Clinicofunctional assessment of electric cardiac unstability in diastolic dysfunction of the left ventricle in patients with coronary heart disease


Cite item

Full Text

Abstract

Aim. To study parameters characterizing electric myocardial unstability in coronary heart disease (CHD) patients with different variants of diastolic dysfunction (DD) of the left ventricle (LV). Material and methods. The study included 86 outpatients (26 females, 60 males, mean age 57,3 ± 5,6 years) who had myocardial infarction (MI) more than 1 year before the trial with stable course of CHD during a previous month, LV ejection fraction more than 45% and with a stable sinus rhythm. Group 1 consisted of 36 patients with abnormal LV relaxation, group 2 - of 28 patients with pseudonormal LV DD, group 3-22 patients with a restrictive type of LV DD. The following examinations were made: Holter ECG monitoring, echocardiography, signal-average ECG with isolation of late ventricular potentials (LVP), estimation of heart rate variability, ventricular repolarization (Q-T interval dispersion, corrected interval Q-T). Results. The following variants of LV DD were detected: type 1 - 42%, type 2 - 32,5%, type 3 - 25,5%. LV DD progression was accompanied with enhancing vegetative imbalance and sympathetic activity: in the group with abnormal relaxation - in 52,5% patients, in the group with a restrictive type - in 93,3%. CHD patients with restrictive DD had more frequent LVP (chi-square = 4,1; p < 0,05) and visualization of anomalous contractility zones (60%), ventricular extrasystole (VE) was registered in 100% cases (VE of grade IV-V in 43,3%), QTc and QTd were higher than threshold - 450.2 ± 5,4 and 71,2 ± 6,5 ms.
Conclusion. Because of multifactorial genesis of electric unstability, perfection of diagnosis and prognosis of risk in CHD patients with aggravation of LV DD demands a complex analysis of parameters respecting functional condition of the myocardium, relations between electric and structural-geometric remodeling of the heart.

About the authors

Ivan Porfir'evich Tatarchenko

Nadezhda Viktorovna Pozdnyakova

Ol'ga Ivanovna Morozova

Igor' Aleksandrovich Petrushin

Kristina Valer'evna Solov'eva

I P Tatarchenko

Institute of Advanced Medical Training, Penza

Institute of Advanced Medical Training, Penza

N V Pozdnyakova

Institute of Advanced Medical Training, Penza

Institute of Advanced Medical Training, Penza

O I Morozova

Institute of Advanced Medical Training, Penza

Institute of Advanced Medical Training, Penza

I A Petrushin

Institute of Advanced Medical Training, Penza

Institute of Advanced Medical Training, Penza

K V Solovyeva

Institute of Advanced Medical Training, Penza

Institute of Advanced Medical Training, Penza

References

  1. Оганов Р. Г., Масленникова Г. Я. Демографическая ситуация и сердечно-сосудистые заболевания в России: пути решения проблем. Кардиоваск. тер. и профилакт. 2007; 6: 7-14.
  2. Агеев Ф. Т., Беленков Ю. Н., Мареев В. Ю., Скворцов А. А. Сердечная недостаточность на фоне ишемической болезни сердца: некоторые вопросы эпидемиологии, патогенеза и лечения. Pyc. мед. журн. 2000; 8 (15): 622-627.
  3. Сидоренко Б. А., Преображенский Д. В. "Спящий миокард" и "оглушенный миокард" как особые формы дисфункции левого желудочка у больных ишемической болезнью сердца. Кардиология 1997; 2: 98-101.
  4. Иванов Г. Г., Грачев С. В., Сыркин А. Л. Электрокардиография высокого разрешения. М.: Триада-Х; 2003.
  5. Мареев В. Ю. Сердечная недостаточность и желудочковые нарушения ритма сердца: проблема лечения. Кардиология 1996; 12: 4-12.
  6. Татарченко И. П., Позднякова Н. В., Морозова О. И. Поздние потенциалы сердца: клинико-электрофизиологическая оценка. Пенза: Элмит; 2000.
  7. Национальные рекомендации ВНОК И ОССН по диагностике и лечению ХСН (второй пересмотр). Сердеч. недостат. 2007; 8: 1-12.
  8. Brutsaert D. L., Sys S. U. Systolic and diastolic heart function. J. Cardiovasc. Pharm. 1996; 28 (2): 1-8.
  9. Simson M. B. Use of signal in the terminal QRS complex to identify patients with ventricular tachycardia after myocardial infarction. Circulation 1981; 64: 235-242.
  10. Devereux R. B. Left ventricular diastolic dysfunction: early diastolic relaxation and late diastolic compliance. J. Am. Coll. Cardiol. 1989; 13: 337-339.
  11. Никитин Н. П., Алявин А. Л., Голоскокова В. Ю., Маджитов Х. Х. Особенности процесса позднего ремоделирования сердца у больных, перенесших инфаркт миокарда, и их прогностическое значение. Кардиология 1999; 1: 54- 58.
  12. Breithardt G., Cain M. E., Steibeck G. et al. Standards for analysis of ventricular late potentials using high-resolution or signal-averaged electrocardiography. Circulation 1991; 83: 1481- 1486.
  13. Wit A. L., Janse M. J. The ventricular arrhythmias of ischemia and infarction. Electrophysiological mechanisms. Mt Kisco, NY: Futura Publishing; 1992.
  14. Moller J. E., Husic M., Sondergaard E. et al. Relation of early changes of Q-T dispersion to changes in left ventricular systolic and diastolic function after a first acute myocardial infarction. Scand. Cardiovasc. J. 2002; 36 (5): 259-261.
  15. Bigger J. T., Fleiss J. L., Rolnitzky L. M. et al. Time course of recovery of heart period variability after myocardial infarction. J. Am. Coll. Cardiol. 991; 18: 1643-1649.
  16. Calkins H., Maughan W. L., Weisman H. F. et al. Effect of acute volume load on refractoriness and arrhythmia development in isolated, chronically infarcted canine hearts. Circulation 1989; 79 (3): 687-697.
  17. Ganau A., Devereux R. B., Roman M. J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J. Am. Coll. Cardiol. 1992; 19: 1550-1558.

Copyright (c) 2011 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 

Address of the Editorial Office:

  • Novij Zykovskij proezd, 3, 40, Moscow, 125167

Correspondence address:

  • Alabyan Street, 13/1, Moscow, 127055, Russian Federation

Managing Editor:

  • Tel.: +7 (926) 905-41-26
  • E-mail: e.gorbacheva@ter-arkhiv.ru

 

 © 2018-2021 "Consilium Medicum" Publishing house


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies