Predictors of survival in patients with ischemic heart disease depending on therapy

• Main Authors: O. Radchenko (Author), R. Guta (Author), A. Filipiuk (Author), W. Zukow (Author)
• Format: Book
• Published: Kazimierz Wielki University, 2020-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<p class="MsoNormal" style="margin-top: 0,0000pt; margin-bottom: 0,0000pt; text-indent: 35,4500pt; text-align: justify; text-justify: inter-ideograph; line-height: 150%;" align="justify"><strong><span style="font-family: 'Times New Roman'; line-height: 150%;">The aim of the study </span></strong><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">is to assess the prognostic value of the structural and functional echocardiographic indicators in IHD patients, depending on acute coronary syndrome management (revascularization vs medical therapy), during </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">60</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> months.</span></p><p class="MsoNormal" style="margin-top: 0,0000pt; margin-bottom: 0,0000pt; text-indent: 35,4000pt; text-align: justify; text-justify: inter-ideograph; line-height: 150%;" align="justify"><strong><span style="font-family: 'Times New Roman'; line-height: 150%;">Materials and methods:</span></strong><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">The total of 101 IHD patients were examined on the clinical bases of the Internal Medicine Department 2. Prior to the study. The 84 males and 17 females aged 58.6±4.2were split into the experimental group after myocardial revascularization (EG, n = 71) and control group with standard medical therapy (CG, n = 30). In addition to the protocol-prescribed clinical lab tests, during five years, the dynamics of the echocardiographic cardiac parameters has been assessed. The digital data was processed by the Kaplan-Meier estimator; </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; letter-spacing: -0,3000pt; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">the 60-month cumulative survival rate (%) was estimated and significance of the difference was assessed by Cox's F-test (</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">p<0.05)</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; letter-spacing: -0,3000pt; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">.</span></p><p class="MsoNormal" style="margin-top: 0,0000pt; margin-bottom: 0,0000pt; text-indent: 35,4500pt; text-align: justify; text-justify: inter-ideograph; line-height: 150%;" align="justify"><strong><span style="font-family: 'Times New Roman'; line-height: 150%;">Results and discussion.</span></strong><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">It appeared that</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">the 5-year prognosis in IHD patients was unaffected by the dimensions of </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">IVST</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">, </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">LVIDD and LVMMI. In 60 months after the surgery, a significantly better prognosis was observed for certain unfavourable initial conditions: enlarged RV ≥</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">2.5 cm (37.5% vs 30.7%, р = 0.008), aortic diameter ≥</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">3.0 cm (57.2% vs 34.3%, р = 0.02), enlarged LA ˃</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">4.0 cm (43.8% vs 24.7%, р</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">=</span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> </span><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">0.046). In addition, revascularization was associated with better survival rates for normal LVMM (<250 g; 75.8% vs 49.1%, р=0.05), without the thickening of the LV walls (66.9% vs 30.5%, р=0.047) and without LV systolic dysfunction (87.7% vs 59.9%, р=0.046). An important place among the echocardiographic criteria of unfavourable prognosis belongs to LV systolic dysfunction (EF ≤ 45%). Therefore, the experimental group patients were distributed according to the EF value, following the Ukrainian Association of Cardiology and EU guidelines, i.e. we singled out the so-called grey zone (EF=45-54%), where the patients featuring LV systolic dysfunction and preserved EF belonged. The analysis of the results showed the cumulative event-free survival to be 87.4% for EF ˃ 55%, 14.6% for EF = 45-54% and 42.9% for EF < 45% (р = 0.01). The patients after the myocardial revascularization with EF = 45-54% had a worse prognosis of event-free survival than those with LV systolic dysfunction. In the group of patients who had undergone only the medical therapy, the survival prognosis was significantly worse, which corresponded to a reduced EF (38.3% for EF ˃ 55%, 15.0% for EF = 45-54% and 0% for EF < 45%, p</span>_{<span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt; vertical-align: sub;">EG-CG</span>}<span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;"> = 0.01).
A similar EF-based distribution was used in the study of patients with decompensated heart failure (REDINSCOR II, 2017), in which the authors revealed that the grey zone patients featured a higher risk of cardiovascular complications than patients with normal EF values did.</span></p><p class="MsoNormal" style="margin-top: 0,0000pt; margin-bottom: 0,0000pt; text-indent: 35,4500pt; text-align: justify; text-justify: inter-ideograph; line-height: 150%;" align="justify"><strong><span style="font-family: 'Times New Roman'; line-height: 150%;">Conclusions.</span></strong><span style="mso-spacerun: 'yes'; font-family: 'Times New Roman'; mso-fareast-font-family: Calibri; line-height: 150%; font-size: 14,0000pt; mso-font-kerning: 0,0000pt;">Revascularization contributed to a considerably better 60-month survival prognosis for cases featuring the enlarged right ventricle (≥2.5 cm), enlarged left atrium (˃4.0 cm) and extended aortic root (≥3.0 cm), but with the normal left ventricular myocardial mass (< 250 g) and without ventricular hypertrophy or systolic dysfunction.</span></p>

Item Description

2391-8306
10.12775/JEHS.2020.10.02.002