Influence of arrhythmogenic activity on postinfarction heart remodeling at comorbid hypertension and diabetes mellitus

Abstract

Objective — to evaluate the morpho-functional features of heart remodeling in the acute period of myocardial infarction complicated by arrhythmias against the background of arterial hypertension and diabetes mellitus.
 Materials and methods. The study included 149 patients with acute myocardial infarction. Depending on the comorbid pathology, patients are divided into 3 groups. Myocardial arrhythmic activity was assessed by clinical examinations, ECG and Holter ECG monitoring.
 Results. The effects of hypertension duration (15.31 ± 0.94 years at average) on the formation of hypertrophic type of remodeling (p < 0.02) and concentric hypertrophy (p = 0.027) have been established. Patients with the mean DM duration of 2.63 ± 0.62 years also tended to develop a hypertrophic type of cardiac remodeling. Reperfusion and non-reperfusion arrhythmias were more common in patients with pre-obesity and 1st degree obesity (p < 0.05). Analysis of arrhythmic syndrome in the MI acute period showed a significant predominance of prehospital, reperfusion and non-reperfusion, in patients with concomitant hypertension who had a hypertrophic type of remodeling. The obtained results are further developed to establish arrhythmogenic activity depending on the functional state of the heart, stage of concomitant hypertension and experience of diabetes in patients with coronary heart disease as a prerequisite for the correction of drug therapy.
 Conclusions. In the investigated subjects, left ventricular concentric hypertrophy prevailed at the pre-hospital stage due to the presence of arterial hypertension. The presence of hypertrophic type of remodeling in patients with arterial hypertension in the acute MI period was characterized by significantly more frequent development of prehospital, prehospital, reperfusion and non-reperfusion heart rhythm disorders. The combination of arterial hypertension with diabetes mellitus significantly worsens the clinical and functional parameters associated with the development of arrhythmic syndrome in this cohort of patients with acute myocardial ischemia.