A.M. VOROBEV^1,2, V.I. RUZOV¹, M.A. MELNIKOVA², V.A. KADEBINA²

 ¹Ulyanovsk State University, Ulyanovsk

²Central City Clinical Hospital, Ulyanovsk

 Contact details:

Vorobev A.M.—post-graduate student of the Department of Faculty Therapy, Institute of Medicine, Ecology and Physical Education, cardiologist

Address: 26 Kuznetsov St., Ulyanovsk, Russian Federation, 432020, tel.:+7-906-14-13-66, e-mail:vrb73@yandex.ru

 The purpose — to assess the importance of stress echocardiography in identifying the nature and severity of cardiac dysfunction in patients with myocardial infarction.

Material and methods.86 patients were examined at the outpatient stage of rehabilitation 6 weeks after myocardial infarction with primary coronary angioplasty with stenting.

Results.Echocardiography revealed left ventricular hypertrophy (LVH) in 34 patients with myocardial infarction with concomitant arterial hypertension. Patients with LVH are characterized by more pronounced structural and functional LV remodeling, which is expressed in a lower LVEF and increased LVEDD, LVESVand LVEDV(p<0.05). There were no differences in stroke volume between patients with and without LVH. The performed diastolic stress test in patients with LVH is characterized by significantly lower average early diastolic mitral annular velocity e` (7.6 vs. 9.3 cm/s, p<0.01) without differences in the peak early transmitral Doppler flow velocity E (69.8 vs 78.0, p>0.05) compared with patients without LVH. The revealed differences between patients with and without LVH are due to a higher post-exercise velocity e` in patients with normal LV geometry and a decrease in eccentric LVH subgroup.

Conclusions.1) Patients with LVH in the early postinfarction period (6 weeks) have more pronounced LV systolic dysfunction, expressed in a decrease in LVEF and an increase in LVEDD, LVESV, LVEDV compared to patients without LVH.2) Left ventricular hypertrophy, in conditions of myocardial infarction, is associated with latent diastolic dysfunction, which is manifested by a lower average early diastolic mitral annular velocity e` after the stress-test.

Key words: left ventricular hypertrophy, postinfarction remodeling, diastolic dysfunction.

REFERENCES

1. Korennova O.Yu., Turusheva E.A., Podol’naya S.P. et al. Efficacy and tolerability of the fixed combination of bisoprolol and perindopril in the treatment of patients with arterial hypertension after revascularization for acute coronary syndrome. Arterial’naya gipertenziya, 2019, vol. 25, no. 3, pp. 295–306 (in Russ.). DOI:10.18705/1607-419X-2019-25-3-295-306
2. Nepper-Christensen L., Lønborg J., Ahtarovski K.A. et al. Left Ventricular Hypertrophy Is Associated With Increased Infarct Size and Decreased Myocardial Salvage in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. J Am Heart Assoc., 2017, vol. 6(1), pp. e004823. DOI:10.1161/JAHA.116.004823
3. Stiermaier T., Pöss J., Eitel C. et al. Impact of left ventricular hypertrophy on myocardial injury in patients with ST-segment elevation myocardial infarction. Clin Res Cardiol, 2018, vol. 107(11), pp. 1013–1020. DOI:10.1007/s00392-018-1273-8
4. Li T., Li G., Guo X. et al. Echocardiographic left ventricular geometry profiles for prediction of stroke, coronary heart disease and all-cause mortality in the Chinese community: a rural cohort population study. BMC Cardiovasc Disord, 2021, vol. 21(1), p. 238. DOI:10.1186/s12872-021-02055-w
5. Ghali J.K., Liao Y., Cooper R.S. Influence of left ventricular geometric patterns on prognosis in patients with or without coronary artery disease. J Am Coll Cardiol, 1998, vol. 31(7), pp. 1635–1640. DOI:10.1016/s0735-1097(98)00131-4
6. Velagaleti R.S., Gona P., Pencina M.J. et al. Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction. Am J Cardiol, 2014, vol. 113(1), pp. 117–122. DOI:10.1016/j.amjcard.2013.09.028
7. de Simone G., Gottdiener J.S., Chinali M. et al. Left ventricular mass predicts heart failure not related to previous myocardial infarction: the Cardiovascular Health Study. Eur Heart J, 2008, vol. 29(6), pp. 741–747. DOI:10.1093/eurheartj/ehm605
8. Soldatova O.A. Features of left ventricular remodeling in patients with myocardial infarction in the formation of chronic heart failure. Vestnik meditsinskogo instituta “REAVIZ”, 2017, vol. 25, no. 1, pp. 91–98 (in Russ,).
9. Bubnova M.G., Barbarash O.L., Doletskiy A.A. et al. Acute myocardial infarction with ST elevation of the electrocardiogram: rehabilitation and secondary prevention. Rossiyskiy kardiologicheskiy zhurnal, 2015, no. 1, pp. 6–52 (in Russ.). DOI:10.15829/1560-4071-2015-1-6-52
10. Nass O., Yang X.P., Liu Y.H. et al. Effects of pre-existing left ventricular hypertrophy on ventricular dysfunction and remodeling following myocardial infarction in rats. J Heart Lung Transplant, 2002, vol. 21(10), pp. 1113–1119. DOI:10.1016/s1053-2498(02)00432-1
11. Małek Ł.A., Spiewak M., Kłopotowski M. et al. Influence of left ventricular hypertrophy on infarct size and left ventricular ejection fraction in ST-elevation myocardial infarction. Eur J Radiol, 2012, vol. 81(3), pp. e177–e181. DOI:10.1016/j.ejrad.2011.01.088
12. Carabello B.A. The Pathophysiology of Afterload Mismatch and Ventricular Hypertrophy. Structural Heart, 2021, vol. 5(5), pp. 446–456. DOI:10.1080/24748706.2021.1944708
13. Purves P.D., Darragh M.A., Gebhardt V.A. et al. Left ventricular volume response to exercise in normal and coronary artery disease patients. Can J Cardiol, 1985, vol. 1(5), pp. 298–301.
14. Kattel S., Memon S., Saito K. et al. An effect of left ventricular hypertrophy on mild-to-moderate left ventricular diastolic dysfunction. Hellenic J Cardiol, 2016, vol. 57 (2), pp. 92–98. DOI:10.1016/j.hjc.2016.03.004
15. Ha J.W., Andersen O.S., Smiseth O.A. et al. Diastolic Stress Test: Invasive and Noninvasive Testing. JACC Cardiovasc Imaging, 2020, vol. 13(1 pt 2), pp. 272–282. DOI:10.1016/j.jcmg.2019.01.037
16. Klein A.L., Garcia M.J. Diastology (Second Edition). Elsevier, 2021, pp. 217–239. DOI:10.1016/B978-0-323-64067-1.00017-6