Оцінка механічної диссинхронії міокарду у хворих з різними формами коронарної хвороби серця, яким проводилась реваскуляризація

Abstract

The purpose of the study was to determine the presence of mechanical dyssynchrony of the myocardium in patients with various clinical variants of coronary heart disease undergoing revascularization. Materials and methods. 137 patients (106 men and 31 women, aged from 31 to 81 years) took part in the study, including 121 patients with coronary heart disease who underwent a revascularization procedure. Results and discussion. The frequency of detection of mechanical dyssynchrony of the myocardium is significantly higher in patients with coronary heart disease compared to patients without coronary heart disease who underwent revascularization (41.3% vs. 6.2%, respectively). Aortic transit time was significantly and significantly greater in the group of patients with coronary heart disease compared to patients without coronary heart disease, while pulmonary transit time was the same in the comparison groups. Accordingly, this caused a significant difference in interventricular mechanical delay. Left ventricular filling time was significantly shorter in the group of patients with coronary heart disease and, conversely, left ventricular ejection time was shorter in the group of patients without coronary heart disease. The study showed a significant increase in the frequency of myocardial dyssynchrony in patients with coronary heart disease who underwent revascularization, which creates conditions for studying the prognostic value in relation to the clinical results of revascularization. The time of advancement to the aorta was significantly and reliably longer in the group of patients with coronary heart disease compared to patients without coronary heart disease, while the time of advancement to the pulmonary artery was the same in the comparison groups, which caused a significant difference in the interventricular mechanical delay and confirms dependence of the development of myocardial dyssynchrony on the localization of the coronary artery lesion. Conclusion. Indicators of diastolic dysfunction of the left ventricular myocardium, although there was a tendency for a difference between the group of patients with coronary heart disease and the comparison group, this tendency was unreliable, which demonstrated their later change in relation to the indicators of myocardial dyssynchrony. The data obtained by us confirm the greater informativeness of mechanical dyssynchrony of the left ventricle indicators in comparison with indicators that characterize diastolic function and their earlier changes in patients with coronary heart disease. In turn, early detection and treatment of mechanical dyssynchrony of the left ventricle can delay the onset of left ventricular dysfunction in patients with coronary heart disease