www.medenosrce.net/arhimed   arhimed(a-t>medenosrce.net   [21/04/2026 21:53:13] http://www.medenosrce.net/arhimed/poglej.asp?id=141 PROGNOSTICNI POMEN KLINICNIH ZNAKOV IN EHOKARDIOGRAFSKE PREISKAVE PRI BOLNIKIH Z AKUTNIM MIOKARDNIM INFARKTOM Avtor: Miha Mežnar Mentor: doc. dr. Gorazd Voga IZHODIŠCE: Srcno popušcanje je eden najpogostejših in najpomembnejših zapletov pri akutnem miokardnem infarktu. Povezano je z višjo umrljivostjo in dolgotrajnešim zdravljenjem. Zdravljenje in nacin nadzora bolnikov sta odvisna od napovedi za zapleten potek bolezni. Klinicno stanje ob sprejemu in elektrokardiografski izvid imata omejeno vrednost pri napovedovanju verjetnosti nastanka srcnega popušcanja pri bolniku z akutnim miokardnim infarktom. Ehokardiografska preiskava nam da podatke o dimenzijah srcnih votlin, funkciji levega prekata, regionalnih motnjah krcljivosti miokarda, delovanju zaklopk in o morebitnih zapletih, kot so perikardialni izliv, ruptura proste stene ali septuma. Je enostavna, neinvazivna in rutinska obposteljna preiskava. NAMEN: Natancnejša napoved za razvoj srcnega popušcanja po AMI bi prinesla vecje možnosti za pravocasno in primerno zdravljenje ter nacin nadzora bolnikov. Študije navajajo številne dejavnike napovedi: klinicne znake, splošne znacilnosti, EKG izvid, izvid ehokardiografske ter nekaterih invazivnih preiskav. Vecinoma opredeljujejo pomen teh dejavnikov za splošno napoved poteka bolezni in so naravnane dolgorocno. Ni še ugotovljeno, kateri so najzanesljivejši dejavniki za napoved nastanka srcnega popušcanja po AMI tekom bolnišnicnega zdravljenja. Želimo pokazati, da je ehokardiografska preiskava pri napovedovanju pomembno dopolnilo ostalih metod, ter ugotoviti, kateri so tisti dejavniki, ki najbolj natancno napovedujejo nastanek srcnega popušcanja po AMI. HIPOTEZA: Zgodnja ehokardiografska preiskava pomembno izboljša napovedno vrednost klinicnih znakov za razvoj srcnega popušcanja po akutnem miokardnem infarktu. METODE: Študija je retrospektivna. Obdelali smo podatke klinicne in zgodnje ehokardiografske preiskave pri 285 bolnikih z akutnim miokardnim infarktom ter jih primerjali s potekom bolezni. Upoštevali smo splošne znacilnosti, kronicne bolezni, klinicne znake ob sprejemu, EKG izvid, izvid ehokardiografske preiskave, nacin zdravljenja in zaplete. Primerjali smo skupini bolnikov s popušcanjem srca in bolnikov brez popušcanja. Uporabili smo Studentov t test za primerjavo kontinuiranih spremenljivk in ?? test z Yatesovo korekcijo za primerjavo nekontinuiranih spremenljivk. Povezavo med spremenljivkami in nastankom srcnega popušcanja smo opredelili z metodo univariantne in multivariantne logisticne regresije. REZULTATI: Preiskovana skupina je štela 285 bolnikov z AMI, 168 moških in 117 žensk. Do srcnega popušcanja je prišlo pri 51.9% vseh bolnikov, umrlo jih je 18.5%. Med umrlimi je 90.5% bolnikov imelo znake srcnega popušcanja. Primerjava skupine bolnikov s popušcanjem in tiste brez je pokazala statisticno pomembne razlike pri skoraj vseh spremenljivkah, ki smo jih po protokolu dolocali. Z univariantno analizo smo ugotovili, da so imele najvecjo napovedno vrednost za nastanek srcnega popušcanja atrijska fibrilacija ob sprejemu, hemodinamsko pomembna mitralna regurgitacija in kronicna ledvicna odpoved. Glede na multivariantno analizo so pomembni napovedni dejavniki ženski spol, starost, hemodinamsko pomembna mitralna regurgitacija, netipni periferni pulzi, akinezija ali diskinezija v infarktnem podrocju ter že prebolel AMI. ZAKLJUCKI: Z rezultati smo potrdili hipotezo. Ehokardiografska preiskava je pomembna za napoved nastanka popušcanja srca kot bolnišnicnega zapleta AMI. Rezultati študije imajo pomen tudi za klinicno prakso, saj omogocajo zgodnje zdravljenje. «» [Abstract / English version] PROGNOSTICNI POMEN KLINICNIH ZNAKOV IN EHOKARDIOGRAFSKE PREISKAVE PRI BOLNIKIH Z AKUTNIM MIOKARDNIM INFARKTOM Author: Miha Mežnar Mentor: doc. dr. Gorazd Voga BACKGROUND: Heart failure is one of the most common as well as most important complications in acute myocardial infarction (AMI). It is related with higher mortality rate and prolonged hospital stay. Treatment and monitoring strategy depend on the prognosis of a complicated course of the disease. Clinical status at the admission and the ECG results are of limited value in predicting the probability of heart failure in patients with AMI. Echocardiography provides us with information on heart dimensions, left ventricle function, wall motion abnormalities, valvular morphology and function, and complications such as pericardial effusion and rupture on free wall or septum. Echocardiography is simple, non-invasive and routine bedside examination. AIM: More precise prognosis of heart failure development in the course of AMI would enable the use of timely and appropriate treatment and monitoring of patients. According to the results of various studies numerous factors contribute to the prognosis: general characteristics, clinical signs, ECG findings, and results of echocardiography and some invasive examinations. The importance of these factors is defined mostly for the general prognosis of disease development in the long-run. It is not yet determined which factors are most reliable in the prognosis of heart failure after AMI during hospital treatment. We wish to demonstrate that echocardiography testing is an important method, and to find out which are the factors that most accurately predict heart failure after AMI. HYPOTHESIS: Early echocardiographic examination is an important contributor to the clinical signs' prognostic value for the development of heart failure after AMI. METHODS: The study is retrospective. We processed the results of clinical and early echocardiography examination of 285 patients affected by AMI and compared them with the development of the disease. We took into consideration general characteristics, chronic and pre-existing diseases, clinical signs at the admission, ECG findings, echocardiographic examination results, treatment and complications. We used the Student t test to compare the continuous variables and ?? test with Yates' correction to compare the discrete variables. The connection between the variables and heart failure development was defined with the method of univariate and multivariate logistic regression. RESULTS: The research group was of 285 patients who were affected with AMI, 168 were male and 117 female. 51.9% of all patients developed heart failure. 18.5% of patients died. 90,5% of those who died had signs of heart failure. The comparison of patients with heart failure and those without showed statistically significant differences with almost all variables determined by protocol. In univariate analysis the highest prognostic value for the development of heart failure was that of atrial fibrillation at the admission, hemodynamically important mitral regurgitation, and chronic renal failure. In multivariate analysis the statistically important prognostic factors are female gender, age, hemodynamically important mitral regurgitation, absent peripheral pulses, akinetic or dyskinetic infartcted area and previous AMI. CONCLUSIONS: The results confirmed the hypothesis. Echocardiography investigation is extremely important when predicting heart failure as a complication of AMI. The study results have considerable value also for clinical practice.