Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction
Chronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a...
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Zaporizhzhia State Medical and Pharmaceutical University
2021-03-01
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| Series: | Aktualʹnì Pitannâ Farmacevtičnoï ì Medičnoï Nauki ta Praktiki |
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| Online Access: | http://pharmed.zsmu.edu.ua/article/view/226853/226532 |
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| author | V. A. Lysenko M. S. Potapenko V. V. Syvolap |
| author_facet | V. A. Lysenko M. S. Potapenko V. V. Syvolap |
| author_sort | V. A. Lysenko |
| collection | DOAJ |
| description | Chronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a further increase in the number of cases of CHF with preserved left ventricular EF.
Despite the large number of studies dedicated to analyzing the features of structural and geometric remodeling of the heart, changes in the systolic and diastolic function of the ventricles in patients with CHF, this issue hasn’t been definitively resolved and needs further improvement.
The aim of the work – to investigate changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic origin with preserved LV EF.
Materials and methods. The study was included 43 patients (men – n = 19; women – n = 24) for CHF of ischemic origin with preserved LV EF, with sinus rhythm, stage II AB, II-IV FC for NYHA (main group), and 90 patients on coronary heart disease without signs of CHF (men – n = 40 (44.5 %); women – n = 50 (55.5 %)), (comparison group). Groups of patients were comparable in age, sex, height, weight, body surface area. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy).
Results. In patients with CHF preserved LV EF, the indicators prevailed: the size of the LA by 25 % (P = 0.005), the long axis of the LA by 11 % (P = 0.001), the LV EDV index of the LV by 13 % (P = 0.042), the LV mass index by 16 % (P = 0.013) according to the Penn Convention and (P = 0.004) the ASE. Eccentric left ventricular hypertrophy was diagnosed in 56 % of patients.
Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. In 72 % of cases, the type of “relaxation disorder” was established, and in 26 % – “pseudonormal” LV filling profile. In none of the cases was a “restrictive” LV filling profile recorded. The following indicators of left ventricular diastolic function were lower in patients with CHF: e’ of the medial fibrous ring of the mitral valve by 26 % (P = 0.0001) and e’ lateral by 21 % (P = 0.0001), and the A’ the medial fibrous ring of mitral valve by 9 % (P = 0.022), and greater ratios of velocities E/e’ medial by 41 % (P = 0.0001), and E/e’ lateral fibrous ring of the mitral valve by 28 % (P = 0.0001), mean E/e’ by 36 % (P = 0.0001), which indicates a significant increase in end-diastolic pressure in the left ventricle.
Conclusions. Structural and geometric remodeling of the heart in patients with CHF with preserved LV EF was characterized by dilatation of the left atrium, a moderate increase in the LV EDV index by 13 % (P = 0.042), a 16 % increase (P = 0.013) in the LV mass index, with the formation eccentric (56 %) and concentric (18 %) LV hypertrophy.
Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. Disorders of diastolic filling of the left ventricle (72 % “relaxation disorder” and 26 % “pseudonormal” type) were occurred due to an increase in end-diastolic pressure in the left ventricle (increase by 41 % (P = 0.0001) ratio E/e’ medial fibrous ring MK), in LA (increase of more than 2 times (P = 0.0001) pulmonary capillary wedge pressure), and was accompanied by the development of postcapillary pulmonary hypertension (increase by 34 % (P = 0.0001) systolic pressure in the pulmonary artery).
Despite the preserved LV EF, patients with CHF had significantly lower left and right ventricular contractility (10 % MAPSE med (P = 0.031), 18 % S med (P = 0.001) and 19 % (P = 0.007) RV EF). |
| format | Article |
| id | doaj-art-25efa3cb32f14d7cb7dd0e38047217c9 |
| institution | DOAJ |
| issn | 2306-8094 2409-2932 |
| language | English |
| publishDate | 2021-03-01 |
| publisher | Zaporizhzhia State Medical and Pharmaceutical University |
| record_format | Article |
| series | Aktualʹnì Pitannâ Farmacevtičnoï ì Medičnoï Nauki ta Praktiki |
| spelling | doaj-art-25efa3cb32f14d7cb7dd0e38047217c92025-08-20T03:15:05ZengZaporizhzhia State Medical and Pharmaceutical UniversityAktualʹnì Pitannâ Farmacevtičnoï ì Medičnoï Nauki ta Praktiki2306-80942409-29322021-03-011419310210.14739/2409-2932.2021.1.226853Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fractionV. A. Lysenko0M. S. Potapenko1V. V. Syvolap2https://orcid.org/0000-0001-9865-4325Zaporizhzhia State Medical University, UkraineZaporizhzhia State Medical University, UkraineZaporizhzhia State Medical University, UkraineChronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a further increase in the number of cases of CHF with preserved left ventricular EF. Despite the large number of studies dedicated to analyzing the features of structural and geometric remodeling of the heart, changes in the systolic and diastolic function of the ventricles in patients with CHF, this issue hasn’t been definitively resolved and needs further improvement. The aim of the work – to investigate changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic origin with preserved LV EF. Materials and methods. The study was included 43 patients (men – n = 19; women – n = 24) for CHF of ischemic origin with preserved LV EF, with sinus rhythm, stage II AB, II-IV FC for NYHA (main group), and 90 patients on coronary heart disease without signs of CHF (men – n = 40 (44.5 %); women – n = 50 (55.5 %)), (comparison group). Groups of patients were comparable in age, sex, height, weight, body surface area. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. In patients with CHF preserved LV EF, the indicators prevailed: the size of the LA by 25 % (P = 0.005), the long axis of the LA by 11 % (P = 0.001), the LV EDV index of the LV by 13 % (P = 0.042), the LV mass index by 16 % (P = 0.013) according to the Penn Convention and (P = 0.004) the ASE. Eccentric left ventricular hypertrophy was diagnosed in 56 % of patients. Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. In 72 % of cases, the type of “relaxation disorder” was established, and in 26 % – “pseudonormal” LV filling profile. In none of the cases was a “restrictive” LV filling profile recorded. The following indicators of left ventricular diastolic function were lower in patients with CHF: e’ of the medial fibrous ring of the mitral valve by 26 % (P = 0.0001) and e’ lateral by 21 % (P = 0.0001), and the A’ the medial fibrous ring of mitral valve by 9 % (P = 0.022), and greater ratios of velocities E/e’ medial by 41 % (P = 0.0001), and E/e’ lateral fibrous ring of the mitral valve by 28 % (P = 0.0001), mean E/e’ by 36 % (P = 0.0001), which indicates a significant increase in end-diastolic pressure in the left ventricle. Conclusions. Structural and geometric remodeling of the heart in patients with CHF with preserved LV EF was characterized by dilatation of the left atrium, a moderate increase in the LV EDV index by 13 % (P = 0.042), a 16 % increase (P = 0.013) in the LV mass index, with the formation eccentric (56 %) and concentric (18 %) LV hypertrophy. Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. Disorders of diastolic filling of the left ventricle (72 % “relaxation disorder” and 26 % “pseudonormal” type) were occurred due to an increase in end-diastolic pressure in the left ventricle (increase by 41 % (P = 0.0001) ratio E/e’ medial fibrous ring MK), in LA (increase of more than 2 times (P = 0.0001) pulmonary capillary wedge pressure), and was accompanied by the development of postcapillary pulmonary hypertension (increase by 34 % (P = 0.0001) systolic pressure in the pulmonary artery). Despite the preserved LV EF, patients with CHF had significantly lower left and right ventricular contractility (10 % MAPSE med (P = 0.031), 18 % S med (P = 0.001) and 19 % (P = 0.007) RV EF).http://pharmed.zsmu.edu.ua/article/view/226853/226532heart failureejection fractioncardiac remodeling |
| spellingShingle | V. A. Lysenko M. S. Potapenko V. V. Syvolap Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction Aktualʹnì Pitannâ Farmacevtičnoï ì Medičnoï Nauki ta Praktiki heart failure ejection fraction cardiac remodeling |
| title | Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| title_full | Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| title_fullStr | Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| title_full_unstemmed | Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| title_short | Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| title_sort | features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction |
| topic | heart failure ejection fraction cardiac remodeling |
| url | http://pharmed.zsmu.edu.ua/article/view/226853/226532 |
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