Objective. To develop structural and hemodynamic criteria of the chronic heart failure (CHF) progression at an elevated left ventricle (LV) filling pressure at rest.
Materials and methods. In 2017—2018, a clinical and instrumental examination of 246 patients aged 40—86 years was performed. Criteria for inclusion in the study were the following: presence of sinus rhythm, essential arterial hypertension, chronic ischemic heart disease, previous left ventricular myocardial infarction, CHF. Transthoracic echocardiography was performed by a Siemens Acuson S1000 ultrasound machine (Germany).
Results. Elevated LV filling pressure at rest is a hemodynamic mechanism of progressing CHF associated with LV diastolic dysfunction type II and III and with the LV systolic dysfunction. It is characterized by structural remodeling of the heart: the stiffness of the LV myocardium is 0.26 mm Hg/ml (sensitivity 91.5%, specificity 60.6%), the LV myocardium mass index 139.8 g/m2 (sensitivity 64.9%, specificity 77.0%), the LV systolic volume 53.4 ml (sensitivity 76.3%, specificity 73.8%). The indicators of the elevated LV filling pressure at rest are: the ratio S2/D in the pulmonary veins £0.78 (sensitivity 73.7%, specificity 80.0%), the systolic blood flow fraction in the pulmonary veins £43% (sensitivity 50.0%, specificity 100.0%). An elevated LV filling pressure at rest is a hemodynamic mechanism for the increased of pulmonary capillary wedge pressure more than 13.56 mm Hg (sensitivity 78.8%, specificity 98.8%, predictive value — 99.9%), for development of post-capillary pulmonary hypertension and right ventricular systolic dysfunction.
Conclusion. The elevated LV filling pressure at rest is an important echocardiographic, hemodynamic marker of the CHF progression.Ключевые слова:
Автор(ы): O. M. Zherko