Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation.

AIM: To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. RESULTS: We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002). CONCLUSIONS: The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

[Time course of changes in left ventricular twist in the presence of idiopathic left bundle branch block during exercise testing]. / Dinamika skruchivaniia levogo zheludochka pri idiopaticheskoi blokade levoi nozhki puchka Gisa vo vremia nagruzochnoi proby.

AIM: To investigate left ventricular (LV) deformation properties, rotation, and twist during a bicycle ergometer exercise test among patients with idiopathic left bundle branch block (LBBB). SUBJECTS AND METHODS: Thirty-four patients with idiopathic LBBB having a mean QRS duration of 153±24 msec were examined. A control group included 18 apparently healthy volunteers. All the patients and apparently healthy individuals underwent echocardiography to determine LV hemodynamic parameters, deformity, rotation and twist at rest and after exercise test. RESULTS: As compared with the control, the idiopathic LBBB group at rest showed decreases in LV global longitudinal deformity (-15.6±4.7 and -18.4±3.1%, respectively; p=0.037), apical rotation (4.59±4.2° and 8.99±3.68°; p=0.0067) and twist (9.08±4.59° and 13.96±4.61°; p=0.0156), whereas there were no differences in LV ejection fraction and end-systolic and end-diastolic volumes. After exercise testing there were no augmentations in basal and apical rotation and resulting ΔTwist in the idiopathic LBBB group compared with the control (-2.05±8.35 and 4.66±8.49%; p=0.0463). The described changes in LV rotation and twist during exercise testing occurred in the presence of elevated pulmonary artery systolic pressure (PASP) in the LBBB group compared with the control (41.6±3.81 and 32.4±3.81 mm Hg, respectively; p=0.0201). CONCLUSION: Decreases in LV basal, apical and resulting twist may lead to elevated PASP in patients with idiopathic LBBB during exercise.

[LEFT HIS BUNDLE BRANCH BLOCK ASSOCIATED WITH LEFT VENTRICULAR TORSION AND REDUCED EJECTION FRACTION].

The influence of left His bundle branch block (LBBB) on left ventricular (LV) torsion in patients with cardiomyopathy remains to be elucidated. The aim of this study was to evaluate LV torsion associated with LBBB and hemodynamic consequences of possible changes. We studied 64 patients with ischemic and dilatation cardiomyopathy (LV ejection fraction less than 40%) divided into 2 groups, with narrow and middle (153 ms) duration QRS complexes. Despite similar LV contractility, patients with LBBB had much less pronounced LV rotation and torsion. Torsion in patients with LBBB and narrow QRS complex was estimated at 2.95 ± 3.34 and 5.87 ± 3.83 respectively (p < 0.01). Moreover; the group of patients with LBBB contained much more subjects with abnormal unidirectional rotation of the basal and apical parts than the group with narrow QRS complex, namely 11 (50%) and 9 (21.9%) respectively (p < 0.001). Patients with LBBB and abnormal LV rotation sowed much longer delay of posterior wall contractility (63.3 ± 35.1 mc) compared with those having LBBB and multidirectional physiological LV rotation (8.0 ± 17/9 mc) (p < 0.001) which suggests a higher degree of mechanical desynchronization. T is concluded that LBBB has negative effect on LV electrical activation and contractility resulting in abnormal torsion and mechanical desynchronization.

Initiation of stress protein synthesis in the myocardium of coronary patients.

We studied myocardial biopsy specimens from the right atrium of cardiological patients with different degree of cardiac ischemia obtained during surgery. No inducible HSP70 stress proteins were detected in atrial cardiomyocytes of patients with the WPW syndrome without signs of ischemic injuries of the heart. These proteins were detected in the myocardium of coronary patients. Their expression was more intense in patients with coronary disease paralleled by the development of myocardial dyskinesia. Two-dimensional electrophoresis showed only acid HSP70 but no alkaline isoforms in coronary patients even with pronounced dyskinesia. Presumably, alkaline HSP70 isoforms are present in the myocardium directly involved in the dyskinesia zone.