ЗНАЧЕНИЕ ПУЛЬСОВОГО ДАВЛЕНИЯ В КЛИНИЧЕСКОМ ТЕЧЕНИИ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА

The aim of the study is to optimize the risk stratification of coronary heart disease based on the assessment of indirect indicators of the stiffness of the great vessels. Material and methods. Based on the set goal in scientific work, 133 patients aged 40 to 70 y.o. (mean age 62,4 ± 7,7 y.o.) with coronary artery disease, verified by CAG data, underwent inpatient treatment in 2019– 2020 at the СHD laboratory of the RSSPMCC were involved for clinical observation. According to the study protocol, control studies, including general clinical examination, electrocardiography, echocardiography, clinical and biochemical studies of blood, including the lipid spectrum and highly sensitive C-reactive protein, were administered to patients in the first 24 hours. Applanational tonometry was performed for all patients to assess the state of vascular wall stiffness and central hemodynamics on the first day of hospitalization. Results of the study. The patients were divided into 2 groups on the basis of the results obtained in terms of peripheral pulse pressure (PP): 95 patients (63 men and 32 women) were included in the 1st group, whose PP values were more than 50 mm Hg; 38 patients (12 men and 26 women) made up the 2nd group with PP less than 50 mm Hg. The mean values of pSBP and pPP in the group of patients with CHD and PP below 50 mm Hg were lower than in patients of the 1st group (р = 0,021). When evaluating the results of laboratory studies, it was found that the average concentration of total cholesterol, LDL cholesterol was higher in patients with CHD and PP of more than 50 mm Hg and it had a significant difference (p < 0,05). According to EchoCG data, a significant difference was noted in terms of such indicators as IVS thickness and LVMM index (p <0.05): in patients of the 1st group, the above indicators were higher than in patients of the 2nd group. When evaluating the results of applanation tonometry, a more significant increased cSBP (р = 0,0012), cPP (р = 0,002), AA (р = 0,031), AIx (р = 0,034), AIx@HR75 (р = 0,042) and PWV (р = 0,0073) and lower cDBP (р = 0,069) were observed in patients with CHD and PP more than 50 mm Hg. During the course of the annual dynamic observation, it was found that the destabilization of CHD (51,6 % versus 23,7 %, χ2 = 12,67, p < 0,001) was more often observed in patients of 1st group. The course of CHD was complicated by myocardial infarction in 5,3 % of cases; PCI (χ2 = 11,5, p < 0,001) was performed in 41 % of patients and CABG (χ2 = 2,196, р = 0,139) in 9,5 % of patients, while in the second group, the destabilization of CHD was observed in 2,2 less often and PCI were performed 4,1 times less often. Conclusions. Higher indicators of SBP, cPP, AA, AIx and AIx@HR75 and PWV are noted in patients with CHD with an increased value of PP (>50 mm Hg) compared with patients with PP less than 50 mm Hg, which indicates a more pronounced remodeling process vascular wall. In addition, episodes of exacerbation of CHD, the number of hospitalizations per year and PCI procedures are observed significantly more often among patients with CHD and increased PP, compared with patients with PP below 50 mm Hg. This indicates that the parameters of the central HD and elastic properties of the vascular wall are one of the most important criteria for the expression of vascular remodeling and the course of CHD.