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@#BACKGROUND: Acute myocardial infarction is leading cause of global morbidity and mortality and major health care burden in worldwide. Previous studies demonstrated that restoration of myocardial tissue perfusion after primary PCI is significant factor of improved outcome. In Mongolia, studying long term effects of primary PCI in patients with AMI and its’ association with coronary blood flow, tissue Doppler imaging, left ventricular global strain pattern in speckle-tracking echocardiography and risk factors are essential in theoretical and clinical practice. AIMS: To determine long term effects of primary PCI in patients with AMI and its’ association with left ventricular strain pattern in speckle-tracking echocardiography, risk factors and patient prognosis. METHODS: We used prospective cohort study design. We were selected 414 patients with AMI who treated by primary PCI between 2015 and 2016 at the State Third Central Hospital. Echocardiographic examination was conducted on Philips iE33 xMATRIX ultrasound machine. The PCI was performed according to the MNS:6379-2013 standard. RESULTS: Mean age was 60±13 and majority of them were male 84% (n=347). Complete coronary perfusion (TIMI-3) was achieved in patients 88% (n=367) after primary PCI. There was weak, negative correlation between coronary TIMI flow grade and left ventricular global longitudinal strain (r=-0.183, CI 95% -0.289 to-0.066, p<0.001). In patients with incomplete coronary perfusion (TIMI<3), mortality rate was significantly higher during 24 months follow-up. After primary PCI, 24 months mortality was 9.9% (n=39). Cut-off value of left ventricular global longitudinal strain which predict long term (within 24 month follow-up) mortality was -12.93% (sensitivity 74.4%, specificity 74.3%). Mortality during 24 months follow-up was significantly different between left ventricular global longitudinal strain groups (log-rank test p<0.001) and mortality was higher in left ventricular global longitudinal strain ≥ -12.93% group. CONCLUSION: Coronary no-reflow phenomenon is associated with long term mortality in patients with AMI. In patients with AMI who treated by PCI, long term mortality is predictable with left ventricular global longitudinal (≥-12.93%, p<0.001) strain.
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@#Article deals with age-related hypogonadism in men as an interdisciplinary problem. Current definition, prevalence, analyzes the relationship between age and the incidents of hypogonadism were shown. The detailed overview of clinical studies, meta analysis of causal link of androgen deficiency and erectile dysfunction, ischemic heart disease, arterial hypertension, dyslipidemia, and diabetes mellitus was presented. To date was found the relationship between metabolic syndrome and androgen deficiency. Low level of testosterone is closely connected with low libido as well as insulin resistance, abdominal obesity, dyslipidemia. Insulin resistance and hyperinsulinemia are noticed in patients with hypogonadism in comparison with obese and normal-weight patients. Therefore, metabolic risk factors are the connecting link of cardiovascular diseases and androgen deficiency. Meta-analysis of clinical trials of the effects of testosterone replacement therapy and safety of long term use was presented in the article. The article discusses the importance of a unified approach to the diagnosis and treatment of androgen-deficient conditions and cardiovascular disease.
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Introduction Coronary TIMI flow gradewas previously demonstrated to be related to outcome after acute myocardial infarction. However, the relationship between coronary flow grade and left ventricular global longitudinal strainin patients with acute myocardial infarction (AMI) treated by primary percutaneous intervention (PCI) were unclear. Goal In this study, we aimed to reveal the relationship between coronary TIMI flow grade and LV GLS in patients with AMI. Materials and Methods We prospectively selected patients with AMI who treated by primary PCI. Based on whether TIMI 3 flow achieved at the end of the procedure patients were divided into two groups. Group I (TIMI 3 flow was achieved, n=367), Group II (TIMI 3 flow was not achieved, n=47). The LV GLS was assessed by 2dimensional speckle-tracking echocardiography (2D STE). Results A total of 413 patients (mean age 60±13, 84% male) were included and TIMI 3 flow was achieved in 367 patients (88%). LV GLS was significantly impaired in patients who had TIMI 3 flow not achieved compared with TIMI 3 flow achieved group (-13.1±4.8% vs. -15.3±3.8%, p<0.001). Multiple linear regression analysis which included age, gender, clinical, biochemical and angiographic variables showed that coronary TIMI flow grade of culprit artery was independently associated with LV GLS. There was negative correlation between coronary TIMI flow grade and LV GLS (Pearson’s r=-0.183, p<0.001). Simple linear regression analysis revealed that coronary TIMI flow grade is directly associated with LV GLS (β=-1.61, p<0.001) and which indicated that every 1 scale increase of final coronary TIMI flow grade resulted -1.61% increase of LV GLS. Conclusion Our study demonstrated the coronary TIMI flow grade of the culprit artery was independently associated with LV GLSin patients with AMI treated by primary PCI.
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Background: Continuous positive airway pressure (CPAP) can improve left and right ventricular (LV and RV) func¬tion in patients with congestive heart failure (CHF). Material and Methods: We have chosen 30 patients with CHF who were treated in Department of Cardiology, Shastin’s Central hospital. CHF etiology was ischemic and dilatation cardiomyopathy. Baseline respiratory rate, SpO2, heart rate, systolic and diastolic blood pressure, cardiac output, ejection fraction and Tricuspid Annular Plane Systolic Excursion (TAPSE) values were noted. All the measurements were repeated at the end of CPAP. Statistical analysis: Statistical analysis performed by SPSS 17.0 program and we compared pre and post CPAP findings. P<0.05 was considered to be significant. Results: After CPAP patients respiratory rate decreased from 23.63±4.72 to 20±3.74 per minute (р=0.01), SpO2 increased from 91.25±4.1% to 98.25±1.16%, heart rate decreased from 86.75±8.28 to 77.38±7.35 per minute (p=0.05), systolic blood pressure decreased from 107.88±17.94 mmHg to 97.75±14.78 mmHg (p=0.01), diastolic blood pressure decreased from 81.13±17.16 mmHg to 73.38±15.89 mmHg (p=0.01), cardiac output increased from 5.57±1.55 l/min to 5.76±1.86 l/min (p=0.01), ejection fraction increased from 27.81±7.66% to 31.7±7.97% (p=0.05), TAPSE increased from 1.49±0.25 mm to 1.69±0.23 mm (p=0.01) respectively. Pearson’s coefficient between dia¬stolic blood pressure and cardiac output is -0.282, between diastolic blood pressure and ejection fraction is -0,493, between diastolic blood pressure and TAPSE is -0.581 respectively. Conclusion: CPAP improves LV, RV function and some respiratory parameters in patients with CHF