Study of factors that affect clinical prognosis and heart remodeling in patients with myocardium infarction with ST segment elevation in remote period

Authors

  • Vira Tseluyko Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176, Ukraine
  • Natalia Mishchuk Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176, Ukraine https://orcid.org/0000-0002-9862-4756
  • Olga Matuzok Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176, Ukraine https://orcid.org/0000-0002-6016-3325

DOI:

https://doi.org/10.15587/2519-4798.2017.116676

Keywords:

Myocardium infarction, thrombolytic therapy, prognosis, end points, remodeling of the left ventricle

Abstract

Aim. To determine factors, connected with the unfavorable prognosis of patients with myocardium infarction (MI) with ST element elevation, who underwent the thrombolytic therapy (TLT).

Materials and methods. There were examined 100 patients with MI with ST segment elevation, who underwent TLT, admitted at hospital during the first 6 hours of the disease. The average time of TLT was 154±75,56 minutes, TLT was realized at the pre-hospital stage in 35(38,5 %) patients.

Blood samples for determining biochemical parameters, especially asymmetric dimethylarginine (ADMA) and high-sensitive C-reactive protein (CRP), were taken at admission at hospital. ADMA level was determined using the high-effective liquid chromatography, the level of high-sensitive CRP – by the immunoturbdiametric analysis. For determining the allele condition of T786C polymorphism of the gene of endothelial NO synthase (eNOS), there was used polymerase chain reaction. All patients underwent echocardioscopy (EchoCS).  

Patients were examined repeatedly in 1 year. The information as to undesirable clinical events was accessible in 91 persons, 60 patients underwent the repeated EchoCS.

Results. Undesirable clinical events took part in 13 (14,3 %) of 91 patients. Among patients, who underwent undesirable events, reliably more patients had the previous localization of MI (39,7 % and 76,9 %, respectively, р=0,03). They had also the more heart rate for the second day of the disease (71,01±12,38 st/min and 77,36±7,84 st/min, respectively, p=0,045). The reliably more part of patients from this group had angina before the development of the current MI - 1 (1,3 %) and 3 ( 23,1 %), respectively, р=0,009. Patients, who had undergone undesirable events, had the reliably higher level of the high-sensitive CRP at admission to hospital (37,47±28,08 against 11,70±12,21in І group, р=0,006). The regression analysis established that the increase of the risk of undesirable events by 9,9 % is connected with angina before MI, by 7,3 % with the previous MI localization, by 5,6 % with the decrease of the emission fraction (EF) in the acute period of MI, by 5,1 % with the increase of the level of the high-sensitive CRP, by 5,1 % with the decrease of smoking length, and by 5,1 % with female sex.

The left ventricle (LV) remodeling (increment of the end diastolic volume (EDV) over 20 % comparing with the results of the first EchCS) was observed in 13 (21,7 %) of 60 examined persons. It was revealed, that patients with the further development of LV remodeling had better parameters of the intracardiac hemodynamics in the acute period of MI – less values of LV EDV (р=0,028), LV end systolic volume (ESV) (р=0,049), LV myocardium mass (р=0,031). At the analysis of laboratory data, it was revealed, that these patients had the reliably higher level of the high-sensitive CRP and ADMA. The method of regression analysis demonstrated that the increase of the risk of LV remodeling is connected with the less size of the left atrium by 12,5 % and by 9,1 % - with the less MMLV in the acute MI period, by 5,9 % with smoking at the moment of MI, by 5,1 % with the increase of the level of high-sensitive CRP, by 4,7 % with angina before MI, by 4,6 % with the previous MI localization.

Conclusions. The risk of clinical undesirable events and LV remodeling in patients with MI with ST segment elevation depends on their anamnesis, infarction localization and clinical course of the disease and also on several biochemical indices

Author Biographies

Vira Tseluyko, Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176

MD, Professor, Honored Worker of Science and Technology of Ukraine, Head of Department

Department of Cardiology and Functional Diagnostics 

Natalia Mishchuk, Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176

PhD, Associate Professor

Department of Cardiology and Functional Diagnostics 

Olga Matuzok, Kharkiv Medical Academy of Postgraduate Education Amosova str., 58, Kharkiv, Ukraine, 61176

Postgraduate student

Department of Cardiology and Functional Diagnostics 

References

  1. Terenda, N. O. (2015). Tendentsiy ta prohnoz poshyrenosti stenokardiy ta infarktu miokarda v Ukraini. Visnyk sotsialnoi hihiyeny ta orhanizatsiy okhorony zdorovia Ukrainy, 3, 35–40.
  2. Handziuk, V. A. (2014). Analiz zakhvoriuvanosti na ishemichnu khvorobu sertsia v Ukraini. Ukrainskyi kardiolohichnyi zhurnal, 3, 45–52.
  3. Valuieva, S. V. (2013). Ukrainskyi reiestr STIMUL: efektyvnist riznykh metodiv likuvannia hostrykh koronarnykh syndromiv z elevatsiyeiu sehmenta ST ta prykhylnist khvorykh do likuvannia v postinfarktnyi period (rezultaty odnorichnoho sposterezhennia). Semeynaya medicina, 1, 27–32.
  4. Zharinov, O. Y. (2010). Sertseva nedostatnist zi zberezhenoiu fraktsiieiu vykydu livoho shlunochka. Novosti mediciny i farmacii, 338. Availale at: http://www.mif-ua.com/archive/article/15023
  5. Galli, A., Lombardi, F. (2016). Postinfarct Left Ventricular Remodelling: A Prevailing Cause of Heart Failure. Cardiology Research and Practice, 2016, 1–12. doi: 10.1155/2016/2579832
  6. Fraccarollo, D., Galuppo, P., Bauersachs, J. (2012). Novel therapeutic approaches to post-infarction remodelling. Cardiovascular Research, 94 (2), 293–303. doi: 10.1093/cvr/cvs109
  7. Parhomenko, A. N., Lutay, Ya. M., Irkin, O. I. et. al. (2014). Kliniko-prognosticheskoe znachenie polimorfizma gena ehndotelial'noy NO-sintetazy u bol'nyh s ostrymi koronarnymi sindromami. Medicina neotlozhnyh sostoyaniy, 3 (58), 45–54.
  8. Tseluiko, V. Y., Yakovleva, L. M., Matuzok, O. E. (2017). Zviazok asymetrychnoho dymetylarhininu z klinichnymy, laboratornymy ta ultrazvukovymy pokaznykamy u khvorykh z infarktom miokarda, yakym provedeno trombolitychnu terapiyu. UKZh, 5, 42–49.
  9. Steg, P. G., James, S. K., Atar, D., Badano, L. P., Lundqvist, C. B. et. al. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal, 33 (20), 2569–2619. doi: 10.1093/eurheartj/ehs215
  10. Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta medychnoi reabilitats (2014). Ministerstvo okhorony zdorovia Ukrainy, No. 455. Available at: http://www.moz.gov.ua/docfiles/dod455_ukp_2014.pdf
  11. Teerlink, T., Nijveldt, R. J., de Jong, S., van Leeuwen, P. A. M. (2002). Determination of Arginine, Asymmetric Dimethylarginine, and Symmetric Dimethylarginine in Human Plasma and Other Biological Samples by High-Performance Liquid Chromatography. Analytical Biochemistry, 303 (2), 131–137. doi: 10.1006/abio.2001.5575
  12. Lieb, W., Gona, P., Larson, M. G., Aragam, J., Zile, M. R., Cheng, S. et. al. (2014). The Natural History of Left Ventricular Geometry in the Community. JACC: Cardiovascular Imaging, 7 (9), 870–878. doi: 10.1016/j.jcmg.2014.05.008
  13. Verma, A., Meris, A., Skali, H., Ghali, J. K., Arnold, J. M. O., Bourgoun, M. et. al. (2008). Prognostic Implications of Left Ventricular Mass and Geometry Following Myocardial Infarction. JACC: Cardiovascular Imaging, 1 (5), 582–591. doi: 10.1016/j.jcmg.2008.05.012
  14. Farah, E., Fusco, D. R., Okumoto, P. R. R., Minicucci, M. F., Azevedo, P. S., Matsubara, B. B. et. al. (2013). Impact of Ventricular Geometric Pattern on Cardiac Remodeling after Myocardial Infarction. Arquivos Brasileiros de Cardiologia, 100 (6), 518–523. doi: 10.5935/abc.20130104
  15. Pop, S., Hodaş, R., Benedek, E., Opincariu, D., Rat, N., Jani, L. et. al. (2016). Predictors of Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction. Journal of Interdisciplinary Medicine, 1 (1), 62–70. doi: 10.1515/jim-2016-0013
  16. Kim, J. A., Chun, E. J., Lee, M. S., Kim, K. J., Choi, S. I. (2013). Relationship between amount of cigarette smoking and coronary atherosclerosis on coronary CTA in asymptomatic individuals. The International Journal of Cardiovascular Imaging, 29 (S1), 21–28. doi: 10.1007/s10554-013-0224-8
  17. Arcari, L., Cimino, S., De Luca, L., Francone, M., Galea, N., Reali, M. et. al. (2015). Impact of Heart Rate on Myocardial Salvage in Timely Reperfused Patients with ST-Segment Elevation Myocardial Infarction: New Insights from Cardiovascular Magnetic Resonance. PLOS ONE, 10 (12), e0145495. doi: 10.1371/journal.pone.0145495
  18. Jensen, M. T., Pereira, M., Araujo, C., Malmivaara, A., Ferrieres, J., Degano, I. R. et. al. (2016). Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study. European Heart Journal: Acute Cardiovascular Care. doi: 10.1177/2048872616672077
  19. Seronde, M. F., Geha, R., Puymirat, E., Chaib, A., Simon, T., Berard, L. et. al. (2014). Discharge Heart Rate and Mortality after Acute Myocardial Infarction. The American Journal of Medicine, 127 (10), 954–962. doi: 10.1016/j.amjmed.2014.06.034
  20. Kosmidou, I., Redfors, B., Selker, H. P., Thiele, H., Patel, M. R., Udelson, J. E. et. al. (2017). Infarct size, left ventricular function, and prognosis in women compared to men after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: results from an individual patient-level pooled analysis of 10 randomized trials. European Heart Journal, 38 (21), 1656–1663. doi: 10.1093/eurheartj/ehx159
  21. Adukauskienė, D., Čiginskienė, A., Adukauskaitė, A., Pentiokinienė, D., Šlapikas, R., Čeponienė, I. (2016). Clinical relevance of high sensitivity C-reactive protein in cardiology. Medicina, 52 (1), 1–10. doi: 10.1016/j.medici.2015.12.001
  22. Mincu, R.-I., Jánosi, R. A., Vinereanu, D., Rassaf, T., Totzeck, M. (2017). Preprocedural C-Reactive Protein Predicts Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-elevation Myocardial Infarction a systematic meta-analysis. Scientific Reports, 7, 41530. doi: 10.1038/srep41530
  23. Anzai, T. (2013). Post-Infarction Inflammation and Left Ventricular Remodeling. Circulation Journal, 77 (3), 580–587. doi: 10.1253/circj.cj-13-0013
  24. Dibra, A. (2003). Predictive value of basal C-reactive protein levels for myocardial salvage in patients with acute myocardial infarction is dependent on the type of reperfusion treatment. European Heart Journal, 24 (12), 1128–1133. doi: 10.1016/s0195-668x(03)00200-8

Published

2017-11-30

How to Cite

Tseluyko, V., Mishchuk, N., & Matuzok, O. (2017). Study of factors that affect clinical prognosis and heart remodeling in patients with myocardium infarction with ST segment elevation in remote period. ScienceRise: Medical Science, (11 (19), 36–43. https://doi.org/10.15587/2519-4798.2017.116676

Issue

Section

Medical Science