Long-Term Prognosis of the Development of Heart Failure With Low Ejection Fraction in Acute Coronary Syndrome in Young and Middle-Aged Patients With Arterial Hypertension

Objective: To determine the prognosis and dynamics of the development of heart failure with low ejection fraction (HFrEF) after percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) in young and middle-aged patients with arterial hypertension (AH) and type 2 diabetes mellitus (DM) Design and method: The study included 191 hypertensive patients aged 36-59 years with ACS after PCI. Group 1 - 76 patients with hypertension in combination with DM, group 2 - 115 patients with hypertension without DM. In 35 (46%) people of the 1st group and in 56 (48.7%) of the 2nd group, myocardial infarction (MI) of the anterior wall of the left ventricle (LV) was determined. The incidence of non-anterior MI (posterior and lateral walls) of the LV was 54% and 51.3% respectively. Patients in both groups were comparable. Observation was carried out for 12±1 months. Ejection fraction (EF), indices of LV end-systolic volume (LVESVI), LV end-diastolic volumes (LVEDVI), and index of impaired local contractility (ILCI) were determined over time. Results: On the first day after PCI, LVEF <40% (36%, 27-39%) in 14 of 76 (18.4%) in group 1; LVESVI - 43 ml/m2 (40-48 ml/m2); LVEDVI - 77 ml/m2 (67-87 ml/m2); ILCI 1.81 (1.63-2.0). After 12 months, LVEF decreased to 33% (28-39%) in 26 of 76 (34.2%) patients. The progression of HFrEF was indicated by an increase in initial LVESVI by 29-30% and LVEDVI by 23-35%. In group 2, on the first day after myocardial reperfusion in 8 out of 115 (7%) patients, LVEF was 38% (37 - 39%), LVESVI 44 ml/m2 (40-46 ml/m2), LVEDVI 69 ml/m2 m2 (64-76 ml/m2), ILCI 1.75 (1.13-1.88). After 12 months, HFrEF was detected in 10 of 115 (8.7%) patients with an increase in initial LVESVI values by 28%, LVEDVI by 31% and a decrease in LVEF to 36% (35-39%) (p = 0.0242). Conclusions: In young and middle-aged patients with hypertension in combination with DM, during the first 12 months after MI, in 34.2% of cases, there is a significant deterioration in the course of HFrEF, which requires an early decision on the timing of complete myocardial revascularization.