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Некомпактный миокард левого желудочка: вторичная профилактика тромбоэмболических осложнений
Некомпактный миокард левого желудочка: вторичная профилактика тромбоэмболических осложнений
Мясников Р.П., Куликова О.В., Харлап М.С. и др. Некомпактный миокард левого желудочка: вторичная профилактика тромбоэмболических осложнений. Consilium Medicum. 2016; 18 (12): 17–21. DOI: 10.26442/2075-1753_2016.12.17-21
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Аннотация
Основными клиническими особенностями некомпактного миокарда левого желудочка (НМЛЖ) являются сердечная недостаточность (СН), аритмии и тромбоэмболические осложнения. Выраженная трабекулярность и глубокие межтрабекулярные пространства, характерные для НМ, могут стать причиной застоя кровотока и образования тромбов в полости ЛЖ. В данной статье рассмотрены современные аспекты назначения антикоагулянтной терапии пациентам с НМ, а также описан клинический случай мужчины 54 лет с диагнозом НМЛЖ. Больной поступил с симптомами выраженной СН и множественным тромбозом ЛЖ, осложнившимся рецидивирующими эмболиями в большой круг кровообращения. В дальнейшем при самостоятельной редукции терапии у пациента случился повторный тромбоз ЛЖ с развитием впоследствии тромбоэмболии подколенных артерий и левой плечевой артерии. Всем больным с НМЛЖ в качестве вторичной профилактики тромбоэмболических осложнений рекомендован постоянный прием антикоагулянтов. При этом в качестве первичной профилактики тромбоэмболий терапию антикоагулянтами следует рассматривать для пациентов с НМЛЖ, которые также имеют факторы риска тромбоэмболии, такие как мерцательная аритмия или систолическая дисфункция ЛЖ.
Ключевые слова: некомпактный миокард левого желудочка, кардиомиопатии, сердечная недостаточность, тромбоз левого желудочка, тромбоэмболии.
Ключевые слова: некомпактный миокард левого желудочка, кардиомиопатии, сердечная недостаточность, тромбоз левого желудочка, тромбоэмболии.
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The main clinical features of left ventricular (NCMLV) are non-compact myocardial heart failure (HF), arrhythmias and thromboembolic complications. Pronounced trabecular and deep inter-trabecular spaces typical of NC, can cause stagnation of blood flow and blood clots in the left ventricular cavity. This article deals with modern aspects of anticoagulant therapy in patients with NC, and describes a clinical case of a man of 54 years with a diagnosis of NCMLV. The patient was admitted with symptoms of severe heart failure and left ventricular thrombosis of multiple complicated with recurrent embolism in the systemic circulation. In the future, when the reduction of self-therapy, the patient suffered repeated thrombosis of the left ventricle with the development of thromboembolic events after popliteal artery and the left brachial artery. All patients with NCMLV as secondary prevention of thromboembolic complications of chronic administration of anticoagulants is recommended. In this case, should be considered for patients with NCMLV, which are also risk factors for thromboembolic events, such as atrial fibrillation or ventricular systolic dysfunction as a primary prevention of thromboembolism anticoagulant therapy.
Key words: non-compact myocardium of the left ventricle, cardiomyopathy, heart failure, left ventricular thrombosis, thromboembolism.
Key words: non-compact myocardium of the left ventricle, cardiomyopathy, heart failure, left ventricular thrombosis, thromboembolism.
Полный текст
Список литературы
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2. Sedmera D, Pexieder T, Vuillemin M et al. Developmental patterning of the myocardium. Anat Rec 2000; 258: 319–37.
3. Ker J, Van Der Merwe C. Isolated left ventricular noncompaction as a cause of thromboembolic stroke: a case report and review. Cardiovasc J S Afr 2006; 17: 146–7.
4. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72: 26–31.
5. Hascelik S, Yalnizoglu D, Kafali G et al. Stroke owing to noncompaction of myocardium. J Child Neurol 2003; 18: 437–9.
6. Stollberger C, Finsterer J. Thrombi in left ventricular hypertrabeculation/noncompaction: review of the literature. Acta Cardiol 2004; 59: 341–4.
7. Stollberger C, Finsterer J. Left ventricular hypertrabeculation/noncompaction and stroke or embolism. Cardiology 2005; 103: 68–72.
8. Eilen D, Peterson N, Karkut C, Movahed A. Isolated non-compaction of the left ventricular myocardium: a case report and literature review. Echocardiography 2008; 25 (7): 755–61.
9. Oechslin EN, Attenhofer Jost CH, Rojas JR et al. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36 (2): 493–500.
10. Myasnikov RP, Blagova OV, Kulikova OV et al. The specifics of noncompacted cardiomyopathy manifestation. Cardiovasc Ther Prevent 2015; 14 (5): 78–82.
11. Cevik C, Shah N, Wilson JM, Stainback RF. Multiple left ventricular: in a patient with left ventricular noncompaction. Tex Heart Inst J 2012; 39 (4): 550–3.
12. Stöllberger C, Blazek G, Dobias C et al. Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction. Am J Cardiol 2011; 108 (7): 1021–3.
13. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72 (1): 26–31.
14. Yelamanchili P, Nanda NC, Patel V et al. Live/real time three-dimensional echocardiographic demonstration of left ventricular noncompaction and thrombi. Echocardiography 2006; 23 (8): 704–6.
15. Cevik C, Stainback RF. Isolated left ventricular noncompaction in a 90-year-old man. Tex Heart Inst J 2012; 39 (2): 255–7.
16. Stöllberger C, Wegner C, Finsterer J. CHADS2- and CHA2DS2VASc scores and embolic risk in left ventricular hypertrabeculation/noncompaction. J Stroke Cerebrovasc Dis 2013; 22 (6): 709–12.
17. Fazio G, Corrado G, Zachara E et al. Anticoagulant drugs in noncompaction: a mandatory therapy? J Cardiovasc Med (Hagerstown) 2008; 9 (11): 1095–7.
2. Sedmera D, Pexieder T, Vuillemin M et al. Developmental patterning of the myocardium. Anat Rec 2000; 258: 319–37.
3. Ker J, Van Der Merwe C. Isolated left ventricular noncompaction as a cause of thromboembolic stroke: a case report and review. Cardiovasc J S Afr 2006; 17: 146–7.
4. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72: 26–31.
5. Hascelik S, Yalnizoglu D, Kafali G et al. Stroke owing to noncompaction of myocardium. J Child Neurol 2003; 18: 437–9.
6. Stollberger C, Finsterer J. Thrombi in left ventricular hypertrabeculation/noncompaction: review of the literature. Acta Cardiol 2004; 59: 341–4.
7. Stollberger C, Finsterer J. Left ventricular hypertrabeculation/noncompaction and stroke or embolism. Cardiology 2005; 103: 68–72.
8. Eilen D, Peterson N, Karkut C, Movahed A. Isolated non-compaction of the left ventricular myocardium: a case report and literature review. Echocardiography 2008; 25 (7): 755–61.
9. Oechslin EN, Attenhofer Jost CH, Rojas JR et al. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36 (2): 493–500.
10. Myasnikov RP, Blagova OV, Kulikova OV et al. The specifics of noncompacted cardiomyopathy manifestation. Cardiovasc Ther Prevent 2015; 14 (5): 78–82.
11. Cevik C, Shah N, Wilson JM, Stainback RF. Multiple left ventricular: in a patient with left ventricular noncompaction. Tex Heart Inst J 2012; 39 (4): 550–3.
12. Stöllberger C, Blazek G, Dobias C et al. Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction. Am J Cardiol 2011; 108 (7): 1021–3.
13. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72 (1): 26–31.
14. Yelamanchili P, Nanda NC, Patel V et al. Live/real time three-dimensional echocardiographic demonstration of left ventricular noncompaction and thrombi. Echocardiography 2006; 23 (8): 704–6.
15. Cevik C, Stainback RF. Isolated left ventricular noncompaction in a 90-year-old man. Tex Heart Inst J 2012; 39 (2): 255–7.
16. Stöllberger C, Wegner C, Finsterer J. CHADS2- and CHA2DS2VASc scores and embolic risk in left ventricular hypertrabeculation/noncompaction. J Stroke Cerebrovasc Dis 2013; 22 (6): 709–12.
17. Fazio G, Corrado G, Zachara E et al. Anticoagulant drugs in noncompaction: a mandatory therapy? J Cardiovasc Med (Hagerstown) 2008; 9 (11): 1095–7.
________________________________________________
2. Sedmera D, Pexieder T, Vuillemin M et al. Developmental patterning of the myocardium. Anat Rec 2000; 258: 319–37.
3. Ker J, Van Der Merwe C. Isolated left ventricular noncompaction as a cause of thromboembolic stroke: a case report and review. Cardiovasc J S Afr 2006; 17: 146–7.
4. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72: 26–31.
5. Hascelik S, Yalnizoglu D, Kafali G et al. Stroke owing to noncompaction of myocardium. J Child Neurol 2003; 18: 437–9.
6. Stollberger C, Finsterer J. Thrombi in left ventricular hypertrabeculation/noncompaction: review of the literature. Acta Cardiol 2004; 59: 341–4.
7. Stollberger C, Finsterer J. Left ventricular hypertrabeculation/noncompaction and stroke or embolism. Cardiology 2005; 103: 68–72.
8. Eilen D, Peterson N, Karkut C, Movahed A. Isolated non-compaction of the left ventricular myocardium: a case report and literature review. Echocardiography 2008; 25 (7): 755–61.
9. Oechslin EN, Attenhofer Jost CH, Rojas JR et al. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol 2000; 36 (2): 493–500.
10. Myasnikov RP, Blagova OV, Kulikova OV et al. The specifics of noncompacted cardiomyopathy manifestation. Cardiovasc Ther Prevent 2015; 14 (5): 78–82.
11. Cevik C, Shah N, Wilson JM, Stainback RF. Multiple left ventricular: in a patient with left ventricular noncompaction. Tex Heart Inst J 2012; 39 (4): 550–3.
12. Stöllberger C, Blazek G, Dobias C et al. Frequency of stroke and embolism in left ventricular hypertrabeculation/noncompaction. Am J Cardiol 2011; 108 (7): 1021–3.
13. Ritter M, Oechslin E, Sutsch G et al. Isolated noncompaction of the myocardium in adults. Mayo Clin Proc 1997; 72 (1): 26–31.
14. Yelamanchili P, Nanda NC, Patel V et al. Live/real time three-dimensional echocardiographic demonstration of left ventricular noncompaction and thrombi. Echocardiography 2006; 23 (8): 704–6.
15. Cevik C, Stainback RF. Isolated left ventricular noncompaction in a 90-year-old man. Tex Heart Inst J 2012; 39 (2): 255–7.
16. Stöllberger C, Wegner C, Finsterer J. CHADS2- and CHA2DS2VASc scores and embolic risk in left ventricular hypertrabeculation/noncompaction. J Stroke Cerebrovasc Dis 2013; 22 (6): 709–12.
17. Fazio G, Corrado G, Zachara E et al. Anticoagulant drugs in noncompaction: a mandatory therapy? J Cardiovasc Med (Hagerstown) 2008; 9 (11): 1095–7.
Авторы
Р.П.Мясников*1, О.В.Куликова1, М.С.Харлап1, С.Н.Корецкий1, Е.Ю.Андреенко1, Е.А.Мершина2,3, В.Е.Синицын2,3, С.А.Бойцов1
1 ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
2 ФГАУ Лечебно-реабилитационный центр Минздрава России. 125367, Россия, Москва, Иваньковское ш., д. 3;
3 ФГБОУ ДПО Российская медицинская академия непрерывного профессионального образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*RMyasnikov@gnicpm.ru
1 ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
2 ФГАУ Лечебно-реабилитационный центр Минздрава России. 125367, Россия, Москва, Иваньковское ш., д. 3;
3 ФГБОУ ДПО Российская медицинская академия непрерывного профессионального образования Минздрава России. 125993, Россия, Москва, ул. Баррикадная, д. 2/1
*RMyasnikov@gnicpm.ru
________________________________________________
R.P.Myasnikov*1, O.V.Kulikova1, M.S.Kharlap1, S.N.Koretskiy1, E.Yu.Andreenko1, E.A.Mershina2,3, V.E.Sinitsyn2,3, S.A.Boytsov1
1 State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3;
2 Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation. 125367, Russian Federation, Moscow, Ivan'kovskoe sh., d. 3;
3 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*RMyasnikov@gnicpm.ru
1 State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigskii per., d. 10, str. 3;
2 Treatment and Rehabilitation Center of the Ministry of Health of the Russian Federation. 125367, Russian Federation, Moscow, Ivan'kovskoe sh., d. 3;
3 Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation. 123995, Russian Federation, Moscow, ul. Barrikadnaia, d. 2/1
*RMyasnikov@gnicpm.ru
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