Резюме
Ігнатенко Г.А., Мухін І.В., Башкірцев О.В. Вплив інтервальної нормобаричної гіпокситерапії на геометричну адаптацію і діастолічну функцію лівого шлуночка у хворих на артеріальну гіпертензію, коморбідну з ішемічною хворобою серця.
В роботі оцінено вплив тривалого використання медикаментозного і гіпокситерапевтичного лікування на процеси патологічного ремоделювання міокарда. Встановлено, що включення в лікувальну програму сеансів гіпокситерапії гальмує подальший процес патологічного ремоделювання міокарда лівого шлуночка.
Ключові слова: інтервальна нормобарична гіпокситерапія, геометрична адаптація, діастолічна функція, артеріальна гіпертензія, ішемічна хвороба серця.

Резюме
Игнатенко Г.А., Мухин И.В., Башкирцев А.В. Влияние интервальной нормобарической гипокситерапии на геометрическую адаптацию и диастолическую функцию левого желудочка у больных артериальной гипертензией, коморбидную с ишемической болезнью сердца.
В работе оценено влияние длительного применения медикаментозного и гипокситерапевтического лечения на процессы патологического ремоделирования миокарда. Установлено, что включение в лечебную программу сеансов гипокситерапии тормозит дальнейший процесс патологического ремоделирования миокарда левого желудочка.
Ключевые слова: интервальная нормобарическая гипокситерапия, геометрическая адаптация, диастолическая функция, артериальная гипертензия, ишемическая болезнь сердца.
Summary
Ignatenko G.A., Mukhin I.V., Bashkirtsev О.V. Impact on the interval normobaric hypoxitherapy on geometric adaptation and diastolic left ventricular function in patients with hypertension, comorbid with coronary heart disease.
In this article estimate the effect of prolonged use of medicamental treatment and hypoxitherapy on pathological cardiac remodeling. It is established that the inclusion of a treatment program sessions hypoxitherapy apply the break process of the pathological remodeling of the left ventricle.
Key words: interval normobaric hypoxitherapy, geometric adaptation, diastolic function, arterial hypertension, coronary heart disease.

Рецензент: д.мед.н., проф. Ю.Г. Бурмак

УДК 616.611-002-036.12+616.24-007.271]-08-035-092

Донецький національний медичний університет ім. М. Горького

83003, Украина, г. Донецк, пр. Ильича 16

Донецкий национальный медицинский университет им. М.Горького

Donetsk National Medical University n. a. M. Gorky 

Illicha Av. 16, Donetsk, 83003, Ukraine

i12041964m@yandex.ru

Introduction. Actuality of research and development of new pathogenetic approaches to the treatment of coronary heart disease (CHD)  and arterial hypertension (AH)  is determined by their very frequent prevalence among Ukrainian population and  community of pathogenetic branches of pathogenesis and complication of follow-up of such patients category [5, 10]. The presence of such combined pathology causes the increase of myocardium rigidity, end diastolic and end systolic tension of the left ventricle(LV) walls  on the background of defective diastolic relaxation that interferes with blood circulation  in  intramural vessels and contributes to  the additional worsening of coronary blood supply and forming of hibernation with post-ischemic abnormality of cardiac muscle stunning  [2].  At the same time the multicomponent damage of heart is formed with participation of hypertrophy, ischemia, hibernation, diastolic and geometrical adaptation abnormalities [3].

Last years the methods of interval normobaric hypoxitherapy (INBHT) are   actively used in treatment and rehabilitation of hypertension patients with coronary heart disease (CHD), basic trend of that is local and system arterial vasodilatation due to the forming of long-term adaptation to the hypoxia [1].

Connection of the work with  scientific programs, plans, themes.

The research was conducted within the framework of planned research department of propedeutic and internal medicine of Donetsk National Medical University named after Gorky M.  "Application of interval normobaric hypoxitherapy in the complex treatment of monoorganic and united therapeutic pathology"(№ of state registration 0108U009884).

The  aim of research  was consisted in the analysis of influence of  prolonged treatment with addition of sessions of INBHT on geometric adaptation and diastolic function of LV for patients with AH with CHD.

Material and research methods

92 patients that had  AH with stable angina of effort in the  age from 49 to 68 took part in the research . The criteria of including to the research were АH of 1-2 stages and 1-2 degrees, angina of effort of 1-2 functional class(FC), CCI (chronic cardiac insufficiency) of 1-2 FC. Patients were divided in two statistically similar groups for supervision by  age (χ2 = 0,8, р = 0,48), gender (χ2 = 2,3, р = 0,22) and by duration of АH(χ2 = 1,3, р = 0,34) and CHD(χ2 = 3,6, р = 0,18)  . The first group (47 patients) after randomization got standard medicamental therapy that is regulated by  modern orders of the Ministry of Healthcare of Ukraine and standards of follow-up of patient. The second group (45 patients) additionally to the base treatment took the daily sessions of INBHT with application of stationary hypoxicators  "GIP (ГИП) 10-1000-0", firm Trade Medical (Russia) and "Tibet-4"  firm "Newlife"(The USA, Russia). The sessions of ІNBHT were conducted in the conditions of in-patient department during 20 days and then in outpatiently conditions, also they continued to take 15-days supporting sessions of hypoxitherapy   each 3 months per year.

According the aim of determination of variant of  diastolic disfunction before beginning of treatment and during  a year after it were estimated the peak  velocity of early and late flows of  transmitral flow, their relations, time of slowing of flow of the rapid filling of the left ventricle and time of its isovolumetric relaxation. After receiving results typing of diastolic abnormalities was conducted.

Statistical processing of results was conducted with the use of the program "Statistica 6.0". Statistically meaningful differences of indexes were determined at the level of meaningfulness < 0,05.

Obtained results and discussions. While analysing variants of remodeling of LV it appeared  that  concentric hypertrophy (74,5 and 75,6 correspondingly) (fig. 1 and 2) prevailed in both groups. On the background of standard treatment in the 1st group was small tendency to reduction of frequency of normal geometry (fig. 1). The increase of frequency of eccentric hypertrophy was determined in this group. Reduction of frequency of concentric hypertrophy took place due to partial transformation of this variant in parts of patients in concentric remodeling. These data testifies to gradual progress of pathological remodeling of LV myocardium . As for representatives of the 2nd group some opposite changes in the process of dynamic supervision took place (fig. 2). For them the increase of frequency of normal geometry is set on the background of reduction of eccentric variant of hypertrophy. Besides, in this group reduction of concentric hypertrophy is set on 11,2% relatively to  initial sizes.

While analysing types of diastolic disfunction before beginning of treatment it appeared that normal type of diastolic function had 2,1% of patients from the  1st group, however there were no  such patients in the 2nd group (fig. 3). Relaxation abnormalities appeared to be the most frequent variants in 63,8 and 62,2% of patients from the 1st and 2nd groups accordingly. More rare there was a pseudonormal type in 25,5 and 24,4% accordingly . The most rare variant was restrictive one that was set in 8,5 and 13,3% patients accordingly. In a year in the 1st group there were disappearance of normal type, reduction of frequency relaxation and increase of pseudonormal and restrictive variants that point to the further processes of progress of ischemic-hypertension remodeling of heart. In the 2nd group on the background of  treatment there was "appearance" of normal type on the background of percent increase of patients with relaxation abnormalities and reduction of pseudonormal ones(fig. 4). Thus frequency of the restrictive changes remained without any dynamics.

One of basic aims of AH and CHD combination there is heart and that is why it is distinguished the features of pathological remodeling that have some different reasons and forming mechanisms [5]. So, the main mechanisms of unfavorable action of  elevated blood pressure  on  progression  of CHD are damage of  spider veins  of  cardiac vasculatures and abnormality of its endothelial function; the growing hemodynamic loading  on  heart with  increase of  cardiac output, frequency of heart-throbs and correspondently requirements of myocardium in oxygen; reduction of duration of diastole and time of cardiac vasculatures blood supply; progression  of hypertrophy of the left ventricle and its pathological remodeling [10].

Frequency of cardiovascular complications and death rate depend on the geometrical model of LV. So the worst prognosis for cardiovascular complications (31,0%) and death rate ( 21,0%) is registered for patients with  concentric hypertrophy of LV. The most favorable prognosis (absence of lethal results and 11,0% of cardiovascular complications) is typical for patients with normal geometry of LV [3]. Patients with eccentric hypertrophy and concentric remodeling occupy intermediate position.

Remodeling of myocardium at CHD has its features [8]. So, at small-focal myocardial infarctions and untransmural infarctions function and geometry can  return to a norm in the phase of renewal, while at transmural ones there are progressive remodeling and changes of LV geometry . In early terms after infarction there is deformation of LV cavity as its compression in the zone of transition from a scar to healthy myocardium through overhigh myocardial stress in this area. On the late stages there is smoothing of transitional zone from a scar to healthy tela that shows up as a late spherification of LV and quite often leads to its dilatation. In time it results in relative reduction of stroke volume that must be compensated by the increase of anastalsis of     cardiac myocyte or additional expansion of ventricle. Progressive abnormality of dynamic change of configuration can also affect on diastolic filling that becomes more dependent on a stretch and active relaxation of cardiac myocytes [6].

Using of INBHT for AH and CHD is conditioned by ability to reactive vasorelaxant function of arterias due to reactiving synthesis of nitrogen oxide  [4]. Thus there is a double positive effect such as decreasing of systemic arterial pressure and occuring of coronal vasodilatation in those vessels where atherosclerotic process does not cause forming of critical devascularization. Besides, during last years was proved the ability of hypoxitherapy to affect positively on the processes of thrombocyte aggregation that has positive influence on the risk of coronary atherothrombosis [7]. Very essential is ability of INBHT to reduce in some way serum concentration of atherogenic lipids and urinary acid that has been examined for the last time as unfavorable marker of cardial prognosis [9].

Conclusions

1.     Including in the therapeutic program sessions of INBHT against the background of standard medicamental therapy comparatively with only medicamental treatment assisted to reversion of frequency of eccentric hypertrophy of the left ventricle on the background of decrease of concentric hypertrophy and remodeling and increase of normal geometry of LV.

2.     Offered complex medicamental hypoxic therapy assists to partial reversion prognosticaly resistant pseudonormal type of remodeling of heart due to partial reclassification in normal and more prognosticaly responsive relaxation types at the unchanged frequency restrictive abnormalities.

Fig. 1. Frequency of types of the left ventricle geometry  for the patients from the 1st group with АH and CHD before and after treatment.

Fig. 2. Frequency of types of the left ventricle geometry  for the patients from the 2nd group with АH and CHD before and after treatment.

Fig. 3. Dynamics of types of LV diastolic function  for the patients from the 1st group before and after treatment.

Fig. 4. Dynamics of types of LV diastolic function  for the patients from the 2nd group before and after treatment.

Література

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