[Assessment of no-reflow phenomenon in patients with acute ST-elevation myocardial infarction]. / Otsenka fenomena 'no-reflow' u patsientov s ostrym infarktom miokarda s pod''emom segmenta ST.

BACKGROUND: The problems concerning assessment of the state of myocardial perfusion in patients with acute ST elevation myocardial infarction after successful revascularization still remain of current importance. Contrast-enhanced echocardiography remains the least studied and most promising ultrasound technology for the diagnosis of the no-reflow phenomenon. AIM: The study was aimed at evaluating echocardiographic and angiographic characteristics of the no-reflow phenomenon detected by means of contrast-enhanced echocardiography in patients with ST-segment elevation myocardial infarction. PATIENTS AND METHODS: The study included a total of forty-three 40-to-82-year-old patients in acute period of myocardial infarction. The patients were divided into two groups: 32 patients with satisfactory myocardial reperfusion after revascularization according to the findings of contrast-enhanced echocardiography and 11 patients with impaired perfusion. RESULTS: The patients in the group with impaired perfusion demonstrated a greater size of the left ventricular (LV) asynergy (40.1±2.2% vs 27.4±8.5%, p<0.001), more frequent LV dilatation (LV end-systolic volume 67.3±20.3 ml vs 51.8±17.2 ml, p=0.015), decreased LV contractility (LV ejection fraction 39.5±3.4% vs 47.2±4.9%, p < 0.001), and significant mitral regurgitation (45.5% vs 3.1%, p=0.011) with a decrease in DP/DT (979.9±363.4 mmHg/s vs 1565.7±502.8 mmHg/s, p<0.001) were more often detected in this group. Coronary angiography showed no perfusion disorders after revascularization in more than a quarter of these patients. In the group with impaired perfusion, more frequently revealed were single-vascular lesions (46.9% vs 9.1%, p=0.033), lesions of the anterior interventricular artery (90.9% vs 40.6%, p=0.004), and acute occlusion (100% vs 68.8%, p=0.043); compliance by the SYNTAX score in this group was higher (18.9±3.7 vs 9.9±5.7, p<0.001). CONCLUSION: In patients with acute myocardial infarction after successfully performed revascularization, perfusion disorders revealed by the findings of contrast-enhanced echocardiography were accompanied by more pronounced echo signs of left-ventricular dysfunction, higher values of the SYNTAX score and significantly more frequently revealed lesions of the anterior interventricular septum as compared with the patients with recovered perfusion.

[Chronic Mitral Regurgitation in Postmyocardial Infarction Patients: Gender Differences].

There are two mechanisms of mitral regurgitation formation in postmyocardial infarction patients: local myocardial remodeling with changing of mitral chord tethering, and global myocardial remodeling with dilatation of mitral ring. Analysis of data of the "Register of provided coronary angiography" showed that the first mechanism in preponderant in men, and the second - in women. Factors found to be associated with chronic moderate and pronounced mitral regurgitation in men and women after myocardial infarction are presented in this article.

[Factors associated with mitral regurgitation in patients with coronary artery disease in the absence of myocardial infarction].

It is known that not only postinfarction left ventricular (LV) remodeling but also chronic regional myocardial hypoperfusion may cause a compensatory hypertrophy of undamaged areas of the left ventricle. Can chronic LV hypoperfusion lead to the development of mitral regurgitation (MR) in CAD patients without previous myocardial infarction We selected patients with significant coronary stenosis (>75%) of at least one epicardial artery who had no acute or previous myocardial infarction: 1162 patients without MR and 76 patients with moderate and severe MR. Patients with MR more often had higher NYHA functional class (II-IV) (91.7 vs 63.0%, p =0.004) and arrhythmias (60.3 vs 14.6%, p<0.001). They also had significantly higher echocardiographic indices of left atrial dimension (23.5+/-2.9 vs. 20.3+/-2.1 mm/m2). MR was independently associated with NYHA class of congestive heart failure, arrhythmias, and index of the left atrium size. No association between MR and the localization of significant coronary lesions was found.

[Mitral regurgitation and coronary stenosis in postmyocardial infarction patients].

The results of investigations devoted to relationship of mitral regurgitation (MR) and scars are contradictive, data on relationship of MR and localization of coronary lesions are few. Purpose. To determinate relationship of moderate or severe MR to localization of coronary stenosis in postmyocardial infarction patients. Methods. There were 1167 patients with no MR and 403 patients with moderate or severe MR. Results. Patients with MR had more severe New York Heart Association (NYHA) functional class (III-IV) (35.5 vs. 11.2%). Echocardiographic indices of left atrial dimension (23.5+/-2.9 vs. 20.3+/-2.1 mm/m) and extent of left ventricular (LV) wall motion abnormalities (32.8+/-14.9 vs. 23.6+/-12.7%) were higher in patients with MR as well as reduced LV systolic function (LV ejection fraction <50% - 63.7 vs. 25.6%) and LV dilatation (63.3 vs. 19.9%, all p<0.001). Rates of multivessel coronary artery involvement (three or more arteries) (27.5 vs. 18.3%, p=0.001), lesions in left main coronary artery (7.2 vs. 1.1%), circumflex (36.2 vs. 26.7), and right coronary artery (57.3 vs. 44.9%) were higher in patients with MR (all p<0.001). According to results of multivariate analysis MR was independently associated with LV dilatation, NYHA class of congestive heart failure, index of left atrial size, and extent of LV wall motion abnormalities. Moderate or severe chronic MR was not related to localization of coronary stenosis in these patients.

[Parameters associated with absence of significant coronary atherosclerosis by data of register of provided coronary angiography].

AIM OF THE STUDY: The study aimed to reveal the sign of coronary atherosclerosis absence using the factor analysis in patients referred for the coronary angiography. PATIENTS AND METHODS: 9409 patients suspected stable coronary artery disease (CAD) or with confirmed diagnosis of CAD from the "Registry of provided coronary angiography" were included in the study. RESULTS OF THE STUDY: Principal factor described about 59% of the variation and included the burdens of 4 parameters (gender, smoking, significant coronary atherosclerosis and hypothyroidism) and was interpreted as factor of coronary atherosclerosis. CONCLUSIONS: It was found that the absence of coronary stenosis was associated with female gender, non-smoking status and hypothyroidism.

[Predictors of hemodynamically significant coronary stenoses in patients with disturbed myocardial perfusion based on the results of single-photon emission computed tomography].

Patients with positive results of single-photon emission CT (SPECT) were examined to identify parameters indicative of hemodynamically significant coronary stenosis (HSCS) prior to coronaroangiography (CAG). 47 of the 84 patients (mean age 49.1 +/- 8.7 yr, 71% men) had positive results of SPECT. Patients with HSCS more frequently experienced acute myocardial infarction (37.1% vs 6.5%. p = 0.005) and circulatory failure (II-IV functional class NYHA) (92.3% vs 51.6%, p = 0.026). Also, they had higher blood glucose levels (6.9 +/- 2.5 vs 5.3 +/- 0.8 mmol/l, p = 0.007). The echocardiographic study more frequently revealed the 50% impairment of left ventricular function in these patients (17.4 vs 7.4%, p = 0.001), reduced ejection fraction (59.6 +/- 8.9 vs 48.9 +/- 10.5%), greater LV size and asynergia (20.8 +/- 18.0 vs 2.0 +/- 5.5% and 1.4 +/- 0.3 vs 1.0 +/- 0.1%), more pronounced mitral insufficiency (81.3 +/- 59.4%, p = 0.026). Only these patients had post-infarctional changes in myocardium (31.3%. p = 0.001). Discrimination analysis revealed independent association of HSCS with LV asynergia and mitral regurgitation. These echocardiographic parameters may be regarded as predictors of HSCS in patients with suspected CHD and positive results of SPECT.

[Thyroid hypofunction as a predictor of the absence of clinically significant coronary stenosis in elderly patients with coronary heart disease and typical stable angina].

The aim of the work was to determine predictors of the absence of hemodynamically significant coronary stenosis (HCS) in elderly patients with coronary heart disease (CHD) and typical stable angina. We compared the results of coronary angiography performed in Tyumen Cardiological Centre in 1998-2010 in CHD patients presenting with typical stable angina with and without HSC at the age of above and below 65 yr (n = 100 and 958 respectively). Women comprised 61.0 and 44.5% of the elderly and younger patients respectively, with 18.8 and 33.4% having inherited risk of CHD (p < 0.001). Angina of effort (I-III FC) was documented in 87.9% of the elderly patients compared with 77.6% among the younger ones (p = 0.018), FC III circulatory insufficiency (NYHA) in 24.0 vs 10.0% (p < 0.001), compensated thyroid hypofunction in 41.6 vs 28.0% (p = 0.010), history of myocardial infarction in 15.0 vs 25.9% (p = 0.016). Results of echocardiography suggest higher indices of linear heart dimension including those of aortic root and left auricle (19.2 +/- -2.5 vs 17. +/- -2.2 mm and 2. +/- -2.7 vs 21. +/- -2.4 mm; p < 0.001). Elderly patients more frequently showed echocardiographic signs of atheroscleotic lesions of aorta (92.8 vs 60.6%; p < 0.001) and valvular pathology including aortic stenosis (9.2 vs 2.9%; p= 0.001). The study revealed the independent relationship of aortic stenosis, thyroid hypofunction, echocardiac signs of aortic atherosclerosis, enlarged left auricle and aortic root, and previous myocardial infarction with the age of patients with CHD and typical stable angina without HCS.