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Funding Acknowledgements Type of funding sources: None. Background Myocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is considered to be a puzzling clinical phenomenon with unclear prognosis. This study aims to compare the clinical characteristics, impact of arrythmias and prognosis of MINOCA with MI with obstructive coronary artery disease (MICAD). Methods Data was obtained from our university hospital database. Patients with MI between 28 August 2018 and 31 December 2020 were included in the study. Subjects were divided in 2 groups: 1 - MINOCA; 2 -MICAD. Follow-up analysis included death from any cause, major adverse cardiac events (MACE: cardiac death, MI, stroke), readmissions due to cardiovascular causes, and in-hospital mortality. Median follow up was 18 months. Results MINOCA occurred in 49 (11 %) out of 443 pts with MI. There were no differences in age (p=0.732). In MINOCA group there were more females (34.7% vs 22.8%, p<0.001), never smokers (30.6% vs 21.8%, p<0.001), lower rates of hypertension (67.3% vs 73.8%, p=0.036), diabetes (18.3% vs 29.9%, p<0.001), hyperlipidaemia (28,5 % vs 35.7%, p=0.475), stroke in anamnesis (2.0% vs 6.8%, p<0.001), preavious MI (2.0% vs 22.8%, p<0.001). Symptoms at admission didn't differ between the two groups, however MINOCA group had lower mean heart rate (72±15 vs 87±19, p<0.001), lower systolic arterial pressure (139±22 vs 145±28, p<0.001). There were no significant differences between STEMI or NSTEMI: 55.1 % and 44.9 % in the MINOCA group vs 53.8 % and 46.2 % in MICAD (p=0.534). MINOCA patients had lower C-RP levels (19 vs 56 mg/L, p<0.001), high-sensitivity cardiac troponin T levels: (112 vs 376 ng/L, p<0.001) and lower BNP levels (99±26.9 vs 142±64.2, p<0.001). Left ventricular dysfunction (EF < 50 %) was more prevalent in the MICAD group (16.3% vs 27.9%, p<0.001). There was no need in inotropic support in MINOCA patients (0% vs 4.8%, p=0.04). Atrial fibrillation (AF) was more often found in MICAD group (4.1% vs 6.8%, p <0.001). There were no diffrenecs in ventricular arrhythmias during admmision in both groups. Death rates were lower in hospital (0% vs 2.8%, p=0.131) and during the follow up period (8.1% vs 10.9 %, p=0.369). There was no significant difference in MACE outcomes (p=0.612) and readmission of cardiovascular causes (p=0.310) in both groups. Independent predictors for MACE in MINOCA patients were older age (≥60 years), females, reduced LVEF and atrial fibrillation. Conclusion MINOCA patients had lower prevalence of classic cardiovascular risk factors, no clinical differences at admission, lower levels of C-RP and high-sensitivity cardiac troponin T, preserved left ventricle EF, lower in- hospital and during follow up death rate, but no significant difference in MACE outcomes. Older age, females, reduced LVEF and atrial fibrillation are considered to be predictors of MACE in MINOCA. Further research is needed to provide more evidence on the optimal management.
Resumo O infarto do miocárdio com artérias coronárias não obstrutivas (MINOCA) é um fenômeno clínico intrigante e de prognóstico incerto, caracterizado pela evidência de infarto do miocárdio (IM) com artérias coronárias normais ou quase normais na angiografia 1 . Atualmente, não há diretrizes para o manejo e muitos pacientes recebem alta sem uma etiologia determinada, significando muitas vezes que o tratamento ideal é adiado.Relatamos três estudos de caso MINOCA com as principais causas fisiopatológicas cardíacas, particularmente epicárdicas, microvasculares e não isquêmicas, levando ao tratamento diferencial. Os pacientes apresentavam dor torácica aguda, aumento da troponina e nenhuma doença coronariana angiograficamente significativa.Neste estudo, analisamos a etiologia, diagnóstico clínico e tratamento da MINOCA em relação à literatura relevante.MINOCA é considerado um diagnóstico de trabalho dinâmico, incluindo distúrbios coronários, miocárdicos e não coronários. Estudos prospectivos e registros são necessários para melhorar o atendimento e o resultado do paciente.
Authors' contribution Wkład autorów: A. Study design/planning zaplanowanie badań B. Data collection/entry zebranie danych C. Data analysis/statistics dane-analiza i statystyki D. Data interpretation interpretacja danych E. Preparation of manuscript przygotowanie artykułu F. Literature analysis/search wyszukiwanie i analiza literatury G. Funds collection zebranie funduszy Summary Background. The study has shown that functional liver disorders develop in patients with MI, which requires correction. Material and methods. The study involved 149 patients with acute MI. All examinations were repeated several times on the 1, 14 and 28 day of the treatment. Results. The patients with functional liver disorders have a higher incidence of epistenocardial pericarditis, arrhythmia and systolic dysfunction. They are characterised by highly activated lipid peroxidation and immunological disorders. A combined therapy with quercetin resulted in improving hemodynamics and reducing the manifestations of liver dysfunction. RNAcontaining drug significantly improved the immune status and reduced signs of immunoinflammatory syndromes. Conclusions. 1.In patients with MI and functional liver disorders, the primary pathological process is characterised by significant violations of systolic and diastolic function of the heart, more frequent development of complications, activation of lipid peroxidation and secondary immunodeficiency. 2. The inclusion of bioflavonoid quercetin in the treatment of patients with MI helps to restore the antioxidant defence system, improve myocardial contractile function and reduce clinical laboratory manifestations of cytolytic and cholestatic syndromes in patients due to antioxidant and membrane stabilizing properties of the drug. 3. The usage of the RNA-containing drug Nuclex improves immune reactivity, reduces symptoms of expressed mesenchymal-inflammatory and necro-resorptive syndromes in patients with MI and functional liver disorders.
SummaryBackground. The recent epidemiological studies have shown that serum uric acid (SUA) is a risk factor for cardiovascular diseases and a negative prognostic marker for mortality in subjects with pre-existing heart failure. Material and methods. 147 patients, (59.2±0.8) years old, with postinfarction cardiosclerosis were included in this study. An evaluation of cardiohemodynamics, heart rhythm disturbances, lipid and purine metabolism's violation and systemic inflammation was performed before treatment and six months afterwards. Results. An elevated SUA level was associated with the progression of postinfarction heart remodeling. Heterogenity of ventricular repolarization, decrease of heart rate variability, as well as high grade premature ventricular complexes were observed in these patients. Complex treatment with eprosartan provided a significant regress of left ventricle hypertrophy, achievement of target blood pressure levels, complete recovery from ventricular tachycardia, prevention of new-onset of atrial fibrillation. The use of fenofibrate resulted in reducing of total cholesterol, triglycerides, low density lipoproteins, SUA and main markers of systemic inflammation as well as an increase high density lipoproteins. Conclusions. The use of eprosartan and fenofibrate is an optimized upstream strategy for managing patients with postinfarction cardiosclerosis associated with hyperuricemia Keywords: postinfarction cardiosclerosis, hyperuricemia, inflammatory biomarkers Streszczenie Wprowadzenie. Ostatnie badania epidemiologiczne wykazały, że stężenie kwasu moczowego w surowicy krwi (SUA) jest czynnikiem ryzyka chorób sercowo-naczyniowych i stanowi ujemny wskaźnik prognostyczny przy klasyfikacji niewydolności serca i określania ryzyka śmiertelności. Materiał i metody. W badaniu uczestniczyło 147 pacjentów, (59,2 ± 0,8) lat, z zespołem stwardnienia kłębków poinfekcyjnych pozawałowych. Badania zostały przeprowadzone w dwóch etapach. W etapie pierwszym przeprowadzono ocenę parametrów hemodynamicznych, zaburzeń rytmu serca, pogorszenia metabolizmu lipidów i puryn oraz zapaleń ogólnoustrojowych przed leczeniem. Etap drugi obejmował ten sam układ badań sześć miesięcy później po zastosowaniu leczenia eprosartanem i fenofibratem. Wyniki. Podwyższony poziom SUA ma ścisły związek z progresją przebudowy lewej komory serca. Zaobserwowano nierówność repolaryzacji komórkowej, spadek zmienności rytmu serca, a także wysokiej jakości przedwczesne kompleksy komorowe. W wyniku leczenia eprosartanem uzyskano istotne zmniejszenie przerostu lewej komory, docelowy poziom ciśnienia krwi, całkowite ustąpienie częstoskurczów komorowych. Leczenie eprosartanem zapobiegło również ponownemu pojawieniu się migotania przedsionków. Natomiast leczenie Fenofibratem spowodowało zmniejszenie poziomu cholesterolu całkowitego, trójglicerydów, lipoprotein o małej gęstości, SUA i głównych markerów zapaleń układowych, uzyskano natomiast zwiększenie poziomu lipoprotein o wysokiej gęstości. Wnioski. Stosowanie eprosartanu i fenofibratu stanowi zo...
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