CHANGES IN THE STRUCTURAL AND FUNCTIONAL STATUS OF THE LEFT VENTRICLE IN PATIENTS WITH ARTERIAL HYPERTENSION WHO HAVE UNDERGONE MYOCARDIAL INFARCTION

  2. 2023
  3. CHANGES IN THE STRUCTURAL AND FUNCTIONAL STATUS OF THE LEFT VENTRICLE IN PATIENTS WITH ARTERIAL HYPERTENSION WHO HAVE UNDERGONE MYOCARDIAL INFARCTION

Kolesnyk T. V., Fursa O. V.

CHANGES IN THE STRUCTURAL AND FUNCTIONAL STATUS OF THE LEFT VENTRICLE IN PATIENTS WITH ARTERIAL HYPERTENSION WHO HAVE UNDERGONE MYOCARDIAL INFARCTION

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About the author:

Kolesnyk T. V., Fursa O. V.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

The relevance of arterial hypertension and coronary heart disease is difficult to overestimate due to the growing prevalence of these diseases and their role in the structure of mortality. Adherence to the strategy of complex treatment of arterial hypertension and coronary heart disease allows to improve clinical results and prognosis. A personalized approach to the treatment of cardiology is already available today, and genetic testing is one of the ways to implement it. The purpose of the study was to determine the characteristics of changes in the structural and functional state of the left ventricle in patients with arterial hypertension who underwent a myocardial infarction, taking into account the A1166C polymorphism of the angiotensin II type 1 receptor gene during long-term dynamic observation. Methods. The study included 36 men with arterial hypertension who had undergone a myocardial infarction. The average age in the study group was 57.0 (52.0; 64.0) years, the history of arterial hypertension was 6.3 (4.0; 15.0) years. The average period after a myocardial infarction was 48.0 (12.0; 144.0) months. All patients were determined to have the A1166C polymorphism of the angiotensin II type 1 receptor gene using the DNA-sorb-B test system by the polymerase chain reaction method with endonuclease restriction products. Daily blood pressure monitoring and echocardiography were performed according to standard methods at the beginning of the study and after 38 months. The patients were divided into 3 groups: group 1 consisted of 18 (50%) patients with the AA genotype of the A1166C gene, angiotensin II type 1 receptor gene polymorphism, group 2 included 12 (33.3%) patients with the AS genotype, and group 3 – 6 (16.7%) patients. Results. In accordance to daily blood pressure monitoring, it was established that the highest blood pressure level for all periods of the day at the beginning of the study was in patients of group 3 (p<0.05 for the average daytime level and p>0.05 for the average nighttime level). After 38 months, the blood pressure level tended to decrease in patients of group 1, did not change in patients of group 2, and decreased in patients of group 3. Patients of group 1 had the largest end-diastolic volume and its index during the initial examination, and patients of group 3 had the smallest (p>0.05). All patients differed significantly in posterior wall thickness, ventricular septal thickness, left ventricular myocardial mass, and indices adjusted for body surface area and height. According to the left ventricular mass index, adjusted to the body surface area, the difference between patients of groups 1 and 2 was 25.01 g/m2 (p>0.05), between patients of groups 1 and 3 – 36.40 g/m2 (p< 0.05), between patients of groups 2 and 3 – 12.39 g/m2 (p>0.05). In general, patients of group 3 had the largest thickness of the walls and left ventricular mass index during the initial examination. During the examination after 38 months, a significant increase in the left ventricle end-diastolic size and volume and their indices was registered in the patients of group 1, although these parameters remained in the normal range. The ejection fraction did not change significantly. Also of note is the significant thickening of the interventricular septum by 0.07 cm behind the median with unchanged posterior wall thickness and the significant increase in the left ventricular mass index by 17.12 g/m2, despite reaching target blood pressure levels. In patients of group 2, a decrease in the hemodynamic parameters of the left ventricle was registered, as well as a decrease in the thickness of the back wall by 0.05 cm and a decrease in the left ventricular mass index by 17.84 g/m2 according to the median with an unchanged left ventricular ejection fraction. Although these changes were imprecise, they illustrate a trend toward regression of left ventricular hypertrophy when target blood pressure levels are reached and an expected response to long-term antihypertensive therapy. In patients of group 3, a tendency to left ventricular dilatation according to the median, a decrease in the ejection fraction by 21.10%, a tendency to an increase in left ventricular mass index and indices adjusted for body surface area and height were registered, despite a tendency to regression of left ventricular hypertrophy according to thickness of the walls (unreliable decrease in the thickness of the posterior wall by 0.11 cm). Correlation analysis showed that in patients of group 1, only the average nocturnal level of systolic blood pressure was associated with the thickness of the posterior wall, mass and mass index of the left ventricle, and in patients of group 2 there was no association between the level of blood pressure for any period of the day and parameters of the left ventricle. In contrast to patients of groups 1 and 2, high strength correlations were established in patients of group 3. The level of nocturnal systolic and diastolic blood pressure was directly associated with end-diastolic size and volume (r=0.89, p<0.05). The increase in the degree of left ventricular hypertrophy was associated primarily with the level of diastolic blood pressure mainly during the day, the nighttime level of systolic and diastolic blood pressure also had an effect, but less in value, on the growth of the thickness of the posterior wall, mass and mass index of the left ventricle. Conclusions. The results of the study demonstrate the need for daily blood pressure monitoring and echocardiography in hypertensive patients who had overwent a myocardial infarction and are patients with a very high cardiovascular risk to establish the true level and all fluctuations of blood pressure during the day with the determination of the effectiveness of treatment, as well as to determine the degree of left ventricular hypertrophy and its reversion against the background of antihypertensive therapy. Determination of the AA11SS polymorphism of the angiotensin II type 1 receptor gene in patients with arterial hypertension after a myocardial infarction made it possible to establish the features of the course of the disease. At a comparable level of office blood pressure, patients with the SS genotype of the angiotensin II type 1 receptor gene showed the highest average nighttime blood pressure level, which was associated with higher values of left ventricular remodeling parameters.

Tags:

A1166C polymorphism of the angiotensin II type 1 receptor gene, arterial hypertension and previous myocardial infarction, left ventricular hypertrophy

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Publication of the article:

«Bulletin of problems biology and medicine», 2023 Issue 1, 168, 187-199 pages, index UDC 616.12-008.331.1+616.127-005.8: 616.124-07: 575.2

DOI:

10.29254/2077-4214-2023-1-168-187-199

2023 Issue 1, 168
A1166C polymorphism of the angiotensin II type 1 receptor gene arterial hypertension and previous myocardial infarction left ventricular hypertrophy
19.06.2023
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