1. P-18 HEART, VESSELS & DIABETES – THE EUROPEAN CONFERENCE, ATHENS, NOVEMBER, stress and inflammation as DETERMINATIVE FACTORS IN the PATIENTS with CORONARY HEART DISEASE and essential hypertension Authors: Kulishov S., Kudria I. Higher State Educational Institution of Ukraine "Ukrainian Medical Stomatological Academy", Poltava, Ukraine
AIM. The purpose of the study was determination of the dependence between tolerance to stress, inflammation syndrome, coronary and myocardial failure, arterial pressure, ventricular arrhythmias in the patients with chronic coronary heart disease (cCHD) and essential hypertension (EH).
Methods: The study included 126 patients (59,330,71; 7,96 years old) with сСРВ and EH, including 104 with stable angina pectoris (SAP), II-III functional class (fc), 22 – with atherosclerotic cardioslerosis and heart failure (HF), arrhythmias. 47 patients had myocardial infarction in anamnesis. Chronic HF II functional class by NYHA was diagnosed at 69 of 126 patients; III-IV functional class - at healthy subjects (52,680,64; 3,72 y.o.) consisted control group. We measured the interleukins – 1 beta, 6, 8, 10, C-reactive protein, factor of tumor necrosis alpha by ELISA. Tolerance to stress was investigated by using Stroop test. Holter electrocardiography monitoring and daily blood pressure monitoring was used. Statistical analysis included t Student criterion (st), analysis of variance ANOVA, correlation by Pearson; tests Mann-Whitney test (mw), Kruskal-Wallis (kw), correlation by Spearman.
RESULTS: Short list of research data is presented as: М – mean, SEM – standard error of mean; SD – standard deviation, 95% CІ - 95% Confidence Interval for Mean – Lower Bound and Upper Bound; Меd – median; Q – Lower and Upper Quartiles. Lower tolerance to stress, ability to concentrate attention were determined by mental and emotional test in the patients with SAP, fc III , postinfarction cardiosclerosis, EH III st. Increasing of IL-6 was observed in the patients with cCPD and heart failure ІІI-IV by NYHA {Med 9; Q (0 - 30)} in comparing with II NYHA {Med 0; Q (0 - 4); Рmw=0,043}. Direct correlation between the average systolic blood pressure at night and class of ventricular arrhythmias by Lown-Wolf per day was determined as r = 0,620; Pr = 0,001. Direct correlation between the average daytime diastolic blood pressure and ventricular arrhythmias by Lown- Wolf per day was consisted r = 0,449; Pr = Combined hypertension type circadian rhythms of systolic blood pressure as «over dipper» and «dipper» accompanied by increased levels of maximum heart rate at night (Med; Q: 139; and 123; 106,25-135,75; Pkw = 0,005). In the patients with cCHD and EH with different types of circadian oscillations in diastolic blood pressure determined by changes of heart rate variability {mean power in the low frequency range for the day - M ± SEM; SD; 95% CІ: «dipper» (670,13 ± 87,26) ms ²; 337,95; 482,98-57,29 and «over dipper» (588,67 ± 102,8) ms ²; 308,59; 351,46-825,88; P ANOVA = 0,044; average high-frequency spectral component in normalized units of the day - Med; Q: «night-peaker» 31% 30-33,5 and «dipper» 22% 15-26; Pkw = 0,01}.
stress and inflammation as DETERMINATIVE FACTORS IN the PATIENTS with CORONARY HEART DISEASE and essential hypertension -
More high level of functional class of stable angina pectoris, ventricular arrhythmias, heart failure was result of:
lower tolerance to stress;
activation of pro-inflammatory activity;
vegetative disbalance;
daily change of cardiac rhythm, arterial pressure;
presence of postinfarction cardiosclerosis
Conclusion: Stable angina pectoris functional class III, postinfarction cardiosclerosis, lower tolerance to stress, activation of pro-inflammatory activity, high arterial pressure, vegetative disbalance, heart failure III-IV NYHA, ventricular arrhythmias IV-V classes by Lown-Wolf are mutually dependent.
Authors:
1.Sergii Kulishov, professor, Ph.D., D.Med. Sci. Higher state educational institution of Ukraine (HSEIU) “Ukrainian Medical Stomatological Academy”, Poltava, Ukraine, department of internal medicine No 1,
2.Irina Kudria, Ph.D, assistant of internal medicine No 1 department, HSEIU “Ukrainian Medical Stomatological Academy”,