Zherko O.M.1, Shkrebneva E.I.2
Ultrasonic diagnosing of the left ventricle remodelling in chronic heart failure with preserved ejection fraction
1Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
2Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology, Minsk, Republic of Belarus
Vestnik VGMU. 2020;19(2):70-77.
Objectives. To develop comprehensive ultrasound criteria of the left ventricle (LV) remodelling in chronic heart failure with preserved ejection fraction (HFpEF).
Material and methods. In 2017-2019, a clinical and instrumental study of 246 patients aged 71 [64; 78] years was performed on the basis of the First City Clinical Hospital in Minsk, and 88 patients aged 64 [58; 70] years were studied on the basis of Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology. Criteria for inclusion in the study: sinus rhythm, essential arterial hypertension, chronic coronary heart disease, past myocardial infarction, after which at least six months have passed, CHF. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or prosthetics, congenital heart defects, acute and chronic diseases of the kidneys, lungs. Echocardiography and 2D Speckle Tracking were performed on ultrasonic devices Siemens Acuson S1000 (Germany), Vivid E9 (GE Healthcare, USA).
Results. Structural and functional abnormalities of the left ventricle (LV) related to the development of HFpEF are LV diastolic dysfunction (DD) of types I and II, LV operative stiffness >0.19 mm Hg/ml, LV myocardial mass indices for men ˃124.8 g/m2, for women ˃109.6 g/m2, peak velocities s′septal≤8 cm/s, s′lateral≤9 cm/s, associated with the severity of DD and increased LV filling pressure indices, LV early diastolic filling indices E/е′septal>7.72, Е/е′lateral>6.4, Е/е′average>5.67, peak velocities е′septal≤7 cm/s, е′lateral≤8 cm/s. Anomalies of segmental and global LV systolic strain are predictive for HFpEF: LV mechanical dispersion index ˃54.69 ms, delta time to LV peak longitudinal strain ˃136 ms, LV global post-systolic index ˃5.24%, global peak systolic strain rate ˃-1,1 s-1, LV global peak longitudinal displacement ≤10.18 mm, LV EF/GLSAvg ratios≤-3.37.
Conclusions. The leading pathofunctional anomalies that are interconnected with the development of HFpEF are LV diastolic dysfunction, mechanical dispersion and dyssynergia.
Key words: transthoracic echocardiography, 2D Speckle Tracking echocardiography, chronic heart failure with preserved ejection fraction, left ventricle, diastolic dysfunction.
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Information about authors:
Zherko O.M. – Candidate of Medical Sciences, associate professor, head of the Chair of Ultrasound Diagnosis, Belarusian Medical Academy of Post-Graduate Education;
Shkrebneva E.I. – head of the Department of Physiologic Diagnosis, Minsk Scientific - Practical Center of Surgery, Transplantation and Hematology.