PREVALENCE AND DYNAMICS OF ENDOTHELIAL DYSFUNCTION, CAROTID AND CORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC RHEUMATIC HEART DISEASE

The aim of study was to assess the prevalence and 5-year dynamics of atherosclerosis and endothelial dysfunction in patients with chronic rheumatic heart disease (CRHD).

Materials and methods. 205 patients with CRHD were examined. Endothelial function was assessed by “AngioScan-01”, ultrasound examination of carotid arteries was performed, and some patients underwent coronaronagiography. The comparison group consisted from 57 patients with aortic stenosis (AS).

Results. In both groups endothelial dysfunction was observed in large (–6.77 ± 0.89 ms – in CRHD group, –6.68 ± 0.04 ms – in AS group) and small (1.73 ± 0.05 – in CRHD group, 1.51 ± 0.04 – in AS group) arteries. Within 5 years of observation in patients with CRHD statistically significant decrease was observed in occlusion index in amplitude (1.5 ± 0.037) and in phase shift between the channels before and after occlusion (–3.13 ± 0.94). It is important that during this period there was no significant deterioration in parameters of echocardiography and 6-minute walk test. Atherosclerosis of coronary arteries was revealed in 33.3 % patients with CRHD and in 52.5 % patients with AS. According to the ultrasound of the neck vessels in 188 patients with CRHD, the average thickness of intima/media complex was 0.84 ± 0.01 on the left and 0.84 ± 0.01 on the right; frequency of atherosclerotic plaques in the carotid arteries was 72.3 % on the left and 68.08 % on the right. The thickness of intima/media complex was statistically significantly higher in patients with AS on the left (1.02 ± 0.02) and on the right (1.15 ± 0.07); frequency of atherosclerotic plaques in the carotid arteries was 93.2 % on the left and 90.9 % on the right. Assessment of ultrasound data dynamics of carotid arteries in patients with CRHD revealed statistically significant increasing of intima/media thickness on the left (0.88 ± 0.01) and on the right (0.9 ± 0.01). There were no statistically significant differences for speed parameters.

Conclusions. Endothelial dysfunction takes place in the presence of mitral stenosis or AS, it is more expressed in AS. Also, atherosclerosis of carotid arteries in patients with CRHD and AS is more prevalent than in the population. And the frequency of coronary atherosclerosis in patients with CRHD is insignificant in comparison with patients with AS. Within 5 years of observation both endothelial dysfunction and atherosclerosis of carotid arteries progress in patients with CRHD.

chronic rheumatic heart disease, mitral stenosis, aortic stenosis, endothelial dysfunction, coronary atherosclerosis, carotid atherosclerosis, valvular heart disease, dyslipidemia, chronic heart failure

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