Morphological Predictors and Molecular Markers of Progressing Postoperative Remodeling of Left Ventricle in Patients with Ischemic Cardiomyopathy

Abstract

1.1 Background Coronary artery disease takes a leading role in the etiology of chronic heart insufficiency in 60% of the cases (Belenkov et al., 2002; Kalon et al., 1993; Oganov & Maslennikova, 2000; Simonsen, 2003). According to the data of different authors patients with coronary artery disease experience development of ischemic cariomyopathy preconditioned by diffuse, significantly pronounced atherosclerosis of coronary arteries manifesting as cardiomegaly termed as “heart remodeling” and symptoms of congestive heart failure in 10-35% of the cases (Belenkov et al., 2002; Mareev, 2002). Postinfarction left ventricular remodeling is one of the most urgent challenges of modern cardiology and cardiac surgery. The heart remodeling process is a combination of changes in cavities’ form and volume and in mass of postinfarction heart myocardium in response to significant inadequate hemodynamic conditions of its functioning not connected with sarcomeres elongation caused by their prior overstretching (Jackson, 2002; Maisch, 1996; Rosenberg & Nepomnyashchih, 2003). Among the patients with different cardiomyopathies these are the ones with ischemic cardiomyopathy who have the most unfavorable prognosis, which makes the problem of ischemic heart failure much more significant (Bellenger, 2000; Buckberg, 2005; Frazier, 2000). Quite frequently the surgical intervention becomes the only treatment method for the patients with chronic heart insufficiency basing on deep changes of functional myocardium morphology. Different approaches to surgical ventricular reconstruction aimed at mechanical changes of the heart cavities sizes in combination with coronary artery bypass grafting (CABG) take the leading place in the complex treatment of this pathology. Nevertheless their outcomes show that in the late postoperative period repeated heart remodeling and CHF progressing i.e. return to the initial preoperative values of the heart cavities sizes and functional capacity of the heart takes place in a part of the operated patients (Batista, 1996; Dickstein, 1997; Dor, 1985; Gradinac, 1998; Menicanti & Di Donato,