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
Keywords:heart failure, ejection fraction, cardiac remodeling
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).
Khatibzadeh, S., Farzadfar, F., Oliver, J., Ezzati, M., & Moran, A. (2013). Worldwide risk factors for heart failure: a systematic review and pooled analysis. International journal of cardiology, 168(2), 1186-1194. https://doi.org/10.1016/j.ijcard.2012.11.065
van Riet, E. E., Hoes, A. W., Wagenaar, K. P., Limburg, A., Landman, M. A., & Rutten, F. H. (2016). Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. European journal of heart failure, 18(3), 242-252. https://doi.org/10.1002/ejhf.483
Andersson, C., & Vasan, R. S. (2014). Epidemiology of heart failure with preserved ejection fraction. Heart failure clinics, 10(3), 377-388. https://doi.org/10.1016/j.hfc.2014.04.003
Ashcheulova, T. V., Demydenko, H. V., Herasymchuk, N. M., Rezunenko, Yu. K., Kochubiei, O. A., & Ambrosova, T. M. (2019). Diastolic dysfunction: from the discovery to the latest updates. Zaporozhye medical journal, 21(4), 538-545. https://doi.org/10.14739/2310-1210.2019.4.173358
Hoffmann, S., Jensen, J. S., Iversen, A. Z., Sogaard, P., Galatius, S., Olsen, N. T., Bech, J., Fritz-Hansen, T., Biering-Sorensen, T., Badskjaer, J., Pietersen, A., & Mogelvang, R. (2012). Tissue Doppler echocardiography improves the diagnosis of coronary artery stenosis in stable angina pectoris. European heart journal cardiovascular Imaging, 13(9), 724-729. https://doi.org/10.1093/ehjci/jes001
Dokainish, H., Nguyen, J. S., Bobek, J., Goswami, R., & Lakkis, N. M. (2011). Assessment of the American Society of Echocardiography-European Association of Echocardiography guidelines for diastolic function in patients with depressed ejection fraction: an echocardiographic and invasive haemodynamic study. European journal of echocardiography, 12(11), 857-864. https://doi.org/10.1093/ejechocard/jer157
Borlaug, B. A. (2014). The pathophysiology of heart failure with preserved ejection fraction. Nature reviews. Cardiology, 11(9), 507-515. https://doi.org/10.1038/nrcardio.2014.83
Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. European heart journal cardiovascular Imaging, 16(3), 233-270. https://doi.org/10.1093/ehjci/jev014
Kane, G. C., Karon, B. L., Mahoney, D. W., Redfield, M. M., Roger, V. L., Burnett, J. C., Jr, Jacobsen, S. J., & Rodeheffer, R. J. (2011). Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA, 306(8), 856-863. https://doi.org/10.1001/jama.2011.1201
Voronkov, L. H., Amosova, K. M., Dziak, H. V., Zharinov, O. Y., Kovalenko, V. M., Korkushko, O. V., Nesukai, O. H., Parkhomenko, O. M., Rudyk, Yu. S., & Sychov, O. S. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti (2017) [Recommendation of Association of Cardiologists of Ukraine for the treatment of chronic heart failure in adults (2017)]. Kyiv. [in Ukranian].
WRITING COMMITTEE MEMBERS, Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Jr, Colvin, M. M., Drazner, M. H., Filippatos, G., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2016). 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 134(13), e282-e293. https://doi.org/10.1161/CIR.0000000000000435
Gaasch, W. H., & Zile, M. R. (2011). Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. Journal of the American College of Cardiology, 58(17), 1733-1740. https://doi.org/10.1016/j.jacc.2011.07.022
Ma, C., Luo, H., Fan, L., Liu, X., & Gao, C. (2020). Heart failure with preserved ejection fraction: an update on pathophysiology, diagnosis, treatment, and prognosis. Brazilian journal of medical and biological research, 53(7), e9646. https://doi.org/10.1590/1414-431X20209646
Smith, D. H., Thorp, M. L., Gurwitz, J. H., McManus, D. D., Goldberg, R. J., Allen, L. A., Hsu, G., Sung, S. H., Magid, D. J., & Go, A. S. (2013). Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study. Circulation. Cardiovascular quality and outcomes, 6(3), 333-342. https://doi.org/10.1161/CIRCOUTCOMES.113.000221
Edwards, N. C., Ferro, C. J., Townend, J. N., & Steeds, R. P. (2008). Aortic distensibility and arterial-ventricular coupling in early chronic kidney disease: a pattern resembling heart failure with preserved ejection fraction. Heart, 94(8), 1038-1043. https://doi.org/10.1136/hrt.2007.137539
Tabakovich-Vatseba, V. O. (2017). Rol kardiotropnykh autoantytil v prohnozuvanni rozvytku systolichnoyi dysfunktsiyi livoho shlunochka ta otsintsi efektyvnosti zastosuvannya beta-adrenoblokatoru u khvorykh na ikhs pokhyloho viku (Author's ref. dis. cand. honey. education: 14.01.11) [The role of cardiotropic autoantibodies in predicting the development of left ventricular systolic dysfunction and assessing the effectiveness of beta-blockers in patients with coronary heart disease in the elderly (Abstract of Doctoral Dissertation)]. Shupyk National Medical Academy of Postgraduate Education, Kyiv. [in Ukrainian].
Velagaleti, R. S., Gona, P., Pencina, M. J., Aragam, J., Wang, T. J., Levy, D., D'Agostino, R. B., Lee, D. S., Kannel, W. B., Benjamin, E. J., & Vasan, R. S. (2014). Left ventricular hypertrophy patterns and incidence of heart failure with preserved versus reduced ejection fraction. The American journal of cardiology, 113(1), 117-122. https://doi.org/10.1016/j.amjcard.2013.09.028
Lam, C. S., Roger, V. L., Rodeheffer, R. J., Bursi, F., Borlaug, B. A., Ommen, S. R., Kass, D. A., & Redfield, M. M. (2007). Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota. Circulation, 115(15), 1982-1990. https://doi.org/10.1161/CIRCULATIONAHA.106.659763
Shah, A. M. (2013). Ventricular remodeling in heart failure with preserved ejection fraction. Current heart failure reports, 10(4), 341-349. https://doi.org/10.1007/s11897-013-0166-4
Gori, M., Senni, M., Gupta, D. K., Charytan, D. M., Kraigher-Krainer, E., Pieske, B., Claggett, B., Shah, A. M., Santos, A. B., Zile, M. R., Voors, A. A., McMurray, J. J., Packer, M., Bransford, T., Lefkowitz, M., Solomon, S. D., & PARAMOUNT Investigators (2014). Association between renal function and cardiovascular structure and function in heart failure with preserved ejection fraction. European heart journal, 35(48), 3442-3451. https://doi.org/10.1093/eurheartj/ehu254
Breitling, S., Ravindran, K., Goldenberg, N. M., & Kuebler, W. M. (2015). The pathophysiology of pulmonary hypertension in left heart disease. American journal of physiology. Lung cellular and molecular physiology, 309(9), L924-L941. https://doi.org/10.1152/ajplung.00146.2015
Meijers, W. C., van der Velde, A. R., & de Boer, R. A. (2016). Biomarkers in heart failure with preserved ejection fraction. Netherlands heart journal, 24(4), 252-258. https://doi.org/10.1007/s12471-016-0817-7
Gorter, T. M., Hoendermis, E. S., van Veldhuisen, D. J., Voors, A. A., Lam, C. S., Geelhoed, B., Willems, T. P., & van Melle, J. P. (2016). Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. European journal of heart failure, 18(12), 1472-1487. https://doi.org/10.1002/ejhf.630
Naeije, R., Vachiery, J. L., Yerly, P., & Vanderpool, R. (2013). The transpulmonary pressure gradient for the diagnosis of pulmonary vascular disease. The European respiratory journal, 41(1), 217-223. https://doi.org/10.1183/09031936.00074312
Obokata, M., Reddy, Y., Melenovsky, V., Pislaru, S., & Borlaug, B. A. (2019). Deterioration in right ventricular structure and function over time in patients with heart failure and preserved ejection fraction. European heart journal, 40(8), 689-697. https://doi.org/10.1093/eurheartj/ehy809
How to Cite
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access)