Predictors of survival in patients with ischemic heart disease depending on therapy

The aim of the study is to assess the prognostic value of the structural and functional echocardiographic indicators in IHD patients, depending on acute coronary syndrome management (revascularization vs medical therapy), during 60 months.Materials and methods:The total of 101 IHD patients were examined on the clinical bases of the Internal Medicine Department 2. Prior to the study. The 84 males and 17 females aged 58.6±4.2were split into the experimental group after myocardial revascularization (EG, n = 71) and control group with standard medical therapy (CG, n = 30). In addition to the protocol-prescribed clinical lab tests, during five years, the dynamics of the echocardiographic cardiac parameters has been assessed. The digital data was processed by the Kaplan–Meier estimator; the 60-month cumulative survival rate (%) was estimated and significance of the difference was assessed by Cox's F-test (p.Results and discussion.It appeared thatthe 5-year prognosis in IHD patients was unaffected by the dimensions of IVST, LVIDD and LVMMI. In 60 months after the surgery, a significantly better prognosis was observed for certain unfavourable initial conditions: enlarged RV ≥ 2.5 cm (37.5% vs 30.7%, р = 0.008), aortic diameter ≥ 3.0 cm (57.2% vs 34.3%, р = 0.02), enlarged LA ˃ 4.0 cm (43.8% vs 24.7%, р = 0.046). In addition, revascularization was associated with better survival rates for normal LVMM (EG-CG = 0.01). A similar EF-based distribution was used in the study of patients with decompensated heart failure (REDINSCOR II, 2017), in which the authors revealed that the grey zone patients featured a higher risk of cardiovascular complications than patients with normal EF values did.Conclusions.Revascularization contributed to a considerably better 60-month survival prognosis for cases featuring the enlarged right ventricle (≥2.5 cm), enlarged left atrium (˃4.0 cm) and extended aortic root (≥3.0 cm), but with the normal left ventricular myocardial mass (< 250 g) and without ventricular hypertrophy or systolic dysfunction.