and echocardiography parameters of DD were determined for 5 days, at the time of discharge, veloergometry was performed to determine the angina pectoris patients, and the patients completed the Sequence Angle Questionnaire (SAQ) questionnaire. Results. The mean NT-proBNP level in patients in the 2nd group was 782.25±17.3 pg/ml, and in the 1st group — 300.5±14.3 pg/ml (p<0.001), which reliably points to less pronounced early LV remodelling processes in patients with STEMI. Indicators of DD were characterized by the ratio of early diastolic filling to late (E/A), and in 1st group were 0,89 (+0.06), which is characteristic for DD with violation of relaxation processes of LV, and in 2nd group — 1,17 (+0.04), which is typical of the restrictive type. According to SAQ scales, patients in 1st group had better quality of life and higher physical activity tolerance at the level of I–II class determined by veloergometry in comparison with patients without revascularization. Conclusions. Patients with STEMI after performed PCI have significantly lower rates of NT-proBNP, which is an early marker of LV remodelling, as well as echocardiography parameters of DD indices have less pronounced pathological character, which results in increased exercise tolerance in the onset of hospitalization and improves the quality of life of patients defined by the SAQ questionnaire.
Key words: myocardial infarction with ST segment elevation, diastolic dysfunction, brain natriuretic peptide, primary stenting of coronary artery.
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