The aim of the dissertation was to improve the medication effectiveness of
the left ventricular (LV) myocardial infarction (MI) with the right ventricle (RV)
involvement, based on the characteristics determining of the course and factors,
affecting the short- and long-term prognosis and processing the methods of their
correction.
309 patients with acute MI with Q wave in the age from 34 to 83 years (an
average age of 65.5±4.42 years) were examined. The patients were divided into 3
groups: the 1st group - 155 patients with MI of the posterior wall (PW) of the LV
with lesions of the RV; the 2nd group - 53 patients with LV MI of the circular
localization with RV MI; the 3rd group (the comparison group) - 101 patients with
MI of the LV PW.
During the 30.6±4.5 months of the overall observation period, the frequency
of the combined cardiovascular (CV) endpoints, included CV-death, the cases of
unstable angina (UA) and heart failure (HF) hospitalizations, stroke, and a
recurrent MI (re-MI), was estimated.
It was proved that for 30.6±4.5 months of observation, the incidence of CVcomplications
was significantly higher in patients after the posterior LV MI with
RV involvement (72.3%; р=0.0001) and in the case of LV MI of the circulary
localization with RV MI (77.4%; р=0.0001) in comparison with patients after
posterior LW MI (Chi-square=13.89759; р=0.00096). There was no significant
difference in the frequency of combined CV events in patients with LV MI with RV
MI (р=0.649).
It was found that the BNP, CRP, and galectin-3 levels, determined in the
acute period and 6 months after LV MI with RV involvement, serve as an additional
risk factor for CV-events and death for 30.6±4.5 months. For the first time, the
correlation between galectin-3 levels in 6 months post-MI of more than 29.28 ng/ml
and the increase of the incidence of CV-death for 30.6±4.5 months (p=0.0001) was
defined in patients with MI of the LV with RV MI.
It was proved, that quercetin usage in the acute period of the LV MI with RV
MI was accompanied by a reduction of the MI acute phase complications and by a
significant influence on the improvement of the long-term prognosis (Cox's F-Test:
p=0.01063). The benefits of the eplerenone usage in the acute period of the LV MI
with RV MI in patients with preserved systolic function of the LV were determined.
It improved the systolic and diastolic functions of the myocardium and reduced
significally the number of CV-complications and death during 30.6±4.5 months
(Cox's F-Test: p=0.0064).
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It was shown that the planned revascularization during the first year after the
LV MI with RV MI was associated with a significant decrease in the number of
CV-complications (Cox's F-Test: p = 0.0001).
The scientific novelty is that for the first time in patients with LV MI in
combined with RV MI the prognostic value of increasing galectin-3 concentration
in the dynamics of 6 months was established as an additional risk factor for CVcomplications
and death during 30.6 ± 4.5 months (sensitivity - 26,6%, specificity -
94,7%, р=0,0076). It has been shown for the first time that the administration of
eplerenone in patients with LV MI with RV lesion with preserved systolic LV
function is associated with improved the long-term prognosis.
The factors associated with the development of CV-events during 30.6±4.5
months were determined: age over 67 years (sensitivity 56.4%, specificity 75.4%,
р˂0.0001), hypotension occurrig at the pre-hospital stage (sensitivity 78.7%,
specificity 83.3%, p=0.0001) and cardiogenic shock (sensitivity 26.6% and
specificity 93.9%, p=0.0106). Inadequate filling (preload) of the impaired RV
(sensitivity 84%, specificity 68.4%, p=0.0001) and non-prescribing of quercetin
(sensitivity 87.2%, specificity 93%, p=0.0001) in acute the period of LV MI with
RV involvement are reliable predictors of worsening long-term prognosis.
In clinical practice the results of the thesis will help to optimize the diagnosis
and risk stratification in patients with LV MI and RV involvement with aim to
apply active treatment tactics and to improve the short- and long-term survival
prognosis. The expediency and benefit of the water soluble form of quercetin and
the early eplerenone usages were justified in patients with LV MI with the RV MI
in connection with significant effects on the the prognosis improvement.
