Acta Medica Leopoliensia (Oct 2024)
STRUCTURAL AND FUNCTIONAL STATE OF THE MYOCARDIUM AND SYSTEMIC INFLAMMATION ACTIVITY IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION IN THE PRESENCE OF ARTERIAL HYPERTENSION AND PREVIOUS COVID-19
Abstract
Aim. The research aims to identify the features of the structural and functional state of the myocardium and manifestations of systemic inflammation in patients with acute ST-elevation myocardial infarction in the presence of such risk factors as arterial hypertension and COVID-19. Material and Methods. The study included 68 patients with STEMI aged 45 to 83 years (mean age 63,80±9,30 years) who underwent primary percutaneous coronary intervention with stenting of the infarcted coronary artery within 24 hours of the onset of clinical manifestations. The proportion of men was 71,43 (60,36-81,33) %, women - 28,57 (18,67-39,64) %. Hypertension was present in 46 patients, and a history of COVID-19 in 26 (67,64 (56,14- 78,17) % and 38,24 (27,12-50,01) %; 17 patients had both risk factors, their proportion in the total sample was 25,00 (15,51-35,90) %. All patients underwent conventional examinations in accordance with local clinical protocols. In addition, the blood levels of natriuretic peptide (NT-proBNP) and C-reactive protein were determined, and an ultrasound examination of the heart was performed at the inpatient stage of treatment and after 6 weeks of follow-up. The results were evaluated using descriptive statistical analysis (arithmetic mean and its standard deviation; median and percentile, proportions and their 95 % confidence intervals calculated using the Wald and Fisher methods), unpaired Student's t-test, and Pearson correlation analysis. Results and Discussion. Most patients with hypertension on admission to the hospital for STEMI have pathological myocardial remodeling, which in 32,61 (19,97-46,69) % of cases is represented by concentric hypertrophy, and in 26,09 (14,56-39,59) % - by concentric left ventricular remodeling. At the time of hospitalization, these patients had a significantly reduced left ventricular ejection fraction (50,00±9,40 %; p<0,001) and higher than the reference values of NT-proBNP (0,50 (0,30;3,30) ng/ml) and C-reactive protein (8,98 (2,30;18,60) IU/ml), p<0,05. During 6 weeks of observation, the left ventricular ejection fraction increased to 55,30±6,80 % (p=0,003), the level of C-reactive protein reached normal values (2,25 (2,30;3,20) IU/mL, p<0,001), but the blood level of NT-proBNP (0,50 (0,40;1,30) ng/mL, p=0,19) remained practically unchanged, indicating the persistence of heart failure in these patients. The correlation between NT-proBNP and ejection fraction in the presence of hypertension is inverse and weak (r=-0,29; p=0,06). In patients with COVID-19, normal left ventricular geometry at hospitalization was noted in only 23,08 (9,24-40,84) % of cases; concentric hypertrophy (42,31 (24,34-61,40) % of cases) and concentric remodeling (34,62 (17,90-53,58) % of patients) prevailed, as in patients with hypertension. In the dynamics of observation, the left ventricular ejection fraction in this category of patients, which was significantly reduced at the time of admission to the hospital (48,50±9,00 %, p<0,001), and also slightly lower than in patients with arterial hypertension (p=0,43), increased to 51,00±9,80 % (p=0,20); C-reactive protein values were normalized, decreasing from 8,20 (5,30;14,30) tо 2,25 (1,30;2,60) IU/mL (p=0,006); the blood content of NT-proBNP, which at hospitalization significantly exceeded the norm and the corresponding values in patients with hypertension (p=0,039), statistically significantly decreased (from 061 (0,30;1,30) to 0,55 (0,40;0.80) ng/ml, p=0,021), indicating a more significant recovery of myocardial function in the presence of COVID-19 compared with such a risk factor as hypertension. The use of sodium-dependent glucose cotransporter type 2 inhibitors (dapagliflozin or empagliflozin) as part of complex treatment contributed to better results in left ventricular geometry and NT-proBNP and C-reactive protein values compared with patients who did not take these drugs, but no significant differences were obtained between these categories of patients. Conclusions. Pathologic myocardial remodeling (with predominance of concentric hypertrophy and concentric remodeling of the left ventricle), inherent in patients with hypertension, worsens (according to the dynamics of NT-proBNP in the blood) the course of the early postinfarction period in the presence of STEMI, contributing to the preservation of heart failure. In patients with COVID-19, at the time of STEMI, concentric hypertrophy (in almost half of patients) and concentric remodeling (in almost a third of patients) of the left ventricle are recorded, accompanied by a significant decrease in left ventricular ejection fraction and significantly higher NT-proBNP values compared with patients with hypertension (p=0,50 and p=0,039, respectively). COVID-19 should be considered, along with arterial hypertension, an important risk factor for adverse STEMI.
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