[Prognostic value of structural-functional and electrical remodeling of myocardium in aged and elderly men with coronary heart disease].

This study had the purpose to assess relative risk of cardiovascular death in aged and elderly men with coronary heart disease depending on electrical and functional remodeling of myocardium. It included 526 patients aged 18-92 years, with 167 ones of mean age 75.4 years. The control group comprised 113 healthy men 18-65 years of age. General clinical examination was supplemented by measurements of heart electrical activity and ventricular activation rate (VAR), detection of myocardial electrical remodeling stages, parameters of repolarization and their dispersion, assessment of structural and functional state of myocardium from the results of two-dimensional echocardioscopy. The clinical course of disease and its fatal outcomes were monitored for 10 days. The risk of death from all cardiovascular events significantly increased as a result of decreased ejection fraction, increased mass of left ventricle (LV), dilation of its cavity, excentric myocardial remodeling, and reduced VAR. An independent predictor of cardiovascular death was increased dispersion of intervals dQtend > 60 ms, dJTapex > 60 ms. Cardiovascular mortality positively correlated with the terminal stage of electrical remodeling, dispersion of interval QT > 60 ms, LV mass, its index, LV end systolic and diastolic size, and ecccentric LV remodeling. Results of logistic regression analysis indicate that functional class of circulatory insufficiency, increased heterogeneity of repolarization (QT end interval), progress of electrical remodeling of myocardium and LV cavity dilatation are high risk factors that can be used to predict cardiovascular events in elderly men with coronary heart disease. Prospective 10 year-long follow up of such patients showed that progressive circulatory insufficiency, terminal stage of electrical remodeling of myocardium, dilatation of LV cavity, and dispersion of repolarization interval QT end are the major factors that significantly influence the risk of cardiovascular death.