P283 Post-reperfusion indicators of left ventricular diastolic function in patients with ST elevation myocardial infarction
Authors: Mirmaksudov M S , Rakhmonov D KH , Kenjaev S R , Koyirov A K , Rakhimova R A , Umarova Z F 
Published: January 2020

Objective

to study the effects of reperfusion on the formation of the type of diastolic dysfunction of the left ventricle in patients with ST elevation acute myocardial infarction (STEMI).

Material and Methods

The diastolic function of the LV was studied in 302 patients with STEMI using Pulse wave doppler with an estimate of transmitral flow and tissue doppler echocardiography. Depending on the effectiveness of reperfusion, the patients were divided into 3 groups: 1st group - 196 (65%) patients with successful reperfusion (with full ST-segment resolution); Group 2 - 76 (25%) patients with partial reperfusion (ST segment decline by more than 30%, but less than 70% from baseline), Group 3 - 30 (10%) patients with no reperfusion (an increase in the degree of elevation, the absence of dynamics or a decrease in ST elevation by less than 30% from baseline).

Results

According to the initial state of transmitral flow, patients of the three groups did not differ significantly. The maximum rate of early filling of the LV (E) in patients with the 1st, 2nd and 3rd groups was 58.0 ± 2.4, 56.0 ± 2.6 and 110.0 ± 2.2 cm / s, respectively. The integrated index of the LV diastolic function - the E/A ratio, which is the most important parameter for evaluating LV diastolic function, was equal to 0.83 ± 0.02, 0.79 ± 0.02, and 2.2 ± 0.02, respectively (p&gt; 0.05). The integral of the rate of early filling of the LV (VTIE) was 9.8 ± 0.6, 9.6 ± 0.5 and 9.0 ± 0.6 cm, respectively, without significant intergroup differences. The time of isovolumic relaxation of the LV myocardium in patients of the three groups was equal to 100 ± 5.0, 103 ± 5.6 and 108 ± 5.1 ms, respectively (p&gt; 0.05).

According to Doppler echocardiography, 242 (80.0%) of all 302 patients with STEMI showed signs of DDLV in type I on the 1st day of the disease, in 15 (5%) types II (pseudonormal type), in 45 (15%) - for type III (restrictive).

The restrictive type of diastolic dysfunction was more common in patients of the 3rd group with no myocardial reperfusion, which may be due to severe myocardial dysfunction. Among patients of the 1st group who had adequate reperfusion, 97% had diastolic dysfunction of the type of relaxation disorder, and 3% had a pseudonormal type of diastolic dysfunction. In this group, the restrictive type of diastolic dysfunction was not registered.

Pseudonormal type of diastolic dysfunction among patients of the 3rd group was found in 13%, the 2nd - in 6%, the 1st - in 3%.

Conclusion

in this way, the process of ischemia and reperfusion, along with impaired systolic function, also leads to impaired LV diastolic function in STEMI. Ontime and successful reperfusion of the myocardium in STEMI contributes to the preservation of indicators of LV diastolic function. With unsuccessful myocardial revascularization, a restrictive type of diastolic dysfunction often develops, which is one of the predictors of unfavorable post-infarction LV remodeling.