ABSTRACT
AIM: To study special characteristics and prognostic value of cardiac remodeling in patients with unstable angina (UA). MATERIAL: Throughout 2 years we performed repetitive echocardiographic examinations of 166 patients with Braunwald class IB and IIB-IIIB UA for assessment of left ventricular (LV) structural-functional changes. RESULTS: More severe form of remodeling (eccentric hypertrophy) was significantly more frequent in patients with IIB-IIB class UA. However in IB class UA during first year after episode of UA we noted rapid progression of remodeling mainly at the account of transition from concentric hypertrophy. Tissue Doppler study revealed more severe type of diastolic dysfunction (type 2 - pseudonormalization) in patients with class IIB-IIIB UA. Changes of some echocardiographic parameters correlated with severity of subsequent remodeling of the heart, development of chronic heart failure (CHF), myocardial infarction, and recurrent episodes of UA. In UA rate of unfavorable outcomes was related to degree of ischemic myocardial remodeling. We established a number of early EchoCG markers of LV remodeling increases of endsystolic dimension and volume, myocardial stress, lowering of ratios of diastolic peaks of filling and relaxation (/ and E`/A`) - preceding the development of systolic, diastolic dysfunction and CHF. IMPLICATION: The use of complex therapy with acetylsalicylic acid in patients with UA, perindopril, nebivolol and simvastatin is justified for prevention LV remodeling and lowering of rate of acute ischemia recurrence and CHF development.
Subject(s)
Angina, Unstable , Aspirin/therapeutic use , Benzopyrans/therapeutic use , Ethanolamines/therapeutic use , Heart Failure/prevention & control , Perindopril/therapeutic use , Simvastatin/therapeutic use , Ventricular Remodeling/drug effects , Aged , Angina, Unstable/complications , Angina, Unstable/drug therapy , Angina, Unstable/physiopathology , Cardiovascular Agents/therapeutic use , Disease Progression , Drug Therapy, Combination , Echocardiography, Doppler/methods , Female , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Male , Middle Aged , Nebivolol , Outcome Assessment, Health Care , Platelet Aggregation Inhibitors/therapeutic use , Prognosis , Severity of Illness Index , Time FactorsABSTRACT
This 2-year comparative study of EchoCG data dynamics included 230 CHD patients after primary non-Q-wave myocardial infarction of whom 76 were treated with A CE inhibitor perindopril throughout the study period (group 1) and 72 with perindopril and carvedilol (non-selective alpha-1, beta-1,2 adrenergic receptor blocker) (group 2). The control group was comprised of 82 patients that could not use either medicine for a variety of reasons. These patients developed signs of post-infarction left ventricular remodeling (enhanced MS and LVMM index, left ventricular spherization, cavity enlargement, systolic and diastolic LF dysfunction). Combined therapy arrested the remodeling process within 12 months after onset, reduced systolic MS, and promoted the tendency toward restoration of the LV geometric shape, size, diastolic and systolic function.