Терапевтический архив (Sep 2011)

Long-term prognosis in patients with acute non-ST elevation myocardial infarction depending on dynamics of tissue myocardial dopplerography

  • Mikhail Yakovlevich Krasnosel'skiy,
  • Ekaterina Vilenovna Koshkina,
  • Aleksandr Aleksandrovich Polupan,
  • Anna Igorevna Gmyzina,
  • Gennadiy Vasil'evich Ponomarev,
  • Vladimir Viktorovich Tsurko,
  • M Ya Krasnoselsky,
  • E V Koshkina,
  • A A Polupan,
  • A I Gmyzina,
  • G V Ponomarev,
  • V V Tsurko

Journal volume & issue
Vol. 83, no. 9
pp. 25 – 29

Abstract

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Aim. To study long-term prognosis in patients with non-ST elevation acute myocardial infarction (AMI) with reference to changes in myocardial tissue dopplerography (MTD) in the course of treatment. Material and methods. MTD echocardiography was conducted in 88 non-ST elevation AMI (mean age 58.0±9.8 years) and 34 healthy volunteers (mean age 58.0±9.8 years). Measurements were made of the velocity of systolic, early and late diastolic peaks at 4 levels of interventricular septum, anterior, lateral and inferior walls of the left ventricle (LV). MTD was repeated before the discharge from hospital. The patients were followed up for 10-18 months after the discharge. Results. By MTD results the patients were divided into 3 subgroups: 1 -an asymmetric decrease of MTD values - 17(19.3%) patients who had a 20% reduction of the systolic and early diastolic peak velocity compared to healthy controls on one or two adjacent LV walls; subgroup 2 - a diffuse decline of MTD values - 61 (69.3%) patients. Their velocity of systolic and early diastolic peaks was subnormal on all the walls, all levels of estimation; subgroup 3 - 10 (11,4 %) patients without MTD changes. These proportions changed in the course of treatment: the number of patients with a diffuse decrease of MTD values reduced to 31 (35.3%), the number of patients with an asymmetric MTD decrease rose to 37 (42%), and with unchanged MTD rose to 20 (22.7%) patients. The rate of development of congestive cardiac failure (CCF) and asymptomatic LV dysfunction in the long-term period was significantly higher in the subgroup with retained diffuse decrease of MTD values. Conclusion. The treatment of non-ST elevation AMI reduces the number of patients with a diffuse decrease of MTD values and elevates the number of patients with asymmetric decrease of MTD and unchanged MTD. Persistence of MTD diffuse changes is an unfavourable prognostic factor in relation to CCF and LV silent dysfunction.

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