The Structural-Functional Peculiarities of Heart in Patients with Acute Coronary Syndrome

Abstract

Acute coronary syndrome (ACS) is associated with very high morbidity and mortality. The American Heart Association estimates – approximately every 40 seconds an American has a myocardial infarction. The aim of this study was to evaluate the structural-functional peculiarities of heart remodeling in patients with acute coronary syndrome.
 Material and Methods. In this observational cohort trial there were observed 184 patients with ACS. Coronary angiography was performed at admission, and lesions that reduced the lumen area at 50% or more were considered angiographically significant. Transthoracic echocardiography was performed in accordance with recommendations of the American Society of Echocardiography.
 Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males. ACS with persistent ST segment elevation more often was presented as the anterior-lateral myocardial infarction with persistent ST segment elevation (STEMI) – in 70 (50.0%) cases. Among patients with STEMI the left anterior descending coronary artery (LAD) was mostly affected as infarction-related artery (IRA): in 74 (52.9%) cases at initial urgent coronary angiography. Multivessel disease (MVD) was identified in 22 (15.7%) patients with STEMI. The most significant variations of EchoCG parameters were observed in STEMI patients with MVD on coronary angiography (Table 2): dilatation of left atrium and left ventricle (increased of End-diastolic volume (EDV), End-systolic volume (ESV), End-diastolic diameter (EDD) and End-systolic diameter (ESD)) and low ejection fraction (EF) of left ventricle. Low EF of left ventricle was observed in 6 patients with culprit of LAD, 3 patients with culprit of LCx and in 6 patients with MVD (φ=0.244; p<0.05).
 Conclusion. Acute STEMI is caused by significant left ventricle remodeling (dilatation and ejection fraction decrease) in case of multivessel disease in coronary angiography.