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    Bulletin of problems biology and medicine / Issue 3 part 3 (112), 2014 / Significance of Assessment of Regional Myocardial Contractility and its Viability in Patients with Myo- cardial Sclerosis

    Tshngryan G. V.

    Significance of Assessment of Regional Myocardial Contractility and its Viability in Patients with Myo- cardial Sclerosis

    About the author:

    Tshngryan G. V.

    Heading:

    CLINICAL AND EXPERIMENTAL MEDICINE

    Type of article:

    Scentific article

    Annotation:

    In order to establish myocardium viability criteria in patients with unstable angina on the background of postinfarction cardiosclerosis by determining the dynamics of the standard echocardiographic (EchoCG) values and parameters of segmental myocardial contractility, 59 patients were examined, who were admitted to the hospi- tal with the signs of unstable angina in the first 2 hours of destabilization. Patients were divided into 2 groups: group I – 27 patients with viable myocardium (mean age 61.94 ± 2.39), II group – 32 patients (mean age 63.09 ± 2.24) with nonviable myocardium. The criterion for myocardial viability was improved left ventricular ejection fraction (LVEF) 5 % in dynamics on EchoCG examination after 14 days of follow-up. In the first day and on day 14 of hospital- ization patients were determined with following EchoCG parameters: end- systolic size (ESS), end-diastolic size (EDS), end-systolic volume (ESV), end-diastolic volume (EDV), stroke volume (SV), EF. Therefore, in addition to the latter, for a more detailed assessment of LV contractile ability we calculated the degree of local (segmental) contractility (DLC) which was derived as the sum of individual scores divided by the total number of segments analyzed and wall motion score index (WMSI) – total score segments/16. The results showed that the dynamics of the 14-day observation established ESS decrease in patients of the group I by 4.8 % (from 4.26 ± 0.24cm to 4.10 ± 0.26cm, p < 0.001), in the second group by 1.1 % (from 4.83 ± 0.18cm to 4.78 ± 0.17cm, p > 0.05). ESV in groups I and II had a similar tendency to change (from 86.64 ± 11.06ml to 76. 82 ± 10.64ml, p < 0.001 (I group) from 117.22 ± 10.54ml to 107.18 ± 9.14ml, p < 0.001 (II group)). Thus SV had a tendency to increase by 16.6 % in the first group of patients (64.47 ± 9.27ml to 77.35 ± 10.01ml, p < 0.0001) and by 7.4 % in the second group (from 61.95 ± 9. 27ml to 66.95 ± 3.42ml p < 0.0001). In assessment of standard measurement of myocardial LVEF a reliable increase was noted in both groups: group I – 18 % (from 37. 76 ± 2.04 % to 47.35 ± 2.37 %, p < 0.001); group II – by 4. 06 % (from 36.72 ± 2.39 % to 38.27 ± 2.00 %, p < 0.001). However, the analysis of WMSI and DLC in two groups reflected a completely opposite trend. In particular DLC: in the I group decreased from 1. 58 ± 0.15 to 1.39 ± 0.13, p < 0.0001, which indicates improved myocardial contractility by 12 %, while in the II – the opposite: elevation of the DLC was observed from 1. 32 ± 0.1 to 1.54 ± 0.14, p < 0.0001, which is a sign of myocardial contractility disorders deepen- ing by 14.3 %. WMSI in the group I decreased (within an interval of 1st and 14 days) from 1.8 ± 0.1 to 1.68 ± 0.12, p < 0.0001, indicating a general area of re-establishment of abnormality segments by 6.7 %. In the second group WMSI increased from 1.47 ± 0.09 to 1.59 ± 0.09, p < 0.0001, which indicates the increase in the area of nonviable myocardium by 7.5 % due to the onset of unstable angina. Assessment of LVEF does not always provide complete information regarding changes in myocardial contractility. Even against the background of some improvement of LVEF, WMSI and DLC, characterizing the dynamics of local contractility of the LV, show differently directed trends. This is especially noticeable in patients with nonviable myocardium (group II), whereas the relative improvement of LVEF (4.06 %) also demonstrated a deterioration of WMSI 14.3 %, and the DLC – 7.5 %, indicating extension of nonviable myocardium regions. Therefore, a full assessment of myocardial hibernation along with determination of ESS, ESV, EDS, EDV, SV and LVEF, WMSI and DLC should be calculated as well.

    Tags:

    viable myocardium, segmental contractility, degree of local contractility, wall motion score index

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    Publication of the article:

    «Bulletin of problems biology and medicine» Issue 3 part 3 (112), 2014 year, 217-221 pages, index UDK 616. 127-005. 8-004. 6-07:612. 171-07