Life quality and prognosis of pati­ents with adverse post-infarction left ventricle remodeling


DOI: https://dx.doi.org/10.18565/therapy.2024.1.30-38

Salyamova L.I., Kvasova O.G., Babkina I.A., Rymar V.V.

1) Penza State University; 2) S.M. Kirov Military Medical Academy of the Ministry of Defence of the Russian Federation, Saint Petersburg
Abstract. Chronic heart failure (CHF) is one of the most common complications of ST-segment elevation myocardial infarction (STEMI) due to pathological or adverse post-infarction remodeling of the left ventricle. At the same time, the subjective estimation of well-being and long-term prognosis of patients with different variants of such remodeling are remaining unclear.
The aim: to study the dynamics of life quality and prognosis in patients after STEMI with adverse left ventricular remodeling (ALVR) and without it.
Material and methods. 141 patients with STEMI aged 51 (45; 58) years was included into the study. Their quality of life was assessed on days 7–9 and after 24 and 48 weeks using a visual analogue scale (VAS) and Minnesota Questionnaire (MLHFQ). According to the results of echocardiography, ALVR was diagnosed in cases when the end-diastolic volume index increased by ≥ 20% and/or end-systolic volume index increased by ≥ 15% at 24 weeks comparatively to the values on days 7–9. Endpoints (cardiac surgery, recurrent MI) were registering during 96 weeks of observation.
Results. 125 patients (88.7%) have passed through observation. After 24 weeks they were divided into groups: 1st – 63 persons with ALVR (“ALVR”), 2nd – 62 persons without signs of ALVR (“No ALVR”). According to VAS data, in “ALVR” group, the subjective assessment of well-being improved by 5,2% (p0–48 = 0.045) only after 48 weeks. In group 2, by the intermediate visit the increase in this parameter reached 6.8% comparatively to the initial level (p0–24 = 0.001), and at the end of the observation it was 6.7% (p0–48 = 0.001). At the same time, VAS values differed in the comparison groups both after 24 and 48 weeks (р1–2 < 0.01). When analyzing the results of MLHFQ, a progressive worsening of CHF symptoms was found in both groups. In group 1, the end points within 96 weeks were detected in 13 (20.6%), in the 2nd group – in 2 (3.2%) patients. Odds ratio for an unfavorable outcome in ALVR was 7,8 (95% CI: 1.7–36.2) (p = 0.003) comparatively with “No ALVR” group.
Conclusion. Obtained results confirm the importance of timely diagnosis of ALVR for the purpose of adequate correction of anti-remodeling pharmacotherapy to improve the life quality and prognosis of STEMI patients.
Keywords: adverse left ventricular remodeling, end points, ST-segment elevation myocardial infarction, chronic heart failure, quality of life
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About the Autors

Lyudmila I. Salyamova, MD, PhD (Medicine), associate professor at the Department of therapy, Penza State University. Address: 440026, Penza, 40 Krasnaya St.
E-mail: l.salyamova@yandex.ru
ORCID: https://orcid.org/0000-0001-7130-0316
Olga G. Kvasova, MD, PhD (Medicine), senior lecturer at the Department of therapy, Penza State University. Address: 440026, Penza, 40 Krasnaya St.
E-mail: olhakvasova@yandex.ru
ORCID: https://orcid.org/0000-0001-7008-6995
Inna A. Babkina, MD, postgraduate student of the Department of therapy, Penza State University. Address: 440026, Penza, 40 Krasnaya St.
E-mail: innalevina@mail.ru
ORCID: https://orcid.org/0000-0002-3845-0854
Vladislav V. Rymar, 6th year cadet of S.M. Kirov Military Medical Academy of the Ministry of Defence of the Russian Federation. Address: 194044, Saint Petersburg, 6 Academica Lebedeva St.
E-mail: vlad1rymar@gmail.com
ORCID: https://orcid.org/0000-0002-3888-1750


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