ГЕМОДИНАМИКА МАЛОГО КРУГА КРОВООБРАЩЕНИЯ У МУЖЧИН МОЛОДОГО И СРЕДНЕГО ВОЗРАСТА С ОСТРЫМ ПОВРЕЖДЕНИЕМ ПОЧЕК ПРИ ИНФАРКТЕ МИОКАРДА

Abstract

Relevance. Hemodynamics changes of the pulmonary circulation in myocardial infarction complicated by acute kidney injury are not well understood. Aim. To evaluate the characteristics of pulmonary circulation in men under 60 years old with acute kidney injury in myocardial infarction to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative analysis of pulmonary circulation parameters in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of the risks of developing acute kidney damage and chronic heart failure in the selected groups were performed. Results. The study group differed in a lower heart rate (HR1) (66.3±12.2 from the control group (75.8±18.8; p=0.003). It showed a tendency towards lower the mean pulmonary artery pressure (MPAP) and total pulmonary resistance (TPR) at both points of the study. In both groups, there was a similar dynamic of decrease in the MPAP and TPR levels, more pronounced in the control group (MPAPII: -14.3%; MPAPI: -6.1 %; TPRII: -29.9%; TPRI: -21.8%; p<0.0001) and multidirectional - for HR: in the study group, an increase in HR was noted by 0.9% (p<0.0001), and in the control - its decrease by 8.4% (p<0.0001). Risk markers of the acute kidney injury developing were MPAP1˂30.4 mm Hg, HR1˂67 per minute and TPR1˂622.8 dyne•s•cm-5, the presence of chronic heart failure and cardiac asthma among the disease complication. The predictors of chronic heart failure in the study group were MPAP1≥26.9 mm Hg and HR1≥62 min. Conclusions. In case of acute kidney injury, lower levels of pulmonary circulation indicators are noted, their lower dynamics during the observation period, and a greater frequency of observation of chronic heart failure in comparison with the control group. The above listed values of the pulmonary circulation parameters have been assessed as a risk marker of the acute kidney injury and chronic heart failure development.