scholarly journals Heart remodeling in elderly patients with isolated systolic arterial hypertension and chronic heart failure with preserved left ventricular ejection fraction

2021 ◽  
Vol 23 (3) ◽  
pp. 331-337
Author(s):  
S. O. Sheiko ◽  
N. O. Kolb
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Arterial Hypertension ◽  
Comparison Group ◽  
Left Ventricular ◽  
Main Group ◽  
Volume Index ◽  
Left Ventricular Ejection

The aim of the work was to study the structural and functional state of the left ventricle (LV) in elderly patients with isolated systolic arterial hypertension (ISAH) and chronic heart failure with preserved ejection fraction (CHF with PEF). Materials and methods. After receiving an informed consent, 134 elderly patients with ISAH were enrolled in the study. The main group included 91 patients aged 71.1 ± 3.5 years with ISAH and ejection fraction (EF) of the LV >50 % and a level of natriuretic peptide (NT-proBNP) >125 pg/ml. Among them, there were 61 women (67 %) and 30 (33 %) men. The comparison group consisted of 43 patients (27 women and 16 men aged 70.4 ± 3.7 years) with ISAH, LV EF >50% and NT-proBNP <125 pg/ml. The geometric changes of the LV were evaluated taking into account the LV myocardial mass index and the relative LV wall thickness. Results. Cardiac remodeling in elderly ISAH patients with CHF and PEF was represented by the following geometric variants of the LV. In the main group patients, concentric LV hypertrophy (LVH) prevailed – 73 (80.2 %) patients, while in the comparison group, concentric modeling (CR) – 25 (58.1 %) patients (P < 0.01 by criterion χ2). CR in the ISAH patients with CHF and PEF was diagnosed in 18 (19.8 %) cases. Concentric LVH was verified in 18 (41.9 %) patients of the comparison group (P < 0.01). It was determined that the hyperfunction of the left atrium (LA) in the patients with ISAH without CHF was compensatory. The maximum volume index of the LA (VILAmax.) in these patients was in the range of 27–32 ml/m2. Hyperfunction of the LA in the ISAH patients with CHF and PEF was accompanied by a statistically significant increase in VILAmax. over 34 ml/m2. Conclusions. The prevalence of ISAH among elderly patients is 35.6 %. The formation of a hypertensive heart in the ISAH patients with CHF and PEF is characterized by a predominant concentric LVH (80.2 %) and hyperfunction of the LA. A significant increase in the LA volumes testifies to increase in its contribution to the LV filling with the formation of LV diastolic dysfunction. The presence of concentric LVH and an increase in VILAmax. ≥34 ml/m2 is a criterion for identifying individuals at high and very high risk among elderly ISAH patients with CHF and PEF.

scholarly journals Arterial hypertension as a trigger for the development of cardiorenal failure in patients of different genders

2019 ◽  
Vol 34 (3) ◽  
pp. 114-121
Author(s):  
E. A. Lopina ◽  
N. P. Grishina ◽  
R. A. Libis
Keyword(s):  
Heart Failure ◽  
Glomerular Filtration Rate ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Arterial Hypertension ◽  
Glomerular Filtration ◽  
Cystatin C ◽  
Filtration Rate ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Aim. To study the peculiarities of changes in the functional state of the kidneys and heart muscle in patients with arterial hypertension.Materials and Methods. A total of 88 patients with arterial hypertension were included in the study. Chronic kidney disease was detected based on glomerular filtration rate, albuminuria, and cystatin levels in serum and urine. The stage of chronic heart failure was determined according to Strazhesko–Vasilenko classification with functional class according to NYHA; functional class of chronic heart failure was determined based on six-minute walking test. Patient inclusion criteria were the presence of essential hypertension of degree 1–3 and the age from 50 to 70 years. Patients underwent anthropometry, biochemical blood tests, six-minute walking test, and standard echocardiography.Results. Arterial hypertension of degree 1–2 was diagnosed in 50 patients including 33 women and 17 men. Grade 3 arterial hypertension was found in 38 patients (28 women and 10 men). Patients were divided into two groups according to gender. The groups with arterial hypertension degree 1–2 differed in their blood pressure levels. Echocardiography data showed the formation of heart failure with preserved ejection fraction. The groups differed in the values of left ventricular ejection fraction and end-systolic and end-diastolic sizes of the left ventricle. The levels of cystatin C in serum were elevated in both groups. The serum and urine creatinine levels and glomerular filtration rates differed between groups. Women had more significant decreases in the values of glomerular filtration rate, cystatin C, and urine creatinine. Correlation relationships were found between systolic blood pressure and glomerular filtration rate (r = 0.27, p < 0.05) and between systolic blood pressure and left ventricular back wall thickness (r = 0.41, p < 0.05). Inverse relationship was found between left ventricular ejection fraction and albuminuria (r = –0.31, p < 0.05). Cystatin C level had inverse relationship with glomerular filtration rate (r = –0.47, p < 0.05) and direct relationship with left ventricular myocardial mass index (r =  0.24, p  <  0.05).Discussion. Chronic kidney disease and chronic heart failure with preserved left ventricular ejection fraction were detected in patients at early stages. In the group of women, more pronounced changes in the renal and cardiac functions were found. Cystatin C is a marker of kidney function reduction and an alternative marker of chronic heart failure. The study showed that the level of cystatin C in blood serum of patients was increased, which correlated with the functional activities of the kidneys and the heart.Conclusion. In case of arterial hypertension in the presence of chronic kidney disease, the development of the left ventricular hypertrophy and heart failure with preserved ejection fraction was found. Women had more significant changes in the renal and cardiac functions compared with those in men. 

scholarly journals Growth-differentiation factor 15, N-terminal pro-brain natriuretic peptide, structural and functional changes of the heart in patients with heart failure and normal ejection fraction after myocardial infarction on the background of arterial hypertension

2014 ◽  
Vol 18 (1 (69)) ◽  
Author(s):  
V. D. Syvolap ◽  
Ya. V. Zemlianyi
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Arterial Hypertension ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Functional Changes ◽  
Patients With Heart Failure

Levels of GDF-15, NTproBNP, structural and functional changes of the heart were assessed in 69 patients with postinfarction cardiosclerosis and preserved left ventricular ejection fraction (EF>45 %). We found out that patients with heart failure and preserved ejection fraction after myocardial infarction on the background of arterial hypertension have increased levels of GDF 15 and NTproBNP. These biomarkers were correlated with left ventricular diastolic dysfunction and left atrial volume index.

scholarly journals Comparative Efficacy of Medical Treatments for Chronic Heart Failure: A Network Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
Boyang Xiang ◽  
Zongliang Yu ◽  
Xiang Zhou
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Current Evidence ◽  
Angiotensin Receptor ◽  
Medical Treatments

Background: The medical treatments of chronic heart failure have made remarkable progress in recent years. It is crucial to determine the optimal drug combination based on current evidence.Methods: A search of PubMed, EMBASE, and Cochrane CENTRAL databases was conducted for studies on angiotensin receptor-neprilysin inhibitors (ARNIs), sodium-glucose cotransporter 2 inhibitors (SGLT2is), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and ivabradine (IVA) between 1987 and 2021. The network meta-analysis was performed to compare the efficacy of drug therapies in heart failure with reduced ejection fraction (HFrEF).Results: Forty-eight randomized controlled trials (RCTs), which overall included 68,074 patients with HF and left ventricular ejection fraction (LVEF) ≤ 40%, were identified and included in the network meta-analysis. The efficacies of 13 intervention classes, including monotherapies or combinations of ACEI, ARB, ARNI, BB, MRA, SGLT2i, IVA, and placebo, on hospitalization for HF, cardiovascular mortality, and all-cause mortality were compared. Among the 13 included interventions, ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were found to be best in terms of all three outcomes. Compared with placebo, these three drug combinations were associated with significant reductions in the risk of all-cause death, cardiovascular mortality and hospitalization for HF.Conclusions: ARNI+BB+MRA, SGLT2i+ACEI+BB+MRA, and IVA+ACEI+BB+MRA were the top three therapies for patients with HFrEF. The increasing use of combinations of conventional and novel drugs contributed to progressive reductions in hospitalization and mortality in patients with HFrEF.

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