RESUMEN
We have assessed parameters of myocardial electrical instability in patients with postinfarction atherosclerosis before and in one year after coronary bypass surgery. Inclusion criteria were history of myocardial infarction, surgical myocardial revascularization between 1 and 2 years before; stable course of coronary heart disease during previous month; preserved ejection fraction ( more or equal 50%), stable sinus rhythm. Heterogeneity of myocardial electrophysiological properties has diminished after coronary bypass surgery due to improvement of coronary perfusion and restoration of function of ischemic myocardium. This have been associated with positive dynamics of interval QT dispersion, parameters of turbulence and variability of cardiac rhythm, reduction of the rate of registration of ventricular late potentials.
Asunto(s)
Puente de Arteria Coronaria , Muerte Súbita Cardíaca/prevención & control , Técnicas Electrofisiológicas Cardíacas , Fenómenos Electrofisiológicos , Infarto del Miocardio , Enfermedad de la Arteria Coronaria/etiología , Enfermedad de la Arteria Coronaria/fisiopatología , Muerte Súbita Cardíaca/etiología , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Monitoreo Fisiológico , Contracción Miocárdica , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Volumen Sistólico , Factores de TiempoRESUMEN
Effect of enalapril and telmisartan on hemodynamic indices, structural-functional parameters of the left ventricle, and vasomotor function of arterial endothelium was studied in 49 patients (mean age 48.3+/-3.2 years) with 1-2 degree arterial hypertension (AH) and abnormal relaxation type of left ventricular diastolic dysfunction. Enalapril was given to 24 and telmisartan to 25 patients. Examination included 24-hour arterial pressure monitoring, echocardiography, duplex scanning of the left brachial artery. At the background of therapy with enalapril target levels of systolic and diastolic arterial pressure (AP) were achieved in 79.2 and 70.85% of patients. This was associated with 54.2% reduction of number of non-dippers and night peakers. Therapy with telmisartan (30 weeks) besides effective AP control provided normalization of 24-hour AP profile in 90% of patients with pathological circadian rhythm. This was accompanied by improvement of vasomotor endothelial function of arteries, positive dynamics of structural-functional parameters of the left heart chambers, improvement of indices of left ventricular diastolic function.
Asunto(s)
Bencimidazoles , Benzoatos , Enalapril , Hipertensión/tratamiento farmacológico , Vasodilatación/efectos de los fármacos , Función Ventricular Izquierda/efectos de los fármacos , Remodelación Ventricular/efectos de los fármacos , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Inhibidores de la Enzima Convertidora de Angiotensina/farmacocinética , Bencimidazoles/administración & dosificación , Bencimidazoles/efectos adversos , Bencimidazoles/farmacocinética , Benzoatos/administración & dosificación , Benzoatos/efectos adversos , Benzoatos/farmacocinética , Presión Sanguínea/efectos de los fármacos , Monitoreo Ambulatorio de la Presión Arterial , Arteria Braquial/diagnóstico por imagen , Ecocardiografía , Enalapril/administración & dosificación , Enalapril/efectos adversos , Enalapril/farmacocinética , Femenino , Humanos , Hipertensión/fisiopatología , Masculino , Persona de Mediana Edad , Telmisartán , Resultado del TratamientoRESUMEN
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 pseudo-normal 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%), QT(c) and QT(d) 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.