ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2025-2-106-115ssmu-6058Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSПредикторы положительной пробы пятиступенчатого протокола стресс-эхокардиографии у пациентов с постинфарктным кардиосклерозомPredictors of positive steps in the five-step stress echocardiography protocol in patients with postinfarction cardiosclerosishttps://orcid.org/0000-0001-6586-7404ТимофееваТ. М.TimofeevaT. M.

Тимофеева Татьяна Михайловна – канд. мед. наук, ассистент, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики имени акад. В.С. Моисеева; врач, отделение функциональной диагностики

Россия, 117198, г. Москва, ул. Миклухо-Маклая, 8Россия, 117292, г. Москва, ул. Вавилова, 61 

8 Miklukho-Maklaya St., 117198 Moscow, Russian Federation61 Vavilova St., 117292, Moscow, Russian Federation 

timtan@bk.ruhttps://orcid.org/0000-0003-2412-5986СафароваА. Ф.SafarovaA. F.

Сафарова Айтен Фуадовна – д-р мед. наук, профессор, профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени акад. В.С. Моисеева; врач, отделение функциональной диагностики

Россия, 117198, г. Москва, ул. Миклухо-Маклая, 8Россия, 117292, г. Москва, ул. Вавилова, 61 

8 Miklukho-Maklaya St., 117198 Moscow, Russian Federation61 Vavilova St., 117292, Moscow, Russian Federation 

aytensaf@mail.ruhttps://orcid.org/0009-0004-7478-5338ПавликовГ. С.PavlikovG. S.

Павликов Григорий Сергеевич – врач, отделение реанимации и интенсивной терапии для пациентов с ОНМК 

Россия, 117292, г. Москва, ул. Вавилова, 61 

61 Vavilova St., 117292, Moscow, Russian Federation 

gregory.pavlikov@gmail.comВладельщиковаД. Н.VladelshchikovaD. N.

Владельщикова Дарья Николаевна – клинический ординатор, кафедра внутренних болезней с курсом кардиологии и функциональной диагностики им. акад. В.С. Моисеева

Россия, 117198, г. Москва, ул. Миклухо-Маклая, 8 

8 Miklukho-Maklaya St., 117198 Moscow, Russian Federation

vladelshikova-da@mail.ruhttps://orcid.org/0000-0002-5873-1768КобалаваЖ. Д.KobalavaZh. D.

Кобалава Жанна Давидовна – д-р мед. наук, профессор, чл.-корр. РАН, зав. кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени акад. В.С. Моисеева 

Россия, 117198, г. Москва, ул. Миклухо-Маклая, 8

8 Miklukho-Maklaya St., 117198 Moscow, Russian Federation

zkobalava@mail.ruРоссийский университет дружбы народов (РУДН) им. Патриса Лумумбы; Университетская клиническая больница им. В.В. Виноградова, филиал РУДН им. Патриса ЛумумбыРоссияPeoples’ Friendship University of Russia (RUDN University); V.V. Vinogradov University Clinical Hospital (branch) of the Peoples’ Friendship University of RussiaRussian FederationУниверситетская клиническая больница им. В.В. Виноградова, филиал РУДН им. Патриса ЛумумбыРоссияV.V. Vinogradov University Clinical Hospital (branch) of the Peoples’ Friendship University of RussiaRussian FederationРоссийский университет дружбы народов (РУДН) им. Патриса ЛумумбыРоссияPeoples’ Friendship University of Russia (RUDN University)Russian Federation202514072025242106115Copyright © Тимофеева Т.М., Сафарова А.Ф., Павликов Г.С., Владельщикова Д.Н., Кобалава Ж.Д., 20252025Тимофеева Т.М., Сафарова А.Ф., Павликов Г.С., Владельщикова Д.Н., Кобалава Ж.Д.Timofeeva T.M., Safarova A.F., Pavlikov G.S., Vladelshchikova D.N., Kobalava Z.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/6058

Цель. Изучить частоту и предикторы положительных шагов пятиступенчатой стресс-эхокардиографии (СЭ) у пациентов с перенесенным инфарктом миокарда (ИМ).Материалы и методы. В одноцентровое исследование включены 75 пациентов (61,6 ± 9,8 лет, 84% – мужчины) с перенесенным ИМ. Медиана давности ИМ составила 1231,0 (381,5; 2698,5) сут. Всем пациентам была проведена СЭ с физической нагрузкой по пятишаговому протоколу. На шаге А выявляли нарушение локальной сократимости (НЛС), на шаге В – сумму В-линий, на шаге С – сократительный резерв (СР) левого желудочка (ЛЖ), на шаге D – коронарный резерв (КР) в левой передней нисходящей артерии, а также резерв частоты сердечных сокращений на шаге Е.Результаты. Частота положительных результатов составила 36,0% для шага А, 18,7% – для шага В, 80,0% – для шага С, 53,3% – для шага D и 50,7% – для шага E. В результате многофакторного анализа выявлены предикторы положительного шага А (диастолическое артериальное давление (АД) в покое, р = 0,030; индекс НЛС в покое, р = 0,007), шага В (прием β-блокаторов, р = 0,035; индексированная масса миокарда ЛЖ, р = 0,005), шага С (прирост систолического АД, р = 0,011; прирост конечно-диастолического объема ЛЖ, р = 0,019; прирост фракции ЛЖ, р = 0,008) и шага D (прием блокаторов рецепторов ангиотензина II, р = 0,026; прирост систолического АД, р = 0,012; прирост силы ЛЖ, р = 0,038). Заключение. Выявление предикторов НЛС на нагрузке, субклинического легочного застоя, снижения СР и КР у пациентов с перенесенным ИМ может быть мишенью для терапевтического воздействия с целью отдаления развития неблагоприятных сердечно-сосудистых событий.

Aim. To study the frequency and predictors of positive steps in five-step stress echocardiography (SE) in patients with previous myocardial infarction (MI).Materials and methods. The single-center study included 75 patients (61.6 ± 9.8 years, 84% men) with previous MI. The median duration of MI was 1,231.0 (381.5; 2,698.5) days. All patients underwent exercise SE according to the five-step protocol. At step A wall motion abnormalities (WMA) were detected, at step B – the sum of B-lines, at step C – contractile reserve (CR) of the left ventricle (LV), at step D – coronary reserve (CorR) in the left anterior descending artery, and at step E – heart rate reserve.Results. The frequency of positive steps was 36.0% for step A, 18.7% for step B, 80.0% for step C, 53.3% for step D, and 50.7% for step E. Following the multivariate analysis, predictors of a positive step A (resting diastolic blood pressure (BP), p = 0.030, resting WMA index, p = 0.007), step B (taking β-blockers, p = 0.035; left ventricular (LV) mass index, p = 0.005), step C (increase in systolic BP (SBP), p = 0.011; increase in LV end-diastolic volume, p = 0.019; increase in LV ejection fraction, p = 0.008), and step D (taking angiotensin II receptor blockers, p = 0.026; increase in SBP, p = 0.012; increase in LV force, p = 0.038) were revealed.Conclusion. Identification of predictors of WMA during exercise, subclinical pulmonary congestion, and a decrease in CR and CorR in patients with previous MI may be a target for therapeutic intervention in order to delay the development of adverse cardiovascular events.

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The authors declare that there are no conflicts of interest present.