2017

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2017/№2

Congestive heart failure in patients with myocardial infarction type 2

Dyatlov N. V., Zhelnov V. V., Dvoretsky L. I.
Federal State Budgetary Educational Institution of Higher Education "I.M. Sechenov First Moscow State Medical University " of the Ministry of Health of the Russian Federation, Trubetskaya 8, Bldg. 2, Moscow 119991

Keywords: type-2 myocardial infarction, CHF, diastolic dysfunction of the left ventricle

DOI: 10.18087/rhj.2017.2.2304

Background. Information about prognosis for patients with type 2 MI (MI-2) is scarce and inconsistent. Aim. To analyze development of heart failure (HF) in patients with type 1 MI (MI-1) and MI-2. Materials and methods. The study included 620 patients (men, 62.5%; women, 37.5%) aged 64.09±12.66. MI-1 was diagnosed in 64% of patients and MI-2 – in 24%. Patients were examined according to a standard method for evaluation of MI patients. Follow-up was performed at 6 months after discharge from the hospital. Results. Factors resulting in an imbalance between myocardial oxygen demand and supply included tachy-/bradycardia, 26.0%; severe anemia, 21.8%; AH with LV myocardial hypertrophy, 41.6%; and severe respiratory insufficiency, 6.4%. Two or more of these factors were detected in 5.2% of patients. Previously diagnosed CHF was present in 18.2 and 43.5% of patients with MI-1 and M2-, respectively (р<0.05). During the 6 month monitoring, CHF developed in 15.3% of patients after MI-1 and 21.5% of patients after MI-2 (р<0.05). At the same time, the proportion of patients with FC III and IV CHF remained unchanged (35%) in the MI-1 group whereas it increased from 55.6% to 62% in the MI-2 group. Requirement for administration of loop diuretics was 10.2% in the MI-1 group vs. 31.3% (р<0.01) in the MI-2 group. Parameters of EchoCG, including septal thickness (1.16±0.17 vs. 1.22±0.21 cm; р=0.006); left atrial size (3.8±0.42 vs. 4.01±0.47 cm; р<0.0001); and LV early filling velocity, Ve (0.61±0.18 vs. 0.72±0.31 m/s; р<0.05); significantly differed between patients with MI-1 and MI-2. EF and stroke volume did not significantly differ between the groups. Conclusion.Comorbidities, such as severe COPD, chronic kidney disease, pronounced anemia, AH with LV hypertrophy, and atrial fibrillation, are more typical for patients with MI-2 and provide more rapid progression of HF within 6 months compared to patients with MI-1.
  1. Dargie HJ. Managing heart failure in primary care. –London: Blackwell Healthcare Communications; 1996. 196 p.
  2. Фомин И. В., Беленков Ю. Н., Мареев В. Ю., Агеев Ф. Т., Бадин Ю. В., Галявич А. С. и др. Распространенность ХСН в Европейской части Российской Федерации – данные ЭПОХА–ХСН. Журнал Сердечная Недостаточность. 2006;7(1):4–7 [Fomin I. V., Belenkov Yu. N., Mareev V. Yu., Ageev F. T., Badin Yu. V., Galyavich A. S. i dr. Rasprostranennost` XSN v Evropejskoj chasti Rossijskoj Federaczii – danny`e E`POXA–XSN. Zhurnal Serdechnaya Nedostatochnost`. 2006;7(1):4–7].
  3. McManus DD, Chinali M, Saczynski JS, Gore JM, Yarzebski J, Spencer FA et al. 30-year trends in heart failure in patients hospitalized with acute myocardial infarction. Am J Cardiol. 2011;107(3):353–9. DOI:10.1016/j.amjcard.2010.09.026.
  4. Thygesen K, Alpert JS, Jaffe AS, Simoons ML, Chaitman BR, White HD et al. Third universal definition of myocardial infarction. J Am Coll Cardiol. 2012;60(16):1581–98. DOI:10.1016/j.jacc.2012.08.001.
  5. Желнов В. В., Дятлов Н. В., Дворецкий Л. И. Инфаркт миокарда второго типа. Миф или реальность? Архивъ внутренней медицины. 2016;6(2):34–41 [Zhelnov V. V., Dyatlov N. V., Dvoreczkij L. I. Infarkt miokarda vtorogo tipa. Mif ili real`nost`? Arxiv`` vnutrennej medicziny`. 2016;6(2):34–41].
  6. Baron T, Hambraeus K, Sundström J, Erlinge D, Jernberg T, Lindahl B et al. Type 2 myocardial infarction in clinical practice. Heart. 2015;101(2):101–6. DOI:10.1136/heartjnl-2014-306093.
  7. Sandoval Y, Smith SW, Thordsen SE, Apple FS. Supply/demand type 2 myocardial infarction: should we be paying more attention? J Am Coll Cardiol. 2014;63(20):2079–87. DOI:10.1016/j.jacc.2014.02.541.
  8. Newby LK, Jesse RL, Babb JD, Christenson RH, De Fer TM, Diamond GA et al. ACCF 2012 expert consensus document on practical clinical considerations in the interpretation of troponin elevations: a report of the American College of Cardiology Foundation task force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2012;60(23):2427–63. DOI:10.1016/j.jacc.2012.08.969.
  9. Saaby L, Poulsen TS, Hosbond S, Larsen TB, Pyndt Diederichsen AC, Hallas J et al. Classification of myocardial infarction: frequency and features of type 2 myocardial infarction. Am J Med. 2013;126(9):789–97. DOI:10.1016/j.amjmed.2013.02.029.
  10. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., Коротеев А. В., Мареев Ю. В., Овчинников А. Г. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Утверждены на Конгрессе ОССН 7 декабря 2012 года, на Правлении ОССН 31 марта 2013 и Конгрессе РКО 25 сентября 2013 года. Журнал Сердечная Недостаточность. 2013;14(7):379–472 [Mareev V. Yu., Ageev F. T., Arutyunov G. P., Koroteev A. V., Mareev Yu. V., Ovchinnikov A. G. i dr. Naczional`ny`e rekomendaczii OSSN, RKO i RNMOT po diagnostike i lecheniyu XSN (chetverty`j peresmotr). Utverzhdeny` na Kongresse OSSN 7 dekabrya 2012 goda, na Pravlenii OSSN 31 marta 2013 i Kongresse RKO 25 sentyabrya 2013 goda. Zhurnal Serdechnaya Nedostatochnost`. 2013;14(7):379–472].
  11. Melberg T, Burman R , Dickstein K. The impact of the 2007 ESC-ACC-AHA-WHF Universal definition on the incidence and classification of acute myocardial infarction: a retrospective cohort study. Int J Cardiol. 2010;139(3):228–33. DOI:10.1016/j.ijcard.2008.10.021.
  12. Javed U, Aftab W, Ambrose JA, Wessel RJ, Mouanoutoua M, Huang G et al. Frequency of elevated troponin I and diagnosis of acute myocardial infarction. Am J Cardiol. 2009;104(1):9–13. DOI:10.1016/j.amjcard.2009.03.003.
  13. Gonzalez MA, Eilen DJ, Marzouq RA, Porterfield CP, Hazarika S, Nasir S et al. The universal classification is an independent predictor of long-term outcomes in acute myocardial infarction. Cardiovasc Revasc Med. 2011;12(1):35–40. DOI:10.1016/j.carrev.2009.11.006.
Dyatlov N. V., Zhelnov V. V., Dvoretsky L. I. Congestive heart failure in patients with myocardial infarction type 2. Russian Heart Journal. 2017;16 (2):144–150

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