心肌梗死后急性和慢性心力衰竭:临床和功能指标

Lozhkina N.G., M. I.
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摘要

В背景。在过去的十年中,心肌梗死(MI)患者的数量有所增加。这一现象导致慢性心血管疾病(包括慢性心力衰竭)的长期发病率增加。研究目的:确定心肌梗死后急性和慢性心力衰竭最重要的临床和功能指标。患者特征和研究方法。该分析纳入了2019年1月至2020年1月期间发生心肌梗死的186例患者:主要亚组86人,CHF体征高于FC 2 (NYHA)(平均年龄64.3 g),比较亚组100人,无CHF体征或患有CHF 1 FC (NYHA)(平均年龄62.6 l)。1年后,评估临床结果:心血管死亡、因心力衰竭失代偿反复住院、其他原因死亡、中风、反复心肌梗死、计划外冠状动脉血运重建术。在主亚组心肌梗死急性期(MI + CHF大于2cl NYHA),所有患者均以Killip II和Killip III的形式出现急性心衰(AHF)症状。慢性心力衰竭发展的预测因素是在心肌梗死之前存在缺血性心脏病史,并根据建议得到证实;出院前及心肌梗死第30天左心室分数下降;心房颤动(AF)的存在主组一年的不良结果明显更频繁。长期药物治疗亚分析显示,服用ARNI亚组患者心血管死亡发生率明显低于依那普利亚组。在本研究中,我们研究了梗死后心肌重构,它以急性和慢性心力衰竭综合征的形成形式实现。研究表明,立即再灌注和限制坏死区,以及长期使用抑制SAS和RAAS的药物,刺激NPP,可以抑制AHF的发展和死亡。CHF问题需要进一步的基础研究,以开发能够影响更微妙机制的新方法,例如与该疾病有关的特定基因的表达,以减少这种病理持续的高死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
ACUTE AND CHRONIC HEART FAILURE AFTER MYOCARDIAL INFARCTION: CLINICAL AND FUNCTIONAL MARKERS
Вackground. The last decade has seen an increase in the number of people who have had myocardial infarction (MI). This phenomenon contributes to an increase in the long-term incidence of chronic cardiovascular diseases, including chronic heart failure. Purpose of the study. To identify the most significant clinical and functional indicators characterizing acute and chronic heart failure after myocardial infarction. Patient Characterization and Research Methods. This analysis included 186 patients who had myocardial infarction from January 2019 to January 2020: 86 people, the main subgroup, with signs of CHF above FC 2 (NYHA) (mean age 64.3 g) and 100 people, the comparison subgroup, without signs of CHF or had CHF 1 FC (NYHA) (mean age 62.6 l). After 1 year, clinical outcomes were assessed: cardiovascular death, repeated hospitalizations due to decompensation of CHF, death from other causes, stroke, repeated myocardial infarction, unplanned coronary revascularization. Results. In the acute period of myocardial infarction in the main subgroup (MI + CHF more than 2cl NYHA), all patients had symptoms of acute heart failure (AHF) in the form of Killip II and Killip III. Predictors of the development of chronic heart failure were the presence of a history of ischemic heart disease, confirmed in accordance with the recommendations, before myocardial infarction; decreased fraction of the left ventricle, detected before discharge and on the 30th day of myocardial infarction; the presence of atrial fibrillation (AF). One-year unfavorable outcomes in the main group were significantly more frequent. Subanalysis of long-term drug therapy showed that cardiovascular death was significantly less common in the subgroup of patients taking ARNI than in the subgroup of enalapril. Conclusion. In the present study, we studied postinfarction myocardial remodeling, which is realized in the form of the formation of a syndrome of acute and chronic heart failure. It has been shown that immediate reperfusion and restriction of the necrosis zone, as well as long-term use of drugs that inhibit SAS and RAAS, stimulating NPP, can inhibit the development of AHF and death. The CHF problem requires further fundamental research in order to develop new approaches that can affect more subtle mechanisms, such as the expression of specific genes involved in the disease, in order to reduce the persisting excess mortality for this pathology.
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