MORPHOLOGICAL AND LABORATORY-FUNCTIONAL PARALLELS IN DIAGNOSTICS OF MYOCARDIAL INFARCTION TYPE II
Abstract
According to the IV universal definition of myocardial infarction (MI), it is currently recommended to distinguish between five types of disease, depending on the mechanism of development of the pathological process. Type 2 myocardial infarction (T2MI) often occurs due to a mismatch between oxygen delivery and consumption. Important criteria for BMI2 are high troponin levels, acute myocardial ischemia, and absence of complications in the form of fibrous plaques on the vessel wall.The aim was to determine meaningful diagnostic criteria for T2MI based on clinical and morphological comparisons. Material and methods. This work is based on a clinical and morphological study of 112 people with various forms of myocardial infarction at the age of 50-70 years od.Results. The main diseases with T2MI were diabetes mellitus, hypertension, cerebrovascular diseases, cancers, others less often. Basically, myocardial infarction was of a transmural nature. Subendocardial location of the infarction zone was often observed, which was more characteristic of T2MI. During the study, it was possible to establish the features of vacuolar degeneration of cardiomyocytes, which are mainly found in individuals with T2MI.Conclusion. With this type of myocardial infarction, the data of anamnesis, clinical and laboratory, functional, instrumental research methods, autopsy results largely indicate the feasibility of searching for the underlying disease. Subendocardial localization is more common in type II MI. Pathohistological examination often reveals vacuolar dystrophy and necrobiotic changes in cardiomyocytes near the necrosis zone, which is typical for this type of disease in conditions of organ hibernation.
About the Authors
T. I. Mustafin
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
S. V. Shchekin
ГБУЗ РБ «Городская клиническая больница №21»
Russian Federation
Russian Federation
V. S. Shchekin
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России; ГБУЗ РБ «Городская клиническая больница №21»
Russian Federation
Russian Federation
References
1. Зайратьянц, О.В. Инфаркт миокарда и острый коронарный синдром: дефиниции, классификация и критерии диагностики / О.В. Зайратьянц, О.Д. Мишнев, Л.В. Кактурский // Архив патологии. - 2014. - Т. 76, № 6. - С. 3-11
2. Дифференцированный подход в диагностике, формулировке диагноза, ведении больных и статистическом учете инфаркта миокарда 2 типа (согласованная позиция) / О.В. Аверков [и др.] // Российский кардиологический журнал. - 2019. - Т. 24, № 6. - С. 7-21. DOI: 10.15829/1560-4071-2019-6-7-21
3. Fourth universal definition of myocardial infarction (2018) / K. Thygesen [et al.] // Circulation. - 2018. - Vol. 138, № 20. - P. e618- e651. DOI: 10.1161/CIR.0000000000000617
4. Supply/demand type 2 myocardial infarction: should we be paying more attention? / Y. Sandoval [et al.] // J Am Coll Cardiol. - 2014. - Vol. 63, № 20. - P. 2079-2087. DOI: 10.1016/j.jacc.2014.02.541
5. Type 2 myocardial infarction: a descriptive analysis and comparison with type 1 myocardial infarction / U. Landes [et al.] // Journal of cardiology. - 2016. - Vol. 67, № 1. - P. 51-56. DOI: 10.1016/j.jjcc.2015.04.001
6. Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland / D. Radovanovic [et al.] // Open Heart. - 2017. - Vol. 4, № 2. - P. e000689. DOI: 10.1136/openhrt-2017-000689
7. A systematic review on the triggers and clinical features of type 2 myocardial infarction / W. Guangqiang [et al.] // Clin Cardiol. - 2019. - Vol. 42, № 10. - P. 1019-1027. DOI: 10.1002/clc.23230
8. Type 2 myocardial infarction in clinical practice / T. Baron [et al.] // Heart. - 2015. - Vol. 101, № 2. - P. 101-106. DOI: 10.1136/heartjnl-2014-306093
9. Impact on long-term mortality of presence of obstructive coronary artery disease and classification of myocardial infarction / T. Baron [et al.] // Am J Med. - 2016. - Vol. 129, № 4. - P. 398-406. DOI: 10.1016/j.amjmed.2015.11.035
10. Type-II myocardial infarction - patient characteristics, management and outcomes / G.Y. Stein [et al.] // PLoS One. - 2014. - Vol. 9, № 1. - P. e84285. DOI: 10.1371/journal.pone.0084285
11. Sensitive troponin assay and the classification of myocardial infarction / A.S.V. Shah [et al.] // Am J Med. - 2015. - Vol. 128, № 5. - P. 493-501. DOI:10.1016/j.amjmed.2014.10.056
12. Sandoval, Y. Myocardial infarction type 2 and myocardial injury / Y. Sandoval, K. Thygesen // Clin Chem. - 2017. - Vol. 63, № 1. - P. 101-107. DOI: 10.1373/clinchem.2016.255521
13. Diagnostic accuracy of a new high-sensitivity troponin I assay and five accelerated diagnostic pathways for ruling out acute myocardial infarction and acute coronary syndrome / J.H. Greenslade [et al.] // Annals of Emergency Medicine. - 2018. - Vol. 71, № 4. - P. 439451. DOI: 10.1016/j.annemergmed.2017.10.030
14. Discordance between ICD-coded myocardial infarction and diagnosis according to the universal definition of myocardial infarction / J. Diaz-Garzon [et al.] // Clin Chem. - 2017. - Vol. 63, № 1. - P. 415-419. DOI: 10.1373/clinchem.2016.263764
15. Основы клинико-анатомического анализа при различных типах инфаркта миокарда / Т.И Мустафин [и др.] // Медицинский вестник Башкортостана. - 2019. - Т. 14, № 2. - С. 18-21
16. Impact of type 2 myocardial infarction (MI) on hospital-level MI outcomes: implications for quality and public reporting / S. Arora [et al.] // J Am Heart Assoc. - 2018. - Vol. 7, № 7. - P. e008661. DOI: 10.1161/JAHA.118.008661
17. Type 2 myocardial infarction: a geriatric population-based model of pathogenesis / A. Putot [et al.] // Aging Dis. - 2020. - Vol. 11, № 1. - P. 108-117. DOI: 10.14336/AD.2019.0405
18. Incident type 2 myocardial infarction in a cohort of patients undergoing coronary or peripheral arterial angiography / H.K. Gaggin [et al.] // Circulation. - 2017. - Vol. 135, № 2. - P. 116-127. DOI: 10.1161/CIRCULATIONAHA.116.023052
19. Javed, U. Beta-adrenergic blockers for chronic heart failure / U. Javed, P.C. Deedwania // Cardiol Rev. - 2009. - Vol. 17, № 6. - P. 287292. DOI: 10.1097/CRD.0b013e3181bdf63e
20. Acute myocardial infarction and renal dysfunction: a high-risk combination / R.S. Wright [et al.] // Ann Intern Med. - 2002. - Vol. 137, № 7. - P. 563-570. DOI: 10.7326/0003-4819-137-7-200210010-00007
21. Troponin as a risk factor for mortality in critically ill patients without acute coronary syndromes / P. Ammann [et al.] // J Am Coll Cardiol. - 2003. - Vol. 41, № 11. - P. 2004-2009. DOI: 10.1016/s0735-1097(03)00421-2
22. Recommendations for the use of cardiac troponin measurement in acute cardiac care / K. Thygesen [et al.] // Eur Heart J. - 2010. - Vol. 31, № 18. - P. 2197-2204. DOI: 10.1093/eurheartj/ehq251
23. Troponin elevation in patients with heart failure: on behalf of the third universal definition of myocardial infarction global task force: heart failure section / J.L. Januzzi Jr [et al.] // Eur Heart J. - 2012. - Vol. 33, № 18. - P. 2265-2271. DOI: 10.1093/eurheartj/ehs191
24. Renal dysfunction in patients with heart failure with preserved versus reduced ejection fraction: impact of the new chronic kidney disease-epidemiology collaboration group formula / F.A. McAlister [et al.] // Circ Heart Fail. - 2012. - Vol. 5, № 3. - P. 309-314. DOI: 10.1161/CIRCHEARTFAILURE.111.966242
25. Siddiqui, Y. Nonischemic myocardial changes detected by cardiac magnetic resonance in critical care patients with sepsis / Y. Siddiqui, E.D. Crouser, S.V. Raman // Am J Respir Crit Care Med. - 2013. - Vol. 188, № 8. - P. 1037-1039. DOI: 10.1164/rccm.201304-0744LE
26. Классификация типов острого инфаркта миокарда и предпосылки для ее создания. Инфаркт миокарда второго типа / О.Ю. Кузнецова [и др.] // Российский семейный врач. - 2017. - Т. 21, № 3. - C. 5-15. DOI: 10.17816/RFD201735-15
27. Майорова, М.В. Патоморфология миокарда у умерших от ишемической болезни сердца и сахарного диабета / М.В. Майорова, В.И. Демидов, Е.А. Конкина // Вестник Ивановской медицинской академии. - 2011. - T. 16, № 3. - С.13-18
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For citations:
Mustafin T.I., Shchekin S.V., Shchekin V.S. MORPHOLOGICAL AND LABORATORY-FUNCTIONAL PARALLELS IN DIAGNOSTICS OF MYOCARDIAL INFARCTION TYPE II. Bashkortostan Medical Journal. 2021;16(2):37-42. (In Russ.)
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