THE SYSTEMIC CIRCULATION IN MEN UNDER 60 YEARS OF OLD WITH MYOCARDIAL INFARCTION AND ACUTE KIDNEY INJURY

Author(s):  
Gordienko A.V. ◽  
Nosovich D.V. ◽  
Tassybayev B.B.

Relevance. Hemodynamics changes in myocardial infarction complicated by acute kidney injury are interpreted in different ways. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative assessment of circulation indices changes in first 48 hours (1) and the end of third week disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in lower values of heart rate1 (66.3±12.2 and 75.8±18.8 (bpm), respectively; p=0.003) and higher - arterial pressure, systolic1 (155.6±24.0 and 139.5±28.9 (mm Hg); p=0.006), diastolic1 (98.0 ± 16.0 and 86.6 ± 18.9 (mm Hg); p = 0.002), mean1 (117.2±17.6 and 104.3±21.3 (mm Hg); p=0.001). In the study group compared in the control group, there was a greater decrease in blood pressure (mean: -18.3 and -8.3%, respectively) and total peripheral resistance (-33.5 and -26.3%) (p<0.0001). The risk markers of the acute kidney injury development were the mean arterial pressure1≥106.7, systolic1≥140.0, diastolic1≥90.0 (mm Hg) and heart rate1˂66 bpm. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by arterial hypertension and bradycardia in the first hours of the disease, as well as more pronounced decline dynamics of blood pressure and total peripheral resistance at the end of its subacute period. The listed above values of the circulation parameters should be used in the high-risk groups for the acute kidney injury development formation, as well as prognostic modeling.

Author(s):  
Gordienko A.V. ◽  
Golikov A.V. ◽  
Tassybayev B.B. ◽  
Reiza V.A.

Relevance. The role of hemodynamic changes in myocardial infarction complicated by acute kidney injury is interpreted in different ways. Aim. To evaluate the heart chambers and structures peculiarities in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 366 patients. A comparative assessment of the heart chambers and structures parameters in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, also acute kidney injury development risk analysis (ANOVA) were performed. Results. The study group differed from the control group in smaller sizes of the left atrium2 (38.1±6.0 and 42.0±5.4 (mm), respectively; p=0.01), a higher frequency of the middle anterior (100 and 15.6%; p=0.02) and antero-septal (100 and 17.7; p=0.04) segments akinesia and the absence (0 and 81.5%; p=0.04) of tricuspid regurgitation. In the study group, there was a smaller increase in the ventricles size than in the control group (left: 0.6 and 1.7%, respectively; right: 15.3 and 33.6%) and a greater decrease in the atria size, compared in the control group (left: -1.8 and -25.3%; right: -25.3 and -0.1%) (p<0.0001). The risk markers of the acute kidney injury developing were the dimensions of the left atrium1˂34 mm, interventricular septum≥12.0 mm, end systolic1≥4.23 and diastolic1≥5.3 of the left ventricle, right ventricle1˂2.6; of the right atrium1≥4.7 (cm), the mass of the left ventricle1≥328.8 g. Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by lesions of the middle anterior and antero-septal segments, the absence of tricuspid regurgitation, and a smaller left atrium in the subacute period of the disease. The above of the heart chambers dimensions values should be used in the high-risk groups for the acute kidney injury development formation, as well as for prognostic modeling.


Author(s):  
Gordienko A.V. ◽  
Balabanov A.S. ◽  
Tassybayev B.B.

Relevance. Hemodynamics changes of the pulmonary circulation in myocardial infarction complicated by acute kidney injury are not well understood. Aim. To evaluate the characteristics of pulmonary circulation in men under 60 years old with acute kidney injury in myocardial infarction to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative analysis of pulmonary circulation parameters in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of the risks of developing acute kidney damage and chronic heart failure in the selected groups were performed. Results. The study group differed in a lower heart rate (HR1) (66.3±12.2 from the control group (75.8±18.8; p=0.003). It showed a tendency towards lower the mean pulmonary artery pressure (MPAP) and total pulmonary resistance (TPR) at both points of the study. In both groups, there was a similar dynamic of decrease in the MPAP and TPR levels, more pronounced in the control group (MPAPII: -14.3%; MPAPI: -6.1 %; TPRII: -29.9%; TPRI: -21.8%; p<0.0001) and multidirectional - for HR: in the study group, an increase in HR was noted by 0.9% (p<0.0001), and in the control - its decrease by 8.4% (p<0.0001). Risk markers of the acute kidney injury developing were MPAP1˂30.4 mm Hg, HR1˂67 per minute and TPR1˂622.8 dyne•s•cm-5, the presence of chronic heart failure and cardiac asthma among the disease complication. The predictors of chronic heart failure in the study group were MPAP1≥26.9 mm Hg and HR1≥62 min. Conclusions. In case of acute kidney injury, lower levels of pulmonary circulation indicators are noted, their lower dynamics during the observation period, and a greater frequency of observation of chronic heart failure in comparison with the control group. The above listed values of the pulmonary circulation parameters have been assessed as a risk marker of the acute kidney injury and chronic heart failure development.


Author(s):  
Balabanov A.S. ◽  
Tupitcyn V.V. ◽  
Tassybayev B.B.

Relevance. Acute kidneys injury (AKI) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with AKI during MI to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 486 patients. A comparative assessment of the MI CF frequency in selected groups were performed. Results. In patients of the study group more often than in the control group, a combination of MI complications (64.0 and 36.9%; respectively; p = 0.009), psychic disorders (20.0 and 6.9%; p = 0.01), chronic heart failure (CHF) of the second functional class and above (NYHA) at the end of the eighth MI week (72.0 and 43.2%; p = 0.005), with a predominance of newly diagnosed CHF forms (36.0 and 28.0%; p = 0.006). In the study group, less often than in the control group, pulmonary hypertension was noted in the first 48 hours of MI (44.0 and 66.0%; p = 0.02) and at the end of the third MI week (38.1 and 60.3%; p = 0.04). Conclusions. There were no specific clinical signs of AKI in men under 60 y.o. with MI. At the same time, the study group has the worst prognosis during the observation period in terms of the frequency of MI complications combinations and CHF, which requires the start of prophylactic therapy from the moment of AKI verification.


Author(s):  
Golikov A.V. ◽  
Epifanov S.Yu. ◽  
Reiza V.A.

Relevance. Hemodynamics changes in recidivating myocardial infarction and early postinfarction angina are not well understood. In recent years, the frequency of these complications has been increasing. Aim. To evaluate peripheral hemodynamics changes in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 102 patients; II - control, without it - 541 patients. A comparative assessment of hemodynamics changes in first 48 hours (1) and the end of third week disease (2), also risk analysis of recurrent ischemia and poor outcome in selected groups were performed. Results. The study group was distinguished by a high level of total peripheral resistance1 (2055.5±965.2 (dyn×sec×cm-5)) from the control (2055.5± 965.2 (dyn×sec×cm-5); p=0.02). In both groups, a decrease in the values of all indicators was noted (p<0.05). A more pronounced decrease in total peripheral resistance was found in the study group, and in the parameters of blood pressure and heart rate - in the control group. The values of total peripheral resistance1 ≥1600 dyne×sec×cm-5 were the markers of the risk of ischemia recurrence. Predictors of poor outcome are blood pressure levels1 (systolic <97; diastolic <70; mean <93.3 (mm Hg)); total peripheral resistance1 <1746.2 dyne×sec×cm-5 and heart rate (˃92 per min). Conclusions. Patients with recurrent ischemia are characterized by higher levels of total peripheral resistance in the first hours of myocardial infarction. For both groups, a decrease in all studied indicators is determined. The above values of hemodynamic parameters should be used in the formation of groups with a high risk of early recurrence of ischemia and an unfavorable outcome, as well as for prognostic modeling of these complications.


Author(s):  
Golikov A.V. ◽  
Reiza V.A. ◽  
Tassybayev B.B. ◽  
Gordienko A.V.

Relevance. Acute kidney injury in myocardial infarction worsens its prognosis, including due to the development of chronic heart failure. Moreover, most of the data was obtained for patients over 60 years old. Aim. To evaluate the features of the heart failure manifestations in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 486 patients. A comparative analysis of the heart failure main manifestations frequency in the first 48 hours (1) and at the end of the third week of the disease (2), their dynamics, analysis of their impact on the risk of chronic heart failure development in acute kidney injury (ANOVA) was performed. Results. The study group (4.0%) differed from the control (21.8%) in a lower frequency of acrocyanosis (p = 0.03) and liver enlargement (8.0 and 25.7%; respectively; p = 0.046) at the end of the eighth week diseases. The main risk markers of the chronic heart failure development in study group were: winter period of the year (absolute risk: 94.1%; relative - 3.76; p = 0.0003), respiratory infections 2-3 times a year (absolute risk: 81.8%; p = 0.003), left ventricular myocardial mass index1 ≥ 173.3 g/m2 (absolute risk: 100%; p = 0.008) and mean arterial pressure1 ≥ 120 mm Hg (absolute risk: 100%; relative - 1.88; p = 0.01). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction are characterized by a higher incidence of chronic heart failure. The listed above values of the different predictors should be used in the formation of the high-risk groups for the chronic heart failure in acute kidney injury development, as well as for prognostic modeling.


Author(s):  
Nosovich D.V. ◽  
Epifanov S.Yu. ◽  
Tassybayev B.B.

Relevance. The role of the coronary arteries angiographic changes severity in myocardial infarction complicated by acute kidney injury is assessed in different ways. Aim. To evaluate the features of the coronary arteries state in men under 60 years old with myocardial infarction complicated by acute kidney injury to improve prevention and outcomes. Material and methods. The study included men 19-60 years old with type I myocardial infarction. The patients were divided into two age-comparable groups: I - study group, with acute kidney injury - 25 patients; II - control, without it - 168 patients. A comparative assessment of coronary angiography indicators, also acute kidney injury and heart failure development risk analysis (ANOVA) were performed. Results. There were no differences in the compared groups in angiographic data, localization, depth of the lesion, and the frequency of the complicated course of the disease. The study group were characterized by akinesia in the middle anterior (in the studied% 100; control: 15.6%; p =0.02) and antero-septal (100 and 17.7%; respectively; p=0.04) segments , as well as the frequency of registration of chronic heart failure (72.0 and 43.2%; p=0.005) by the eighth week of myocardial infarction. Bypass surgery (absolute risk: 46.2%; relative - 4.37; p=0.0002) and unstable angina (absolute risk: 19.8%; relative - 2,46; p=0.02) in the medical history, as well as the presence of peripheral angiopathies (absolute risk: 18.9%; relative - 3.21; p=0.0008). Conclusions. Men under 60 years old with acute kidney injury in myocardial infarction were not differ in the number and extent of large coronary artery lesions from the general group. They are characterized by large in area and severity of dysfunction lesions of the anterior middle segments of the left ventricle with a higher frequency of chronic heart failure than in the general group. The anamnestic data listed above associated with coronary arteries is advisable to use in the formation of groups at high risk for the acute kidney injury development formation, as well as prognostic modeling.


Author(s):  
Balabanov A.S. ◽  
Tupitcyn V.V. ◽  
Tassybayev B.B.

Relevance. The quality-of-life assessment in patients with myocardial infarction and acute kidney injury in differs significantly among different researchers. Aim. To evaluate the changes in the quality-of-life indicator associated with heart failure in men under 60 years old with myocardial infarction and acute kidney injury to search for opportunities to improve prevention. Material and methods. The study included men aged 19-60 years old with type I of myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with acute kidney injury - 25 patients; II - control, without it - 167 patients. A comparative analysis of the quality-of-life indicator associated with heart failure (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of myocardial infarction. The changes and correlations (C. Spearmen) of quality-of-life indicator with various clinical features were studied. Results. The quality-of-life in patients in the study group did not differ from the control in both phases of the study (1: 58.8 ± 15.8 and 63.7 ± 20.0; 2: 19.1 ± 8.6 and 20.4 ± 13, 5, respectively; p ˂ 0.05) with positive (68%) dynamics in both groups of patients. Significant correlations of the quality-of-life indicator with age, heart rate, blood pressure, lipid metabolism, left ventricular systolic function, total calcium, GRACE index was revealed. Conclusions. The quality of life associated with heart failure indicator dynamics in the study group did not differ from the control group. Tachycardia, arterial hypertension, dyslipidemia, and hypocalcemia were found to be early markers of deterioration in the quality of life. They can be used in the early diagnosis of chronic heart failure for the timely implementation of preventive measures.


Author(s):  
Tupitsyn V.V. ◽  
Bataev Kh.M. ◽  
Men’shikova A.N. ◽  
Godina Z.N.

Relevance. Information about the cardiovascular diseases risk factors (CVD RF) for in men with chronic lung inflam-matory pathology (CLID) is contradictory and requires clarification. Aim. To evaluate the peculiarities of CVD RF in men under 60 years of age with CLID in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with CLID - 142 patients; II - control, without it - 424 patients. A comparative analysis of the frequency of observation of the main and additional cardiovascular risk fac-tors in groups was performed. Results. In patients of the study group, more often than in the control group we observed: hereditary burden of is-chemic heart disease (40.8 and 31.6%, respectively; p = 0.0461) and arterial hypertension (54.2 and 44.6%; p = 0.0461), frequent colds (24.6 and 12.0%; p = 0.0003), a history of extrasystoles (19.7 and 12.7%; p = 0.04); chronic foci of infections of internal organs (75.4 and 29.5%; p˂0.0001), non-ulcer lesions of the digestive system (26.1 and 14.6%; p = 0.007), smoking (95.1 and 66.3%; p˂0.0001), MI in winter (40.8 and 25.9%; p = 0.006). Less commonly were observed: oral cavity infections (9.2 and 23.6%; p˂0.0001); hypodynamia (74.5 and 82.5%; p = 0.0358), over-weight (44.4 and 55.2%; p = 0.0136), a subjective relationship between the worsening of the course of coronary heart disease and the season of the year (43.7 and 55.2%; p = 0.0173) and MI - in the autumn (14.1 and 21.9%; p = 0.006) period. Conclusions. The structure of CVD RF in men under 60 years of age with CLID with MI is characterized by the pre-dominance of smoking, non-ulcer pathology of the digestive system, frequent pro-student diseases, meteorological dependence, a history of cardiac arrhythmias and foci of internal organ infections. It is advisable to use the listed factors when planning preventive measures in such patients.


Author(s):  
Gordienko A.V. ◽  
Epifanov S.Yu. ◽  
Sotnikov A.V.

Relevance. Recurrent myocardial infarction and early postinfarction angina negatively affects on the prognosis of myocardial infarction. Aim. To evaluate myocardial infarction clinical features in men under 60 years old with recurrent myocardial infarction and early postinfarction angina to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 79 patients; II - control, without it - 432 patients. A comparative assessment of the myocardial infarction clinical features frequency in selected groups were performed. Results. The studied groups did not differ in the frequency of the main variants of the myocardial infarction course. In patients of the study group more often than in the control group, a complicated course of the disease was observed (88.2 and 50.2%, respectively; p < 0.0001), deaths (13.6 and 3.4%; p < 0.0001). Complications in the study group were dominated by arrhythmias (47.3 and 33.7%; p = 0.007), cardiogenic shock (13.6 and 6.1%; p = 0.006), myocardial ruptures (3.6 and 0.5% ; p = 0.004), thromboembolism (15.5 and 2.2%; p <0.0001), urinary dysfunction (7.3 and 2.5%; p = 0.01), Dressler's syndrome (4.5 and 1.1%; p = 0.009) and mental disorders (16.4 and 5.6%; p < 0.0001). Conclusions. Nonanginal forms of the disease in the study group were observed in 17% of cases. The complications of the disease for group I are characterized by cardiac arrhythmias and conduction disorders, thromboembolism, myocardial ruptures, cardiogenic shock, extracardiac complications of myocardial infarction. The study group has a worse prognosis, which requires early diagnosis, revascularization, the use of auxiliary mechanical devices, and careful implementation of standardized treatment algorithms.


Author(s):  
Golikov A.V. ◽  
Epifanov S.Yu. ◽  
Reiza V.A.

Relevance. Dyslipidemia is considered one of the main risk factors for the development of recurrent myocardial infarction and early postinfarction angina. Aim. To evaluate the features of lipid metabolism in acute and subacute myocardial infarction in men under 60 years old with recurrent episodes of ischemia (recurrent myocardial infarction and/or early postinfarction angina) to search for new approaches to improve prevention measures. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with recurrent myocardial infarction - 68 patients; II - control, without it - 427 patients. A comparative assessment of lipid metabolism parameters and their dynamics in selected groups were performed. Results. The study group differed in higher levels of total serum cholesterol (6.17±1.78 mmol/l) from the control group (5.56±1.28 mmol/l; p=0.02) at the end of the third week of disease, its dynamics during the observation period (I: 9.1%; p<0.0001; II: -1.8%; p<0.0001) and the dynamics of the atherogenic coefficient (I: -4.7.1; p=0.02; II: 6.3%; p<0.0001). In both groups, the group showed an increase in lipoproteins of low (I: 33.1; p=0.02; II: 45.5%; p<0.0001) and very low density (I: 275.8; p=0,0004; II: 233.4%; p<0.0001), atherogenic indices, decrease: triglycerides (I: -31.8%; p=0.02; II: -1.7%; p<0.0001) and high-density lipoproteins (I: -0.6%; p=0.02; II: -6.1%; p<0.0001). Conclusions. The group with recurrent ischemia is characterized by more pronounced hypercholesterolemia at the end of the subacute period of myocardial infarction in comparison with the control group due to an increase in the concentrations of atherogenic lipid metabolism fractions. The dynamics of indices and the coefficient of atherogenicity during this period is multidirectional, which requires additional study.


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