Endothelial function, systemic inflammation and cardiac hemodynamics in different age patients with post infarction chronic heart failure.

Abstract

Heart failure (HF) is a major cause of morbidity and mortality. After myocardial infarction, physiological and anatomical ventricular changes occur, There is also an inflammatory reaction with release of cytokines, growth factors and reactive oxygen species production, which contributes to perpetuate ventricular dysfunction. The study was designed to evaluate the level of inflammatory markers (white blood cells and C-reactive protein), endothelial function and cardiac hemodynamic in different age patients with post infarction heart failure. We divided 45 patients with HF with preserved ejection fraction (HFpEF) with mean age 67,5 [65,5; 71,7] years into two main groups. 1st group: 25 patients with HFpEF and history of myocardial infarction. 2nd group: 20 patients with HFpEF and stable angina (without myocardial infarction in anamnesis). Standard laboratory blood tests for erythrocyte sedimentation rate, C-reactive protein, haematological parameters, lipid profile, glucose, renal and liver function tests, echocardiographic examination, endothelial function estimation were performed. Patients with a history of myocardial infarction had significantly higher levels of left ventricle end diastolic volume, left ventricle end systolic dimension (p<0.05). There was estimated direct correlation between LVEDV, LVESD and age - R=0.68 (p<0.05), R=0.52 (p<0.05). Further analysis of cardiac hemodynamics depending on age revealed significant differences between LVEDV indices in patients with myocardial infarction. A significantly higher level of leukocytes was found in patients with HFpEF with a history of myocardial infarction in both groups (p<0.05). A direct correlation between the leukocyte count and age in patients with HFpEF-R = 0.48 (p< 0.05) was also found. Patients with HFpEF with a history of myocardial infarction had a significantly higher level of CRP, including in the age aspect (p<0.05). A direct correlation between CRP level and age was established in patients with HFpEF - R=0.46 (p<0.05). It was revealed that in the older age groups with myocardial infarction the signs of endothelial dysfunction were significantly more frequent (p<0.05). Reverse correlations were established between the level of endothelium dependent vasodilatation (ESVD) and CRP (R=-0.48, p<0.05), triglycerides (R=-0.45, p<0.05), diastolic blood pressure (R=-0.54, p<0.05). Conclusion: high level of inflammation markers, endothelial dysfunction and changes in cardiac hemodynamics were recorded more often in elderly patients with post infarction heart failure.