Focus on Stable Angina from the Perspective of Affected Coronary Artery Number and Structural and Functional Myocardial Changes
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Keywords

chronic coronary artery disease
coronary arteries
Holter monitoring
echocardioscopy
N-terminal pro-brain natriuretic peptide

Abstract

         The objective of the research was to study myocardial hemodynamics and contractility, as well as N-terminal pro-brain natriuretic peptide secretion in the patients with chronic coronary artery disease depending on affected coronary artery number according to coronary angiography.          Materials and methods. The study included 62 patients with chronic coronary artery disease, heart failure with preserved left ventricular ejection fraction. Among the examined patients, males prevailed – 52 (83.9%) individuals. The average age was 61.2±1.2 years. The control group included 15 apparently healthy individuals with preserved gender and age proportions. The patients were randomized by the number of the affected coronary arteries and divided into 2 subgroups according to the results of coronary angiography. Subgroup I included 16 (25.8%) patients with single-vessel coronary artery disease; subgroup II comprised 46 (74.2%) patients with multivessel coronary artery disease.           Results and discussion. According to Holter monitoring, average and maximum heart rate, extrasystoles and episodes of ST-segment depression/elevation were more often found in the patients with multivessel coronary artery disease (p<0.05). According to echocardioscopy, in the patients with coronary artery disease regardless of affected coronary artery number, hemodynamic indicators were higher as compared to healthy individuals (p<0.001), while left ventricular ejection fraction was lower in the patients with multivessel coronary artery disease (р<0.001). Serum level of N-terminal pro-brain natriuretic peptide exceeded reference value in both single-vessel coronary artery disease and multivessel coronary artery disease (р<0.001); however, the secretion of this peptide increased in multivessel coronary artery disease (р<0.05). There was observed a strong inverse correlation between left ventricular ejection fraction and N-terminal pro-brain natriuretic peptide in the patients with multivessel coronary artery disease and a moderate correlation in the patients with single-vessel coronary artery disease.          Conclusions. The nature and severity of coronary artery disease clinical course are associated with the number of the coronary arteries affected by atherosclerotic plaques. In multivessel coronary artery disease, according to the results of clinical, functional and laboratory studies, there was observed persistent progression of coronary artery disease and, consequently, chronic heart failure that is the reason for the improvement of schemata for successful treatment of the disease.
https://doi.org/10.21802/gmj.2019.2.5
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