Objective: 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).
Material and methods: 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.
Results: 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.
Conclusions: 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.
Meta doslidzhennia poliagala u vyvchenni v uchasnykiv likvidatsiï naslidkiv avariï (ULNA) na Chornobyl's'kiy̆ atom niy̆ elektrostantsiï (ChAES) dynamiky rozvytku zakhvoriuvan' systemy krovoobigu za 30 richnyy̆ period pislia op rominennia, zminy stanu systolichnoï funktsiï livogo shlunochka (LSh) sertsia ta osoblyvosti y̆ogo remodeliuvannia. Materialy ta metody. Obstezheno 144 ULNA na ChAES, vkliuchaiuchy 52 khvorykh, iaki perenesly gostru promenevu khvorobu (GPKh) 1–3 st. tiazhkosti, ta 105 osib kontrol'noï grupy (KG). ULNA buly rozpodileni na dvi pidgrupy: bez oznak GPKh (GPKh0) ta ti, shcho perenesly GPKh 1–3 stupenia tiazhkosti (GPKh). Vsi obstezheni buly cholovikamy, iaki do po chatku avariï na ChAES ne maly oznak sertsevo sudynnoï, nervovoï, legenevoï abo endokrynnoï patologiï. Ïkh se redniy̆ vik na pochatok avariï buv 33,9–37,7 rokiv. V programu doslidzhennia vkhodyly klinichne obstezhennia, ekho kardiografiia, retrospektyvnyy̆ ta statystychnyy̆ analiz.Rezul'taty. V ULNA, vkliuchaiuchy rekonvalestsentiv GPKh, gipertonichna khvoroba (GKh) rozvynulas' na 12 rokiv, a ishemichna khvoroba sertsia (IKhS) na 9–11 rokiv virogidno ranishe, nizh sered porivniannykh za vikom neoprominenykh patsiientiv. V pisliaavariy̆nomu periodi vidmichalosia zbil'shennia serednikh pokaznykiv tovshchyny zadn'oï stinky LSh (ZSLSh), mizhshlunochkovoï peretynky (MShP), masy miokarda ta indeksu masy miokarda, iaki zrostaly zi zbil'shen niam tryvalosti zakhvoriuvannia na GKh. Za 30 richniy̆ period sposterezhennia sered ULNA i osib KG vyiavleno vid 14,3 do 28,6 % patsiientiv zi zbil'shenniam ob’iemiv LSh, v iakykh bula znyzhena fraktsiia vykydu (FV), shcho svidchylo pro roz vytok systolichnoï dysfunktsiï LSh z iavyshchamy livoshlunochkovoï sertsevoï nedostatnosti (SN). Znyzhennia FV z bil' shoiu statystychnoiu syloiu koreliuvalo zi zbil'shenniam kintsevo systolichnogo ob’iemu (KSO).Sered ULNA i osib KG vid 77,3 do 84,8 % khvorykh maly klinichni oznaky SN pry zberezhenoï FV. Z ts'ogo chysla v 56–63,6 % patsiientiv spos terigalasia kontsentrychna, a v 18,8–26,7 % – ekstsentrychna gipertrofiia LSh (GLSh), v 6,1–15,6 % khvorykh bula nor mal'na geometriia LSh abo y̆ogo kontsentrychne remodeliuvannia.Vysnovky. ULNA ta neopromineni osoby virogidno rozriznialysia mizh soboiu za chasom vynyknennia v nykh GKh ta IKhS, iaki ranishe rozvyvalysia v ULNA, vkliuchaiuchy rekonvalestsentiv GPKh. Zminy strukturno funktsional'nogo stanu miokarda LSh v protsesi tryvalogo sposterezhennia ne maly virogidnykh vidminnostey̆ mizh ULNA ta neopromineny my osobamy i poliagaly v potovshchenni ZSLSh i MShP, shcho obumovliuvalo rozvytok GLSh. V ULNA ta osib KG dominu vala kontsentrychna GLSh. Systolichna dysfunktsiï LSh zi znyzhenniam FV ta zbil'shenniam KSO v klinichnomu plani kha rakteryzuvalas' livoshlunochkovoiu SN. Sered ULNA i osib KG z klinichnymy oznakamy SN zi zberezhenoï FV, bil'sh polovyny patsiientiv maly oznaky kontsentrychnoï gipertrofiï.
Keywords: clean up workers of the accident at the Chernobyl nuclear power plant; coronary heart disease; hypertensive heart disease; ionizing radiation; left ventricular systolic dysfunction; myocardial hypertrophy.
O. D. Bazyka, D. O. Belyi.