DOI: https://doi.org/10.22263/2312-4156.2020.2.63
Zherko O.M.
Integrated diagnosis of global remodelling of the heart in diastolic dysfunction of the left ventricle
Belarusian Medical Academy of Post-Graduate Education, Minsk, Republic of Belarus
Vestnik VGMU. 2020;19(2):63-69.
Abstract.
Objectives. To develop criteria for the determination of global heart remodelling in diastolic dysfunction (DD) of the left ventricle (LV).
Material and methods. In 2017-2018 a clinical and instrumental examination of 303 patients aged 40-86 years was performed. Inclusion criteria: sinus rhythm, essential arterial hypertension, chronic ischemic heart disease, previous myocardial infarction, chronic heart failure. Exclusion criteria: primary mitral regurgitation, mitral stenosis, plastic surgery or mitral valve replacement, congenital heart disease. The level of the N-terminal pro-B type natriuretic peptide (NT-proBNP) was determined in the blood serum of patients. Transthoracic echocardiography was performed on the Siemens Acuson S1000 ultrasound machine (Germany).
Results. The LV myocardial mass index prognostic for LV DD is >124.0 g/m2. The predictive values for LV DD of type II are NT-pro BNP ˃311 pg/ml, peak ratio S/D≤0.97, systolic pulmonary vein filling fraction ≤57%, mean pulmonary capillary wedge pressure (PCWP)>11.51 mm Hg, pulmonary vascular resistance (PVR)>1.77 u. Wood, systolic pressure in the right ventricle (RV)>33.5 mm Hg. Prognostic for LV DD of type III are NT-proBNP>408 pg/ml, PCWP >13.68 mm Hg, PVR >1.77 u. Wood, RV systolic pressure > 41.2 mm Hg. NT-proBNP predictive values for elevated LV filling pressure at rest are ˃663 pg/ml, mean PCWP are ˃13.56 mm Hg.
Conclusions. The developed prognostic and diagnostic criteria of the heart global remodelling, interconnected with the development and progression of LV DD, will enable the increase of the sensitivity and specificity of the diagnosis of LV DD.
Key words: echocardiography, diastolic dysfunction, left ventricle, chronic heart failure, N-terminal pro-B type natriuretic peptide.
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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.
Correspondence address: Republic of Belarus, 220013, Minsk, 3-3 P. Brovki str., Belarusian Medical Academy of Post-Graduate Education, Chair of Ultrasound Diagnosis. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Olga М. Zherko.
