The thesis refers to the issues of improving the efficiency of diagnosis, prognosis and treatment of Q-myocardial infarction (Q-MI) complicated by acute heart failure (AHF) associated with hyperglycemia (HG) on admission to the hospital. The results are drawn from the study of copeptin and NTproBNP levels, clinical peculiarities of the disease, observations on structural and functional changes in the heart, variability of glycemic profile (GP) and the assessment of the complex treatment effectiveness.
The total number of patients with Q-MI complicated by AHF constituted 139 people. The examined patients were divided into 2 groups: group 1 - 108 patients with marked HG оn admission (blood glucose level > 7,8 mmol/l), group 2 - 31 patients with normoglycemia. After the examination group 1 was further divided into subgroups according the type of HG: subgroup 1 (n = 34) - stress GH, subgroup 2 (n = 26) - impaired glucose tolerance, subgroup 3 (n = 25) - new-onset diabetes, subgroup 4 (n = 33) - type 2 diabetes in the history. 28 healthy people entered the control group.
The results of the study demonstrated distinct differences in the clinical course of AHF in patients with Q-MI associated with HG on admission. The later are prone to more frequent development of shortness of breath (χ2=8,169, p=0,005), gallop rhythm (χ2=7,881; p=0,005), dry cough (χ2=9,773; p=0,002), wet wheezing in the lungs (χ2=8,787; p=0,004) and AF paroxysm (χ2=4,036; p=0,04). An increase in glycemia values and variability of GP are associated with accelerated heart rate, decrease in SBP and DBP on the initial examination of the patient and an increase in Killip class of AHF.
In acute period of Q-MI, a significant increase in the LVEF by 5 % was registered only in the patients with normoglycemia. In patients with Q-MI complicated by AHF associated with HG on admission, structural and functional changes in the heart result from a significant increase in EDD by 9 % on day 1, ESD by 6 % on day 1 and 7 % on day 12, systolic PAP by 17 % on day 1 and 25 % on day 12, a decrease in LVEF by 17 % on day 1 and 16 % on day 12. Systolic dysfunction is more regularly registered in patients with HG on admission both on day 1 (χ2=4,647; p=0,03) and day 12 (χ2=6,501; p=0,01), eccentric hypertrophy - in patients with HG on admission (χ2=5,813; p=0,02) and stress HG (χ2=4,916; p=0,03) on day 1. Correlation analysis proved the impact of glycemia on admission and variability of GP on the size of the LA, ESD, EDD, LVMI and LVEF. The maximal changes were observed in following HG subgroups: enlargement of the heart chambers and a decrease in the LVEF on day 1 were revealed in the patients with DM type 2 in the history, on day 12 - in patients with new-onset diabetes.
