Chronic Postinfarction Aneurism: Hybernation, Apoptosis and Secondary Necrosis of Cardiomyocytes

G.V. Svitlyk, Yu.G. Kiyak, G.V. Tchngryan, D.I. Besh, M.O. Garbar, O.Yu. Barnett

Abstract


Postinfarction scar formation modifies the structure and function of the myocardium. Formation of chronic aneurysms reduces the contractility of the left ventricle and worsens the prognosis of the patient.
Objective. To assess the nature of remodeling of left ventricle (LV) after myocardial infarction with ST elevation (STEMI) and condition of cardiomyocytes of pericicatrical areas of aneurysms with taking into account the patient's prolonged contact with industrial hazards.
Material and Methods. The study involved 119 patients (mean age 52.18 ± 6.38 years) with stable forms of ischemic heart disease who underwent 5–6 years ago STEMI. Among the examined patients 54 individuals (group 1) had prolonged exposure to xenobiotics due to the professional harmful work, and work of 65 patients (group 2) was not associated with occupational hazards. 9 patients underwent ultrastructural study of biopsy from pericicatrical zones of LV during coronary artery bypass grafting with resection of left ventricular aneurysm.
Results and Discussion. Acute myocardial infarction (MI) underwent 5–6 years ago was characterized by a large area of myocardial damage. Echocardiography, performed on first-second day of hospital period, revealed increasing (р > 0.05) of means values of end-diastolic diameter (EDD) of LV in both assessed groups (the difference between groups was not significant, р = 0.181) and decreasing of mean values of ejection fraction (EF) of LV in all patients (р < 0.0001), significantly greater in first group (р < 0.0001).Most of patients of first group had anterior myocardial infarction (87.04 %, 47 patients) and acute aneurysms of LV in those patients developed more frequently (35.19 %, 19 persons). Among the patients of second group rate of people with anterior MI was 50.77 % (33 patients), acute aneurism developed in 20.00 % of cases (13 persons).
Long-term (5–6 years) monitoring of patients showed improved of LV systolic function, significantly greater ­(р1–2 < 0.0001) in patients of second group, and practically absence of the positive dynamics of the average values of EDD in all investigated persons (р > 0.05).
Chronic ventricular aneurysm was formed in 19 patients — in 15 persons (27.78 %) of first group and in 4 persons of second group (6.15 %). Nine patients (4 from first group and 5 — second) underwent surgery — coronary artery bypass grafting with resection of aneurism.
Examination of ultrastructure of biopsies, obtained from peryscares zones after resection of aneurysms of LV, revealed the presence of hibernated cardiomyocytes, and also cells with sings of apoptosis and secondary necrosis. The described changes were more typical in patients with professional hazards.
Conclusions. The course of STEMI on the stationary phase is accompanied by remodeling of the left ventricle and lowering of systolic function, more pronounced in patients with professionally harmful work. These patients more often had severe left ventricular aneurysm and complications in the early postinfarction period. During rehabilitation period these patients had not so prominent restoring of contractility of the myocardium, more often had forming of chronic left ventricular aneurysm and due to this worsened prognosis.
In case of chronic hypoperfusion long-term exposition of man-made xenobiotics increased susceptibility of cardiomyocytes to development of hibernation, apoptosis and secondary necrosis.
Improvement of coronary blood flow (coronary artery stenting, coronary artery bypass grafting) can stop a hibernation of cardiomyocytes and restore function of hypoperfused myocardium.


Keywords


acute myocardial infarction with ST elevation; chronic postinfarction left ventricular aneurysm; ultrastructure of pericicatrical area; hibernation; apoptosis and secondary necrosis of cardiomyocytes

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DOI: https://doi.org/10.22141/2224-0586.4.51.2013.89352

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