2009-4

.: Дата публікації 2009-12-22 :: Переглядів: 6 :: :.

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VALUE STRESS-TEST FOR TREATMENT TACTICS DEFINITION IN PATIENTS WITH LOW EXTREMITIES ISCHEMIA AND ISCHEMIC HEART DISEASE
L.B. Malynovska, V.G. Mishalov

The aim – stress-test (ST) eligibility estimation with transoesophageal loading elctrocardiostimulation (TEECS) with nitroglycerine test (NGT) in patients with an leg ischemia with ischemic heart disease (IHD) for cardiac complications development prediction after operations on abdominal aorta and leg arteries.

Materials and methods. СТ with TEECS loading TEECS with NGT For the purpose of coronary insufficiency diagnostics were executed in 80 patient (75 men and 5 women in the age of from 46 till 78 years) with an leg ischemia which were treated in cardiovascular surgery department from 2005 to 2008. СТ was done with our proposed technique. Before СТ an ischemic changes on the electrocardiograms was registered at daily allowances Holter monitoring and on an ECG on rest were analyzed. During СТ were estimated: 1) the fact of myocardial ischemia presence; 2) a myocardial ischemic zone; 3) a myocardial ischemia by F. Ргоchaczek; 4) a coronary reserve restriction degree and its conformity to certain stenocardia FC; 5) mutual induction relation of myocardial ischemia subjective and objective signs (a frequencies rate of an painful and silent myocardial ischemia, a «passage through a pain» phenomenon); 6) ECG changes character during NGT; 7) delayed myocardial ischemia attributes presence on ECG in the regenerative period.

Results and discussion. It was no coronary complication (CC) in patients with high coronary reserve. An moderate CC often registered (73.6 %) (acute heart insufficiency within 3 days) in cases of myocardial ischemia occurred with 120–130 impulses per min. frequency stimulation. In patients with low coronary reserves (TEECS 1–3) severe CC have occurred in 69.2 % and in 30.7 % from them the acute heart attack has resulted in MI and a lethal outcome. The greatest amount of CC (61.5 %) has developed in patients with IHD silent form, and in the majority of them (> 80 %) – an advanced ones. When the typical anginal attack occurred during SТ, cardiovascular complication developed in 28.2 % after operation on abdominal aorta and leg arteries. In patients with developed collateral blood circulation CC was revealed much less (10.2 %) and all of them were quickly recovered. Differences in groups were authentic (р < 0.001).

Conclusions. SТ allows defining following risk factors for CC development: 1) the lowest coronary reserve (frequency of stimulation less than 120 impulses per minute without passage through a pain phenomenon); 2) significant coronary reserve reduction (frequency of stimulation 120–140 impulses per minute) in silent IHD form. The passage through pain phenomenon is favorable predictor even in patient with low coronary reserve. It is possible to explain this fact with developed myocardial collateral vascular flow which partially compensates haemodinamically significant stenoses of the main coronary arteries.