Q-wave Acute Myocardial Infarction Research Articles

Effect of eplerenone on aldosterone and von Willebrand factor levelsin patients with myocardial infarction and chronic kidney disease

Aim: to study the levels of aldosterone and von Willebrand factor (VWF) in patients with Q-wave acute myocardial infarction (Q-AMI) and underling chronic kidney disease (CKD) using aldosterone antagonists. Materials and methods. The study group consisted of 106 patients with renal dysfunction who were hospitalized for acute Q-AMI. Serum levels of neurohumoral parameters (aldosterone and VWF) were determined in all the patients by enzyme-linked immunosorbent assay kits. Results. Reduction in the aldosterone levels was found in patients with Q-AMI and stage 2 CKD from 245.08 ± 17.38 pmol/l to 195.15 ± 13.82 pmol/l (P < 0.05;) who received spironolactone and from 275.59 ± 23.43 to 169.37 ± 24.46 pmol/l (P < 0.001) with eplerenone usage. Patients with stage 1 CKD showed a decreasing trend in aldosterone levels when using spironolactone (from 238.04 ± 20.37 pmol/l to 200.78 ± 9.15 pmol/l), and significantly decreased aldosterone levels when receiving eplerenone (from 229.77 ± 13.76 pmol/l to 156.76 ± 5.76 pmol/l; P < 0.05). The serum concentration of VWF in stage 2 CKD patients was changed insignificantly on spironolactone therapy (from 0.99 ± 0.13 mg/l to 1.13 ± 0.06 mg/l) and it was significantly decreased in the eplerenone group – from 1.29 ± 0.19 mg/l to 0.71 ± 0.14 mg/l (P < 0.05). In stage 1 CKD patients, the concentration of VWF was not decreased significantly with the use of spironolactone (from 1.22 ± 0.13 mg/l to 1.03 ± 0.06 mg/l), but it was decreased significantly when receiving eplerenone (from 1.14 ± 0.09 mg/l to 0.79 ± 0.08 mg/l; P < 0.05). The data obtained indicate the significantly higher probability of declining both aldosterone (t = 2.91; P < 0.01) and VWF (t = 2.59; P < 0.01) with the use of eplerenone in the complex treatment as compared to the spironolactone administration. Conclusions. The effect of eplerenone to decrease the concentration of aldosterone and VWF is significantly greater than that of spironolactone, especially in AMI patients with stage 2 CKD.

Gender peculiarities of clinical and instrumental indexes in patients with acute Q-wave myocardial infarction after primary coronary intervention

The aim: to determine gender differences in the course of acute Q-wave myocardial infarction in patients after primary coronary intervention. Materials and methods. Results of clinical and instrumental examination of 58 patients with acute Q-wave myocardial infarction were analyzed. Patients were divided into 2 groups according to gender: group 1 (n = 33) – men, mean age 61.0 (55.0; 69.0) years, group 2 (n = 25) – women, mean age 69.0 (63.0; 78.0) years. All the patients underwent coronary angiography followed by angioplasty and stenting of the infarct-dependent coronary artery. Results. In men, the number of leukocytes was significantly higher (by 24.7 %, P = 0.02) and the plasma level of low-density lipoproteins was significantly lower (by 30.9 %, P = 0.007), there was a tendency towards a higher concentration of creatine kinase-MB (by 41.0 %, P = 0.11) at the time of hospital admission as compared to women. Women showed significantly increased thickness of the posterior wall of the left ventricle (LV) (by 7.31 %, P = 0.02) and a tendency towards the prevalence of the interventricular septum wall thickness (by 7.46 %, P = 0.1). The LV end-diastolic and end-systolic dimensions tended to prevail in men (by 2.41 %, P = 0.47 and by 7.81 %, P = 0.19, respectively). Men were found to have a lower peak A rate (by 23.37 %, P = 0.007), a higher E/A ratio (by 52.27 %, P = 0.009), LV diastolic dysfunction (DD) occurred less frequently (χ2 = 2.89, P = 0.08), and there was a tendency to develop eccentric LV hypertrophy (χ2 = 2.39, P = 0.12) and type 2 LV DD (χ2 = 3.82, P = 0.07). Type 1 DD was more common in women (χ2 = 5.71, P = 0.02). In men, there was a tendency to the formation of zones of LV akinesia (χ2 = 2.5, P = 0.09) and decreased LV ejection fraction (χ2 = 1.57, P = 0.31). Conclusions. In the acute period of Q-wave myocardial infarction after revascularization, in men, unlike in women, systolic dysfunction is developed more often. It is accompanied by acute left ventricular failure, eccentric left ventricular hypertrophy and type 2 diastolic dysfunction formation as well as signs of systemic inflammation. In women, in the acute period of Q-wave myocardial infarction after revascularization, concentric left ventricular remodeling occurs more frequently and is accompanied by type 1 left ventricular diastolic dysfunction.

Predictors of acute heart failure in patients during the acute period of Q-wave myocardial infarction

The aim was to identify predictors of acute heart failure (AHF) in patients with acute Q-wave myocardial infarction (MI).Materials and methods. A total of 139 patients in the acute period of Q-wave MI were examined, average age was 66.00 ± 0.97 years (M ± m). Patients were divided into 2 groups depending on AHF presence: without AHF – 46 persons, the mean age was 61.00 ± 1.87 years (M ± m) and with developed AHF – 93 persons (Killip II, n = 51; Killip III, n = 42), the mean age was 69.2 ± 8.3 years (M ± m). The patients underwent general clinical examination, blood glucose level was determined on admission, transthoracic Doppler echocardiography was performed and copeptin and NTproBNP levels were measured.Results. According to univariate logistic regression analysis, hyperglycemia in the acute period of Q-wave MI was associated with a probable increase in the odds ratio of AHF by 1.24 times (95 % CI 1.08–1.44; P = 0.003). According to the results of the ROC-analysis, the critical level of glycemia was >9.3 mmol/l (sensitivity 47.8 %, specificity 78.3 %), the area under the ROC-curve was 0.666 (95 % CI 0.580–0.745; P = 0.0004). With the development of systolic dysfunction in the acute period of MI, the odds ratio of AHF increased by 5.69 times (95 % CI 2.47–13.14; P < 0.0001). An increase in copeptin level of more than 0.53 ng/ml (sensitivity 93.1 %, specificity 28.6 %) and the area under the ROC curve of 0.633 (95 % CI 0.543–0.716; P = 0.0086) were associated with an increase in the odds ratio of AHF by 1.39 times (95 % CI 1.06–1.83; P = 0.02). There was no dependence of AHF on NTproBNP level – OR = 1.001 (95 % CI 0.99–1.01; P = 0.36). According to multivariate logistic regression analysis, independent risk factors for AHF were the hyperglycemia level on admission of more than 9.3 mmol/l OR = 1.19 (95 % CI 1.01–1.39; P = 0.036) and left ventricular (LV) systolic dysfunction – OR = 5.24 (95 % CI 2.03–13.55; P = 0.001).Conclusions. In patients with acute Q-wave MI complicated by AHF, the admission levels of copeptin and glycemia were significantly higher andLV ejection fraction was significantly lower. The dependent risk factors for AHF in patients with acute Q-wave MI were glycemia level of more than 9.3 mmol/l, an increase in copeptin level of more than 0.53 ng/ml, andLV systolic dysfunction. Independent risk factors for AHF in the acute period Q-wave MI were hyperglycemia andLV systolic dysfunction.

Obesity, laparoscopic surgery, fluid therapy, solutions

Prognosis in acute Q-wave myocardial infarction is an actual problem till nowadays.Aim: to determine the different regimens of anticoagulation therapy impact on hospital and one-year mortality, acute postinfarction aneurysm and left ventricle thrombus formation in patients with acute Q-wave myocardial infarction after thrombolytic therapy.Materials and methods: hospital and one-year mortality, risk of postinfarction aneurysm and left ventricle thrombus formation were investigated in 167 patients with acute Q-wave myocardial infarction after thrombolytic period depending on anticoagulation therapy. Probability of unfavorable cardiovascular events was assessed by the relative risk with a confidence interval of 95 %. The multiple method of Kaplan-Meier estimation was used to determine the survival distributions. In order to compare survival in different groups the Log-rank test was used. For all types of analyses differences were significant if P < 0.05.Results. It was found that survival during the hospital period was significantly higher in the group of patients received unfractionated heparin compared to patients received fondaparinux. Treatment with unfractionated heparin in comparison with fondaparinux, reliably reduces the relative risk of death during the hospital period. There were no significant differences in the one-year survival of patients who received fondaparinux, enoxaparin, and unfractionated heparin. Thus, all three approaches were equally effective for the long-term prognosis in patients with Q-wave myocardial infarction.There were no significant differences when comparing the relative risk of aneurysm formation and left ventricular aneurysm with a thrombus in the groups of patients with Q-wave myocardial infarction and different anticoagulation therapy. Thus, aneurysm of the left ventricle and left ventricular aneurysm with a thrombus occurred with the same frequency in patients with Q-wave myocardial infarction who were treated with low-molecular or unfractionated heparin.Conclusions. The usage of unfractionated heparin in patients with acute Q-wave myocardial infarction after thrombolytic therapy significantly reduces the risk of hospital mortality by 1.46 times compared with low-molecular-weight heparin. As for one-year mortality, the risk of acute aneurysm and left ventricular aneurysm with a thrombus, the unfractionated and low-molecular-weight heparin were equally effective.

Heart remodeling in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block

The prevalence of left bundle branch block (LBBB) in the general population is 0.1–0.8 %, and in patients with ST-segment elevation Q-wave myocardial infarction (Q-MI) varies from 1 % to 15 %. The aim - to evaluate the structural and functional features of the heart in patients with acute Q-wave myocardial infarction in the presence of left bundle branch block. Materials and methods. The study involved 60 patients with Q-MI (40 men and 20 women), who were hospitalized in cardiology department for patients with myocardial infarction treatment of Zaporizhzhіa City Emergency and Urgent Care Clinic. Patients were divided into two groups: 40 patients with Q-MI and the LBBB (the mean age was 71.53 ± 1.23 years), 20 patients with Q-MI without LBBB (the mean age was 65.47 ± 2.25 years). Assessment of intracardiac hemodynamics were performed by echocardiography using a “MyLab50” (“Esaote”,Italy) ultrasound system on the recommendations of the American Society of Echocardiography. Results. Patients with acute Q-MI with LBBB were significantly older than patients who had acute Q-MI without LBBB (9.2 %, P < 0.05). Patients with anterior acute Q-MI prevailed among persons with LBBB (75 %). Thickening of the posterior wall (by 9.6 %; P < 0.05), an increase in LVMMI (by 11.2 %; P < 0.05), an increase in end-diastolic size (by 12.9 %; P < 0.05) and end-systolic size (by 18.6 %; P < 0.05); acceleration of MVE (by 18.3 %; P < 0.05); and an increase systolic pressure in the pulmonary artery (by 23.1 %; P < 0.05) were found in patients with Q-MI with LBBB compared to patients with Q-MI without LBBB. The analysis of contingency table revealed significant association between LBBB presence in patients with Q-MI and diabetes mellitus (χ 2 = 4.53; P < 0.05), female gender (χ 2 = 3.87; P < 0.05) and age over 65 years (χ 2 = 5.71; P < 0.05). In patients with acute Q-MI and LBBB a significant positive correlation between the QRS width and end-diastolic size (+0.49; P < 0.05), end-systolic size (+0.45; P < 0.05), systolic pressure in pulmonary artery (+0.31; P < 0.05) and diastolic size of right ventricle (+0.38; P < 0.05), and a negative correlation between the QRS width and ejection fraction (-0.71; P < 0.05) and IVRT (-0.37; P < 0.05) were noted. Conclusions. LBBB in patients with acute Q-MI is associated with female gender, age over 65 years and past history of diabetes mellitus. Acute Q-MI in the presence of LBBB is characterized by eccentric hypertrophy with an increase in the left ventricular size and pulmonary hypertension. QRS complex duration in patients with acute Q-MI and LBBB is associated with systolic function deterioration, left ventricular dilatation and pulmonary hypertension.

SIGNIFICANCE OF LABORATORY PARAMETERS IN PROGNOSIS OF OUTCOMES OF ACUTE MYOCARDIAL INFARCTION

The study objective is to validate a mathematical model for prognosis of progression of the acute period of myocardial infarction. Materials and methods . We examined 135 patients with acute Q-wave myocardial infarction of the left ventricle aged between 34 and 88 years (mean age 66, standard deviation 12 years), among them 64 women and 71 men. For prognosis of the outcome of the acute period of myocardial infarction we used an approach based on intellectual data analysis (data mining) in combination with mathematical methods based on decision trees. Results. Using decision tree algorithms, we singled out laboratory parameters (attributes) which were subsequently used as input. Adequacy of classification of these attributes was determined by a contingency table. Accuracy of the obtained calculation results was 95.56 % demonstrating good agreement between the model and observed data. In a decision tree visualization, the most significant 8 laboratory parameters were determined. Significance of NO 2 metabolite was 24.9 %, triglycerides – 16.7 %, urea – 14.8 %, erythrocytes – 11.2 %, alanine aminotransferase – 9.4 %, very low density lipoproteins – 9.4 %, creatinine – 8.5 %, prothrombin index – 5.1 %. In the Rules tab, only rules 4 and 9 can be used with confidence, because their confidence level approaches 100 %, and effect cost for the fact of death was 33.59 % and 32.03 %, respectively. Conclusion. Using a decision tree algorithm, we determined prognostically significant factors for progression of acute myocardial infarction. The following set of parameters predicts unfavorable outcome (death) with 95.56 % accuracy: NO 2 &lt; level 22.755 mmol/l, triglycerides ≥ 1.565 mmol/l, erythrocytes &lt; 4.91 M/uL, alanine aminotransferase &lt; 1.23 mmol/l, urea &lt; 7.05 mmol/l, very low-density lipoproteins &lt; 0.965 mmol/l, creatinine ≥ 91.55 µmol/l, NO 2 level ≥ 22.755 mmol/l predicts a favorable outcome with 95.56 % accuracy.

The estimation of selen content in blood serum and the diet correction in patients with acute Q-wave myocardial infarction

The use of selenium-containing specialized food products in prophylactic and therapeutic diets is based on hypothesis that selenium as antioxidant can potentially decrease the risk of oxidative stress induced diseases. There is a hypothesis, which is strongly supported during last 10-15 years that the reactive oxygen species are generated during ischemic myocardium reperfusion and cardiomyocyte damage. In addition selenium as an important component of glutationperoxidaze, it promotes protection against ischemic damage, improvement of functional regeneration and reduction of morphological changes in cardiomyocytes. We established a low serum selenium level in patients with acute and subacute stage of Q-wave myocardial infarction (75.5±1.8 mcg/L). New dietary product - jam made of seaweed with dried apricot enriched with selenium - was included in patient diet. We observed 72 persons (40-75 years old) who were randomized in a control group (30 patients) on standard treatment and a main group (42 patients) that received the dietary product (80 mcg Se) in addition to the standard treatment. Critical serum selenium level was found initially in 16 main group patients (38%), in 2 patients (7%) 2 weeks later and in none of patients in a month of dietary jam treatment. Selen concentration in blood serum increased from basal value 78.3±3.1 mcg/L after 2 weeks of treatment by 16% and after one month of treatment by 20% (p <0.05). In the control group the serum selenium level remained on critical and selenium-deficient levels during a month on standard treatment without dietary compensation. No adverse events were revealed in patients of main group, the investigated product was well tolerated.

Influence of beta-adrenoblockers on structural-functional heart indices in patients with acute q-wave myocardial infarction

The problem of myocardium infraction (MI) remains actually. An early postinfraction period is characterized with intensive remodeling of the left ventricle (LV) and high risk of dangerous complications that is ten times more than the monthly number of complications during the next year. The aim of research was the study of an influence of beta-1 adrenoreceptors on the heart rhythm variability, ectopic heart activity, daily profile of arterial pressure, postinfraction remodeling in patients with an acute Q-myocardium infraction. Methods. There were examined 235 patients with Q-myocardium infraction. There was evaluated the risk of forming LV aneurism, dynamic indices of combined daily monitoring of arterial pressure and electrocardiogram, echocardiography under influence of the complex treatment using beta-1 adrenoreceptors blockers.Results. Under an influence of treatment there was established the growth of temporal indices of the heart rhythm variability (HRV), spectral indices that present the parasympathetic influence on the background of decrease of the spectral components of sympathetic origin and mean HR, decrease of ectopic heart activity, normalization of daily profile of arterial pressure, improvement of systolic and diastolic function of LV.Conclusions. The use of beta-1 adrenoreceptors in the complex treatment of patients with acute Q-MI decreases the risk of forming LV aneurism, favors an improvement of HRV indices, ectopic heart activity, daily profile of arterial pressure, intracardiac hemodynamics

Peculiarities of vegetative regulation of heart activity and diurnal profile of blood pressure in patients with acute myocardial infarction, complicated by left ventricle aneurysm

In patients with myocardial infarction indexes of vegetative regulation of heart activity and diurnal blood pressure profile are connected with complicated trend of the disease. Aim. To study peculiarities of heart activity vegetative regulation, violations of heart rhythm and diurnal profile of blood pressure. Methods and results. In 108 patients with acute Q-wave myocardial infarction were investigated indexes of combined diurnal monitoring of ECG and blood pressure in dependence of left ventricle aneurysm formation. Conclusions. Increasing of sympatic influence of vegetative nervous system, prevalence of ventricular arrhythmias of «high grade», QT-interval length and predominantly adverse type of diurnal blood pressure profile were noticed in patients with myocardial infarction, complicated by left ventricle aneurysm.

Gender peculiarities and prognostic value of matrix metalloproteinase and their inhibitors system in patients with acute Q-wave left ventricle myocardial infarction

Matrix metalloproteinases play a key role in postinfarction remodeling of the heart.The aim was to study gender and age peculiarities of matrix metalloproteinases and their inhibitors, and determine their prognostic value in post-infarction aneurysm of the left ventricle formation.Methods and results. 76 patients with Q-wave myocardial infarction was studied by immunoassay analysis serum levels of matrix metalloproteinases and their inhibitors depending on patients sex and age. On the 1st day of the disease higher concentrations of MMP-9 and TIMP-1 were determined in women of elder age group. On the 10th day of the disease, in case of aneurysm formation, as in men, as women of any age, increasing of MMP-9 and decreasing of TIMP-1 levels was determined.Conclusion. Powerful prognostic potential of MMP-9 and TIMP-1 in post-infarction aneurysm formation was determined especially in women of elder age group.

Influence of thrombolytic therapy on the condition of matrix metalloproteinase and their inhibitors system in patients with Q-wave myocardial infarction

Myocardial infarction (MI) is one of the most important problems of modern cardiology all over the world and, particularly, in Ukraine. Implementation of thrombolysis into the treatment leads to significant reduction of mortality from MI. Nowadays the most progressive treatment method is percutaneous coronary intervention. It was proved in several randomized controlled clinical trials (DANAMI-2, PRAGUE-2, SIAM-III). But in our country not all centers for treatment of MI are equipped by catheterization laboratory. That is why thrombolytic therapy (TLT) remains actual till today. In any type of treatment tactic in postinfarction heart would be seen remodeling processes with involvement to the pathological process of extracellular morphologic substrate. Pathological changes of extracellular matrix lead to increases of myocardium stiffness and reconstruction of heart chambers geometry. It leads to transformation of spatial organization of heart chambers, violation of blood filling and ejection and formation of systolic and diastolic dysfunction. The synthesis and degradation of extracellular substance is controlled by systems MMP/TIMP, the ratio of which influence on the character of extracellular matrix of myocardium restructuring. Till today influence of TLT on the state of MMP/TIMP system and postinfarction remodeling formation still is not clarified.The purpose of the study - to investigate the influence of thrombolytic therapy on condition of system of matrix metalloproteinase (MMP-9) and its inhibitors (TIMP-1), the status of intracardiac hemodynamics, frequency of acute postinfarction left ventricular aneurysm development in patients with Q-wave myocardial infarction.Patients and methods. 116 patients with a diagnosis of acute Q-wave MI of anterior wall of the left ventricle (LV) were examined. Patients, admitted before 12 hours from the beginning of MI and who had no contraindications, received TLT using streptokinase and basic therapy. Patients, admitted later than 12 hours from the beginning of MI or who had contraindications, received basic therapy only, which included statins, anticoagulants, antiplatelet agents, beta-blockers, ACE inhibitors, nitrates by demand. Depending on the implementation of TLT all patients were divided into next groups: the 1st – 74 patients who received TLT, the 2nd - 42 patients, who were treated without TLT. All patients were examined by clinical, laboratory and EchoCG methods on the fifth day. Serum levels of matrix metalloproteinases-9 (MMP-9) and tissue inhibitor of metalloproteinases-1 (TIMP-1) were determined.Results and discussion. Analysis of indicators which characterize the MMP/TIMP system showed the lower level of MMP-9 in patients of the first group. Serum level of TIMP-1 in the first group was higher in comparison with patients of the second group.During EchoCG in patients of the second group higher than in the first group indexes of end-diastolic diameter of LV, end-systolic diameter of LV, LV myocardial mass index, stroke volume, stroke index, cardiac output, velocity of early diastolic filling of LV, the ratio of the velocity of early diastolic filling and late diastolic filling of LV, average pressure in pulmonic artery, the frequency of left ventricular aneurysm detection and the phenomenon of spontaneous ventricular contrasting were found. Such indexes as ejection fraction, atrial systole flow velocity, deceleration time of early diastolic filling flow and isovolumic relaxation time of LV were lower than in the first group.ConclusionsExcessive activation of proteolysis system on the background of relative deficit of TIMP-1was revealed in patients with Q-wave MI, who were treated without TLT.Treatment of patients with Q-wave MI with basic therapy only, lead to the LV remodeling, to dilation way predominantly.Violation of diastolic function of LV was typical for all patients with Q-wave MI, but absence of TLT changes it from impaired relaxation to the restrictive type.In patients with Q-wave MI without usage of TLT more frequently aneurysm of LV and the phenomenon of spontaneous ventricular contrast were revealed, that confirms the high thrombogenic potential.Correlation analysis demonstrated close relationship between main regulators of extracellular matrix condition and indicators of postinfarction remodeling process.

Selecting of statins optimum dosage regimen in patients with acute Q-wave myocardial infarction after thrombolytic therapy

Cardiovascular diseases is the leading cause of death in the Ukraine in a nowadays. Despite the priority role of angioplasty in the treatment of acute Q-wave myocardial infarction, as demonstrated in recent clinical trials, in our country still actual urgent pharmacological recanalization of infarct-associated artery, that is thrombolytic therapy. However, during thrombolytic therapy in many cases fail to achieve optimal reperfusion of the myocardium, resulting in an active search for factors that increase the effectiveness of thrombolytic therapy, and medications that can improve the flow of Q-wave myocardial infarction. In this context, stabilization of atherosclerotic process is a priority after thrombolytic therapy in patients with acute Q-wave myocardial infarction. Pleotropic effects of statins allowed to justify the early administration of drugs in this group of patients after thrombolytic therapy, but there are some differences as to prescribe the dose that is appropriate in these conditions.The aim of research: to study the effect of different dosing regimens of statins on clinical course, peculiarities of the aggregation and coagulation hemostasis, heart hemodynamics and incidence of complications in patients with acute Q-wave myocardial infarction after thrombolytic therapy.Patients and methods.The study involved 67 patients (43 men and 24 women), mean age - 64,5 ± 7,2 years, with a diagnosis of acute coronary syndrome with ST-segment elevation. All patients received thrombolytic therapy with streptokinase and basic therapy that included statins, anticoagulants, antiplatelet agents, beta-blockers, ACE inhibitors, nitrates. Depending on the dosage regimen of statins, patients were divided into groups: the first (18 people) - low-dose regimen (atorvastatin 20 mg/day or rosuvastatin 10 mg/day), second (27 people ) – medium-dose (atorvastatin 40 mg/day or rosuvastatin 20 mg/day), third ( 22 people ) – high-dose (atorvastatin 80 mg/day or rosuvastatin 40 mg/day). All patients were examined by clinical and laboratory methods, ECG and echocardiography on the fifth day and 6- minute walk test at the end of treatment (Day 14).Statistical analysis of the results was performed on a personal computer using the licensed program "Statistica" (version 6.0, Stat Soft Inc, USA). The reliability performance differences were evaluated by Mann-Whitney and Wilcoxon, believed reliable differences at p &lt; 0.05.Results.Clinical analysis in comparison with the first group in the second and third groups revealed significantly smaller quantity of anginal attacks per day, duration of anginal pain in the third group were significantly less patients with severe acute heart failure and ventricular arrhythmias. During the 6-minute walking test, patients of the third group underwent a longer distance than the first and second groups.Study of coagulation hemostasis revealed that prothrombin in the third group is lower compared to the first and second groups as well as fibrinogen. Analyzing the platelets aggregation was clarified that the degree of aggregation in the first group was higher than in the second and third groups, the rate of aggregation was significantly higher in the first group than in the third, an the background of much less time of aggregation.During the study of structural and functional parameters of the heart in the third group compared to the first and second significant advantage observed end-diastolic, end- systolic diameters and ejection fraction; in the second and third groups compared with the first group higher appeared stroke volume, stroke index, cardiac output and cardiac index.In addition, the second and third groups compared with the first observed larger values of blood flow velocity during early diastolic filling of the left ventricle and the ratio of transmitral velocity of blood on the background of smaller values of blood flow velocity during atrial systole, deceleration time of transmitral blood flow and left ventricular isovolumic relaxation time, indicating a greater severity of violations of left ventricular diastolic function in the background of low-dose statin regimens.Conclusions.1. Patients receiving medium- and high-dose statin regimens have fewer clinical manifestations of coronary heart disease, the disease is easier, they have lower incidence of complications.2. When using medium and high doses of statins decrease blood coagulation ability, at both the coagulation and hemostasis link aggregation.3. In group of high-doses of statins in the subacute period of Q-wave myocardial infarction observed higher exercise tolerance against the backdrop of increasing the power of global LV systolic function.4. The use of low-dose statin regimens accompanied by more severe violations of diastolic LV function.Further studies of pathogenetic mechanisms and the clinical features of the course of acute Q-wave myocardial infarction left ventricular allow to identify possible ways of preventing life-threatening complications and optimize treatment tactics.

Gender inequality in the clinical outcomes of equally treated acute coronary syndrome patients in Saudi Arabia

BACKGROUND AND OBJECTIVESGender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.DESIGN AND SETTINGSA prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.PATIENTS AND METHODSPatients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.RESULTSOf 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given β-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7–5.5; P=.14).CONCLUSIONThese data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.

CLINICAL AND FUNCTIONAL CHARACTERISTICS OF PATIENTS AFTER Q-WAVE MYOCARDIAL INFARCTION DEPENDING ON THE METABOLIC SYNDROME PRESENCE OR ABSENCE

Aim. To study the clinical and functional parameters of patients after acute Q-wave myocardial infarction (Q-MI) depending on the concomitant metabolic syndrome (MS). Material and methods. Men after Q-MI (n=79; aged 51.7±8.9 years) were included into the study. Patients were divided into two groups depending on the MS presence or absence. Doppler echocardiography and determination of the serum C-reactive protein (CRP) level were performed in all patients on the 10-14 days after Q-MI, and treadmill test was performed in 25 patients. Results. Left ventricular ejection fraction was 12% lower and the CRP level was 2 times higher in MS patients versus these in non-MS patients (p<0.01). The silent segment ST depression ≥1.0 mm were more often observed in MS patients compared with this in non-MS patients (40% vs 5%; respectively, p<0.05). Conclusion. The MS presence complicates the post-infarction period by early heart failure progression, characterized by elevated CRP levels and more frequent occurrence of silent myocardial ischemia.

Trends in Q-wave acute myocardial infarction case fatality from 1978 to 2007 and analysis of the effectiveness of different treatments

We sought to analyze the trends in first Q-wave acute myocardial infarction (AMI) case fatality from 1978 to 2007 in a population-based hospital register, to determine the variables related to these changes, and to assess the effectiveness of current AMI management. Population-based hospital registry included patients with first Q-wave AMI aged 25 to 74 years admitted between 1978 and 2007. Sociodemographic and clinical characteristics, treatments, and procedures used during hospital stay, and 28-day case fatality were recorded. Logistic regression was used for multivariate analysis of six 5-year periods. The 30-year study included 3,982 patients. Mean 28-day case fatality was 8.96%, with a decreasing trend from 16.6% in the first 5-year period to 4.7% in the sixth (P for trend < .001). Study period was independently associated with case fatality. Case-fatality reduction attributable to pharmacologic treatments was 51% overall; in 24-hour survivors, pharmacologic treatments and broad use of invasive procedures explained 39% and 38%, respectively, of the difference between the observed case fatality in 2003-2007 and 1978-1982. A dramatic decrease in 28-day case fatality occurred during this 30-year period and was mainly related to the use of antiplatelet drugs, β-blockers, thrombolysis, and invasive procedures. These data support the current guidelines for the management of acute coronary syndrome.

Age-related short-term effect of ramipril on N-terminal pro-brain natriuretic peptide and markers of hemostasis in patients after acute myocardial infarction

Angiotensin-converting enzyme (ACE) inhibitors after acute myocardial infarction (MI) prevent heart failure and recurrent ischemic events. Our aim was to evaluate the effect of ramipril on N-terminal pro-brain natriuretic peptide (NT-proBNP) and on markers of hemostasis, including plasminogen-activator-inhibitor-1 (PAI-1), von Willebrand factor (vWF), factor VIII (FVIII) and fibrinogen, in patients after acute MI, with emphasis on those over 55 years of age. In this prospective, single-center, observational study 38 patients were treated with ramipril after the first Q-wave MI. Markers of hemostasis and NT-proBNP were estimated before and two weeks after ramipril treatment. Significant differences were observed in PAI-1 and NT-proBNP levels in patients over 55 years. In this age group the mean PAI-1 level decreased significantly after ramipril therapy (3.6 +/- 1.25 U/ml vs. 2.65 +/- 1.4 U/ml, P = 0.011) and was significantly lower than in younger (<55 years) patients (2.65 +/- 1.4 U/ml vs. 4.39 +/- 1.7 U/ml, P = 0.002). In addition, in the older patients the mean baseline NT-proBNP level was significantly higher than in the younger age group (258.35 +/- 347.6 pmol/l vs. 17.1 +/- 22 pmol/l, P = 0.028) and was also higher after ramipril therapy (240.5 +/- 254.3 pmol/l vs. 67.3 +/- 75.2 pmol/l, P = 0.034). In the younger patients, mean NT-proBNP after short-term ramipril therapy increased significantly in comparison with baseline (67.3 +/- 75.2 pmol/l vs. 17.15 +/- 22.0 pmol/l, P = 0.046). In acute Q-wave MI, increased PAI-1 levels, but not increased NT-proBNP, respond rapidly to early ACE inhibition by ramipril in patients over 55 years of age but not in younger patients.

Cardiovascular Manifestations in Patients With Thrombotic Thrombocytopenic Purpura: A Single‐center Experience

Cardiovascular manifestation in patients with thrombotic thrombocytopenic purpura. The aim of this study was to investigate the incidence of acute myocardial infarction (AMI), arrhythmias, congestive heart failure, and mortality in patients hospitalized for thrombotic thrombocytopenic purpura (TTP). Thirty-eight patients (27 women and 11 men), mean age 44 years, were hospitalized with the diagnosis of TTP confirmed by a hematologist. We investigated the incidence of AMI which developed during hospitalization for TTP. AMI was diagnosed by new electrocardiographic changes, increased serum cardiac troponin I levels, and clinical symptomatology. The patients with AMI were also monitored for development of arrhythmias during hospitalization. Of the 38 patients, 8 (21%) developed new Q-wave AMI. There was no significant difference in baseline characteristics between patients who developed AMI and those who did not develop AMI. Of the 8 patients with AMI, 2 (25%) developed atrial fibrillation, 1 (13%) developed atrial flutter, 1 (13%) developed supraventricular tachycardia, and 2 (25%) developed congestive heart failure. Death occurred in 3 of 8 patients (38%) with AMI and in 1 of 30 patients (3%) without AMI (P < 0.01). New Q-wave AMI developed in 21% of 38 patients hospitalized with TTP. Supraventricular tachyarrhythmias developed in 50% of 8 patients with TTP who developed AMI. Patients hospitalized for TTP should be monitored for adverse cardiac events due to the high incidence of new AMI, supraventricular tachyarrhythmias, and mortality.

Inter- and left intraventricular dyssynchrony in patients with Q-wave acute myocardial infarction

Inter- and left intraventricular dyssynchrony in patients with Q-wave acute myocardial infarction

Elevação da creatinoquinase-MB após intervenção coronária percutânea e ocorrência de eventos cardíacos adversos

INTRODUCAO: A elevacao da creatinoquinase-MB (CK-MB) em pacientes submetidos a intervencao coronaria percutânea (ICP) tem mostrado estar associada a ocorrencia de eventos clinicos desfavoraveis no acompanhamento a longo prazo, incluindo morte de causa cardiaca. O objetivo deste estudo foi avaliar a associacao entre o aumento de CK-MB e a ocorrencia de eventos cardiacos adversos em um ano, em pacientes submetidos a ICP eletiva em um hospital de referencia terciario. METODO: Estudo de coorte prospectivo, em que foram avaliados 114 pacientes consecutivos, submetidos a ICP com intervencao em um unico vaso. Os niveis de CK-MB foram rotineiramente obtidos pre-procedimento, 6 e 24 horas pos-procedimento. Os pacientes foram reavaliados por meio de entrevistas, revisao de prontuarios e realizacao de eletrocardiograma aos 6 e 12 meses para analise de eventos cardiacos adversos (obito, infarto agudo do miocardio, necessidade de nova revascularizacao miocardica ou isquemia recorrente) RESULTADOS: Os pacientes foram divididos em dois grupos, de acordo com a ocorrencia ou nao de elevacao enzimatica. Dos 19 (16,7%) pacientes com elevacao de CK-MB, 11 (57,9%) apresentaram eventos cardiacos adversos maiores ao final de 6 meses versus 21 (22,1%) pacientes sem elevacao enzimatica (p = 0,004). Aos 12 meses, observamos que esse grupo continuou a mostrar maior numero de eventos, embora sem diferenca estatistica ate o nivel de significância usual de 5% (63,2% vs. 37,9%; p = 0,075). Analise multivariada identificou a elevacao da CK-MB como preditor independente de eventos cardiacos adversos aos 6 meses (odds ratio [OR], 4,34; intervalo de confianca de 95% [IC 95%], 1,88-10,03; p < 0,001), mas nao aos 12 meses (OR, 1,77; IC 95%, 0,773-4,055; p = 0,182). CONCLUSAO: A elevacao de CK-MB apos angioplastia coronaria esta associada a maior ocorrencia de eventos cardiacos adversos, particularmente nos 6 primeiros meses de acompanhamento.

Temporal trends in the frequency and longer‐term outcome of heart failure complicating myocardial infarction

To investigate trends in incidence and long-term outcome of heart failure (HF) developing within 28 days of first-ever acute myocardial infarction (AMI). We identified all residents of Perth, Western Australia aged 25-64 years, with no history of HF, who experienced a non-fatal, first-ever AMI between 1984 and 1993, and followed them for ten years. All patients (N=4006) met the criteria for 'definite AMI' in WHO MONItoring trends and determinants of CArdiovascular disease (MONICA) Project and 897 (22.4%) had early-onset HF complicating the index event. After adjustment for age, current smoking, history of diabetes and hypertension, Q-wave and anterior wall AMI, the odds of developing HF declined by 9% (odds ratio for period 1989-1993 relative to 1984-1988=0.91, 95% confidence interval (95%CI): 0.78 to 1.06). Over 10 years of follow-up, patients with early-onset HF had a cumulative average number of re-admissions of 28 per 100 as compared with 9 per 100 in patients without HF. After adjustment for age, history of diabetes and hypertension, the hazard of death in patients with early-onset HF declined by 26% (HR for the period 1989-1993 relative to 1984-1988=0.74, 95%CI: 0.57 to 0.96). Our data suggest a decline in the incidence of, and show encouraging evidence of improvement in survival after, early-onset HF complicating AMI.