Pocheptsova E. Аngiotensin converting enzyme gene polymorphism and ACE activity in the patients with acute miocardial infarction.

Object of the study: Patients with acute myocardial infarction. Purpose of the study: To optimize the treatment for myocardial infarction basing on the study of the association between the degree of severity of the clinical course and prognosis of the disease and gene polymorphism and ACE activity, the level of troponin I in the blood, thrombocytes aggregation as well as comparative evaluation of the efficacy of beta-blockers Carvedilol and Metoprolol Methods of research: To solve the tasks clinical instrumental methods were used. General clinical information was obtained by analysis of complaints, history taking and physical examination of the patients, to verify the diagnosis of MI instrumental study, electrocardiography (ECG) and echocardiography (EchoCG). Laboratory study included determining total cholesterol level and its fractions and thrombocyte aggregation under the influence of various inducers (ADP and adrenaline), immunoenzyme analysis (troponin I in the blood serum), polymerase chain reaction followed by electrophoresis (determining ACE gene poly-morphism), spectrophotometry (ACE activity evaluation), statistical to assess the findings of the research. Theoretical and practical results: Additional criteria for prognosis of complicated course of MI, the degree of troponin I level elevation and increase in ACE activity were suggested. Predictors of unfavorable immediate and long-term prognosis were determined. Improvement of the treatment efficacy in an acute period of MI and deceleration of early remodeling at Carvedilol administration were substantiated. Novelty: It was established that in patients with MI D allele of ACE gene is more common. Presence of D allele in ACE gene was associated with more severe course of MI (larger involve-ment), more frequent development of complications and more pronounced manifestation of the heart remodeling. In D allele carriers higher ACE activity was noted. With the increase of ACE activity the danger of MI complications increased. The presence of association between the volume of the damage and early heart remodeling was shown, which is suggested by corre-lation between the level of troponin I and changes in the size of the left atrium and ejection fraction. Higher troponin I level was noted in D allele carriers. Unfavorable influence of hyperactivation of ACE on the course and prognosis of MI was proved. In the group with lethal out-come marked increase of ACE activity was observed. According to correlation analysis findings, increase of ACE activity was ac-companied by enlargement of the left atrium, end-systolic and end-diastolic size, reduction of ejection fraction. It was revealed that in patients who did not take aspirin and beta-blockers before infarction, MI developed against a background of less severe disturbances of lipid metabolism. It was established that early administration of Carvedilol positively influenced the clinical course and immediate prognosis. Predictors of unfavorable im-mediate and long-term (a year later) prognosis of MI coursewere determined. Degree of introduction: Main findings of the research were in-troduced to the clinical practice of infarction and cardiology de-partments of City Clinical Hospital (Kharkiv), City Clinical Hos-pital for Urgent medical Aid, Institute of Therapy of Academy of Medical Sciences of Ukraine (Kharkiv), which is confirmed by Acts of Introduction. Sphere of application: Medicine, cardiology.