FEATURES OF ACUTE MYOCARDIAL INFARCTION COURSE IN PATIENTS WITH METABOLIC SYNDROME
DOI:
https://doi.org/10.11603/1811-2471.2020.v.i2.11343Keywords:
аcute myocardial infarction, metabolic syndrome, obesity, insulin resistanceAbstract
Coronary heart disease continues to play a major role in the structure of morbidity and is one of the leading causes of death and disability.
The aim – to investigate the features of the course of myocardial infarction on the background of metabolic syndrome and to establish predictors of metabolic disorders and pathogenetic mechanisms of the aggravating effect of these pathological processes.
Material and Methods. The study included 87 patients with acute myocardial infarction with ST-segment elevation, of whom 59 patients were diagnosed with MS, who formed the experimental group. The control group consisted of 28 patients with MI without MS. The diagnosis of acute myocardial infarction was verified according to ESC recommendations. Diagnosis of MS was performed according to the recommendations of the International Diabetes Federation (IDF, 2016). Insulin resistance was determined using the HOMA index.
Results. It was found that the presence of MS significantly affects the clinical course of the pathological process, which manifested itself in the development of myocardial infarction in young people, and the disease itself was characterized by significantly longer pain, more frequent recurrences, and much more pronounced manifestations of resorptive-necrotic syndrome about a larger area of myocardial damage in patients with metabolic syndrome. At the same time, this category of patients is diagnosed with a significantly higher frequency of complications in the acute period of the disease, which manifested itself in more frequent arrhythmias and conduction and signs of acute heart failure. Analysis of lipid profile data suggests that myocardial infarction in patients with metabolic syndrome occurs against the background of not only disorders of carbohydrate metabolism, but also prognostically unfavorable indicators of the blood lipid spectrum.
Conclusions. It should be noted the accumulation in the group of patients with myocardial infarction with metabolic syndrome prognostically unfavorable characteristics – lower values of the left ventricular ejection fraction, violation of remodeling processes, increasing the index of local myocardial contractility, prognostic unfavorable indicators of lipid spectrum disorders accompanied by the predisposition of this category of patients to the development of complications in the acute period of the disease.
References
Kovalenko, V.M., & Kornatskyi, V.M. (2017). Problemy zdorovia i tryvalosti zhyttia v suchasnykh umovakh [Health and life expectancy issues in todays environment]. Kornatskyi, V.M. (Eds.). Kyiv: M.D. Strazhesk Institute of Cardiology [in Ukrainian].
(2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal, 33, 20, 2569-2619. Retrieved from: https://doi.org/10.1093/eurheartj/ehs215. DOI: https://doi.org/10.1093/eurheartj/ehs215
Handziuk, V.A., Diachuk, D.D., & Kondratiuk, N.Yu. (2017). Dynamika zakhvoriuvanosti i smertnosti vnaslidok khvorob systemy krovoobihu v Ukraini (rehionalnyi aspekt) [Dynamics of morbidity and mortality due to diseases of the circulatory system in Ukraine (regional aspect)]. Visnyk problem biolohii i medytsyny – Bulletin of Problems of Biology and Medicine, 2 (136), 319-322 [in Ukrainian].
Khobzey, M.K., Sirenko, Yu.M., & Stepanenko, A.V. (2014). Nakaz MOZ Ukrainy № 455 vid 02.07.2014. Unifikovanyi klinichnyi protokol ekstrenoi, pervynnoi, vtorynnoi (spetsializovanoi) ta tretynnoi (vysokospetsializovanoi) medychnoi dopomohy ta medychnoi reabilitatsii khvorykh na hostryi koronarnyi syndrom z elevatsiieiu sehmenta ST [Ministry of Health of Ukraine Order No. 455 dated 2 July 2014. Unified clinical protocol of emergency, primary, secondary (specialized) and tertiary (highly specialized) medical care and medical rehabilitation of patients with acute coronary syndrome with ST segment elevation]. [in Ukrainian].
Fox, K.A., Carruthers, K.F., Dunbar, D.R., Graham, C., Manning, J.R., De Raedt, H., ..., & Van de Werf, F. (2010). Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK–Belgian Study). Eur. Heart J., 31, 2755-2764. DOI: 10.1093/eurheartj/ehq326. DOI: https://doi.org/10.1093/eurheartj/ehq326
Kovalenko, V.N., Talaeva, T.V., & Kozliuk, A.S. (2013). Metabolichnyi syndrom: mekhanizmy rozvytku, znachennia yak faktora sertsevo-sudynnoho ryzyku, pryntsypy diahnostyky ta likuvannia [Metabolic syndrome: mechanisms of development, significance as a cardiovascular risk factor, principles of diagnosis and treatment]. Ukrayinskyi kardiolohichnyi zhurnal – Ukrainian Cardiology Journal, 5, 80–87.
Kostina, V.M., Zyuzin, O.V., & Zinchenko, T.M. (2011). Metabolichnyi syndrom: metody diahnostyky ta reabilitatsii [Metabolic syndrome: methods of diagnosis and rehabilitation]. Ekolohiia – Ecology, 152 (140), 76-78 [in Ukrainian].
Kravchun, P.P. (2014). Stan systolichnoi ta diastolichnoi funktsii livoho shlunochka u khvorykh z postinfarktnym kardiosklerozom ta ozhyrinniam [Status of left ventricular systolic and diastolic function in patients with postinfarction cardiosclerosis and obesity]. Mizhnarodnyi endokrynolohichnyi zhurnal – International Journal of Endocrinology, 6, 37-40 [in Ukrainian].
Kryvenko, V.I., Fedorova, O.P., Pakhomova, S.P., Kolesnyk, M.Yu., Nepryadkina, I.V., & Kachan, I.S. (2016). Osnovni syndromy, poviazani z metabolichnymy porushenniamy, u praktytsi likaria zahalnoi praktyky [Major syndromes associated with metabolic disorders in the practice of a GP]. Zaporizhzhia: ZDMU [in Ukrainian].
Martynyuk, H.V., Skoreyko, N.T., Skoreyko, R.S., & Skoreyko, S.S. (2016). Metabolichnyi syndrom – deiaki osoblyvosti patohenezu ta yoho vplyv na rozvytok arterialnoi hipertenzii [Metabolic syndrome – some features of pathogenesis and its effect on the development of hypertension]. Bukovynskyi medychnyi visnyk – Bukovyna Medical Bulletin, 20 (2), 85-87 [in Ukrainian].
Shved, M.I., Beniv, M.Ya., Levytska, L.V., & Tsuhlevych, L.V. (2017). Vplyv osnovnykh faktoriv ryzyku na perebih infarktu miokarda u khvorykh z nadmirnoiu masoiu tila [Influence of major risk factors on the course of myocardial infarction in patients with overweight]. Visnyk naukovykh doslidzhen – Bulletin of Scientific Researches, 1 (86), 21-27 [in Ukrainian].
Mitchenko, O.I., & Lutay, M.I. (2017). Metodychni rekomendatsii asotsiatsii kardiolohiv Ukrainy ta ukrainskoho tovarystva z aterosklerozu shchodo diahnostyky profilaktyky ta likuvannia dyslipidemii [Methodological recommendations of the Association of Cardiologists of Ukraine and the Ukrainian Society of Atherosclerosis on the diagnosis of prevention and treatment of dyslipidemias]. Kyiv [in Ukrainian].
Mitchenko, O.I. (2007). Vid imeni Robochoi hrupy z metabolichnoho syndromu, preddiabetu i sertsevo-sudynnykh zakhvoriuvan Ukrainskoi asotsiatsii kardiolohiv i Ukrayinskoi asotsiatsii endokrynolohiv [On behalf of the Working Group on Metabolic Syndrome, Prediabetes and Cardiovascular Diseases of the Ukrainian Association of Cardiologists and the Ukrainian Association of Endocrinologists]. Ukrayinskyi medychnyi chasopys – Ukrainian Medical Journal, 2 (58), 4-13 [in Ukrainian].
Netyazhenko, V.Z. (2008). Patsiient vysokoho kardiovaskuliarnoho ryzyku: yak pokrashchyty prohnoz [High cardiovascular risk patient: how to improve prognosis]. Vnutrishnia medytsyna – Internal Medicine, 5, 145-167 [in Ukrainian].
