Zaporožskij Medicinskij Žurnal (Dec 2017)
Laboratory and instrumental parameters of patients with ischemic heart disease in dependence of gallbladder condition: correlational analysis
Abstract
The correlations of right coronary artery (RCA) diameter with gallbladder (GB) width and GB distension with the development of coronary arteries anomalies have already been described. Accordingly, the GB disorders are accompanied by structural and functional heart changes, but its exact criteria have not yet been established. Therefore, the substantiation of the prognostic role of GB distension as a risk factor for the coronary arteries anomalies development determined the usefulness of our study. The aim of this study was to establish correlations of GB condition with clinical, laboratory and instrumental parameters in patients with ischemic heart disease (IHD). Materials and мethods. We analyzed 35 clinical, laboratory and instrumental parameters of 98 patients with verified IHD (40 % – acute myocardial infarction, 60 % – unstable angina pectoris; 79 % males and 21 % females; mean age –61.7 ± 1.6 years). These patients were divided into groups depending on GB condition (intact GB, n = 29; sludge and cholesterosis, n = 13; bend GB body, n = 13; GB neck deformations and cholecystitis, n = 27; cholelithiasis, n = 11; cholecystectomy in anamnesis, n = 5). Obtained data were analyzed with the help of correlation analysis (correlations of quantitative parameters – by Pearson’s method and correlations of qualitative parameters – by Spearman’s method). We took into account only significant correlations (p < 0.05). Ranking of GB condition was held on the background of GB disorders’ pathogenesis: changes usually start from sludge and cholesterosis, which in case of various GB deformations together with bile flow difficulties and impaired GB motility lead to cholelithiasis. Complications of cholelithiasis can lead to cholecystectomy, which was rated the worst GB condition. Results. The GB condition significantly correlated with RCA affection grade, alanine aminotransferase (ALT) activity and prothrombin time: worsening of GB condition was accompanied by increase of RCA stenosis grade on the background of decrease in prothrombin time (which shows tendency to hypercoagulability and thrombi formation) and absence of hepatocytes cytolysis. Correlations of RCA stenosis grade depended on GB conditions including metabolic, inflammatory and haemostatic parameters, size and blood supply of left atrium. Prothrombin time increasing was associated with left ventricle hypertrophy, hyperkaliemia, diastolic dysfunction and higher grade of RCA affection. ALT activity was proportional to ejection fraction together with general fibrinogen in case of GB sludge and to fasting glucose level in case of bent GB body. Conclusions. Established reliable correlations of both type and degree of GB damage with RCA stenosis grade and other clinical, laboratory and instrumental parameters (prothrombin time, fibrinogen and ALT levels, hypertrophy and diastolic dysfunction of the left ventricle etc.) are associated with a tendency to hypercoagulability and thrombi formation, hyperkaliemia, and define both morphological and functional interrelations of GB disorders with coronary arteries anomalies. Thus, monitoring of these parameters has a significant prognostic value in the clinical practice and must influence the choice of appropriate therapeutic tactics.
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