Dzeytova Aminat Khoz-MagamedovnaTBA, Russia
Title: Dynamics of mitral regurgitation in acute coronary syndrome before and after coronary artery stenting
Objective: to evaluate the dynamics of mitral insufficiency after coronary artery stenting in acute coronary syndrome.
Material and methods: The study included 61 patients diagnosed with ACS who underwent coronary artery stenting. All patients underwent transthoracic echocardiography before stenting, 2 months later and 6-8 months after coronary artery stenting.
Results: In the first group (single-vessel lesion), the average value of the regurgitation fraction was 27.92±13.46%, in the second group (multi-vessel lesion) - 38.95±18.35% (p=0.0271). In patients with a single-vascular lesion, PKA is more often involved, the average value of the regurgitation fraction in the case of PKA is 30.32± 9.75%, in the case of a lesion of permanent pancreas - 29.25± 18.36%, in the case of a lesion of OV-15.62± 3.25% p-0.104. Dynamic observation revealed that two months after coronary artery stenting, positive dynamics is observed, and after 6 months, the results of the majority remain F=15.48, df=120, p=0.0001. The correlation of the assessment on the SYNTAX Score scale with the severity of mitral regurgitation was revealed, the more pronounced the MR, the greater the value of the SYNTAX Score (Spearman's correlation coefficient p = 0.69, p <0.0001). The statistical predictor of unfavorable progression of MR was a higher score on the Syntax Score scale, in a mixed model of proportional odds: the coefficient for interaction was (0.25 (0.14), p = 0.0049). In the course of the dissertation research, the relationship between the severity of mitral regurgitation and remodeling of the left heart before and after coronary artery stenting was studied. It has been established that the BDO before stenting has a prognostic value in relation to cardiac remodeling. The prognostic value of the selected LV BWW value before surgery = 150.0 ml was: sensitivity is 47%, specificity is 88%, the probability of an unfavorable prognosis for remodeling is 73%. Thus, LV BDO before surgery > 150 ml is associated with the development of global remodeling of the left chambers of the heart and a decrease in the contractility of the LV myocardium after coronary artery stenting. LV BDO can be used as a predictor of the effectiveness of surgical treatment.
Conclusion: The study found that the frequency, severity and dynamics of mitral regurgitation after coronary artery stenting in acute coronary syndrome depends on the involved coronary artery and the number of affected coronary arteries. Risk factors for the progression of mitral regurgitation in acute coronary syndrome include widespread damage to the coronary arteries, as well as a high score on the Syntax Score scale. For the first time, according to the developed prognostic model, the value of the end-diastolic volume associated with the unfavorable course of mitral regurgitation after coronary artery stenting was determined.