Abstract
Aim. To investigate the correlation between clinical and morphological characteristics of coronary heart disease (CHD) and high-definition electrocardiography (HD-ECG) parameters. Material and methods. In total, 85 patients with unstable angina and ST segment depression (ST-UA) underwent HD-ECG during the angina attack, with late ventricular potential (LVP) analysis. One-year survival data were also analysed. Post-mortem histological examination of cardiac tissue was performed in 6 patients with ST-UA. Results. The important morphologic features of ST-UA included cardiomyocyte (CMC) dystrophy, due to acute and chronic myocardial ischemia, and acute injury in the cardiac conduction areas. LVPs were registered in 27 % of the ST-UA patients, mostly among people with transient myocardial ischemia (69,57 %). In patients who previ-ously underwent myocardial infarction, LVP prevalence was lower (28,57 %). At the early stages of hospitalization, LVP were registered in 14 patients (60,87 %), while pharmacotherapy and clinical course stabilization were associated with decreased LVP prevalence (21,74 %). The study results suggest that in patients with acute coronary syndrome, LVP registration predicts not an adverse outcome, but a better prognosis. Conclusion. ST-UA is characterised by typical changes of CMC and myocardial stroma in posterior septal area, which result in metabolic, energetic, and electrical myocardial instability. LVPs could be used as a marker of functional (ischemic) myocardial heterogeneity in patients with ST-UA. LVP registration could be associated with a better prognosis in this clinical group.
Highlights
late ventricular potential (LVP) were registered in 27 % of the ST-UA patients, mostly among people with transient myocardial ischemia (69,57 %)
The study results suggest that in patients with acute coronary syndrome, LVP registration predicts not an adverse outcome, but a better prognosis
Метод спектрального анализа поздние потенциалы желудочков (ППЖ) позволит расширить диагностические возможности и, возможно, поможет в прогнозировании развития желудочковых нарушений ритма у больных ишемической болезнью сердца (ИБС) и некоронарогенными заболеваниями сердца, даже в тех случаях, когда обычное усреднение сигнала оказывается мало- или неинформативным
Summary
Обследованы 85 больных нестабильной стенокардией (НС), госпитализированных в отделение неотложной кардиологии БСМП-1 г.Казань. У 33 (38,82 %) больных развился ОИМ. У 42 (48,28 %) пациентов в анамнезе перенесенный ранее ИМ; повторный ИМ развился у 16 (48,49 % от количества ОИМ). При поступлении в стационар у 19 (21,84 %) пациентов наблюдались признаки сердечной недостаточности (СН): I функционального класса (ФК) по классификации Нью-йоркской ассоциации сердца (NYHA) — у 9 (10,59 %), II ФК — у 6 (7,06 %), III ФК — у 2 (2,35 %), IV ФК — у 2 (2,35 %). Регистрацию и анализ ЭКГ выполняли на компьютерном кардиографе [6] при поступлении больного в стационар, а также на 3, 7, 14 сут. Для выявления прогностического значения ППЖ по данным поликлиник по месту жительства пациентов проспективно оценивали выживаемость больных в течение 1 года; в случае летального исхода выясняли причину смерти.
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