DYNAMICS OF LEFT VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION IN PATIENTS WITH HYPERTENSION AND DIABETES MELLITUS ON THE BACKGROUND OF TAKING RAMIPRIL AND ZOFENOPRIL

Abstract

SUMMARY. Today in Ukraine more than 500 thousand patients die from cardiovascular diseases, which is 64 % of the total mortality structure. According to a study of local scientists, the overall incidence of myocardial infarction in Ukraine will increase by 2025 on 24 %. In the last almost 40 years, the number of people with diabetes in the world has quadrupled. In Ukraine, the significant prevalence of hypertension among the population has led to an increase in the number of diseases of the circulatory system during 1991–2016 in 3 times.

The aim – to assess the dynamics of postinfarction remodeling heart, using the method of echocardioscopy in patients with myocardial infarction in comorbidity with diabetes mellitus and hypertension.

Material and Maethods. We examined 54 patients who at hospitalization was diagnosed with acute myocardial infarction and who had concomitant pathology with diabetes mellitus and hypertension.

Results. Comparison of groups of patients with myocardial infarction and concomitant pathology with diabetes mellitus and hypertension showed, that regardless the presence of diabetes, both drugs did not cause statistically significant deviations in end-diastolic index in groups. Comparison of groups with patients that was prescribed different drugs showed that in the group without diabetes after the use of zofenopril, the value of end-systolic index in the late period of observation was significantly lower than in the group in which ramipril was used (18.7 %, p₁<0.05). In the presence of diabetes, the effect of both drugs on the value of end-systolic index was almost the same (p₁>0.05, p₂>0.05). Comparison of groups of patients depending on the used antihypertensive drugs showed that in patients without diabetes ramipril and zofenopril caused almost the same level of stroke index in the dynamics of the examination (p₁>0.05). At the same time, in patients with diabetes after 3 months under the conditions of zofenopril, the value of stroke index became statistically significantly higher than under the conditions of ramipril (by 19.2 %, p₂<0.05). Comparison of both observation groups showed that after 3 months the value of ejection fraction of left ventricle was significantly higher in patients with diabetes compared with patients without diabetes (13.0 %, p<0.05). Comparison of groups of patients depending on the antihypertensive drugs used showed that in patients without diabetes after 3 months of follow-up zofenopril caused a statistically significantly higher value of ejection fraction of left ventricle compared with patients receiving ramipril (16.8 %, p₁<0.05).

Conclusions. Thus, our studies revealed a differentiated effect of ramipril and zofenopril on heart rate in myocardial infarction depending on the presence of diabetes. The obtained data on the restructuring of intracardiac hemodynamics in patients with concomitant diabetes indicate a higher effect of the use of zofenopril, while in patients without concomitant diabetes – ramipril.