ELEVATED FILLING PRESSURE OF LEFT VENTRICLE AS HEMODYNAMIC MECHANISM OF PROGRESSION OF CHRONIC HEART FAILURE

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.

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Автор(ы): O. M. Zherko