QUANTITATIVE METHODS FOR ASSESSING CONTRACTILE RESERVE IN PATIENTS WITH HYPERTENSION AND DIASTOLIC HEART FAILURE

Abstract

Objective: We assessed the effect of several hemodynamic parameters and it changes during handgrip maneuvers in patients with different stages of diastolic heart failure during chemotherapy and their improvements after 4 months follow up (4mFU) treatment with single pill combination of ACE inhibitor ACE) and beta –blocker (BB). Design and method: The study population included 65 patients- female / mean age of 45 ± 12 years/ 55 with breast cancer and undergoing chemotherapy / 30 pts with HFpEF and 25 pts with HFmrEF / and 10 pts with HFnEF and without chemotherapy. Following maximal squeeze by 100%, during the next 3 minutes patients were instructed to apply pressure at 50%. The global longitudinal strain and MAP and HR were performed at basal level, 1st, 2nd and 3rd minutes during handgrip stress test. The contractility /force/ of LV were also calculate as ratio SBP / ESV. Results: Heart rate (HR) and mean arterial pressure (MAP) increased significantly after handgrip maneuver / from 75 ± 6 beats /min to 101 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19 mmHg, p < 0,05 /. Pulmonary artery systolic(s) and diastolic (d) pressure (PAP),pulmonary capillary wedge pressure (PCWP), cardiac index (CI), LVEF did not change significantly (p > 0,5) after handgrip maneuvers. On the other hand, LV force (SBP/ ESV ratio), MAP and HR decreases significantly (p < 0,01) in group with HFmrEF. In same group were found significantly decreased GLVLS at 2nd and 3rd minutes during stress- test comparable with other 2 groups with HFpEF and HFnEF. After 4mFU and treatment with 5/5 mg doses combination of ACE / BB were found improvement in parameters: HR /p < 0,001/, MAP /p < 0.01/ and contractile reserve as well as LV force /p < 0, 01/ and GLVLS /p < 0,001/. Conclusions: Patients with good LV reserve had a rise in stroke –work with little or no change in LVEDP. Patients with poor contractile reserve had a fall in stroke- work reserve together with a substantial rise in LVEDP. The treatment with combination with small doses ACE/BB is a big challenge in patients with HFmrEF and HFpEF to improve the contractile reserve.