Влияние миокардиального станнинга на динамику показателей митральной регургитации и ремоделирования после перенесенного инфаркта миокарда

Abstract

Aim. To study the dynamics of mitral regurgitation depending on the results of low dose dobutaminestress-echocardiography with effectiveness of myocardial reperfusion and in patients after MI with STsegment elevation.Material and methods. The study included 302 patients with STeMI. All patients underwent myocardialreperfusion. Depending on the effectiveness of reperfusion, the patients were divided into 3 groups: group1 – 196 (65%) patients with successful reperfusion; group 2 – 76 (25%) patients with partial reperfusion,group 3 – 30 (10%) patients with no reperfusion. The indicators of systolic function, LV remodeling, mitralregurgitation at rest, under pharmacological load and after a month were studied. To determine the zoneof viable myocardium, stress echocardiography with low doses of dobutamine was used.Results. Indicators characterizing the severity of MR had a negative trend in patients of group 3, who showedan increase in ERO, PISA and vena contracta width. But in patients of the 1st and 2nd groups with the presence of myocardial stunning, an unreliable decrease in these indicators of the degree of MR was noted. Identification of viable zones by low-dose dobutamine stress echocardiography in areas of LV dysfunction preventsthe progression of MR and serious intracardiac hemodynamic disturbances and will also be reversible.Conclusion. The main mechanism in the progression of MR in patients after AMI is LV myocardial dysfunction with further LV remodeling accompanied by dilatation and spherification of its cavity. The presenceof a viable myocardium in the zone of dysfunction can prevent the progression of MR, and even lead toa decrease in its degree with adequate revascularization. Patients with MR, with a lack of viability in thearea of myocardial dysfunction, are candidates for the development of severe MI.