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Echocardiographic and angiographic predictors of left ventricular remodeling after the acute anterior myocardial infarction

dc.contributor.advisorJung, Robert
dc.contributor.advisorPavlović, Katica
dc.contributor.otherDejanović, Jadranka
dc.contributor.otherKalimanovska-Oštrić, Dimitra
dc.contributor.otherPetrović, Milovan
dc.contributor.otherIvanović, Vladimir
dc.contributor.otherStojšić-Milosavljević, Anastazija
dc.creatorTadić, Snežana
dc.date.accessioned2016-07-18T06:40:38Z
dc.date.available2016-07-18T06:40:38Z
dc.date.available2020-07-03T13:25:54Z
dc.date.issued2016-06-23
dc.identifier.urihttp://www.cris.uns.ac.rs/DownloadFileServlet/Disertacija145933593383885.pdf?controlNumber=(BISIS)100413&fileName=145933593383885.pdf&id=5241&source=NaRDuS&language=srsr
dc.identifier.urihttp://nardus.mpn.gov.rs/handle/123456789/5917
dc.identifier.urihttp://www.cris.uns.ac.rs/record.jsf?recordId=100413&source=NaRDuS&language=srsr
dc.identifier.urihttp://www.cris.uns.ac.rs/DownloadFileServlet/IzvestajKomisije145933594179080.pdf?controlNumber=(BISIS)100413&fileName=145933594179080.pdf&id=5242&source=NaRDuS&language=srsr
dc.description.abstractCilj: Kod trećine bolesnika sa akutnim ST-eleviranim infarktom (STEMI) nakon primarne angioplastike (pPCI) razvije se postinfarktno remodelovanje leve komore (LK). Cilj istraživanja je nalaženje ranih prediktora post-infarktnog remodelovanja leve komore nakon akutnog STEMI i pPCI. Metodologija: Uključeno je 210 ispitanika sa prvim akutnim STEMI prednjeg zida, lečenih pPCI. Urađena je ehokardiografija u prva 24h, a zatim nakon 6 meseci, kada su ispitanici podeljeni u 2 grupe: ispitivanu sa remodelovanjem (n=55; 26%) i kontrolnu bez remodelovanja (n=155; 74%). Ispitanici su klinički praćeni godinu dana. Rezultati i dikusija: Multivarijantnom regresionom analizom, kao najsnažniji rani prediktori post-infarktnog remodelovanja izdvojili su se: postojanje "no reflow" fenomena nakon pPCI (OR=30.0 95% CI, p<0.0001), pojava dijastolne disfunkcije u prva 24h (OR=27.7 95% CI, p<0.0001), povećan dijametar leve pretkomore - LA (OR=5.0 95% CI, p=0,044) i srčana slabost na prijemu - Killip klasa 2-4 (OR=3.4 95% CI, p=0.003.). Univarijantnom regresionom analizom, snažni prediktori su neadekvatna rezolucija ST segmenta - STR (OR 2.0 95% CI, p=0.024) i zbirni indeks zidne pokretljivosti – WMSI >2 (OR 21.6 95% CI, p<0.0001). Totalno ishemijsko vreme nije imalo uticaja na post-infarktno remodelovanje (p=0.546). Tokom jednogodišnjeg praćenja ispitanici sa post-infarktnim remodelovanjem su imali značajno veću incidencu glavnih neželjenih kardioloških događaja: rehospitalizacija (61.8% vs 22.6%; p<0.0001) / najviše rehospitalizacija zbog srčane slabosti (40% vs 2.6%; p<0.0001), sa mortalitetom 5.5%/; reinfarkta (20% vs 7.1%; p=0.007); rekoronarografija (45.5% vs 18.1%; p<0.0001); revaskularizacija (30.9% vs 11%; p=0.001). Zaključak: Kod pacijenata sa akutnim STEMI prednjeg zida lečenih pPCI, pojava "no reflow" fenomena, dijastolne disfunkcije, povećana LA i srčana slabosti na prijemu su najjači rani nezavisni prediktivni faktori za nastanak post-infarktnog remodelovanja. Značajni prediktori su i neadekvatna STR i WMSI>2. Pacijenti sa post-infarktnim remodelovanjem imaju veću incidencu glavnih neželjenih kardioloških događaja i mortaliteta.sr
dc.description.abstractObjective: Patients with ST-elevated myocardial infarction (STEMI) treated by primary angioplasty (pPCI) will develop left ventricular (LV) remodeling in one third of the cases. The purpose of this study is to determine early predictors of LV remodeling after acute STEMI and pPCI. Methods: 210 patients with a first acute anterior STEMI treated by pPCI were included. All participants underwent echocardiography in the first 24hrs and again after 6 months, after which they were divided into two groups: remodeling (n=55; 26%) and nonremodeling (n=155; 74%). Results and discussion: The most powerful independent early predictors were: "no reflow" after pPCI (OR=30.0 95% CI, p<0.0001), diastolic dysfunction in the first 24hrs (OR=27.7 95% CI, p<0.0001), increased diameter of the left atrium - LA (OR=5.0 95% CI, p=0.044) and at admission Killip class 2-4 (OR=3.4 95% CI, p=0.003), by multivariant regression analysis. Also, strong predictors were incomplete ST-resolution - STR (OR 2.0 95% CI, p=0.024) and Wall motion score index - WMSI >2 (OR 21.6 95% CI, p<0.0001), by univariant regression analysis. Total ischaemic time had no influence on LV remodeling. The group with remodeling had more frequent major adverse cardiac events (MACE) during one year follow-up: re-hospitalisation (61.8% vs 22.6%; p<0.0001) / mostly re-hospitalisation due to heart failure (40% vs 2.6%; p<0.0001) and mortality 5.5%; reinfarction (20% vs 7.1%; p=0.007); recoronagraphy (45.5% vs 18.1%; p<0.0001); revascularisation (30.9% vs 11%; p=0.001). Conclusion: For the patients with a first acute anterior STEMI, treated by pPCI, development of "no reflow" after pPCI, diastolic dysfunction, increased LA and heart failure on admission are the most powerful early independent predictors for LV remodeling. Incomplete STR and WMSI>2 are strong predictors too. Remodeling patients will have a more frequent incidence of MACE and mortality.en
dc.languagesr (latin script)
dc.publisherУниверзитет у Новом Саду, Медицински факултетsr
dc.rightsopenAccessen
dc.sourceУниверзитет у Новом Садуsr
dc.subjectremodelovanje komorasr
dc.subjectMyocardial Infarctionen
dc.subjectLeften
dc.subjectinfarkt miokardasr
dc.subjectangioplastikasr
dc.subjectfunkcija leve komoresr
dc.subjectdijastolasr
dc.subjectsistolasr
dc.subjectsrčana slabostsr
dc.subject“no-reflow” fenomensr
dc.subjectkoronarna cirkulacijasr
dc.subjectmikrocirkulacijasr
dc.subjectDiastoleen
dc.subjectSystoleen
dc.subjectHeart Failureen
dc.subjectNo-Reflow Phenomenonen
dc.subjectCoronary Circulationen
dc.subjectMicrocirculationen
dc.subjectAngioplastyen
dc.subjectVentricular Functionen
dc.titleEhokardiografski i angiološki prediktori remodelovanja leve komore nakon akutnog infarkta miokarda prednjeg zidasr
dc.titleEchocardiographic and angiographic predictors of left ventricular remodeling after the acute anterior myocardial infarctionen
dc.typedoctoralThesissr
dc.rights.licenseBY-NC-ND
dcterms.abstractЈунг, Роберт; Павловић, Катица; Дејановић, Јадранка; Калимановска-Оштрић, Димитра; Петровић, Милован; Ивановић, Владимир; Стојшић-Милосављевић, Aнастазија; Тадић, Снежана; Ехокардиографски и ангиолошки предиктори ремоделовања леве коморе након акутног инфаркта миокарда предњег зида; Ехокардиографски и ангиолошки предиктори ремоделовања леве коморе након акутног инфаркта миокарда предњег зида;
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/34575/Disertacija3845.pdf
dc.identifier.fulltexthttp://nardus.mpn.gov.rs/bitstream/id/34574/IzvestajKomisije3845.pdf


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