Special characteristics of progression of myocardial remodeling in patients with various forms of unstable angina

Abstract

To study special characteristics and prognostic value of cardiac remodeling in patients with unstable angina (UA). Throughout 2 years we performed repetitive echocardiographic examinations of 166 patients with Braunwald class IB and IIB-IIIB UA for assessment of left ventricular (LV) structural-functional changes. More severe form of remodeling (eccentric hypertrophy) was significantly more frequent in patients with IIB-IIB class UA. However in IB class UA during first year after episode of UA we noted rapid progression of remodeling mainly at the account of transition from concentric hypertrophy. Tissue Doppler study revealed more severe type of diastolic dysfunction (type 2 - pseudonormalization) in patients with class IIB-IIIB UA. Changes of some echocardiographic parameters correlated with severity of subsequent remodeling of the heart, development of chronic heart failure (CHF), myocardial infarction, and recurrent episodes of UA. In UA rate of unfavorable outcomes was related to degree of ischemic myocardial remodeling. We established a number of early EchoCG markers of LV remodeling increases of endsystolic dimension and volume, myocardial stress, lowering of ratios of diastolic peaks of filling and relaxation (/ and E`/A`) - preceding the development of systolic, diastolic dysfunction and CHF. The use of complex therapy with acetylsalicylic acid in patients with UA, perindopril, nebivolol and simvastatin is justified for prevention LV remodeling and lowering of rate of acute ischemia recurrence and CHF development.