Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure

Abstract

Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period.
 The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period.
 Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender.
 Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling.
 Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well.