ECHOCARDIOGRAPHIC ASPECTS OF ASSESSMENT OF MITRAL INSUFFICIENCY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITH REDUCED LEFT VENTRICULAR EJECTION FRACTION.

OBJECTIVE: The aim is to analyze patients with acute myocardial infarction with reduced ejection fraction in order to determine risk factors for mitral insufficiency. PATIENTS AND METHODS: Materials and methods: The study included 149 patients with acute myocardial infarction. Among the patients, there were 113 males (75.8%) and 36 females (24.2%). The age of the patients ranged from 43 to 86 years. Echocardiography was performed using a Phillips Epiq 7 machine. Patients were examined three times: upon admission to the hospital, after revascularization, and six months after discharge. Patients received transthoracic echocardiography, which was used to determine the presence and degree of mitral regurgitation. RESULTS: Results: According to the results of the study, it was found that the presence of concomitant somatic pathology worsens the course of an acute myocardial infarction, in turn increasing the likelihood of valvular pathology. An increase in left ventricular volume indicators, such as end-diastolic volume, end-systolic volume, end-diastolic index, and the index of contractile function (ejection fraction) contributes to the development of mitral valve insufficiency. CONCLUSION: Conclusions: The presence of mitral regurgitation in patients with acute myocardial infarction and reduced left ventricular ejection fraction worsens the course of the disease and negatively affects the prognosis.

RESOURCES OF CARDIOLOGICAL CARE (ON THE EXAMPLE OF THE KYIV REGION OF UKRAINE).

OBJECTIVE: The aim: To analyze the network, resources of outpatient clinics in the Kyiv region (Ukraine) that provide cardiac care. PATIENTS AND METHODS: Materials and methods: With the help of the medical - statistical method the analysis of the network of outpatient clinics of the Kyiv region which render cardiological medical care and their resources in dynamics from 1995 to 2019 was carried out. During the analysis the methods of statisticalgrouping, compilation, generalization, statisticalcomparisonwere used. The materials for the analysis were the data of reporting statistical forms № 20 "Report of the treatment and prevention institution" and form № 17 "Report on medical staff" of the Kyiv region individual institutions and districts, as well as statistical directories of the information-analytical center. CONCLUSION: Conclusions: On the basis of the analysis of the network, resources and activity of outpatient clinics of the Kyiv region that provide cardiac care the existing problems of this type of care were revealed. The provision of cardiac diagnostic tests over five years did not change, which is proved by analysis made. It is established that at the present stage of providing high-quality and affordable cardiac medical services within the existing system of cardiac outpatient care to the population of the Kyiv region has great difficulties and needs to be solved.

ASSOCIATION OF FRACTIONAL FLOW RESERVE WITH CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH STABLE CORONARY ARTERY DISEASE.

OBJECTIVE: The aim: To identify clinical and angiographic factors, associated with fractional flow reserve (FFR), in stable coronary artery disease (CAD) patients. PATIENTS AND METHODS: Materials and methods: The study consecutively enrolled 68 patients with stable CAD (mean age (63±8,0) ys) and angiographically intermediate coronary lesions (diameter stenosis 50-90 %), with FFR assessment. Stable angina of CCS classes II and III was diagnosed in 42 (62 %) and 15 (22 %) patients, respectively; left ventricular hypertrophy (LVH) - 27 (40 %); severe coronary stenosis (SCS) (70-90 %) - 46 (68 %). The overall CAD complexity was assessed by SYNTAX score. FFR «negative¼ group (FFRNEG) included the patients with non-significant FFRs (>0,80) (n=28 [41 %]). In case of at least one significant FFR (≤0,80), a patient was assigned to FFR «positive¼ group (FFRPOS) (n=40 [59 %]). RESULTS: Results: FFRPOS (vs. FFRNEG, respectively) was characterized by the higher frequency of angina class III (32 % vs. 7 %; p<0,001), LVH (53 % vs. 21 %; p=0,010) and SCS (98 % vs. 25 %; p<0,001). The SYNTAX score was strongly associated with FFR ≤0,70 and ≤0,65, and moderately - with FFR ≤0,65. CONCLUSION: Conclusions: In patients with stable CAD and intermediate coronary artery stenosis, the presence of at least one functionally significant lesion (FFR ≤0,80) was associated with the higher prevalence of angina class III, LVH and more advanced coronary stenosis (≥70 %). The greater overall CAD complexity increased the probability for the angiographically significant coronary lesions to be more functionally compromised.

Extracorporeal Membrane Oxygenation during Percutaneous Coronary Intervention in Patients with Coronary Heart Disease.

Extracorporeal membrane oxygenation (ECMO) has become an effective method in the treatment of adults and children with severe cardiac and pulmonary dysfunction that is resistant to conventional therapy. The aim of this article was to summarize an experience of ECMO usage for cardiac dysfunction, which develops in patients with coronary heart disease (CHD) during percutaneous transluminal coronary angioplasty. The study comprised a retrospective, single-center analysis of 23 patients with CHD (19 men and four women, average age 65.7 ± 12.3 years), who undertook the ECMO technique during percutaneous transluminal coronary angioplasty. A total of 13 (56.52%) patients died directly in the hospital, or 30 days after a discharge. Independent predictors of fatal outcomes were diabetes mellitus (odds ratio [OR] = 17.58; 95% confidence interval [CI] = 6.47-47.48; p = .00125), chronic renal failure (CRF) (OR = 20.81; 95% CI = 5.95-72.21; p = .00014), and damage to the right coronary artery (RCA) (OR = 25.51; 95% CI = 8.27-79.12; p = .00013). For deceased patients, the "no reflow" phenomenon was indicated in a larger percentage of cases (23.1% in the group of deceased, vs. 10% in the group of survivors). A routine connection to ECMO before the occurrence of cardiac events was significantly more often used in the group of survived patients (90% of cases) than in the deceased (p = .0000001). Diabetes mellitus, CRF, and damage to the RCA were independent predictors of mortality during percutaneous transluminal coronary angioplasty in patients with CHD. The routine use of ECMO in high-risk patients with percutaneous transluminal coronary angioplasty was a positive prognostic factor of patient survival.