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CNAA / Theses / 2017 / May /

Cardiac remodeling and the evolution of chronic heart failure after coronary revascularization


Author: Grivenco Aliona
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Reumatology
Year:2017
Scientific adviser: Eleonora Vataman
doctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology
Institution: Medical-Sanitary Public Institution Institute of Cardiology

Status

The thesis was presented on the 11 May, 2017
Approved by NCAA on the 31 May, 2017

Abstract

Adobe PDF document – 1.07 Mb / in romanian

Thesis

CZU 616.1-008.46-036.12+616.132.-09

Adobe PDF document 2.83 Mb / in romanian
164 pages

Keywords

cardiac remodeling, chronic heart failure, coronary revascularization, coronary artery disease, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty

Summary

The field of research: cardiology.

Aim of the study: the role of cardiac remodeling as a key link in the evolution of chronic heart failure in patients after coronary revascularization.

Objectives of the study: analyzing the evolution of cardiac structural and geometric parameters during 1 year after coronary revascularization, revealing types of cardiac remodeling in relation to functional class of chronic heart failure; assessment of the coronary circulation status, the severity of myocardial injury, exercise tolerance on the type of coronary revascularization; estimate the frequency of recurrent ischemic events in the first year after coronary revascularization; prognosis of cardiac remodeling progress toward regression or progression.

The scientific novelty and originality of the work. The first was conducted a analytical study of prospective and another retrospective assessment of complex structural and geometric changes of heart in the context of clinical manifestations in patients after coronary revascularization by the method of stenting and coronary shunting. The analysis provides an assessment of the relationship between cardiac remodeling, the evolution of chronic heart failure and the frequency of repeated hospitalizations. It was found that patients with signs of pathological remodeling at the final stage of the study (12 months) already had systolic and diastolic dysfunction, signs of residual ischemia, a decrease in exercise tolerance, a higher frequency of concomitant pathology at the time of inclusion in the study.

Solved scientific problem. There were developed criteria for the prognosis of pathological cardiac remodeling, their relation to chronic heart failure and identifying the important morphologic and clinical factors for probability of repeated hospitalization during the first year after coronary revascularization.

Theoretical value of thesis. The results of the study substantiate the need to monitor the structural and morphological cardiac parameters with the help of echocardiography in patients with different coronary revascularization tactics to assess cardiac remodeling, correction of drug therapy, and the risk of development of pathological cardiac remodeling and repeated hospitalizations.

Practical value of thesis. Identification of patients at high risk of cardiac remodeling progression and repeated hospitalization after coronary revascularization will help in correcting drug therapy and timely inclusion in the program of cardiovascular rehabilitation.

The scientific results implemented in the clinical activity of laboratory Chronic heart failure Institute of Cardiology, Clinic Municipal hospital and the Faculty of Continuing Medical Education at the Medical University of Medicine and Pharmacy ―N.Testemiţanu".