Relevance. Acute kidney injury (AKI) worsens the prognosis of myocardial infarction (MI). Aim. To study the characteristics of cardiovascular (CVD) risk factors in men under 60 years of age with AKI in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 168 patients. A comparative analysis of the frequency of observation of the main and additional CVD risk factors in groups was performed. Results. In the patients of the study group, more often than in the control group, the following was observed: MI in winter (68.0 and 36.3%, respectively; p = 0.01), with repeated cases - the interval between infarction of more than one year (48.0 and 29.8%; p = 0.04); psychoemotional stress (64.0 and 46.1%; p = 0.04) or hypertensive crisis as a situation provoking MI (28.0 and 19.2%; p = 0.04); a history of: overweight less than 10 years (72.0 and 35.7%; p = 0.002) with moderate obesity (48.0 and 22.6%; p = 0.03), chronic heart failure (36.0 and 14.0%; p = 0.006), peptic ulcer (32.0 and 13.7%; p = 0.01), unstable angina (64.0 and 42.6%; p = 0.003), peripheral angiopathies (80.0 and 56.5%; p = 0.02), coronary angiography (45.5 and 25.5%; p = 0.04) and coronary artery bypass surgery (24.0 and 8.6%; p = 0.009). Conclusions. The structure of CVD risk factors in men under 60 years old with MI and AKI is characterized by the prevalence of moderate obesity, gastroduodenal ulcers, chronic heart failure, stress and crisis course of hypertension, coronary angiography and a history of coronary artery bypass surgery, as well as MI in winter. It is advisable to use the listed combinations of factors in predictive modeling and planning of preventive measures in such patients.
Relevance. The quality-of-life assessment in patients with myocardial infarction and acute kidney injury in differs significantly among different researchers. Aim. To evaluate the changes in the quality-of-life indicator associated with heart failure in men under 60 years old with myocardial infarction and acute kidney injury to search for opportunities to improve prevention. Material and methods. The study included men aged 19-60 years old with type I of myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with acute kidney injury - 25 patients; II - control, without it - 167 patients. A comparative analysis of the quality-of-life indicator associated with heart failure (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of myocardial infarction. The changes and correlations (C. Spearmen) of quality-of-life indicator with various clinical features were studied. Results. The quality-of-life in patients in the study group did not differ from the control in both phases of the study (1: 58.8 ± 15.8 and 63.7 ± 20.0; 2: 19.1 ± 8.6 and 20.4 ± 13, 5, respectively; p ˂ 0.05) with positive (68%) dynamics in both groups of patients. Significant correlations of the quality-of-life indicator with age, heart rate, blood pressure, lipid metabolism, left ventricular systolic function, total calcium, GRACE index was revealed. Conclusions. The quality of life associated with heart failure indicator dynamics in the study group did not differ from the control group. Tachycardia, arterial hypertension, dyslipidemia, and hypocalcemia were found to be early markers of deterioration in the quality of life. They can be used in the early diagnosis of chronic heart failure for the timely implementation of preventive measures.
Relevance. Acute kidneys injury (AKI) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with AKI during MI to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 486 patients. A comparative assessment of the MI CF frequency in selected groups were performed. Results. In patients of the study group more often than in the control group, a combination of MI complications (64.0 and 36.9%; respectively; p = 0.009), psychic disorders (20.0 and 6.9%; p = 0.01), chronic heart failure (CHF) of the second functional class and above (NYHA) at the end of the eighth MI week (72.0 and 43.2%; p = 0.005), with a predominance of newly diagnosed CHF forms (36.0 and 28.0%; p = 0.006). In the study group, less often than in the control group, pulmonary hypertension was noted in the first 48 hours of MI (44.0 and 66.0%; p = 0.02) and at the end of the third MI week (38.1 and 60.3%; p = 0.04). Conclusions. There were no specific clinical signs of AKI in men under 60 y.o. with MI. At the same time, the study group has the worst prognosis during the observation period in terms of the frequency of MI complications combinations and CHF, which requires the start of prophylactic therapy from the moment of AKI verification.
Relevance. Hemodynamics changes in myocardial infarction complicated by acute kidney injury are interpreted in different ways. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative assessment of circulation indices changes in first 48 hours (1) and the end of third week disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in lower values of heart rate1 (66.3±12.2 and 75.8±18.8 (bpm), respectively; p=0.003) and higher - arterial pressure, systolic1 (155.6±24.0 and 139.5±28.9 (mm Hg); p=0.006), diastolic1 (98.0 ± 16.0 and 86.6 ± 18.9 (mm Hg); p = 0.002), mean1 (117.2±17.6 and 104.3±21.3 (mm Hg); p=0.001). In the study group compared in the control group, there was a greater decrease in blood pressure (mean: -18.3 and -8.3%, respectively) and total peripheral resistance (-33.5 and -26.3%) (p<0.0001). The risk markers of the acute kidney injury development were the mean arterial pressure1≥106.7, systolic1≥140.0, diastolic1≥90.0 (mm Hg) and heart rate1˂66 bpm. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by arterial hypertension and bradycardia in the first hours of the disease, as well as more pronounced decline dynamics of blood pressure and total peripheral resistance at the end of its subacute period. The listed above values of the circulation parameters should be used in the high-risk groups for the acute kidney injury development formation, as well as prognostic modeling.
Relevance. The role of hemodynamic changes in myocardial infarction complicated by acute kidney injury is interpreted in different ways. Aim. To evaluate the heart chambers and structures peculiarities in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 366 patients. A comparative assessment of the heart chambers and structures parameters in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in smaller sizes of the left atrium2 (38.1±6.0 and 42.0±5.4 (mm), respectively; p=0.01), a higher frequency of the middle anterior (100 and 15.6%; p=0.02) and antero-septal (100 and 17.7; p=0.04) segments akinesia and the absence (0 and 81.5%; p=0.04) of tricuspid regurgitation. In the study group, there was a smaller increase in the ventricles size than in the control group (left: 0.6 and 1.7%, respectively; right: 15.3 and 33.6%) and a greater decrease in the atria size, compared in the control group (left: -1.8 and -25.3%; right: -25.3 and -0.1%) (p<0.0001). The risk markers of the acute kidney injury developing were the dimensions of the left atrium1˂34 mm, interventricular septum≥12.0 mm, end systolic1≥4.23 and diastolic1≥5.3 of the left ventricle, right ventricle1˂2.6; of the right atrium1≥4.7 (cm), the mass of the left ventricle1≥328.8 g. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by lesions of the middle anterior and antero-septal segments, the absence of tricuspid regurgitation, and a smaller left atrium in the subacute period of the disease. The above of the heart chambers dimensions values should be used in the high-risk groups for the acute kidney injury development formation, as well as for prognostic modeling.
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