MORPHOLOGICAL AND FUNCTIONAL CONDITION OF THE CORONARY CIRCULATION IN PERIMENOPAUSAL WOMEN HOSPITALIZED WITH NON ST ELEVATION ACUTE CORONARY SYNDROME

Autor: T. M. Solomenchuk, V. V. Protsko
Jazyk: ukrajinština
Rok vydání: 2017
Předmět:
Zdroj: Vіsnik Naukovih Doslіdžen', Vol 0, Iss 2 (2017)
Druh dokumentu: article
ISSN: 1681-276X
2415-8798
DOI: 10.11603/2415-8798.2017.2.7853
Popis: Particular attention cardiologists and researchers provided women with acute coronary syndrome (ACS) perimenopausal age. Due to the action of estrogen in women during the reproductive period with a lower risk of acute coronary disease, cardiovascular protective values are lost due to a significant reduction in estrogen background in the perimenopausal period. The aim of the study – to conduct a comparative analysis of the coronary circulation according to coronary angiography in women with non ST elevation acute coronary syndrome (non STEMI), depending on the level of female sex hormones. Materials and Methods. The study involved 81 women aged 35–76 (middle age 59.1 ± 1.06) years old who were hospitalized with non STEMI, the level of female’s sex hormones was determined (estradiol, LH (luteinizing hormone), FSH (follicle stimulating hormone) and coronary angiography was performed. Depending on the hormonal status of all patients overall group were divided into two subgroups (n = 50) – women with an index value of LH / FSH 1 (relatively preserved estrogen background). Results and Discussion. Compared with women who relatively preserved estrohen background (subgroup II), women with estrohen deficiency (I subgroup) have significantly more difficult hemodynamically significant coronary artery disease, namely 6 times more frequent multivessel disease (35.14 % (I) to 5.88 % (II)) in 2–2.8 times more localized predominantly in the proximal (81.08 % (I) and 29.41 % (II)) medial segments (70.83 % (I) 35.29 % (II)), almost half – combined with lesions distal segments (48.65 % (I) to 17.65 % (II)). Most often are changes in the main trunk artery – the left coronary artery and the left anterior descending. In two of the three women with non STEMI of total group (55 patients, 67.90 %) are observed indirect evidence of significant coronary microcirculation disorders and myocardial perfusion that one half times recorded significantly more in patients with symptoms of estrogen deficiency in postmenopausal period. One-third of surveyed women (33.33 %) of the total group had almost intact coronary artery. Women with hemodynamically significant stenoses had defects (ulceration) of atherosclerotic plaques. Ulceration index that in the total group was 0.770 ± 0.012 units, was significantly lower among women and subgroups (0.736 ± 0.013 units.) compared with patients of second subgroup (0.830 ± 0.018 units), indicating deeper destructive changes in diseased coronary arteries on the ground of estrogen deficiency. Conclusions. Estrogen deficiency in perimenopausal women non STEMI leads to severe diffuse lesions of coronary, forming multiple hemodynamically significant stenosis and thrombosis on the ground of more expressive ulceration of atherosclerotic plaques in the main coronary arteries, the occurrence of gross violations of myocardial perfusion and microcirculation, which is the basis of acute disorders of coronary circulation in women.
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