Obesity impact on the clinical course of myocardial infarction
A.I. German1, N.V. Fedorova1, T.B. Pecherina1. A.G. Chernobai1, O.V. Gruzdeva1,2, V.N. Karetnikova1,2, V.V. Kashtalap1,2
1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
2Kemerovo State Medical University
Aim: to study an obesity impact on the clinical course of myocardial infarction (MI) with LVEF over 40% by means of diastolic dysfunction assessment and evaluation of echocardiographic parameters associated with remodeling.
Patients and Methods: 120 patients with past history of MI in 2014–2015 and LVEF over 40% underwent the study. On admission, patients underwent angioplasty with stenting of the infarct-related artery. Patients were divided into 2 groups, according to the body mass index (BMI): group I — 90 (75%) patients without obesity, group II — 30 (25%) patients with obesity. Echocardiography (EchoCG) was performed on patients on the 1st and 10–12th day of hospitalization. Comparative analysis of indicators in groups was performed to evaluate the obesity impact on the clinical course of MI with LVEF over 40%, taking into account the development of the following study endpoints within the in-hospital period: recurrent MI, post-infarction angina, acute left ventricular failure, life-threatening arrhythmias, clinical death.
Results: initially, group 2 with obesity was characterized by a higher incidence of cardiovascular comorbidity (according to the incidence of arterial hypertension, diabetes mellitus, past MI). According to the EchoCG, patients with obesity were characterized by a hyperkinetic type of intracardiac hemodynamics upon admission, and on the 10–12th day — by a greater dilatation degree of the LV and RA. LV diastolic dysfunction was detected on the first day in 46.7% of patients from the group with obesity and in 48.9% of patients in the group without obesity. The main manifestation of diastolic dysfunction in patients with obesity was a slower LV relaxation. On the 10–12th day of MI, only a more favorable type of diastolic dysfunction was found with a slightly higher frequency in the group with obesity. Relaxation slowed down, unlike in the group without obesity which had all types of diastolic dysfunction. Early prognosis in patients of the two groups did not differ.
Conclusion: this study did not show significant differences in the clinical course of MI with LVEF over 40% and early prognosis in patients with and without obesity. Obesity did not affect the early prognosis of the disease.
Keywords: myocardial infarction, obesity, diastolic dysfunction, clinical severity, prognosis.
For citation: German A.I., Fedorova N.V., Pecherina T.B. et al. Obesity impact on the clinical course of myocardial infarction. RMJ. Medical Review. 2019;1(II):70–75.
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28. Груздева О.В., Акбашева О.Е., Матвеева В.Г. и др. Цитокиновый профиль при висцеральном ожирении и неблагоприятный кардиоваскулярный прогноз инфаркта. Медицинская иммунология. 2015;17(3):211‒220. DOI: 10.15789/1563-0625-2015-3-211-220. [Gruzdeva O.V., Akbasheva O.E., Matveyeva V.G. et al. Cytokine profile in visceral obesity and an advarse cardiovascular prognosis of infarction. Medical Immunology. 2015;17(3):211‒220 (in Russ.)].
29. Gruberg L., Weissman N.J., Waksman R. et al. The impact of obesity on the short-term and long-term outcomes after percutaneous coronary intervention: the obesity paradox? J Am Coll Cardiol. 2002;39(4):578‒584.
30. Buettner H.J., Mueller C., Gick M. The impact of obesity on mortality in UA /non-ST-segment elevation. Eur Heart J. 2007;28(14):1694‒1701. DOI: 10.1093/eurheartj/ehm220.
31. Nikolsky E., Stone G.W., Grines C.L. et al. Impact of body mass index on outcomes after primary angioplasty in acute myocardial infarction. Am Heart J. 2006;151(1):168‒175. DOI: 10.1016/j.ahj.2005.03.024.
32. Timoteo A.T., Ramos R., Toste A. Impact of body mass index in the results after primary angioplasty in patients with ST segment elevation acute myocardial infarction. Acute Cardiac Care. 2011;13:123–128. DOI: 10.3109/17482941.2011.606469.
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