evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2017-4-74-85evrazkar-260Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSТЕЧЕНИЕ СОЧЕТАННОГО ИНФАРКТА МИОКАРДА НИЖНЕЙ СТЕНКИ ЛЕВОГО ЖЕЛУДОЧКА И ПРАВОГО ЖЕЛУДОЧКА С ТРАНЗИТОРНОЙ АРТЕРИАЛЬНОЙ ГИПОТОНИЕЙTHE PROCESS OF COMBINED INFERIOR MYOCARDIAL INFARCTION AND RIGHT VENTRICLE MYOCARDIAL INFARCTION WITH TRANSIENT ARTERIAL HYPOTENSIONЧазымоваЗ. М.ChazymovaZ. M.

Научный сотрудник отделения ургентной кардиологии и реанимации

720040, Кыргызстан, г. Бишкек, ул. Тоголок Молдо, 3,

тел.: 0312625682

Research officer of Urgent Cardiology and Resuscitation Department 

720040, Kyrgyzstan, Bishkek city, str. Togolok Moldo, 3

tel.: 0312625682

chzalina88@gmail.comБейшенкуловМ. Т.BeishenkulovM. T.

Профессор, д.м.н., заведующий отделением ургентной кардиологии и реанимации

720040, Кыргызстан, г. Бишкек, ул. Тоголок Молдо, 3

тел.: 0702-23-22-44

Professor, grand Ph.D., the head of Urgent Cardiology and Resuscitation Department 

720040, Kyrgyzstan, Bishkek city, str. Togolok Moldo, 3

tel.: 0702-23-22-44

medettb62@gmail.comКалиевК. Р.KalievK. R.

Научный сотрудник отделения ургентной кардиологии и реанимации

720040, Кыргызстан, г. Бишкек, ул. Тоголок Молдо, 3

тел.: 0555-09-77-74

Research officer of Urgent Cardiology and Resuscitation Department 

720040, Kyrgyzstan, Bishkek city, str. Togolok Moldo, 3

tel.: 0555-09-77-74

dissmed@gmail.comТоктосуноваА. К.ToktosunovaA. K.

Младший научный сотрудник отделения ургентной кардиологии и реанимации,

720040, Кыргызстан, г. Бишкек, ул. Тоголок Молдо, 3

тел. 0550-91-79-10

Research assistant of Urgent Cardiology and Resuscitation Department 

720040, Kyrgyzstan, Bishkek city, str. Togolok Moldo, 3

tel. 0550-91-79-10

aiperi1771@mail.ruАбдурашидоваТ. Ш.AbdurashidovaT. S.

Младший научный сотрудник отделения ургентной кардиологии и реанимации

720040, Кыргызстан, г. Бишкек, ул. Тоголок Молдо, 3

тел.: 0700-30-12-90

Research assistant of Urgent Cardiology and Resuscitation Department 

720040, Kyrgyzstan, Bishkek city, str. Togolok Moldo, 3

tel.: 0700-30-12-90

chzalina88@gmail.comНациональный Центр Кардиологии и Терапии им. академика М. МиррахимоваКыргызстанNational center of Cardiology and Internal Medicine named after academician Mirrachimov M.MKyrgyzstan201730122017047485Copyright © Чазымова З.М., Бейшенкулов М.Т., Калиев К.Р., Токтосунова А.К., Абдурашидова Т.Ш., 20172017Чазымова З.М., Бейшенкулов М.Т., Калиев К.Р., Токтосунова А.К., Абдурашидова Т.Ш.Chazymova Z.M., Beishenkulov M.T., Kaliev K.R., Toktosunova A.K., Abdurashidova T.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/260Цель

Цель: изучение влияния артериальной гипотонии на течение сочетанного инфаркта миокарда нижней стенки левого желудочка (ЛЖ) и правого желудочка (ПЖ).

Материал и методы

Материал и методы. Обследовано 66 больных первичным ИМ нижней стенки ЛЖ и ПЖ. Больные разделены на 2 группы: 1 группа - больные ИМ нижней стенки ЛЖ и ПЖ со стабильной гемодинамикой (n=34); 2 группа - больные ИМ нижней стенки ЛЖ и ПЖ с артериальной гипотонией в раннем периоде (n=32). Электрокардиография (ЭКГ) и эхокардиография (ЭхоКГ) проводились всем пациентам при поступлении, на 3, 30 дни и 6 месяц после ИМ.

Результаты

Результаты. К 6 месяцу заболевания, несмотря на адекватную консервативную терапию, произошло достоверное увеличение объемных показателей ЛЖ у больных 2 гр., так КДО ЛЖ составил 164,2±4,2 мл<sup>3</sup>, КСО 94,1±2,8 мл3 (р<0,028). Прослеживалась положительная динамика в восстановлении систолической функции ПЖ у больных обеих групп. Так КДП ПЖ у больных 2 гр. составила 31,4±2,0 см<sup>2</sup>, а у больных 1 гр. -25,1±2,2 см2 (р<0,05), КСП ПЖ у больных 2 гр. - 19,8±2,0 см2, у больных 1 гр. - 14,4±1,9 см<sup>2</sup> (р<0,05). К 6 месяцу заболевания ФИП ПЖ у больных 1 гр. составила 40,3±3,2%, у больных 2 гр. - 39,4% (р<0,05 внутри группы). К 6 месяцу заболевания у больных 1 группы: повторные эпизоды ОКС - у 6 человек (18%), сердечная недостаточность ФК III у 4 человек (12%), летальных исходов - 2 человека (6%). У больных 2 группы: повторные эпизоды ОКС - у 10 человек (30%) (ОШ 2,167; 95% ДИ 0,674-6,967), сердечная недостаточность ФК III у 7 человек (21%), летальных исходов - 3 человека (10%) (ОШ 2,2; 95% ДИ 0,190-25,517).

Заключение

Заключение. К 6 месяцу у больных с транзиторной артериальной гипотонией в дебюте заболевания, отмечаются признаки патологического ремоделирования ЛЖ, что утяжеляет клиническое течение больных, а вот функция ПЖ улучшается в обеих группах.

Aim

Aim. To study the arterial hypotension influence to the progress of combined inferior and right ventricle myocardial infarction.

Material and methods

Material and methods. There were studied 66 patients with the primary inferior and right ventricle myocardial infarction. Patients were divided into 2 groups: 1st group - patients with inferior and right ventricle myocardial infarction with stable hemodynamics (n=34); 2nd group - patients with inferior and right ventricle myocardial infarction complicated by arterial hypotension in early period (n=32). Electrocardiography (ECG) and echocardiography (EchoCG) were performed in patients 1, 3, 30 days and 6 months after.

Results

Results. On the 6th month of the disease, despite adequate conservative therapy, there was a significant increase of LV volume index in patients from the 2nd group, thus EDV LV was 164.2±4.2 ml<sup>3</sup>, ESV 94.1±2.8 ml<sup>3</sup> (p<0.028). It was positive dynamics in rehabilitationof systolic function of RV in two groups. Thus EDS RV in patients from the 2nd group was 31.4±2.0 sm<sup>3</sup>, and in patients from the 1st group 25.1±2.2 cm<sup>3</sup> (p<0.05), ESS RV in 2nd group became 19.8±2.0 cm<sup>3</sup>, and in the 1st group 14.4±1.9 cm<sup>3</sup> (p<0.05). To the 6th month of disease FIP LV in the 1st group 40.3±3.2%, in the 2nd group 39.4% (p<0.05 in the group). To the 6th month of disease in the 1st group: ACS repeated episodes were in 6 patients (18%), 4 patients with heart failure FC III (12%), death was in 6% (2 patients). In the 2nd group: ACS repeated episodes were in 10 patients (30%) (OR 2.167; 95% CI 0.674-6.967), 7 patients with heart failure fC III (21%), death was in 10% (3 patients) (OR 2.2; 95% CI 0.190-25.517).

Conclusion

Conclusion. The patients with transitory arterial hypotension at the beginning of disease, have the singes of pathological LV remodeling, which complicate the course of disease, but the RV function becomes better.

инфаркт миокарда правого желудочкаэхокардиографияремоделирование левого желудочкадиастолическая функциямежжелудочковая и внутрижелудочковаяright ventricle myocardial infarctionechocardiographyleft ventricle remodelingdiastolic functionReferencesБыстров В.В., Макаренко А.С., Дячок С.В., Раков А.Л. Особенности электрокардиографической картины при изолированном инфаркте миокарда правого желудочка. Клин. медицина 2001;6:61-63Bystrov V.V., Makarenko A.S., Dyachok S.V., Rakov A.L. Features of the electrocardiographic pattern in isolated myocardial infarction of the right ventricle. Klin.medicina 2001;6:61-63 [in Russian].Нетяженко В.З., Пленова О.М., Строганова Н.П. та ін. Клінічні аспекти тромболітичної терапії. Клінічна фармакологія, фізіологія, біохімія 1997;1:71-80Netyazhenko V.Z., Plienova O.M., Stroganova N.P. et al. Clinical aspects of thrombolytic therapy. Clinicalpharmacology, physiology, biochemistry 1997;1:71-80 [in Ukrainian].Остроумов Е.Н., Кармер А.Я., Ермоленко А.Е. и др. Фракция выброса правого желудочка, как показатель эффективности реваскуляризации у больных с ишемической болезнью сердца с застойной недостаточностью кровообращения// Кардиология 1996;4:57-61Ostroumov E.N., Karmer A.Ya., Ermolenko A.E. Emission fraction of the right ventricle as an indicator of the effectiveness of revascularization in patients with ischemic heart disease with congestive circulatory insufficiency. Cardiology 1996;4:57-61. [in Russian].Antman E., Hand M., Armstrong P. et al. Focused Update 2007 of the ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (STEMI): A Report of the ACC/AHA Task Force on Practice Guidelines. Circulation 2008;117:296-329Antman E., Hand M., Armstrong P. et al. Focused Update 2007 of the ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (STEMI): A Report of the ACC/AHA Task Force on Practice Guidelines. Circulation 2008;117:296-329.Oguzhan A., Abaci A., Eryol N.K. Evaluation of right ventricular function by colour Doppler tissue imaging can help to identify patients with right ventricular infarction. Eur. Heart J. 2000;21:110-119Oguzhan A., Abaci A., Eryol N.K. Evaluation of right ventricular function by colour Doppler tissue imaging can help to identify patients with right ventricular infarction. Eur. Heart J. 2000;21:110-119.Serrano Junior C.V., Ramires J.A., Cesar L.A. Prognostic significance of right ventricular dysfunction in patients with acute inferior myocardial infarction and right ventricle involvement. Clin. Cardiology 1995;18:1210-1218Serrano Junior C.V., Ramires J.A., Cesar L.A. Prognostic significance of right ventricular dysfunction in patients with acute inferior myocardial infarction and right ventricle involvement. Clin. Cardiology 1995;18:1210-1218.Bowers T.R., O’Neill W.W., Grines C. et al. Effect of reperfusion on biventricular function and survival after right ventricular infarction. N Engl J Med. 1998; 338:933-40Bowers T.R., O’Neill W.W., Grines C. et al. Effect of reperfusion on biventricular function and survival after right ventricular infarction. N Engl J Med. 1998; 338:933–40.Sagawa K. The End-systolic pressure-volume relation of the ventricle: definition, modification and clinical use. Circulation 1981;63:1225-1227Sagawa K. The End-systolic pressure-volume relation of the ventricle: definition, modification and clinical use. Circulation 1981;63:1225-1227.Braat S.H., Brugada P., de Zwaan С. et al. Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Brit. Heart J. 1983;49:368-372Braat S.H., Brugada P., de Zwaan С. et al. Value of electrocardiogram in diagnosing right ventricular involvement in patients with an acute inferior wall myocardial infarction. Brit. Heart J. 1983;49:368-372Cohn J.N., Guiha N.H., Broder M.I., Limas C.J. Right ventricular infarction: Clinical and hemodynamic features. Amer. J. Cardiology 1974; 33:209-214.Cohn J.N., Guiha N.H., Broder M.I., Limas C.J. Right ventricular infarction: Clinical and hemodynamic features. Amer. J. Cardiology 1974; 33:209-214.Klein H.O., Tordjman T., Ninio R. et al. The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation 1983;67:558-565.Klein H.O., TordjmanТ., Ninio R. et al. The early recognition of right ventricular infarction: diagnostic accuracy of the electrocardiographic V4R lead. Circulation 1983;67:558-565.Lopez-Sendon J., Coma-Canella I., Gamallo C. Sencitivity and specificity of hemodynamic criteria in the diagnosis of acute rigft ventricular infarction. Circulation 1981; 64:515-525.Lopez-Sendon J., Coma-Canella I., Gamallo C. Sencitivity and specificity of hemodynamic criteria in the diagnosis of acute rigft ventricular infarction. Circulation 1981; 64:515-525.Stoian I., Ginghina C., Coman I. The relation between right ventricular ejection fraction and left ventricular wall motion score. Eur. Heart J 2001; 22:580-586.Stoian I., Ginghina C., Coman I. The relation between right ventricular ejection fraction and left ventricular wall motion score. Eur. Heart J 2001; 22:580-586.Орлов М.В., Грачев С.П., Несветов В.Н. Комплексное ультразвуковое исследование в диагностике и оценке функции сердца при инфаркте миокарда правого желудочка. Кардиология 1989; 3:41-45Orlov M.V., Grachev S.P., Nesvetov V.N. Complex ultrasound in the diagnosis and evaluation of heart function with myocardial infarction of the right ventricle. Cardiology 1989; 3:41-45 [in Russian].Isner J.M., Roberts W.C. Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease: Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol. 1978;42:885–94.Isner J.M., Roberts W.C. Right ventricular infarction complicating left ventricular infarction secondary to coronary heart disease: Frequency, location, associated findings and significance from analysis of 236 necropsy patients with acute or healed myocardial infarction. Am J Cardiol. 1978;42:885–94.Shah P.K., Maddahi J., Berman D.S. Scintigraphically detected predominant right ventricular dysfunction in acute myocardial infarction: Clinical and hemodynamic correlates and implications for therapy and prognosis.J Am CollCardiol. 1985;6:1264–72.Shah P.K., Maddahi J., Berman D.S. Scintigraphically detected predominant right ventricular dysfunction in acute myocardial infarction: Clinical and hemodynamic correlates and implications for therapy and prognosis.J Am CollCardiol. 1985;6:1264–72.Horan L.G., Flowers N.C. Right ventricular infarction: Specific requirements of management. Am Fam Physician. 1999;60:1727–34.Horan L.G., Flowers N.C. Right ventricular infarction: Specific requirements of management. Am Fam Physician. 1999;60:1727–34.Lamas G.A., Pfeffer M.A. Left ventricular remodeling after acute myocardial infarction: clinical course and beneficial effects of angiotensin; converting enzyme inhibition. Am. Heart. J 1991; 121 (4), part. 1:1194–1202.Lamas G.A., Pfeffer M.A. Left ventricular remodeling after acute myocardial infarction: clinical course and beneficial effects of angiotensin; converting enzyme inhibition. Am. Heart. J 1991; 121 (4), part. 1:1194–1202.Sabbah H.N., Goldstein S. Ventricular remodelling: consequences and therapy. Eur. Heart. J 1993;14:24–29.Sabbah H.N., Goldstein S. Ventricular remodelling: consequences and therapy. Eur. Heart. J 1993;14:24–29.Bordachar P., Garrigue S., Lafitte S. et al. Interventricular and intra-left ventricular electromechanical delays in right ventricular paced patients with heart failure: implications for upgrading to biventricular stimulation. Heart 2003; 89:1401-1405.Bordachar P., Garrigue S., Lafitte S. et al. Interventricular and intra-left ventricular electromechanical delays in right ventricular paced patients with heart failure: implications for upgrading to biventricular stimulation. Heart 2003; 89:1401-1405.Cardim N., Castela S., Cordeiro R. et al. Tissue Doppler imaging assessment of long axis left ventricular function in hypertrophic cardiomyopathy. Rev Port Cardiol 2002 Sep; 21(9): 953-85Cardim N., Castela S., Cordeiro R. et al. Tissue Doppler imaging assessment of long axis left ventricular function in hypertrophic cardiomyopathy. Rev Port Cardiol 2002 Sep; 21(9): 953-85D’Andrea A., Ducceschi V., Caso P. et al. Usefulness of Doppler tissue imaging for the assessment of right and left ventricular myocardial function in patients with dual-chamber pacing. Int J Cardiol. 2001 Nov; 81(1): 75-83D’Andrea A., Ducceschi V., Caso P. et al. Usefulness of Doppler tissue imaging for the assessment of right and left ventricular myocardial function in patients with dual-chamber pacing. Int J Cardiol. 2001 Nov; 81(1): 75-83Kass D.A., Chen C.H., Curry C. et al. Improved Left Ventricular Mechanics From Acute VDD Pacing in Patients With Dilated Cardiomyopathy and Ventricular Conduction Delay. Circulation. 1999; 99: 1567-1573Kass D.A., Chen C.H., Curry C. et al. Improved Left Ventricular Mechanics From Acute VDD Pacing in Patients With Dilated Cardiomyopathy and Ventricular Conduction Delay. Circulation. 1999; 99: 1567-1573Yu C.M., Lin H., Yang H. et al. Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction. Cirulation 2002; 105: 1195–201Yu C.M., Lin H., Yang H. et al. Progression of systolic abnormalities in patients with “isolated” diastolic heart failure and diastolic dysfunction. Cirulation 2002; 105: 1195–201Wildgruber M., Bielicki I., Aichler M. et al. Assessment of myocardial infarction and postinfarction scar remodeling with an elastin-specific magnetic resonance agent. Circ Cardiovasc Imaging. 2014; 7(2): 321-329.Wildgruber M., Bielicki I., Aichler M. et al. Assessment of myocardial infarction and postinfarction scar remodeling with an elastin-specific magnetic resonance agent. Circ Cardiovasc Imaging. 2014; 7(2): 321-329.Reis Filho J.R., Cardoso J.N., Cardoso C.M. et al. Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure. Arq Bras Card. 2015; 104(6): 502-506.Reis Filho J.R., Cardoso J.N., Cardoso C.M. et al. Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure. Arq Bras Card. 2015; 104(6): 502-506.Grothoff M., Elpert C., Hoffmann J. et al. Right ventricular injury in ST-elevation myocardial infarction: risk stratification by visualization of wall motion, edema, and delayedenhancement cardiac magnetic resonance. Circ Cardiovasc Imaging. 2012; 5(1): 60-68.Grothoff M., Elpert C., Hoffmann J. et al. Right ventricular injury in ST-elevation myocardial infarction: risk stratification by visualization of wall motion, edema, and delayedenhancement cardiac magnetic resonance. Circ Cardiovasc Imaging. 2012; 5(1): 60-68.Ondrus T., Kanovsky J., Novotny T. et al. Right ventricular myocardial: From pathophysiology to prognosis. Exp Clin Cardiol. 2013; 18(1): 27-30.Ondrus T., Kanovsky J., Novotny T. et al. Right ventricular myocardial: From pathophysiology to prognosis. Exp Clin Cardiol. 2013; 18(1): 27-30.Yasuda T., Okada R.D., Leinbach R.C. et al. Serial evaluation of right ventricular dysfunction associated with acute inferior myocardial infarction. Am Heart J. 1990;119:816–22. [PubMed]Yasuda T., Okada R.D., Leinbach R.C. et al. Serial evaluation of right ventricular dysfunction associated with acute inferior myocardial infarction. Am Heart J. 1990;119:816–22. [PubMed]Chanal A.A., Kim M.Y., Borg A.N. et al. Primary angioplasty for infarction due to isolated right ventricular artery occlusion. World J Cardiol. 2014; 6(11): 1223-1226.Chanal A.A., Kim M.Y., Borg A.N. et al. Primary angioplasty for infarction due to isolated right ventricular artery occlusion. World J Cardiol. 2014; 6(11): 1223-1226.O’Rourke RA, Dell’Italia LJ. Diagnosis and management of right ventricular myocardial infarction. CurrProblCardiol. 2004;29:6–47. [PubMed]O’Rourke RA, Dell’Italia LJ. Diagnosis and management of right ventricular myocardial infarction. CurrProblCardiol. 2004;29:6–47. [PubMed]Lim St., Marcovitz P., O’Neill W.A., Goldstein J.A. Right ventricular performance is preserved during stress in patients with chronic proximal right coronary occlusion. J Am CollCardiol 2001;37:2 Suppl A:347A.Lim St., Marcovitz P., O’Neill W.A., Goldstein J.A. Right ventricular performance is preserved during stress in patients with chronic proximal right coronary occlusion. J Am CollCardiol 2001;37:2 Suppl A:347A.Yasuda T., Okada R.D., Leinbach R.C.,et al. Serial evaluation of right ventricular dysfunction associated with acute inferior myocardial infarction. Am Heart J .1990; 119:816–822.Yasuda T., Okada R.D., Leinbach R.C.,et al. Serial evaluation of right ventricular dysfunction associated with acute inferior myocardial infarction. Am Heart J .1990; 119:816–822.Sheehan F.H., Braunwald E., Canner P. et al. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) Trial. Circulation 1987; 75:817–829.Sheehan F.H., Braunwald E., Canner P. et al. The effect of intravenous thrombolytic therapy on left ventricular function: a report on tissue-type plasminogen activator and streptokinase from the Thrombolysis in Myocardial Infarction (TIMI Phase I) Trial. Circulation 1987; 75:817–829.Bates E.R., Califf R.M., Stack R.S. et al. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI-1) trial: influence of infarct location on arterial patency, left ventricular function and mortality. J Am CollCardiol 1989; 1:12–18.Bates E.R., Califf R.M., Stack R.S. et al. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI-1) trial: influence of infarct location on arterial patency, left ventricular function and mortality. J Am CollCardiol 1989; 1:12–18.Owens C.G., McClelland A.J., Walsh S.J. et al. In-hospital percutaneous coronary intervention improves in-hospital survival in patients with acute inferior myocardial infarction particularly with right ventricular involvement. J InvasiveCardiol 2009; 21: 40–44.Owens C.G., McClelland A.J., Walsh S.J. et al. In-hospital percutaneous coronary intervention improves in-hospital survival in patients with acute inferior myocardial infarction particularly with right ventricular involvement. J InvasiveCardiol 2009; 21: 40–44.

The authors declare that there are no conflicts of interest present.