1Government institution“L.T. Malaya Therapy National institute of the National academy of medical sci - Kharkiv - Ukraine
Purpose. To perform medical-genetic analysis of dynamic of structural and functional myocardial parameters, heart rate variability data depending on polymorphism ?1166? of R1 receptor of angiotensin II (AGTIIR1) gene in patients with myocardial infarction with ST segment elevation - STEMI.
Matherials and methods. 87 patients with STEMI, 70 (80%) male and 17 (20%) female at average age (58,94±10,16) years were examined. Patients were hospitalized during first three days after selective coronary angiography and infarct-related artery stenting were performed. After 6-month observation period patients were reexamined. Allele polymorphism A1166C of AGTIIR1 gene was determined by polymerase chain reaction in real time, heart rate variability (HRV) – Cholter 24-hour monitoring, morpho-functional data – ultrasound research.
Results and discussion. In patients with ??+??-genotypes compared with ?? on 1-3 day of STEMI higher level of left ventricular (LV) end diastolic diameter (EDD) (?=0,004), LV end systolic diameter (ESD) (?=0,043), LV myocardial mass (MM) (?=0,041), frequency of mitral regurgitation (?=0,028), the tendency to higher LV end diastolic volume (EDV) (?=0,089) were revealed. These means unfavorable structure of early after infarction myocardial remodeling (RM). After 6 month patients with ??+??- genotypes compared with ?? demonstrated higher LVEDD (?=0,083), left atrium (?=0,091), LVMM (?=0,081). When analysed echocardiographic data in acute period of STEMI and after 6-month observation, groups with ?? and ??+??-genotypes demonstrated significant or tendency to higher level of LVEDV (?=0,06, ?=0,034), LVEDD (?=0,057, ?=0,01), LV ejection fraction (EF) (?=0,037, ?=0,07) respectevly. In patients with AC+CC-genotypes compared with AA were lower level of SDNN (P=0,049), HF (?=0,053), higher level of LF (P=0,069) and LF/HF-index (P=0,046).
Conclusions. Polymorphic ??+??-genotype cariers compared with ??-genotype of AGTIIR1 gene demonstrated more relevant increase of left ventricular diameters and volume, left atrium and LV myocardial mass in acute period of STEMI. After 6-month period in both groups LV dilatation and LVEF were observed. These data refer to the similar with Frank-Starling law dynamic of compensation. Patients with ??+??-genotypes compared with A? demonstrated unfavorable structure of LV CR and associates with more expressed sympathic-vagous dysbalance.