Bazyka O D, Belyi D O
State Institution «National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine», Melnykova str., 53, Kyiv, 04050, Ukraine.
Probl Radiac Med Radiobiol. 2017 Dec;22:292-305.
To study the dynamics of circulatory system diseases during the 30 year period after irradiation, changes in the status of systolic function of heart left ventricle (LV) and the features of its remodeling in clean up workers (CW) of the accident at the Chernobyl nuclear power plant (ChNPP).
It was examined 144 CW at ChNPP, including 52 patients, who survived acute radiation sick ness (ARS) grade of severity 1-3, and 105 non irradiated persons (control group - CG). CW have been divided into two subgroups: without signs of ARS (ARS0) and those who suffered from ARS. CW and CG patients were male who had no signs of cardiovascular, nervous, pulmonary or endocrine pathology prior to the Chernobyl accident. Their average age at the beginning of the accident was 33.9-37.7 years. The study program included clinical examina tion, echocardiography, retrospective and statistical analysis.
Hypertensive heart disease (HHD) has developed in the CW, including the ARS convalescents, by 12 years, and ischemic heart disease (CHD) at 9-11 years is believed to be earlier than in comparable non irradiated patients. In the post accident period, there was an increased mean value of LV posterior wall (PW) thickness, interventricular septum (IVS), myocardium mass and myocardium mass normalized by body surface area. These indices grew with the increase of HHD duration. Over the 30 year follow up period, between CW and CG from 14.3 to 28.6 % of patients with LV increased volumes it was found a decreased ejection fraction (EF), what indicated the development of sys tolic LV dysfunction with the phenomena of left ventricular heart failure (HF). Reduction of EF correlated with increase of end systolic volume (ESV) having the highest statistical strength. In CW and persons of CG there was from 77.3 to 84.8 % of patients had clinical signs of HF with preserved EF. From this number, 56-63.6 % of patients had concentric and 18.8-26.7 % had eccentric LV hypertrophy (LVH), and in 6.1 to 15.6% of patients, normal LV geom etry or its concentric remodeling was observed.
The CW and non irradiated persons differed significantly by the onset of HHD and CHD, which previ ously developed in the CW, including the ARS survivors. Changes in the structural and functional state of myocardi um during long term follow up did not have any probable differences between CW and non irradiated persons and consisted of BW and IVS thickening, which predetermined the development of LVH. In CW and CG concentric LVH was dominant. The LV systolic dysfunction with decreased EF and increased ESV was characterized by clinical symptoms of left ventricular HF. More than half of patients with clinical symptoms of HF and preserved EF had signs of concen tric hypertrophy.
研究切尔诺贝利核电站事故清理人员在辐射后30年期间循环系统疾病的动态变化、心脏左心室（LV）收缩功能状态的改变及其重塑特征。
对144名切尔诺贝利核电站事故清理人员进行检查，其中包括52名急性放射病（ARS）1 - 3级严重程度的幸存者，以及105名未受辐射者（对照组 - CG）。事故清理人员被分为两个亚组：无ARS迹象者（ARS0）和患有ARS者。事故清理人员和对照组患者均为男性，在切尔诺贝利事故前无心血管、神经、肺部或内分泌疾病迹象。事故开始时他们的平均年龄为33.9 - 37.7岁。研究方案包括临床检查、超声心动图检查、回顾性分析和统计分析。
事故清理人员，包括ARS康复者，在12年后出现高血压性心脏病（HHD），9 - 11年后出现缺血性心脏病（CHD），这被认为比未受辐射的类似患者更早。在事故后时期，左心室后壁（PW）厚度、室间隔（IVS）、心肌质量以及按体表面积标准化的心肌质量的平均值增加。这些指标随着HHD病程的增加而增长。在30年的随访期内，在事故清理人员和对照组中，发现左心室容积增加的患者中有14.3%至28.6%射血分数（EF）降低，这表明左心室收缩功能障碍伴左心室心力衰竭（HF）现象的发展。EF降低与收缩末期容积（ESV）增加相关，具有最高的统计强度。在事故清理人员和对照组人员中，有77.3%至84.8%的患者有EF保留的HF临床症状。其中，56% - 63.6%的患者有向心性肥厚，18.8% - 26.7%的患者有离心性左心室肥厚（LVH），6.1%至15.6%的患者观察到正常左心室几何形态或其向心性重塑。
事故清理人员和未受辐射者在HHD和CHD的发病方面存在显著差异，HHD和CHD先前在事故清理人员中包括ARS幸存者中有所发展。在长期随访期间，心肌结构和功能状态的变化在事故清理人员和未受辐射者之间没有任何可能的差异，包括PW和IVS增厚，这预示着LVH的发展。在事故清理人员和对照组中，向心性LVH占主导。EF降低和ESV增加的左心室收缩功能障碍以左心室HF的临床症状为特征。超过一半有HF临床症状且EF保留的患者有向心性肥厚迹象。
