DOI: https://doi.org/10.22263/2312-4156.2022.1.75
Zherko O.M.1, Mikhaylov A.N.1, Shkrebneva E.I.2
New algorithm for determining the remodelling of the heart 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. 2022;21(1):75-87.
Abstract.
Objectives. To develop an algorithm for determining the remodelling of the heart in chronic heart failure with preserved ejection fraction (HFpEF).
Material and methods. In 2017-2019, on the basis of the Healthcare Institution «1st City Clinical Hospital» in Minsk, a one-stage (cross-sectional) comparative clinical and instrumental study of a stratified random sample consisting of 175 patients aged 71.0 (64.0; 78.0) years was performed. In 2019-2021, the State Institution «Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology» performed an independent reproductive (examination) clinical and instrumental study of a stratified random sample, which included 129 patients aged 64.5 (58.0; 70.0) years. Criteria for inclusion in the study: sinus rhythm; essential arterial hypertension; chronic ischemic heart disease; HFpEF; the presence of voluntary informed consent of the patient to participate in the study. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or replacement, congenital heart defects, cardiomyopathies, acute and chronic respiratory diseases. Echocardiography and 2D Speckle Tracking were performed using ultrasound devices Siemens Acuson S1000 (Germany), Vivid E9 (GE Healthcare, USA).
Results. An algorithm for determining heart remodelling in HFpEF is based on the concept of a comprehensive, targeted echocardiographic assessment of the leading risk factors, pathofunctional mechanisms of the heart failure development, structural, functional abnormalities, intracardiac and pulmonary hemodynamics, contains scientifically based ultrasound signs characterized by high diagnostic efficiency. The application of the 2D Speckle Tracking echocardiography technology in the algorithm is aimed at determining subthreshold systolic ventricular dysfunction, mechanical dispersion and myocardial dyssynergy.
Conclusions. The developed algorithm for determining heart remodelling in HFpEF is characterized by reproducibility and high accuracy (93.8%), as has been shown in an independent examination sample, which makes it possible to recommend its practical use in the clinical and instrumental determination of HFpEF.
Key words: echocardiography, 2D Speckle Tracking, chronic heart failure with preserved ejection fraction, heart remodelling, scoring scale, algorithm.
Acknowledgements. The authors express their gratitude to the head of the cardiology department No. 3 of the Healthcare Institution «1st City Clinical Hospital» in Minsk Oliferko N.P. for enabling the participation of patients in the research and their treatment, as well as to anonymous reviewers of this article.
References
1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep;42(36):3599-3726. doi: http://dx.doi.org/10.1093/eurheartj/ehab368
2. Ostrovskii IuP, Valentiukevich AV, Ilina TV, Koliadko MG, Kurlianskaia EK, Ostrovskii AIu, i dr, Ostrovskii IuP red; Nats akad nauk Belarusi. Cardiac insufficiency. Minsk, RB: Belarus navuka; 2016. 503 р. (In Russ.)
3. Pieske B, Tschöpe C, de Boer RA, Fraser AG, Anker SD, Donal E, et al. How to diagnose heart failure with preserved ejection fraction: the HFA–PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019 Oct;40(40):3297-3317. doi: http://dx.doi.org/10.1093/eurheartj/ehz641
4. Lourenço AP, Leite-Moreira AF, Balligand J-L, Bauersachs J, Dawson D, de Boer RA, et al. An integrative translational approach to study heart failure with preserved ejection fraction: a position paper from the Working Group on Myocardial Function of the European Society of Cardiology. Eur J Heart Fail. 2018 Feb;20(2):216-227. doi: http://dx.doi.org/10.1002/ejhf.1059
5. Doherty JU, Kort S, Mehran R, Schoenhagen P, Soman P, Members RP, et al. ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/ SCCT/SCMR/STS 2019 Appropriate Use Criteria for Multimodality Imaging in the Assessment of Cardiac Structure and Function in Nonvalvular Heart Disease. A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and the Society of Thoracic Surgeons. J Am Soc Echocardiogr. 2019 May;32(5):553-579. doi: http://dx.doi.org/10.1016/j.echo.2019.01.008
6. Otto CМ, ed. The practice of clinical echocardiography. 5th ed. Philadelphia, Pennsylvania: Elsevier; 2017. 965 р.
7. Garcia MJ, Firstenberg MS, Greenberg NL, Smedira N, Rodriguez L, Prior D, et al. Estimation of left ventricular operating stiffness from Doppler early filling deceleration time in humans. Am J Physiol Heart Circ Physiol. 2001 Feb;280(2):H554-61. doi: http://dx.doi.org/10.1152/ajpheart.2001.280.2.H554
8. Marino P, Little WC, Rossi A, Barbieri E, Anselmi M, Destro G, et al. Can left ventricular diastolic stiffness be measured noninvasively? J Am Soc Echocardiogr. 2002 Sep;15(9):935-43. doi: http://dx.doi.org/10.1067/mje.2002.121196
9. Zherko OM. Ultrasound markers of chronic heart failure with preserved left ventricular ejection fraction. Kardiologiia Belarusi. 2020;12(3):330-41. (In Russ.)
10. Zherko OM, Shkrebneva EI. Ultrasound Imaging of Left Ventricular Remodeling in Chronic Heart Failure with Preserved Ejection Fraction. Vestn VGMU. 2020;19(2):70-7. (In Russ.)
11. Zherko OM, Shkrebneva EI. 2D Speckle Tracking Echocardiography in the Prediction of Chronic Heart Failure with Preserved Ejection Fraction. Lecheb Delo. 2020;(4):30-35. (In Russ.)
12. Zherko OM, Mikhailov AN, Shkrebneva EI. Mechanical dispersion and myocardial dissynergy as pathofunctional mechanisms of chronic heart failure. Lecheb Delo. 2021;(3):24-8. (In Russ.)
13. Zherko OM, Shkrebneva EI. New Risk Scale for Establishing Chronic Heart Failure with Preserved Ejection Fraction. Med Vizualizatsiia. 2021;25(3):83-96. (In Russ.)
14. Mareev VIu, Fomin IV, Ageev FT, Begrambekova IuL, Vasiuk IuA, Garganeeva AA, i dr. Clinical guidelines of OSHA - RCO - RNMOT. Heart failure: chronic (CHF) and acute decompensated (AODN). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(S6):8-158. (In Russ.)
15. Mitkovskaia NP, Nizhnikova OG, Statkevich TV, Pateiuk IV, Balysh EM, Pinchuk AF. Pathogenetic aspects of postinfarction myocardial remodeling. Med Zhurn. 2013;(1):12-8. (In Russ.)
16. de Boer RA, De Keulenaer G, Bauersachs J, Brutsaert D, Cleland JG, Diez J, et al. Towards better definition, quantification and treatment of fibrosis in heart failure. A scientific roadmap by the Committee of Translational Research of the Heart Failure Association (HFA) of the European Society of Cardiology. Eur J Heart Fail. 2019 Mar;21(3):272-285. doi: http://dx.doi.org/10.1002/ejhf.1406
17. Triposkiadis F, Butler J, Abboud FM, Armstrong PW, Adamopoulos S, Atherton JJ, et al. The continuous heart failure spectrum: moving beyond an ejection fraction classification. Eur Heart J. 2019 Jul;40(26):2155-2163. doi: http://dx.doi.org/10.1093/eurheartj/ehz158
18. Ovchinnikov AG, Ageev FT, Alekhin MN, Belenkov IuN, Vasiuk IuA, Galiavich AS, i dr. Diastolic transthoracic stress-echocardiography with metered exercise in the diagnosis of heart failure with preserved ejection fraction: indications, methodology, interpretation of results. Ul'trazvukovaia Funktsion Diagnostika. 2020;(2):60-90. (In Russ.)
19. Reddy YNV, Carter RE, Obokata M, Redfield MM, Borlaug BA. A Simple, Evidence-Based Approach to Help Guide Diagnosis of Heart Failure With Preserved Ejection Fraction. Circulation. 2018 Aug;138(9):861-870. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.118.034646
20. Segar MW, Patel KV, Berry JD, Grodin JL, Pandey A. Generalizability and Implications of the H2FPEF Score in a Cohort of Patients With Heart Failure With Preserved Ejection Fraction. Circulation. 2019 Apr;139(15):1851-1853. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.118.039051
21. Sanders-van Wijk S, Aizpurua AB, Brunner-La Rocca H-P, Henkens MTHM, Weerts J, Knackstedt C, et al. The HFA‐PEFF and H2FPEF scores largely disagree in classifying patients with suspected heart failure with preserved ejection fraction. Eur J Heart Fail. 2021 May;23(5):838-840. doi: http://dx.doi.org/10.1002/ejhf.2019
22. Ho JE, Zern EK, Wooster L, Bailey CS, Cunningham T, Eisman AS, et al. Differential Clinical Profiles, Exercise Responses and Outcomes Associated with Existing HFpEF Definitions. Circulation. 2019 Jul;140(5):353-365. doi: http://dx.doi.org/10.1161/CIRCULATIONAHA.118.039136
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,
ORCID: https://orcid.org/0000-0001-5752-0988
Mikhaylov A.N. – Doctor of Medical Sciences, professor, academician of the National Academy of Sciences of Belarus, head of the Chair of Radiation 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.
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.
