The Contractive Function Peculiarities of the Heart in Men Under 60 Years Old With Myocardial Infarction and Acute Kidney Injury

Abstract

Relevance. The significance of changes in intracardiac hemodynamics during myocardial infarction for the acute kidney injury development is assessed in different ways. Aim. To evaluate the intracardiac hemodynamics features 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 - 168 patients. A comparative analysis of the left ventricular systolic and diastolic function indicators in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of their influence (ANOVA) on the risk of acute kidney injury development were performed. Results. In the first hours of the disease, the study group differed from the control group by the prevalence of end-diastolic values (164.3±48.0 and 145.7±56.2 (ml), respectively; p=0.04), left ventricular stroke volume (73.7±20.6 and 62.4±21.7 (ml); p=0.01) and its index (35.6±9.9 and 30.9±11.1 (ml/m2); p=0.04). At the end of the third disease week in the study group, compared with the control group, there was a lower level of the left ventricular early and late diastolic filling velocity relationship (0.76±0.12 and 0.91±0.35; p=0.01), lower dynamics of the stroke index (8.4%; p<0.0001 and 20.5%; p<0.0001) and left ventricular ejection fraction (14.6%; p<0.0001 and 20.4%; р<0.0001). The most significant risk markers of the acute kidney injury development were the levels of the left ventricular early and late diastolic filling velocity relationship1≤0.88, the end-diastolic volume index1≥72.2 ml/m2, stroke1≥64.4 ml and end systolic its volume1≥79.9 ml and its index1≥38.8 ml/m2. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by more left ventricular systolic dysfunction in the first hours of the disease, as well as its systolic and diastolic dysfunction at the end of its subacute period. The above values of the intracardiac hemodynamics parameters should be used during the high-risk groups’ formation for the acute kidney injury development, as well as for prognostic modeling.