Abstract
Objective: to evaluate the structural and functional state of the right cardiac cavities in acute left ventricular myocardial infarction and in progressive chronic heart failure (CHF) in patients with coronary heart disease. Materials and methods. 20 patients with acute myocardial infarction and 48 with postinfarct cardiosclerosis with NYHA functional classes I to IV CHF were examined. The structural and functional state of the right heart was evaluated in progressive left ventricular systolic and diastolic dysfunction by echocardiography. Results. In the acute period of infarction, remodeling processes occur in the left ventricle, with normal postload values, volumetric indices and right ventricular contractility are in the normal range. There is right cardiac dilatation at the early stage of left ventricular systolic and diastolic dysfunction in postinfarct remodeling and evolving CHF, normal pulmonary arterial and right atrial pressures. With a significant reduction in left ventricular contractility and its pronounced filling impairment, increases in post- and preload for the right ventricle occur with a just considerable change in its structural and functional state. Conclusion. In impaired myocardial relaxation in the presence of CHF, remodeling of the right cardiac cavities takes place without the influence of a hemodynamic factor. There is a close relationship of remodeling of both ventricles from the very early CHF stages, which suggests that there are common pathogenetic mechanisms responsible for the development of myocardial dysfunction.
Highlights
Research Institute of General Reanimatology, Russian Academy of Medical Sciences, Moscow Novokuznetsk Institute of Postgraduate Education, Russian Committee of Health Care, Novokuznetsk
In the acute period of infarction, remodeling processes occur in the left ventricle, with normal postload values, volumetric indices and right ventricular contractility are in the normal range
There is a close relationship of remodeling of both ventricles from the very early chronic heart failure (CHF) stages, which suggests that there are common pathogenetic mechanisms responsible for the development of myocardial dysfunction
Summary
ГУ НИИ общей реаниматологии РАМН, Москва 1 ГОУ ДПО «Новокузнецкий ГИУВ Росздрава», Новокузнецк. Оценить структурно функциональное состояние правых отделов сердца в острый период инфарк та миокарда левого желудочка и при прогрессировании хронической сердечной недостаточности (ХСН) у больных ИБС. Оценивали структурно функциональное со стояние правых отделов сердца при прогрессировании систоло диастолической дисфункции левого желудочка мето дом эхокардиографии. На начальной стадии систоло диастолической дисфункции левого желудочка при постинфарктном ремоделировании и развитии ХСН, нормальном давлении в легочной артерии и правом предсердии от мечается дилатация правых отделов сердца. Objective: to evaluate the structural and functional state of the right cardiac cavities in acute left ventricular myocardial infarction and in progressive chronic heart failure (CHF) in patients with coronary heart disease. К основным механизмам поражения правого же лудочка (ПЖ) у пациентов с ишемической болезнью сердца (ИБС) относится нарушение коронарного кро вообращения и повышение миокардиального стресса на стенку вследствие увеличения постнагрузки при систо ло диастолической дисфункции левого желудочка (ЛЖ). Таблица 1 Клинические, структурно геометрические показатели состояния левых отделов сердца и системной гемодинамики у больных с острым инфарктом и с ХСН (М±m)
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