Background. During the restoration of blood flow in the ischemic area of the myocardium, viable cardiomyocytes are damaged over a few minutes of tissue reperfusion (reperfusion myocardial damage). It is known that ischemic mitral regurgitation (IMR) develops in 11–19 % of patients who have undergoing percutaneous coronary intervention (PCI) in symptomatic coronary heart disease (CHD). To present day, the influence of myocardial reperfusion on IMR in patients with acute myocardial infarction (AMI) is not fully understood.Objective. To study dynamics of quantitative indicators of IMR in patients with AMI after myocardial reperfusion.Materials and methods. We included in this study 68 patients with AMI and IMR aged 36–79 years, who were hospitalized in cardiac intensive care unit of the Moscow S. S. Yudin hospital in 2016. All patients before and on the 7th day after PCI underwent doppler echocardiography study with calculation of quantitative parameters of IMR and index of local contractility (ILC) of the left ventricle (LV).Results. Three groups of patients were identified based on the analysis of the dynamics of quantitative parameters of IMR after myocardial reperfusion: group 1 – patients who had a decrease in IMR (n=23, 33.8 %), group 2 – patients with increase of IMR (n=28, 41.1 %), group 3 – patients with unchanged IMR (n=17, 25.1 %). The study of systolicLV function in all patients before PCI revealed moderately decreased ejection fraction (EF) (mean 49.05±1.19 %). On day 7 after myocardial reperfusion in group 2 we detected significant increases of end-diastolic volume (EDV), end-systolic volume (ESV), and the volume of the left atrium (LA), while in groups 1 and 3 these indexes remained unchanged. LV ILC did not differ between three groups, both at admission and on day 7 after reperfusion (p>0.05). There was no correlation between severity of IMR and ILC (correlation coefficient 0.24).Conclusion. Dynamics of quantitative parameters of IMR in 7 days after myocardial reperfusion in patients with AMI without endogenous and drug protection of the myocardium from reperfusion injury was multidirectional. IMR decreased in 33.8, increased in 41.1 and did not change in 25.1 % of patients. Systolic function and LV ILC underwent no significant dynamics.
According to the literature, 40-60% of patients with acute myocardial infarction (AMI) have obstructive multivessel coronary artery disease (CA) and 8.8% of patients have non-obstructive CA lesions. And it is around these two groups of patients that there are active discussions and disputes regarding the choice of optimal treatment tactics and further prognosis. The aim of the study was to study clinical and laboratory features of development and course of primary AMI in patients with multi-and single-vessel obstructive lesion of the CA compared with patients with non-obstructive CA lesions. Methods. The study has included patients hospitalized "through the ambulance channel" in the Department of cardiac intensive care of municipal clinical hospital named after S. S. Yudin Moscow with a diagnosis “primary acute myocardial infarction”, ACS with and without ST segment elevation, unstable angina in 2015-2016. The diagnosis of acute myocardial infarction (AMI) was established at the hospital stage according to the criteria of the "Third universal definition of myocardial infarction" in 2012. The study included 1240 patients who underwent coronary angiography (CAG) no later than 12 hours from the time of admission. The first group (comparison group) consisted of patients with AMI and the first detected multivessel obstructive atherosclerotic lesion of CA (664 patients), the second (interest group) consisted of patients with AMI and non-obstructive atherosclerotic lesion of CA (96 patients) meeting the MINOCA criteria. The third group consisted of patients with single-vessel obstructive lesion and complete acute occlusion of the CA (272 patients). Patients with hemodynamically significant lesions of the left CA trunk were not included in the study. The clinical and laboratory features of the course of acute primary myocardial infarction in patients with obstructive and non-obstructive coronary atherosclerosis were studied. The generally accepted statistical processing methods were used. A year after discharge from the hospital, 727 patients (468 patients from the 1st group, 78 from the 2nd group, 181 from the 3rd group) were interviewed by means of a structured telephone survey about the course of the disease (collection of medical history). The median follow-up was 12 months. (interquartile range 11-13 months). The endpoints were: re-hospitalization for any reason, re-coronary event, death. The received answers are entered into questionnaires and statistically processed. Results and conclusions. In patients with AMI and non-obstructive atherosclerotic CA lesion, pain behind the sternum is observed one and a half times less often (54.2%) than in patients with obstructive CA lesion (MOAPCA 86.1%, OAPCA 89.7%) and the cardiac co duction system is almost three times more likely to be affected ( 30% versus 8.4% and 12%). Only 12.5% of patients in this group had an abnormal Q wave (Q – myocardial infarction) on the ECG, therefore, a smaller volume of myocardial damage and a lower level of troponin than in patients of groups 1 and 3. During the first year after the development of AMI, patients with obstructive coronary atherosclerosis did not experience repeated coronary events, there were no indications for conducting CAG, PCI or CABG, in contrast to patients with obstructive lesion of CA. For multivascular obstruction (group 1), PCI was performed in 9.6% of patients and 3.8% of CABG. PCI was performed in group 3 with obstructive single-vessel lesion of CA in 7.7% of patients. In patients with AMI and obstructive single-vessel atherosclerotic lesion of CA (group 3), two and a half times less often (9.1%) myocardial reperfusion injury is observed, while in patients with multivascular obstructive CA defeat, this syndrome was observed in 21.3%.
Post-reperfusion syndrome is a chronic multi-factorial syndrome, caused by restoration of coronary blood flow of de novo in patients after coronary stenting. Pathophysiological processes occurring in stenting segment (incomplete endothelization of vessel, excessive regeneration of neointima, formation of neoatherosclerosis) the risk of partial or total stent thrombosis due to the low level of compliance of the patient, as well as local changes in blood flow to the myocardium and modification of hemodynamics in stented arteries have a significant impact on the clinical course and prognosis of the disease. In contrast to the syndrome of reperfusion occurring after restoration of blood flow in the infarct-dependent coronary artery syndrome and postischemic reperfusion syndrome in patients with acute myocardial infarction after spontaneous or therapeutic thrombolysis, post-reperfusion syndrome is characterized by prolonged course (months and years). Clinical symptoms depend of the localization of pathological process (in stented arteries or in other non-stented arteries of the heart), as well as the presence of comorbidity and the factors of risk of the coronary heart disease.
1 Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет) Россия, 119991, г. Москва, ул. Трубецкая, 8/2 2 Сибирский государственный медицинский университет (СибГМУ) Россия, 634050, г. Томск, Московский тракт, 2 3 Лечебно-реабилитационный центр Россия, 119192, г. Москва, Ломоносовский пр., 43 РЕЗЮМЕ Цель исследования. Установить ценность измерения уровня ýозинофильного катионного протеина в плазме крови у больных хронической обструктивной болезнью легких (ХОБЛ) как потенциального биомаркера для определения активности ýозинофильного воспаления в сравнении с определением количества ýозинофилов крови и прогнозирования тяжести ее течения на основании таких клинических характеристик, как функция внешнего дыхания, частота обострений и индекс BODE.Материалы и методы. В исследовании приняли участие больные ХОБЛ (n = 161), для которых предусмотрено два визита, включающих сбор анамнестических данных и выполнение основных процедур исследования (функция внешнего дыхания, 6-минутный шаговый тест, оценка одышки по опроснику Medical Research Council Scale, исследование мокроты и крови с определением уровня ýозинофилов и ýозинофильного катионного белка). Второй визит проводился через 12 мес после первого для оценки динамики заболевания. Особое внимание уделялось наличию аллергии в анамнезе, частоте обострений, количеству курсов терапии антибактериальными препаратами и приему ингаляционных и системных глюкокортикостероидов.Результаты. Исследование продемонстрировало, что высокий уровень ýозинофильного катионного белка в плазме крови у больных ХОБЛ ассоциирован с более тяжелым течением и развитием более частых инфекционно-зависимых обострений заболевания, требующих назначения ингаляционных глюкокортикостероидов и антибиотиков. Нами была продемонстрирована обратная связь между уровнем ýозинофильного катионного белка ECP и ОФВ1, что позволяет использовать данный показатель как предиктор тяжести течения ХОБЛ.Заключение. Учитывая полученные нами данные, измерение ýозинофильного катионного белка плазмы крови, являющееся неинвазивным и относительно легко выполнимым методом исследования, можно рекомендовать использовать в качестве клинического маркера при прогнозе ХОБЛ и персонифицированном подборе терапии.Ключевые слова: ХОБЛ, ýозинофилы, ýозинофильный катионный белок, фенотип, степень тяжести, глюкокортикостероиды.Конфликт интересов. Авторы декларируют отсутствие явных и потенциальных конфликтов интересов, связанных с публикацией настоящей статьи.
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