Echocardiographic Predictors of the Development of Various Complications of Blood Circulatory System in Patients with Acute Coronary Syndrome (Literature Review with Own Research Results)

Abstract

Introduction. A big number of publications are reporting results obtained while using echocardiography (EchoCG) in heart diseases. However, so far, applicability of EchoCG data to predict possible complications in cardiovascular system have not been studied sufficiently. The aim of the study. Using available literature and own research results to analyze EchoCG predictors of the development of various complications of the blood circulatory system during acute coronary syndrome. Materials and methods. Literature review covered 41 analyzed articles, results of which were compared with our own observations. Results. Two years after the myocardial infarction there exist several variants of further disease development: favorable, with the preserved left ventricle dysfunction; conditionally preserved and moderately preserved, with pronounced dilatation and compensatory left ventricle hypertrophy; and unfavorable, with reduced left ventricle systolic function accompanied by the increased end systolic and end diastolic volumes. Repeated myocardial infarction is more often supplemented with the secondary myocardial necrosis in the perifocal zone and dilatation of the left ventricular cavities. Our observations revealed that violation of myocardial contractility is manifested in those cases, when the myocardial damage exceeds 20.0 % of the thickness of the left ventricular wall; in those cases, when the damage covers from 20.0 to 50.0 % – a Q wave is registered on the electrocardiography. Prognostic predictors and criteria for the development of unfavorable cardiovascular events after being subjected to ST elevation of myocardial infarction include: increased angina attacks, progression of congestive heart failure, age over 60 years, increased heart rate more than 90 beats/min, ventricular extrasystole 3-5 grades according to B. Laun, elevation of the ST segment more is equal 1 mm, left ventricle hypertrophy, alteration of two or more coronary arteries. Conclusions. Unfavorable prognostic predictors according to EchoCG data are as follows: increased end diastolic and end systolic volumes, decreased left ventricular ejection fraction is less than 40.0 % on the background of early or late remodeling, concentric type of remodeling. Eccentric left ventricular ejection fraction, being initially compensatory in nature, due to its increased severity and cardiomegaly accompanied by a decrease in left ventricular ejection fraction is less than 40.0 % – decompensated. Predictors of the right cardiac cusp are: ventricular extrasystoly of 3-5 gradations, ventricular tachicardia of the “pirouette” type, prolongation of Q-T interval, decrease in left ventricular ejection fraction is less than 40.0 %, increased anginal attacks and progression of congestive heart failure. Keywords: echocardiographic predictors, acute coronary syndrome, myocardial infarction, ventricular extrasystole.