MORPHOLOGICAL AND FUNCTIONAL CONDITION OF THE CORONARY CIRCULATION IN PERIMENOPAUSAL WOMEN HOSPITALIZED WITH NON ST ELEVATION ACUTE CORONARY SYNDROME
DOI:
https://doi.org/10.11603/2415-8798.2017.2.7853Keywords:
acute coronary syndrome, women, menopause, coronary angiography, the ulceration index, microcirculation.Abstract
Particular attention cardiologists and researchers provided women with acute coronary syndrome (ACS) perimenopausal age. Due to the action of estrogen in women during the reproductive period with a lower risk of acute coronary disease, cardiovascular protective values are lost due to a significant reduction in estrogen background in the perimenopausal period.
The aim of the study – to conduct a comparative analysis of the coronary circulation according to coronary angiography in women with non ST elevation acute coronary syndrome (non STEMI), depending on the level of female sex hormones.
Materials and Methods. The study involved 81 women aged 35–76 (middle age 59.1 ± 1.06) years old who were hospitalized with non STEMI, the level of female’s sex hormones was determined (estradiol, LH (luteinizing hormone), FSH (follicle stimulating hormone) and coronary angiography was performed. Depending on the hormonal status of all patients overall group were divided into two subgroups (n = 50) – women with an index value of LH / FSH <1 (estrogen deficiency). Second subgroup (n = 31) included women with an index of LH / FSH> 1 (relatively preserved estrogen background).
Results and Discussion. Compared with women who relatively preserved estrohen background (subgroup II), women with estrohen deficiency (I subgroup) have significantly more difficult hemodynamically significant coronary artery disease, namely 6 times more frequent multivessel disease (35.14 % (I) to 5.88 % (II)) in 2–2.8 times more localized predominantly in the proximal (81.08 % (I) and 29.41 % (II)) medial segments (70.83 % (I) 35.29 % (II)), almost half – combined with lesions distal segments (48.65 % (I) to 17.65 % (II)). Most often are changes in the main trunk artery – the left coronary artery and the left anterior descending. In two of the three women with non STEMI of total group (55 patients, 67.90 %) are observed indirect evidence of significant coronary microcirculation disorders and myocardial perfusion that one half times recorded significantly more in patients with symptoms of estrogen deficiency in postmenopausal period. One-third of surveyed women (33.33 %) of the total group had almost intact coronary artery. Women with hemodynamically significant stenoses had defects (ulceration) of atherosclerotic plaques. Ulceration index that in the total group was 0.770 ± 0.012 units, was significantly lower among women and subgroups (0.736 ± 0.013 units.) compared with patients of second subgroup (0.830 ± 0.018 units), indicating deeper destructive changes in diseased coronary arteries on the ground of estrogen deficiency.
Conclusions. Estrogen deficiency in perimenopausal women non STEMI leads to severe diffuse lesions of coronary, forming multiple hemodynamically significant stenosis and thrombosis on the ground of more expressive ulceration of atherosclerotic plaques in the main coronary arteries, the occurrence of gross violations of myocardial perfusion and microcirculation, which is the basis of acute disorders of coronary circulation in women.
References
Amosova, K.M., Stremenyuk, O.T., Zakharova V.I. (2011) Neinvazivna otsinka hemodynamichno neznachushchoho aterosklerozu koronarnykh arterii sertsia u khvoroho na khronichnu ishemichnu khvorobu sertsia [Non invasive raiting of hemodynamically insignificant coronary artery atherosclerosis in pations whith coronary heart disease]. Sertse i sudyny – Heart and Vessels, 4, 68-73 [in Ukrainian].
Stremenyuk, O.T. (2012). Hemodinamichno neznachushchii ateroskleroz koronarnykh arterii: vyznachennia, patohenez, klinichna znachushchist, diahnostyka, mozhlyvosti likuvannia i profilaktyky [Hemodynamically insignificant atherosclerosis: definition, pathogenesis, clinical significance, diagnostics, treatment options and prevention]. Sertse i sudyny – Heart and Vessels, 3, 92-101 [in Ukrainian].
Burke, A.P. (2001). Effect of menopause on plaque morphologic characteristics in coronary atherosclerosis. American Heart, 141 (2), 558-562.
Shaw, L.J. (2009). Women and ischemic heart disease: evolving knowledge. JACC, 54, 1561-1575.
Mozaffarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., Blaha, M.J., Cushman, M., Das, S.R., et al. (2016). Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation, 133, 38-360.
Mehta, L.S., Beckie, T.M., DeVon, H.A. (2016). Acute myocardial infarction in women: a scientific statement from the American Heart Association. Circulation. 133, 916-947.
Asymbekova, E.U. (2014). Osobennosti techeniya ishemicheskoy bolezni serdtsa v zavisimosti ot urovnya zhenskikh polovykh gormonov [The features of the course of coronary heart disease in relation to the level of female sex hormones]. Byulleten NTsSSKh im. A.N. Bakuleva RAMN – Journal of Scientific Centre of Cardiovascular Diseases named after A.N. Bakulev of RAMS, 15 (1), 39-46 [in Russian].
Vatutin, M.T., Yeshchenko, E.V., Gritsenko Yu.P. & Naschlavi, D.S. (2016). Ostriy infarkt miokarda u zhenshchin. Obzor nauchnogo polozheniya Amerikanskoy assotsiatsii serdtsa [Acute myocardial infarction in women. Review of scientific position of American Heart Association]. Praktychna angiologiya – Practical Angiology, (2), 34-40 [in Russian].
Nakaz № 164. (2016) Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi), tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta medychnoi reabilitatsii: hostryi koronarnyi syndrom bez elevatsii sehmenta ST [Order no 164. Unified clinical protocols of emergency, primary, secondary (specialized), tertiary (highly specialized) care and rehabilitation with non – ST elevation acute coronary syndrome]. Kyiv [in Ukrainian].
Bassand, J.P., Hamm, C.W., Ardissino, D., Boersma, E., Budaj, A., Fernández-Avilés F. et al. (2011). Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. European Heart Journal, 93, 2999-3054.
Zaremba, Ye.Kh., Hzhehotskyi, M.R., & Shatinska-Mytsyk, I.S. (2014) Menopauza: mizhdistsiplinarni aspekty [Menopause: interdisciplinary aspects]. Lviv: ART Studiya AKME. [in Ukrainian].
Gehrie, E.R., Reynolds, H.R., Chen, A.Y., Neelon, B.T., Roe, M.T., Gibler, W.B., Ohman, E.M., Newby, L.K., Peterson, E.D., & Hochman J.S. (2009). Characterization and outcomes of women and men with non-ST-segment elevation myocardial infarction and nonobstructive coronary artery disease: results from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA Guidelines (CRUSADE) quality improvement initiative. American Heart Journal, 158, 688-694.
Sokolov, Yu.N., Sokolov, M.Yu., & Terentyev, V.G. (2011) Koronarnaya bolezn i interventsionnaya kardiologiya [Coronary heart disease and interventional cardiology]. Kyiv: MORION [in Russian].
Pedko, V.N. (2013) Vidminnosti faktoriv ryzyku ta osoblyvosti perebihu infarktu miokarda v zalezhnosti vid stati [Risk factors differences and peculiarities of myocardium infarction course depending on sex]. Ukrainskyi zhurnal klinichnoi ta laboratornoi medytsyny – Ukrainian Journal of Clinical and Laboratory Medicine, 8 (1), 32-36 [in Ukrainian].
Rustamova, Ya.K. Alokhin, M.N., Sidorenko B.A. & Azizov, V.A. (2008). Patohenez, klinika i diagnostika koronarnogo sindroma X [Pathogenesis, clinics and diagnostics of X coronary syndrome]. Kardiologya – Cardiology, 11, 74-78 [in Russian].
Moskalenko, V.F, Hulchii, O.P, & Holubchykov, M.V. (2009). Biostatystyka. Pid zahalnoiu redaktsiieiu chlena-korespondenta AMN Ukrainy, profesora V.F. Moskalenka [Biostatistiks. Under the general editorship of Corresponding Member of AMS of Ukraine, Professor Moskalenko V.F]. Kyiv: Knyha plius [in Ukrainian].
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