Aim      To identify early predictors for progression of chronic heart failure (CHF) in patients with ST-segment elevation myocardial infarction (STEMI). Material and methods  The study included 113 patients with STEMI aged 52 (95 % confidence interval, 36 to 65) years. 24-h ECG monitoring was performed with assessment of ventricular late potentials, QT dispersion, heart rhythm turbulence (HRT), and heart rhythm variability (HRV); XStrain 2D echocardiograpy with determination of volumetric parameters, myocardial strain characteristics and velocities; and measurement of brain natriuretic peptide (BNP) concentrations. The endpoint was CHF progression during 48 weeks of follow-up, which was observed in 26 (23 %) patients. Based on the outcome, two groups were isolated, with CHF progression (Prg) (26(23%)) and with a relatively stable CHF postinfarction course (Stb) (87 (77 %)). Results At 12 weeks following MI, the Prg group showed increases in left ventricular (LV) end-diastolic dimension (EDD) (р<0.05) and end-diastolic and end-systolic volumes (EDV, ESV), (р<0.01), and EDV and ESV indexes (EDVi and ESVi, р<0.01). In this group, global longitudinal strain (GLS) was decreased at 24 weeks (р<0.05) and global radial strain (GRS) was decreased at 48 weeks (р=0.0003). In the Prg group, values of strain parameters (GLS, global circular strain (GCS), and GRS) were lower at all times. At 7-9 days, 24 weeks, and 48 weeks, the proportion of patients with pathological HRT was higher in the Prg group (38, 27, and 19 % for the Prg group vs 14 % (р=0.006); 3,4 % (р=0.001), and 2.3 % (р=0.002) for the Stb group, respectively). Only in the Stb group, increases in HRV were observed (SDNNi by 13 % (р=0.001), rMSSD by 24 % (р=0.0002), TotP by 49 % (р=0.00002), VLfP by 23 % (р=0.003), LfP by 22 % (р=0.008), and HfP by 77 % (р=0.002). At 7-9 days of MI, the Stb group had greater values of SDANN (р=0.013) and HfP (р=0.01). CHF progression correlated with abnormal values of turbulence onset (TO), disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. Combined assessment of HRT, LV ESD, and GLS at 7–9 days after STEMI allows identifying patients with high risk for CHF progression in the next 48 weeks. Conclusion      The markers for CHF progression after STEMI include abnormal TO values, disturbed HRT, increased BNP levels and LV ESD, and low values of GLS, GCS, and GRS. The multifactor logistic regression analysis revealed early predictors of CHF in the postinfarction period, including abnormal TO, increased LV ESD, and reduced GLS.

Рассматриваются современные представления о распространенности, электрофизиологических причинах развития, механизмах, факторах риска внезапной сердечной смерти у пациентов, перенесших острый инфаркт миокарда. Представлены данные по применению Холтеровского мониторирования ЭКГ в качестве методики (совокупность данных методик реализованна в таких системах как, например, Астрокард® Holtersystem, GE Healthcare MARS, medilog® DARWIN), позволяющей стратифицировать риск развития внезапной сердечной смерти. Изучена прогностическая роль и актуальность отдельных параметров суточного мониторирования ЭКГ , коррелирующих с высоким риском развития жизнеугрожающих нарушений ритма, которые являются основными механизмами развития внезапной сердечной смерти. Проведена оценка значимости предикторов электрической нестабильности миокарда.

The latest technologies of long-term ECG registration improve detection of rhythm and conduction disturbances, as well as comprehensively assess autonomic regulation of heart rhythm. OBJECTIVE To identify the advantages of long-term telemetric ECG monitoring for 72 hours (TMM₇₂ ECG) for recording arrhythmic events, episodes of conduction disturbances, as well as for evaluating the parameters of electrical instability in patients with myocardial infarction (MI). MATERIAL AND METHODS The study included 114 ICU patients aged 58 (52; 62) years with MI. TMM₇₂ Nehb 3-lead (A, D, I) ECG was performed using the ASTROCARD®-TELEMETRY telemetry complex for 72 hours from the 4^th day after MI. We assessed frequent and paired supraventricular premature contractions, supraventricular tachycardia (SVT), ventricular arrhythmias Lown—Wolf grade ≥3, sinoatrial and atrioventricular (SA- and AV-) blockages, paroxysms of atrial fibrillation. Chronotropic load (CL), heart rate variability (HRV), heart rate turbulence (HRT), microvolt alternation of T wave (MAT), late ventricular potentials (LVPs), and QT interval variance were evaluated. The transmitted data were analyzed at the end of each day of monitoring, and then we estimated certain time intervals (24, 48 and 72 hours). RESULTS The number of patients with frequent supraventricular premature contractions increased by 13.1% (p=0.04), paired supraventricular premature contractions by 22.7% (p=0.001) and SVT by 21% (p=0.003) compared to standard 24-hour ECG monitoring. Ventricular premature contractions Lown—Wolf grade ≥3 were registered in 65 patients (57%) that is 1.6 times higher compared to standard 24-hour ECG monitoring (p=0.031). SA- and AV- blockages grade 2 were 2 times more common (p=0.044). Impaired HRT was detected in 32.5% and 15.8% of cases, respectively (p=0.06). The number of patients with MAT increased by 14.9% (p=0.021) after 72 hours of continuous monitoring. CL Sa demonstrated total decrease from 1.07 (0.26; 3.8) on the first day to 0.94 (0.26;4.2) (p=0.022) by the end of TMM₇₂ ECG. HRV parameters positively changed by the end of monitoring: TotP — by 46% (p=0.001), ULfP — by 47% (p=0.001), LfP — by 43% (p=0.001), HfP — by 37% (p=0.001), L/H increased by 49% (p=0.001). CONCLUSION TMM₇₂ ECG significantly improves detection of clinically significant rhythm and conduction disorders. This method is valuable for comprehensive assessment of autonomic regulation of heart rhythm and markers of myocardial electrical instability in early period after MI.

Sudden cardiac death (SCD) is a major medical, economic and social problem. Survival after SCD remains low. Its leading mechanism is fatal ventricular tachyarrhythmias. The only highly effective aid remains an implantable cardioverter defibrillator (ICD). According to modern concepts, myocardial fibrosis (MF) is the leading cause of life-threatening ventricular arrhythmias. Magnetic resonance imaging (MRI) has become the standard for non-invasive MF imaging and one of the leading methods for its quantification, which is why this method is recommended for determining indications for ICD implantation. MRI can show the scar location, which should be taken into account when placing the lead, and determine its size, which predicts the effectiveness of ICD implantation. Identification of MF in patients with life-threatening ventricular arrhythmias is an important area of research aimed at identifying the risk of SCD. Delayed contrast-enhanced MRI can be considered as a marker to improve SCD risk stratification.

The problem of ischemia-reperfusion injury, in particular, reperfusion arrhythmias, has remained controversial for many years. To date, there are no one frame of mind on the clinical and prognostic significance of tachyarrhythmias in the acute period of myocardial infarction. In addition, data on the incidence of reperfusion arrhythmias and related mortality are very contradictory. The review summarizes current concepts and results of studies devoted to the study of the clinical role of reperfusion arrhythmias. Their pathogenesis, structure, and impact on the long-term prognosis of patients are discussed. The need to study ischemia-reperfusion injury within the pharmacoinvasive strategy using modern thrombolytic agents is emphasized, which seems especially relevant given the Russian geographical features.

Комплексная модель многофакторного прогнозирования жизнеугрожающих желудочковых нарушений ритма у больных инфарктом миокарда