Features of the clinical course and remodeling of left ventriculi in patients with acute myocardial infarction with ST segment elevation for 1 year after the primary coronary artery stenting
Summary. The purpose — to determine the predictive effect of primary stenting of coronary arteries on the clinical course and features of left ventricular remodeling in patients with ST segment elevation myocardial infarction (STEMI) and diastolic dysfunction (DD) in the remote period (1 year). Objects and methods. The study included 80 patients with STEMI who had undergone primary coronary intervention (1st group) and 20 patients with STEMI who did not undergo a revascularization of the myocardium (2nd control group). The analysis of the coronary artery in the hospital and the results of the primary coronary intervention (PCI) were analyzed. The following were determined: the level of the N-terminal fragment of the brain precursor natriuretic peptide (NT-proBNP), echocardiographic indicators of diastolic function (for the 5th day), functional class of angina with bicycle ergometry, quality of life according to the SAQ questionnaire (Seattle Angina Questionnaire), cardiovascular complications in the form of repeated acute MI, violation of rhythm and conduction, hospitalization due to unstable angina or symptoms of heart failure, sudden death at discharge from the hospital (21–28 days). Patient re-examination and measurement of the parameters described above (except for coronary angiography) were performed after 1 year of observation. Results. The average NT-proBNP level for day 5 and 1 year in patients in the 2nd group was 1182.6±280.8 and 609.3±57.2 pg/ml, and in group 1 — 434.6±36.3 and 122.8±4.13 pg/ml (p<0.001) respectively, suggesting a statistically significantly less pronounced late remodeling of LV in patients with STEMI, which was undergoing revascularization. Diastolic function was evaluated using indicators such as the ratio of early and late diastolic filling (E/A) and the time of retardation of the early transdermal flow (DT). Patients in the 1st group E/A and DT were 0.87±0.005 and 186±0.82 m/s, and after 1 year — 0.76±0.003 and 198±0.75 m/s respectively, which characterizes a decrease in the parameters of the DD by the type of violation of the relaxation processes of the LV. Echocardiographic parameters of diastolic dysfunction E/A and DT in patients in the 2nd group were 1.37±0.03 and 145.75±2.91 m/s, and in 1 year — 1.49±0.01 and 135.3±2.91 m/s respectively that is inherent in the deterioration of the DD by the restrictive type. Within 1 year, patients in group 1, according to SAQ, had better quality of life and higher exercise tolerance at the level of the I–II functional class determined by bicycle ergometry compared with patients without revascularization, which had a rather poor quality of life according to SAQ and angina pectoris at the level of III–IV. Conclusions. In patients with STEMI, after PCI, a significantly lower level of NT-proBNP, a marker of pathological remodeling of the lungs, and less pronounced DD manifestations in the long-term (1 year) period was observed, which was shown to be better tolerated to physical activity and improve the quality of life, defined by the questionnaire of SAQ and a lower frequency of development of cardiovascular complications.
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