ASSOCIATION OF HYPERTENSIVE ENDOTHELIAL DYSFUNCTION WITH THE SEVERITY OF MYOCARDIAL DYSFUNCTION AND CHRONIC HEART FAILURE IN ELDERLY PATIENTS

Abstract

Objective. To determine the pathogenic conjugation of functional disorders of the endothelium with the severity of myocardial dysfunction and heart failure in hypertensive elderly patients. Design and methods. The study included 66 patients with hypertension (HTN) II and III stages of 60–74 years (mean age — 66,1 ± 0,5 years), and 26 age-matched people without heart disease. The following examination were performed: brachial artery dopplerography, echocardiography with doppler analysis of transmitral diastolic flow, evaluation of laboratory markers of subclinical inflammation, dyslipidemia, oxidative and nitrosative stress, tolerance to physical activity. Results. Mild and moderate severity of endothelial dysfunction (ED) in elderly HTN patients correlaes with diastolic myocardial disorders, confirmed in 70% patients. Severe endothelial lesions in 18% patients correspond to systolic myocardial dysfunction due to concentric myocardial remodeling, identified in 87,5%. The ED progression is characterized by activation of oxidative and nitrosative stress and loss of the antioxidant defense mechanisms, which accelerate death and desquamation of endothelial cells. Conclusions. Involutive reduction of the vascular endothelium functional properties is accompanied by the development of favorable cardiac remodeling and mild diastolic dysfunction. The progression of endothelial lesions in HTN is associated with the severity of myocardial dysfunction: mild or moderate endothelial functional disorders predominantly are associated with isolated diastolic disorders with prevalence of concentric left ventricular hypertrophy and heart failure NYHA II. Higher degree of ED is associated with systolic left ventricular dysfunction and higher functional class of chronic heart failure due to the concentric left ventricular remodeling.