CONSTELLATION OF BIOCHEMICAL AND PHYSICAL MARKERS OF THE FUNCTIONAL STATE OF THE BODY IN PATIENTS WITH MYOCARDIAL INFARCTION WITH OF SISTOLIC AND DIASTOLOGICAL ARTERIAL PRESSURE LEVELS AND THE POSSIBILITY OF THEIR USING IN THE REHABILITATION PROCESS

  • L. V. Levytska I. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY
Keywords: myocardial infarction, comorbid pathology, arterial hypertension, cardio-rehabilitation

Abstract

Introduction. Providing full medical care to patients with myocardial infarction (MI) with comorbid pathology (CP) on the background of arterial hypertension remains a complicated medical problem, which has not been resolved to date.

The aim of the studyto study the peculiarities of the clinical course of myocardial infarction with comorbid pathology depending on the levels of systolic and diastolic blood pressure, to identify the early marker and limiting parameters of the functional parameters of the body and stratification risks to control the effectiveness of the rehabilitation process in this category of patients.

Research Methods. We examined 371 patients with myocardial infarction aged (66.2±10.4) years. In 93.8 % of the surveyed, concomitant pathology was detected. The basic functional indicators of a patient's body condition on the MI with CP and their relationship with SAP and DBP, as well as indicators of physical activity tolerance were studied.

Results and Discussion. There was a direct correlation between the levels of SBP in the acute MI period and the duration of the history of arterial hypertension (r = 0.130; P = 0.040); left ventricular posterior wall thickness (r = 0.189; P <0.001); left ventricular ejection fraction (r = 0.275; P <0.0001) and the size of aorta (r = 0.228; P <0.0001). There was also a direct relationship between the levels of DBP and the left ventricular posterior wall thickness (r = 0.130; P = 0.022); the size of the aorta (r = 0.172; P = 0.002); the size of the left atrium (r = 0.188; P = 0.001), left ventricular ejection fraction (r = 0,210; P <0,001), as well as blood creatinine levels (r = 0,119; P = 0,023). Authentic feedback between SBP/DBP levels and paroxysmal atrial fibrillation, cardiogenic shock, pulmonary edema, and left ventricular aneurysm may indicate a depletion of hemodynamic reserves reduced due to acute ischemic damage to the myocardium.

Conclusions. SBP/DBP indicators in the acute MI period are early prognostic markers of biochemical, morphological and hemodynamic changes in patients with MI with CP, adequately reflect the overall functional state of the patient and cardiovascular risks, and therefore they should be monitored during the rehabilitation process. There is a significant direct correlation between creatinine levels in such patients with DBP in acute MI and morphological changes in the cardiac muscle, so it can be successfully used as a marker for systemic hemodynamic control at the stages of cardio-rehabilitation.

References

World Health Organization: WHO. Retrieved from: https://www.who.int/ru/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).

Mozaffarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., Blaha, M.J., & Cushman, M. (2016). Heart disease and stroke statistics–2016 update: a report from the American Heart Association. Circulation, 133 (4), e38-e360.

Townsend, N., Nichols, M. Scarborough, P. & Rayner, M. (2015). Cardiovascular disease in Europe – epidemiological update 2015. Eur. Heart J., 36, 2696-2705.

Diachuk, D.D., Moroz, H.Z., Hidzynska, I.M., & Lasytsya, T.S. (2018). Poshyrenist faktoriv ryzyku sertsevo-sudynnykh zakhvoriuvan v Ukraini: suchasnyi pohliad na problemu [Prevalence of risk factors for cardiovascular diseases in Ukraine: a modern view of the problem]. Ukrainskyi kardiolohichnyi zhurnal – Ukrainian Cardiology Journal, 1, 91-101 [in Ukrainian]. URL: http://journal.ukrcardio.org/wp-content/uploads/2018/01/10_1_2018.pdf [in Ukrainian].

Pedrinelli, R., Ballo, P., Fiorentini, C., Denti, S., Galderisi, M., Ganau, A., … & Zacà, V. (2012). Hypertension and acute myocardial infarction : an overview. J. Cardiovasc. Med. (Hagerstown), 13 (3), 194-202. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22317927. doi:10.2459/JCM.0b013e3283511ee2.

Hall, M., Dondo, T.B., Yan, A.T., Mamas, M.A., Timmis, A.D., Deanfield, J.E., … & Gale, C.P. (2018). Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLoS Med., 15 (3), e1002501. doi:10.1371/journal.pmed.1002501.

Ibanez, B., James, S., Agewall, S., Antunes, M.J., Bucciarelli-Ducci, C., Bueno, H., … & Goudevenos, J.A. (2018). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal, 39, 2, 119-177. Retrieved from: https://doi.org/10.1093/eurheartj/ehx393

Roffi, M., Patrono, C., Collet, J.-Ph., Mueller, Ch., Valgimigli, M., Andreotti, F., … & Chew, D.P. (2016). 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). European Heart Journal, 37, 3, 267-315. Retrieved from: https://doi.org/10.1093/eurheartj/ehv320

Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi, tretynnoi medychnoi dopomohy ta medychnoi reabilitatsii “Hostryi koronarnyi syndrom bez elevatsii sehmenta ST” [Unified clinical protocol for emergency, primary, secondary, tertiary care and medical rehabilitation "Acute coronary syndrome without ST segment elevation"]. Retrieved from: http://www.webcardio.org/unifikovanyj-klinichnyj-protokol-ekstrenoji-pervynnoji-vtorynnoji-tretynnoji-medychnoji-dopomoghy-ta-medychnoji-reabilitatsiji-ghostryj-koronarnyj-syndrom-bez-elevatsiji-seghmenta-st.aspx

Charlson, M.E., Pompei, P., & Ales, H.L. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal Chronic Disease, 40, 373-383.

Shved, M.I., & Levytska, L.V. (2018). Pidkhody do otsinky ryzykiv ta funktsionalnykh rezerviv sertsevo-sudynnoi systemy u khvorykh na infarkt miokarda z komorbidnoiu patolohiieiu, yaki perebuvaiut u hostromu periodi kardioreabilitatsii [Approaches to the assessment of the risks and functional reserves of the cardiovascular system in patients with myocardial infarction with comorbid pathology, who are in the acute period of cardio-rehabilitation]. Svit medytsyny ta biolohii – World of Medicine and Biology, 4 (66), 124-130 [in Ukrainian].

Bellet, R.N., Francis, R., Jacob, J.S., Healy, K.M., Bartlett, H.J., Adams, H.J., & Morris, M. (2011). Repeated six-minute walk tests for outcome measurement and exercise prescription in outpatient cardiac rehabilitation: a longitudinal study. Arch. Phys. Med. Rehabil., 92 (9), 1388-1394.

Utkin, V.A. (2009). Metodicheskiie aspekty matematiko-statisticheskogo analiza meditsinskikh dannykh Chast 2. Atributivnaia statistika v meditsinskikh issledovaniyakh [Methodological aspects of the mathematical-statistical analysis of medical data Part 2. Attributive statistics in medical research]. Meditsinskiy vestnik Severnogo Kavkaza – Medical Journal of the North Caucasus, 3 (15), 70-75.

Pett, M.A. (1997). Nonparametric statistics for health care research: Statistics for small samples and unusual distributions. Thousand Oaks. CA: Sage Publications.

Zhao, H., Jiang, Y.F., Zhou, X.C., Yao, L., Chen, J., Wang, D., & Fu, D.Y. (2017). An effective indicator in predicting cardiovascular events: urine albumin to creatinine ratio. Eur. Rev. Med. Pharmacol. Sci., 21 (14), 3290-3295.

Rashid, M., Kwok, C.S., Gale, C.P., Doherty, P., Olier, I., & Sperrin, M. (2017). Impact of co-morbid burden on mortality in patients with coronary heart disease, heart failure and cerebrovascular accident: a systematic review and meta-analysis. Eur. Heart J. Qual. Care Clin. Outcomes, 3 (1), 20-36.

Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet, 380 (9836), 37-43.

Shved, M., Tsuglevych, L., Kyrychok, I., Levytska, L., Boiko, T., & Kitsak, Y. (2017). Cardio-rehabilitation peculiarities and correction of violations of systolic, diastolic function and heart rate variability in patients with acute coronary syndrome and coronary artery revascularization. Georgian Medical News, 265, 46-53.

Verdecchia, P., Reboldi, G., Angeli, F., Trimarco, B., Mancia, G., Pogue, J., … & Yusuf, S. (2015). Systolic and diastolic blood pressure changes in relation with myocardial infarction and stroke in patients with coronary artery disease. Hypertension, 65 (1), 108-114. doi: 10.1161/HYPERTENSIONAHA.114.04310.

Roth, D., Van Tulder, R., Heidinger, B., Herkner, H., Schreiber, W., & Havel, C. (2015). Admission blood pressure and 1-year mortality in acute myocardial infarction. Int. J. Clin. Pract., 69 (8), 812-819. doi:10.1111/ijcp.12588.

Ferreira, J.P., Duarte, K., Pfeffer, M.A., McMurray, J.J.V., Pitt, B., Dickstein, K., … & Rossignol, P. (2018). Association between mean systolic and diastolic blood pressure throughout the follow-up and cardiovascular events in acute myocardial infarction patients with systolic dysfunction and/or heart failure: an analysis from the High-Risk Myocardial Infarction Database Initiative. Eur. J. Heart Fail, 20 (2), 323-331. doi: 10.1002/ejhf.1131.

Sola, M., Venkatesh, K., Caughey, M., Rayson, R., Dai, X., Stouffer, G.A., & Yeung, M. (2017). Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction. Catheter Cardiovasc. Interv., 90 (3), 389-395. doi:10.1002/ccd.26963.

Ndrepepa, G., Cassese, S., Emmer, M., Mayer, K., Kufner, S., Xhepa, E., … & Kastrati, A. (2018). Relation of ratio of left ventricular ejection fraction to left ventricular end-diastolic pressure to long-term prognosis after ST-segment elevation acute myocardial infarction. The American Journal of Cardiology, 123 (2), 199-205. DOI: 10.1016/j.amjcard.2018.10.007.

Published
2019-04-16
How to Cite
Levytska, L. (2019). CONSTELLATION OF BIOCHEMICAL AND PHYSICAL MARKERS OF THE FUNCTIONAL STATE OF THE BODY IN PATIENTS WITH MYOCARDIAL INFARCTION WITH OF SISTOLIC AND DIASTOLOGICAL ARTERIAL PRESSURE LEVELS AND THE POSSIBILITY OF THEIR USING IN THE REHABILITATION PROCESS. Medical and Clinical Chemistry, (1), 92-102. https://doi.org/10.11603/mcch.2410-681X.2019.v0.i1.10013
Section
ORIGINAL INVESTIGATIONS