Медицина/4. Терапия
Stilidi M.I,
Stilidi E.I
Crimean State Medical University
The Effect of
different variants of metabolic syndrome on myocardial remodeling processes
The aim of this work: identification
of the nature of remodeling and functional state of the myocardium in patients suffering
from hypertension depending on the variants of the metabolic syndrome (MS).
Materials and Methods: We studied 87
patients with MS at the Crimean cardiological clinic in Simferopol. Patients
with MS were divided into 3 groups. To the 1-st group belong hypertension
patients without coronary heart disease (CHD), In the 2-nd group there are
patients with coronary heart disease but without myocardial infarction and the
patients of the 3rd group are those CHD patients with postinfarction
cardiosclerosis. On the basis of clinical presentations of MS there have also
been allocated the groups with its
typical variants. The first variant is characterized by obesity, hypertension,
lipid exchange violation, the violation of carbohydrate metabolism. This group
included 26 patients. The second variant characterized by obesity,
hypertension, a violation of lipid metabolism is observed in the group of 23
patients. The third variant characterized by obesity, hypertension, a violation
of carbohydrate metabolism is found in the group of 20 patients. The fourth
variant revealed in the group of 18 patients is featured by obesity,
fat-sharing violation, the violation of carbohydrate metabolism.
All the patients underwent a clinical survey that included the collection of
complaints, case history, the objective research methods (measurement of heart
rate, blood pressure). Clinical diagnoses, CHD, heart attack, diabetes,
hypertension were determined in accordance with the recommendations of Ukrainian
and European cardiological societies.
The analysis of the left ventricle geometry types of the patients was carried
out.
To study the heart morphometric and functional state echocardiography method
was used. The study was carried out using the apparatus Philips EnVisor HDI
5000.
The study determined the following parameters: the diameter of the aorta, left
atrium diameter, the final diastolic left ventricular size, the final systolic
left ventricular size, the thickness of left ventricular posterior wall, the thickness
of ventricular septum, right ventricle diameter in diastole, left ventricle
ejection fraction.
Results: It was found out that in the
group of patients suffering from hypertension the concentric left ventricular
hypertrophy (LV) predominates (76.92%). Concentric remodeling of LV myocardial was
determined in 11,54% of patients. In the group with coronary heart disease a
concentric hypertrophy prevails (70.37%). In the group with the postinfarction
cardiosclerosis the number of patients with concentric hypertrophy (38.24%) slightly
prevails over the number of patients
with eccentric hypertrophy of LV (29.41%). While comparing the percent rates of
remodeling myocardium types it is revealed that the myocardial hypertrophy of
concentric-type with all variants of metabolic syndrome predominates. The
highest proportion of patients with concentric hypertrophy (68.42%) suffered
from the 1st (classic) version of MS.
Table №1
Types of left ventricular geometry in the studied groups
|
Indicator |
The frequency of detection, abs. (%) in groups |
||
|
Arterial hypertension (n=26) |
CHD (n=27) |
Postinfarction cardiosclerosis (n=34) |
|
|
Normal
geometry |
2(7,69) |
1(3,7) |
9(26,47) |
|
Concentric
remodelling |
3(11,54) |
2(7,4) |
2(5,88) |
|
Concentric
hypertrophy |
20(76,92) |
19(70,37) |
13(38,24) |
|
Excentric
hypertrophy |
1(3,85) |
5(18,52) |
10(29,41) |
Conclusions: The more components the metabolic syndrome includes, the higher the
probability of developing type concentric hypertrophy of the myocardium is. The
eccentric hypertrophy of the myocardium is characteristic for the 1-st variant of
MS (21.05%), for the 2-nd it is 4%, for the 3rd - 24%, as for the 4-th - 27.78%.
There has been a decrease in the percentage of patients with eccentric
hypertrophy myocardium at the 2-nd variant of the MS, that can be attributed to
the absence of violations of carbohydrate metabolism in this group of patients.
Concentric remodeling is typical for 12% of patients with the 3-nd variant of MS,
8% - of the 2-nd variant, 5.26% of the 1-st and 5.56% of the 4-th MS variant.
The largest number of patients with normal left ventricular geometry is observed
in the 4-th MS variant in the absence of hypertension.