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  • 112 -11 (49) 2022 — A.L. Аlavi, S.R. Kenjaev — EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

112 -11 (49) 2022 — A.L. Аlavi, S.R. Kenjaev — EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION

A.L. Аlavi, Bukhara branch of the Republican Scientific Center of Emergency Medical Care

S.R. Kenjaev Bukhara branch of the Republican Scientific Center of Emergency Medical Care Bukhara State Medical Institute

Resume

Objective: to study the effect of prehospital thrombolysis on left ventricular diastolic function in patients with acute ST-segment elevation coronary syndrome.

Material and methods: We examined cases of LV diastolic function in 108 STEMI patients aged 35 to 67 years. The average age was 44.2 ± 1.3 years. All 108 patients underwent echocardiography (1 day after myocardial revascularization and 3 months later. Patients were randomized into two groups: group 1 – 50 patients receiving standard therapy, and prehospital hospital TLT. Group 2 included 58 patients who underwent standard therapy and hospital TLT. Transmitral blood flow (TMBF) parameters were assessed using Doppler echocardiography to assess diastolic dysfunction of the left ventricular myocardium.

Results: according to the initial state of TMBF, the groups of patients did not differ significantly among themselves. The maximum speed of early LV filling (E) in patients of groups 1 and 2 was 58.0 ± 2.4 and 56.0 ± 2.6 cm /s, respectively. The integrated indicator of LV diastolic function – the E / A ratio – was 0.83 ± 0.02 and 0.79 ± 0.02, respectively. The integral of the rate of early LV filling (VTIE) was 9.8 ± 0.6 and 9.6 ± 0.5 cm, while no significant intergroup differences were found. The time of isovolumetric relaxation of the LV myocardium in the group of patients receiving prehospital thrombolysis and hospitalized patients was 100 ± 5.0 and 103 ± 5.6 ms, respectively (p> 0.05).

Conclusion: thus, changes in LV diastolic function indicators after prehospital trombolytic therapy associated with the presence of reversible myocardial dysfunction.The use of prehospital thrombolytic therapy leads to the development of reversible diastolic dysfunction in the area of ​​ischemic myocardial damage.

Key words: STEMI, left ventricular diastolic function, prehospital thrombolytic therapy.

First page

655

Last page

661

For citation: A.L. Аlavi, S.R. Kenjaev – EFFECT OF PREHOSPITAL SYSTEMIC THROMBOLYSIS ON LEFT VENTRICULAR DIASTOLIC FUNCTION IN ST-SEGMENT ELEVATION ACUTE MYOCARDIAL INFARCTION //New Day in Medicine 11(49)2022 655-661 https://clck.ru/32vgvA

LIST OF REFERENCES:

  1. Клинические рекомендации по остром инфаркте миокарда с элевацией сегмента ST на электрокардиограммы. /РФ. 2020г. Стр 28-33.
  2. Аляви А.Л., Кенжаев М.Л. и др. Выбор метода реваскуляризации у больных с острым коронарным синдромом с подъемом сегмента ST // Вестник экстренной помошы №1 2013. Стр 67-71.
  3. Амосова Е.Н., Дыкун Я.В., Мишалов В.Г. Руководство по тромболитической терапии. К.: IT-studio, 1998. Стр. 168.
  4. Дзяк Г.В., Коваль Е.А. Тромболитическая терапия при остром коронарном синдроме с элевацией сегмента ST: необходимо ли изменить стандарт реперфузионной терапии? // Укр. кардіол. журн. – 2004. – №1. – С.15-21.
  5. Дядык А.И., Багрий А.Э., Приколота О.А., Вишневецкий И.В. и др. Желудочковые нарушения ритма при остром инфаркте миокарда. Часть 2. Патогенез желудочковых нарушений ритма при остром инфаркте миокарда //Укр. кардіол. журн. – 2001. – № 4. – С. 104-109.
  6. Литвицкий П.Ф., Сандриков В.А., Демуров Е.А. Адаптивные и патогенные эффекты реперфузии и реоксигенации миокарда. – М. Медицина, 1994. – 230 с.
  7. Скрипкин С.А., Лоленко А.В., Радионов В.В., Манько М.В., Булак А.Е. Догоспитальный тромболизис в красноярске: результаты ретроспективного сравнительного исследования. //Рациональная Фармакотерапия в Кардиологии. 2011;7(5):609-612.
  8. Чазов Е.И., Матвеева Л.С., Мазаев А.В. и др. Внутрикоронарное введение фибринолизина при остром инфаркте миокарда //Тер. арх. – 1976. – № 4. – C. 8-19.
  9. Braunwald E. The open-artery theory is alive and well-again // N. Engl. J. Med. – 1993. – Vol. 329.-P. 1650-1652.
  10. Braunwald E. Myocardial reperfusion limitation of infarct size, reduction of left ventricular dysfunction and improved survival. Should the paradigm be expanded? //Circulation. – 1989. – Vol.79. – P. 441-444.
  11. Califf R.M., Topol E.J., Stack R.S. еt al. Evaluation of combination thrombolysic therapy and timing of cardiac catheterization in acute myocardial infarction: results of Thrombolysis and Angioplasty in Myocardial Infarction phase 5 randomized trial //Circulation. – 1991. – Vol. 83. – P. 1543-1546.
  12. The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction //N. EngI. J. Med. – 1993. – Vol. 329. – P. 673-682.
  13. Grunewald M., Seifried E. Meta-analysis of all available published clinical trials (1958-1990) on thrombolytic therapy for AMI: Relative efficacy of different therapeutic strategies // Fibrinolysis. – 1994. – Vol.8. – P. 67-86.
  14. Cannon C.P., Gibson C.M., Lambrew C.T. et al. Longer Thrombolysis Door-to-Needle Times are Associated With Increased Mortality in Acute Myocardial Infarction: An Analysis of 85,589 Patients in the National Registry of Myocardial Infarction 2 + 3 // Suppl. to Journal of the American College of Cardiology. – Febr. 2000. – Vol. 35, Issue 2, Suppl. A. – P. 376.
  15. Weaver W.D., Cerqueira M., Hallstrom A.P. et al. Prehospital-initiated vs hospital-Initiated thrombolytic therapy the Myocardial Infarction. Triage and Intervention Trial // JAMA. – 1993. – Vol. 270. – P. 1211-1216.
  16. Clemmensen P., Grande P., Nielsen W.B. et al. Evolving non-Q-wave vs. Q-wave myocardial infarction after thrombolysis: a high risk population benefitting from early revascularization. Results from the DANAMI study // Europ. Heart Journ. – Aug/Sept. 2000. – Vol. 21, Abstr. Suppl. – P. 504.
  17. Goldstein P. Pre-hospital triage (How to organize and conduct) // International Experts Workshop on early treatment strategies for MI. Mallorka; April 16TH – 18TH, 2005.
  18. Van de Werf F. Combination therapy of any of the above. Facilitated PCI: Combination Therapy // International Experts Workshop on early treatment strategies for MI. Mallorka; April 16TH – 18TH, 2005.
  19. Kenjaev S.R., Boltayev E.B., Comparative analysis of methods for diagnosing myocardial stunning after myocardial infarction //New Day in Medicine 7(45)2022 236-243 https://newdaymedicine.com/index.php/2022/07/10/48-7-45-2022

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