Object of the study: acute myocardial infarction (AMI). Purpose of the study: to devise methods for prognosticating the development of heart failure and differential approaches to its treatment on the basis of the study of clinical-pathogenetic characteristics of the left ventricle (LV) remodelling in AMI patients followed up for a prolonged period of time. Methods of the investigation: a retrospective analysis of patients’ case histories, an objective examination and clinical observation of the patients, serial electrocardiogram, two-dimensional echocardiography, dopplerechocardiography, laboratory and biochemical, radioimmunological, immunoenzymatic investigations, mathematical and statistical methods of processing the results obtained. Theoretical and practical results: it is shown that in order to re-ceive a more complete assessment of dysfunctions of the LV myo-cardium in AMI patients with signs of acute left ventricle failure (ALVF) it is necessary to study the parameters which characterize boththe systolic and diastolic functions. Doing of stress echocar-diography with small doses of Dobutamine to myocardial infarction (MI) patients in the end of their hospital period makes it possible to increase the quality of diagnosing the functional state and reserve abilities of the cardiovascular system, to assess the prognosis and plan a tactics for further management of the patients. It is shown that absence of any partially viable myocardium in the infarction area can be regarded as an unfavourable prognostic criterion and is a basis for some more active medicamentous therapy in these patients. Revealing of some partially viable myocardium makes it possible to prognosticate the efficacy of the medicamentous therapy and select candidates for cardiosurgical interventions. The study of plasma levels of atrial natriuretic peptide on days 5-7 and endothelin-1 on days 27-30 of MI provides additional information for assessing the severity of disruptions of the LV myocardial function and prognosticating the disease. Novelty: it was shown that revealing of the signs of an early re-modeling of the LV in patients with an uncomplicated course of MI demonstrated formation of chronic heart failure in future. Pe-culiarities of the postinfarction remodelling of the myocardium, a change of the systolic and diastolic LV functions, as well as auto-nomic regulation of the heart rhythm depending upon the presence of left ventricular failure within an acute period of MI during a prolonged follow-up, were revealed. For the first time, peculiari-ties in disruptions of the LV systolic and diastolic functions at an early term of AMI, complicated with ALVF, and their relationship with the development of different complications were studied. It was found out that AMI patients with ALVF signs often devel-oped LV diastolic dysfunctions of the restrictive type, it being as-sociated with an unfavourable prognosis irrespective of the pres-ence of a systolic dysfunction. Possibilities of using stress echo-cardiography with small doses of Dobutamine for studying the ef-fect produced by some partially viable myocardium in the infarc-tion area on the clinical course of the disease, indices of the cen-tral haemodynamics and LV contractility were studied. For the first time in Ukraine, a relationship was revealed between the hi-bernated myocardium, the state of its contractility function and processes of postinfarction remodelling. Degree of introduction: results of the thesis were introduced into medical practice of clinical departments of Malaya Institute of Therapy (Academy of Medical Sciences of Ukraine), the Rehabili-tation Department of Kharkiv City Hospital No. 28, the Cardiol-ogy Department of the Sumy Regional Hospital, the Cardiology Department of the Poltava Regional Hospital, the Therapy De-partment of the Ivano-Frankivsk Regional Hospital, the Cardiol-ogy Department of the Lviv Regional Hospital, the Therapy De-partment of the Cherkasy Regional Hospital, the Cardiology De-partment of the Crimean Republican Cardiological Dispensary, the Therapy Department of the Mykolaiv Regional Hospital, the Therapy Department of the Kherson Regional Hospital, the Ther-apy Department of the Lozovaya Town Hospital, as it is testified to by corresponding acts on introduction of the thesis results. Sphere of application: medicine, cardiology.
