Title : Features of cardiac remodeling processes in patients with chronic heart failure depending on the degree of kidney dysfunction
Abstract:
Purpose of the study:
To study the features of cardiac remodeling depending on the degree of kidney dysfunction. Left ventricular ejection fraction (LVEF) in CHF with kidney dysfunction (KD).
Materials and methods of research:
A comprehensive examination of 150 patients with coronary heart disease (CHD) with functional class I-III and chronic heart failure (CHF) was carried out, assessing the clinical condition, exercise tolerance, left ventricular remodeling processes, and the functional state of the kidneys. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (38 patients), with FC II CHF (62 patients and with FC III CHF (50 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (group I patients with CHF I-III FC eGFRCKD-EPI≥6 ml/min/1.73m2 (n=81) Group II patients with CHF I-III FC eGFRCKD-EPI≥60 ml/min/1.73m2 (n=69) ). The average age of patients in group I was 58.77±0.94 years, in group II 61.3±0.68 years and 62.14±0.79 in group III patients.
Research results:
The results of the analysis of EchoCG indicators established the features of changes in the structural and geometric parameters of the heart and the functional state of the LV in patients with FC I-III CHF depending on eGFR. It was found that in patients of group II with eGFR≤60 ml/min/1.73 m2 there was a slight increase in LA size by 10.23% (p<0.001) in relation to group I and amounted to 3.36±0.04 versus 3.74 ±0.05cm.The progression of KD in patients with CHF is characterized by changes in the size of the LV. At the same time, group II of patients with eGFR≤60 ml/min/1.73 m2 differs from group I eGFR>60 ml/min/1.73 m2 in terms of the CFR value: 3.72±0.04 versus 4.1±0.05 (8 .44%; p<0.01). These changes in LV parameters were the reason for the increase in LVMM in the group of patients with eGFR≤60 ml/min/1.73 m2. There was a significant increase in LVMM by 10.25% (p <0.001) in relation to the data of group I with eGFR>60 ml/min/1.73 m2, respectively. At the same time, the parameters Ls - the longitudinal size of the LV, defined as the distance from the base of the papillary muscles to the apex of the heart in systole increased by 8.6% (p <0.01) and the parameter Ld by 6.02% and was not significant. Analysis of LV systolic function depending on the presence of renal dysfunction showed that the progression of KD severity is accompanied by an increase in LV volumetric parameters, pronounced structural changes, as well as the degree of LV dilatation. At the same time, in group II with eGFR≤60 ml/min/1.73 m2 there was an increase in EDV by 10.1% (p<0.001), ESV by 20.7% (p<0.001) in relation to the data of group I with eGFR> 60 ml/min/1.73m2. Further analysis of the parameters of LV systolic function (EF), as well as LV fractional shortening in systole (Fs%) showed that in group II these indicators had significant differences with group I. There was a significant difference in EF by 10.5% and 25.4% Fs% by 11.2% (p<0.001).
Conclusion:
Thus, the results of the study of EchoCG parameters indicate a significant contribution of the development of CHF to the progression of LV remodeling, deterioration of both systolic and diastolic function of the LV in patients with coronary artery disease. The results of the analysis of indicators of the sizes of the cavities of the LV and LA, as well as the walls of the LV, established the peculiarity of structural and geometric changes in the left parts of the heart in patients with CHF I-III FC. Patients with FC III CHF are characterized by more pronounced manifestations of cardiac remodeling and with a predominance of eccentric LVH, which undoubtedly should be reflected in the state of LV function. A comprehensive analysis of EchoCG indicators indicates that CHF contributes to a pronounced decrease in LV systolic function, another evidence of which is a decrease in EF.
