Objective: To study the correlations between the parameters of the left ventricular-arterial coupling (LVAC) and the parameters of local arterial stiffness in patients after STEMI 6 months after revascularization. Design and method: 125 patients (mean age 51.2 ± 8.8 years) after STEMI were included in the study. The diagnosis was confirmed by biomarkers of myocardial necrosis, ECG, coronary angiography. Echocardiography was performed at the 7–9th day and 6 months after STEMI (MyLab, Esaote, Italy), followed by calculation of LVAC indices: arterial elastance (Ea), left ventricular elastance (Ees), LVAC index (Ea/Ees). The study of the right and left common carotid arteries (CCA) was carried out on a MyLab ultrasound scanner (Esaote, Italy) using high-frequency RF signal technology. The following parameters were recorded: QIMT - intima-media thickness, DC - lateral distensibility coefficient, stiffness index β, loc Psys - local SBP, locPdia - local DBP, locPWV - local pulse wave velocity, AP - amplification pressure. Results: In the study of the correlation of LVAC indices with the CCA rigidity parameters recorded on 7–9th day from the STEMI, a relationship was revealed only between Ees and LocPsys (r = 0.40; p = 0.01), Ees and LocPdia (r = 0, 26; p = 0.004). After 6 months of follow-up, a closer relationship between the LVAC and the parameters of the local CCA stiffness was diagnosed. The Ea indicator correlated with DC (r = -0.23; p = 0.009), PWV (r = 0.21; p = 0.02), LocPsys (r = 0.33; p = 0.0002), LocPdia (r = 0.26; p = 0.004) and AP (r = 0.19; p = 0.03). The Ees indicator was found to be associated with LocPsys (r = 0.38; p = 0.00001), LocPdia (r = 0.27; p = 0.002), AP (r = 0.22; p = 0.01). Conclusions: After 6 months, there was a closer correlation between the LVAC indices and the parameters of local pressure and rigidity. This is probably partly due to the remodeling of the cardiovascular system in the postinfarction period and the inclusion of compensatory-adaptive mechanisms that ensure the contractile function of the heart.
Objective: To study adherence to treatment with atorvastatin at various doses for 48 weeks in patients with STEMI. Design and method: The study included 117 STEMI patients mean age 52.1 ± 8.4 years in the first 24–96 hours from the disease onset. In accordance with the lipid-lowering therapy, the patients were divided into two groups. The first group included 39 people taking atorvastatin 40 mg/day. The second group consisted of 78 patients who received atorvastatin 80 mg/day. On 7–9th day from the STEMIt, after 24 and 48 weeks of follow-up, treatment adherence was assessed using the Morisky-Green questionnaire. In addition, compliance was determined based on the number of dispensed and returned drugs. Results: After 48 weeks of follow-up, pharmacotherapy was continued in the 1st group of 30 people (76.9%), in the 2nd group - 73 (93.6%) patients (p = 0.008); 9 patients (23.1%) from group 1 and 5 people (6.4%) from group 2 (p = 0.008) independently discontinued treatment. After 48 weeks of follow-up, 17 patients (43.6%) in the 1st group were assigned to the number of compliant patients, and 39 people (50%) in the 2nd subgroup (p = 0.54). Ten patients (25.6%) in group 1 and 15 patients (19.2%) in group 2 (p = 0.39) turned out to be insufficiently adherent. There were 3 people not adhering to treatment in the 1st group (7.7%), in the 2nd group - 19 people (24.4%) (p = 0.03). In group 1, the mean score was initially 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.96), after 48 weeks - 4 (3;4) points (p = 0.87). In the group 2 - 4 (4;4) points, after 24 weeks - 4 (3;4) points (p = 0.99), after 48 weeks - 4 (2;4) points (p = 0.34). According to the number of issued and returned drugs, the average amount of drugs taken in group 1 was 91.8 (79;99)%, in the 2nd group - 96.9 (82.8; 100)% (p = 0.23). The correct drug intake (>80% compliance) in group 1 was observed in 21 patients (76.7%); in group 2 - 57 (78.1%). Conclusions: in STEMI patients, 48-week atorvastatin treatment was characterized by good adherence and did not depend on the dose of the drug taken
Objective: To assess the state of the arterial bed in patients with CAD with varying degrees of coronary artery injuries (CA) and healthy peers. Design and method: The study included 92 patients with CAD (mean age 41.3 ± 8.2 years). Inclusion criteria: CAD verified by coronary angiography (CAG), ECG and/or biomarkers, hospitalization for unstable angina. After CAG, the patients were divided into 3 groups: the first - 30 people without hemodynamically significant stenoses (HSS1 < 50%) of CA, the second - 37 patients with HSS of 1 CA (HSS1 > 50%), the third group - 35 patients with HSS 2 or more CA (HSS2 > 50%). The control (C) group consisted of 28 healthy individuals. Regional arterial stiffness was assessed by volume sphygmography (Fukuda Denshi, Japan): R/L–PWV - PWV in elastic arteries, L-/CAVI-1 - cardio-ankle vascular index. Applanation tonometry (AtCorMedical, Australia) was used to record carotid-femoral PWV (cfPWV) and indicators of central aortic pressure: systolic (SBPao), pulse (PPao). Results: The lowest R/L-PWV values were in control - 10.1 ± 1.9 m/s; in patients with CAD, an increase in R/L-PWV was revealed in the HSS1 < 50% group - 11.9 ± 1.5 m/s and in the group HSS1 > 50% - 13.9 ± 0.9 m/s. The highest values were found in the group HSS2 > 50% - 13.9 (9.6;14.7) m/s (p < 0.05). The L-/CAVI-1 index in control was 6.4 (5.6;7.3), in group 1 - 7.2 (6.2;8.4), in group 2 - 8.3 (6.7;9.4) in group 3 - 9.5 (7.1;10.4) (p < 0.05). According to the applanation tonometry, in healthy people HSS1 < 50%, HSS1 > 50%, and HSS2 > 50%, a comparable level of central BP was recorded: SBPao - 100.9 ± 8.1mmHg, 100.5 ± 9.7mmHg, 100.3 ± 8.4mmHg 101.3 ± 7.7mmHg, PPao - 26.8 ± 6.1mmHg, 27.0 ± 5.9mmHg, 29.0 ± 5.3mmHg, 28.7 ± 6.4mmHg, respectively (p > 0.05), which is probably due to the examination in pharmacotherapy. The smallest cfPWV values were recorded in control - 6.5 ± 0.9 m/s compared with group 1 - 7.4 (6.2;8.7) m/s, in the group 2 - 8.5 ± 1.1 m/s, group 3 - 9.6 ± 1.4 m/s (p < 0.05). Conclusions: In patients with CAD, a significant violation of the vascular stiffness parameters was diagnosed, more pronounced in people with stenosis of two or more CA. The study results confirm that the CAD in young adult is a clinical manifestation of the widespread process of early vascular aging.
Aim. To investigate the correlation between clinical and morphological characteristics of coronary heart disease (CHD) and high-definition electrocardiography (HD-ECG) parameters. Material and methods. In total, 85 patients with unstable angina and ST segment depression (ST-UA) underwent HD-ECG during the angina attack, with late ventricular potential (LVP) analysis. One-year survival data were also analysed. Post-mortem histological examination of cardiac tissue was performed in 6 patients with ST-UA. Results. The important morphologic features of ST-UA included cardiomyocyte (CMC) dystrophy, due to acute and chronic myocardial ischemia, and acute injury in the cardiac conduction areas. LVPs were registered in 27 % of the ST-UA patients, mostly among people with transient myocardial ischemia (69,57 %). In patients who previ-ously underwent myocardial infarction, LVP prevalence was lower (28,57 %). At the early stages of hospitalization, LVP were registered in 14 patients (60,87 %), while pharmacotherapy and clinical course stabilization were associated with decreased LVP prevalence (21,74 %). The study results suggest that in patients with acute coronary syndrome, LVP registration predicts not an adverse outcome, but a better prognosis. Conclusion. ST-UA is characterised by typical changes of CMC and myocardial stroma in posterior septal area, which result in metabolic, energetic, and electrical myocardial instability. LVPs could be used as a marker of functional (ischemic) myocardial heterogeneity in patients with ST-UA. LVP registration could be associated with a better prognosis in this clinical group.
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