Features Of Cardiac Remodeling Research Articles

Features of cardiac remodeling and GDF 15 and NTproBNP levels in patients with heart failure and preserved ejection fraction depending on the history of myocardial infarction

Features of cardiac remodeling and GDF 15 and NTproBNP levels in patients with heart failure and preserved ejection fraction depending on the history of myocardial infarction

Structural and functional changes of the heart in patients with coronary heart disease who have had coronavirus disease COVID-19

The aim of the study: to investigate the effect of the previous COVID-19 coronavirus disease on the features of cardiac remodeling in patients with coronary heart disease (CHD). Materials and methods. 71 patients with CHD were involved in the study: stable angina pectoris II–III FC (age 69.0 (64.0; 76.0) years): 1 group (main) – 31 patients with CHD in long COVID-19 period; group 2 (comparison) – 40 patients with CHD without a history of COVID-19. Features of cardiac remodeling and energy work of the left ventricular (LV) myocardium were assessed using the echocardiography method. Results. CHD patients with a history of COVID-19 had greater changes in linear and volumetric parameters of the heart, an increase in the degree of hypertrophy of the LV myocardium, frequency of registration of LV diastolic dysfunction against the background of an increase in the mean pressure in the pulmonary artery, end-systolic pressure, decrease in global LV contractile function (LVF) compared to patients without COVID-19 history (p < 0.05). In CHD patients who suffered from COVID-19, there was an increase in the estimated energy expenditure of the LV myocardium: shock work by 14.77 % (U = 461.5; p < 0.05), potential energy by 34.68 % (U = 316.5; p < 0.05) and the pressure-volume zone by 17.78 % (U = 373.0; p < 0.05), which indicates a decrease in the speed of myocardial recovery in long COVID period. It was established that the presence of COVID-19 in the history of patients with CHD is associated with an increased risk of LV dilatation by 5.6 times (95 % CI 1.71–18.29; p < 0.05), LV myocardial hypertrophy by 3.05 times (95 % CI 1.79–5.91; p < 0.05), LV diastolic dysfunction by 1.44 times (95 % CI 0.91–2.29; p < 0.05), an increase in energy expenditure during heart work by 1.66 times (95 % CI 0.68–4.02; p < 0.05). Conclusions. Patients with coronary heart disease have more significant structural and functional changes and energy expenditure during the work of the heart, which proves the negative impact of SARS-CoV-2 on the state of cardiac remodeling in patients with CHD in long COVID-19 period.

Structural and functional changes of the heart and electrical disorders in patients with coronary artery disease with concomitant anemia

The aim of the study: to investigate the effect of concomitant anemia on the features of cardiac remodeling and electrical disorders in patients with coronary artery disease (CAD). Materials and methods. In total, 89 patients with CAD, stable angina II–III FC were examined (men – 34, women – 55, age – 69 (61; 72) years). All patients were divided into 2 groups: the main group (n = 44) consisted of patients with CAD and anemia, the comparison group (n = 45) – patients with CAD without iron-deficiency anemia. The results of echocardioscopy and 24-hour ECG (Holter) monitoring were analyzed. Results. Left ventricular (LV) end-diastolic and end-systolic volume were higher in the main group by 24.7 % (U = 60.0; P < 0.05) and 25.9 % (U = 53.5, P < 0.05), respectively; end-diastolic and end-systolic left ventricular index also were higher in the main group by 20.2 % (U = 99.5; P < 0.05) and 34.8 % (U = 98.5; P < 0.05), respectively. There was no statistically significant difference in the types of LV geometry; however, the left ventricular mass index was significantly higher by 12.0 % in patients of the main group (U = 315.5; P < 0.05). The patients of both groups mostly showed diastolic dysfunction type 1, however, in the main group, there was a tendency to increase the number of patients with diastolic dysfunction type 2 and type 3. In patients of the main group, in the active period, there was a decrease in SDNNi by 31.85 % (U = 216; P < 0.05), VLF by 53.79 % (U = 176; P < 0.05); increase in LF by 60.56 % (U = 53; P < 0.05) and SI by 2.14 times (U = 43.5; P < 0.05). The presence of anemia in patients with CAD caused a twofold increase in the risk of autonomic dysfunction (BP = 2.045; 95 % CI 1.084–3.861; P < 0.05), 1.5 times increase in tachycardia episodes (BP = 1.510; 95 % CI 1.047–2.178; P < 0.05) and 2.2 times increase in myocardial ischemia (BP = 2.173; 95 % CI 1.047–4.512; P < 0.05). Conclusions. Concomitant anemia in patients with coronary artery disease adversely affects the structural and geometric properties of the heart, leads to an overall suppression of heart rate variability, increases the sympathetic tone of the autonomic nervous system in daytime period and the stress index, as well as raises the risk of autonomic dysfunction, tachycardia and myocardial ischemia.

Minimally invasive and endovascular closure of atrial septal defect in children of different ages

Highlights. The article presents the outcomes of endovascular and minimally invasive atrial septal defect closure in children under the age of 3 and aged 3 to 18 years with subsequent assessment of heart remodeling.Aim. To compare the outcome and features of cardiac remodeling (CR) in children under and over 3 years of age after minimally invasive (MI) and endovascular closure of atrial septal defect (ASD).Methods. The retrospective single-center study included 100 children with secondary ASD who underwent endovascular and MI ASD closure. The patients were divided into 2 groups. The first group (n = 42) included children under the age of 3 years after MI and EC, the median age was 2 years [1.5; 3], and the second group (n = 58) included children aged 4-18 years after MI and EC, the median age was 7 years [6; 12], respectively, p = 0.001. According to the design of the study, the groups statistically differed in height and body weight (p = 0.001). According to the ASD diameter, there were no differences between the groups (p<0.05) in the number of patients with perforated atrial septal aneurysms and aortic rim deficiency. During inpatient care and 3–4 months after surgery, the outcome and indices of CR obtained by echo imaging were assessed.Results. Surgical outcomes and medium-term follow-up analysis revealed that all children in both groups successfully underwent ASD closure in the absence of residual shunts. There were no hospital-acquired and medium-term complications. The length of hospital stay of children under 3 years was 7.5 days. [3; 9], which was significantly longer in comparison with the children of the older age group (3 days. [3;7]), (p = 0,001). ICU length of stay in the younger group of children was 24 hours [0; 24], while in the older group it was 0 days. [0; 24], p = 0,001. In the postoperative period, hemoglobin levels significantly decreased in children under 3 years of age (from 124.5 [119; 130] g/L, to 105 [97; 122] g/L, (p = 0.001)), while in the older age group this indicator remained the same. The analysis of features of CR during 3-4-month follow-up in both groups revealed that the initial changes indicating pathological CR were more pronounced in children older than 3 years. Significant dynamics of echocardiographic indices were observed in both groups during follow-up period, it manifested in the form of an increased volume and size of the left heart, and decreased volume and size of the right heart.Conclusion. Endovascular and minimally invasive ASD closure is an effective and safe technique of ASD closure in children of various ages. In children over 3 years of age, pathological CR is initially more pronounced than in children under 3 years of age, indicating the expediency of an early ASD closure. At the same time, younger children more often require mechanical ventilation, cardiopulmonary bypass, and a longer hospital stay and ICU stay. Higher number of EC performed in the group of young children could offset these negative consequences. Changes in CR indices after ASD closure in groups of children of different ages demonstrates comparable positive trends.

Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

Pathogenetic role of the autonomic nervous system in arterial hypotension cardiac remodeling in young women

Aim. To study the features of cardiac remodeling on condition of the autonomic nervous system (ANS) in young women with idiopathic arterial hypotension (IAH).Material and methods. A comparative analysis of the echocardiography data in women with IAH aged 18-25 years with a predominance of sympathetic (n=150) and parasympathetic (n=60) parts of the ANS was performed. The level of systolic blood pressure ≤98 mm Hg worked as the criterion of IAH. The activity of the ANS was evaluated by the I. Kérdö index.Results. It has been shown that women with IAH with sympathicotonia are characterized by a significant decrease in the structural parameters of the heart: the size of all chambers and the aortic ostium, contractile function decrease and a slower relaxation of the left ventricle (LV). Acceleration of intracardiac hemodynamics was observed: an increase in blood flow rates and pressure gradients on the mitral, tricuspid and pulmonary artery valves, an increase in the rates of early and late diastolic LV filling. Changes in early LV diastole are associated with an increase of pressure in the left atrium. We identified a restrictive type of diastolic dysfunction in women with parasympathicotonia.Conclusion. Sympathicotonia and parasympathicotonia in young women with IAH are associated with different heart remodeling variants. Cardiac hypotrophy, decrease of contractile function and impaired LV relaxation during hypotension are associated with low sympathetic activity against the background of parasympathicotonia. The restrictive type of diastolic dysfunction during hypotension is associated with parasympathicotonia. Use of cholinolytics and anticholinesterase reactivators are the potential way of correction of ANS dysfunction, IAH regression and cardiac remodeling.

MYOCARDIAL REMODELING IN PATIENTS WITH ATRIAL FIBRILLATION IN CHRONIC HEART FAILURE

Background . Dissatisfaction with the results of drug and non-drug therapy of atrial fibrillation causes clinicians and scientists to seek new methods for treatment of this arrhythmia. Objective . The paper aims at studying the features of cardiac remodeling and morphological changes of myocardium in chronic heart failure patients with atrial fibrillation. Materials and methods . The features myocardial remodeling and the morphology of the myocardium of a right atrial auricle segment were studied, respectively, by echocardiography and by microscopy in chronic heart failure patients with and without atrial fibrillation. Results . Compared to patients without cardiac arrhythmia, patients with chronic heart failure, with atrial fibrillation, revealed more pronounced hypertrophy of the walls of the myocardium of the left and right ventricles, increased myocardial mass index, dilatation of both right and left atria, increased pressure in the pulmonary artery and veins. With a constant form, unlike paroxysmal atrial fibrillation, structural disorders of the walls and chambers of the heart were more pronounced. The interstitial edema of the myocardium of the auricle of the right atrium was detected in patients with atrial fibrillation compared to patients without arrhythmias. Conclusion . More pronounced atrial dilatation in heart failure patients with atrial fibrillation is accompanied by interstitial myocardial edema, which, perhaps, is one of the reasons for the emergence and maintenance of atrial fibrillation.

Features of cardiac remodeling in Patients with Acute Coronary Syndrome Complicated with Rheumatoid Arthritis

Cardiovascular diseases are important factors to increased morbidity and mortality in patients with rheumatoid arthritis (RA). The aim of this study is to investigate the effects of RA on cardiac remodeling in patients with acute coronary syndrome (ACS). Sixty-one patients with ACS complicated with RA (RA group) and 55 age- and sex-matched patients with ACS without RA (control group) were enrolled. We compared the parameters of laboratory and echocardiogram across the 2 groups. Levels of serum brain natriuretic peptide in patients with RA were significantly higher than control group. Prevalence of left ventricular hypertrophy (LVH), and LV diastolic dysfunction (E/A < 1) were significantly higher in the RA patients, while the LV ejection fraction (EF%) was significantly lower in RA patients. Incidence of tricuspid regurgitation and pulmonary regurgitation were significantly higher in ACS patients with RA than in the ACS patients without RA. In RA group, levels of serum high density lipoprotein cholesterol were negatively correlated with C reactive protein (CRP), EF% was also negatively correlated with CRP. The prevalence of LVH and mitral regurgitation showed positive correlations with ESR. Early intervention for controlling the inflammation associated with RA can play a significant role in preventing cardiac remodeling in ACS patients.

Features of cardiac remodeling in patients with hypertension of different ethnic groups

Objective. To study the features of different types of left ventricles (LV) geometry in patients with essential hypertension (EH) of different ethnic groups. Materials and methods. We examined 180 patients, residents of the Sakhalin Region, with 1-3 degree arterial hypertension, including 88 patients of Korean ethnicity aged from 45 to 63 years (mean age - 59.2±0.86 years) and 92 patients of Slavic ethnicity in age from 43 to 64 years (mean age - 58.2±0.93 years). LV structural and functional characteristics were studied by means of echocardiography with Doppler analysis on the ultrasonic system Acuson X300 (HP, USA). Results. The results of assessment of different types of LV geometry revealed the following differences: prevalence of the LV concentric remodeling was higher in patients with EH of Korean ethnicity (21.5% versus 13% among the Slavs, p=0.04). Conclusion. The study of the structural characteristics of left ventricular in patients with hypertension, residents of the Sakhalin Region, revealed that concentric remodeling and concentric left ventricular hypertrophy are the main types of LV geometry in hypertensive patients of both ethnic groups. However, concentric LV remodeling was more often detected in patients with hypertension of Korean ethnicity.

Features of cardiac remodeling in sclerodermic lung lesions

Objective: to examine the relationship between structural and functional heart remodeling and sclerodermic lung disease. Material and methods . The study involved 62 women: 21 with systemic sclerosis (SSC) (mean age 49,4±2,1 years) and 41 healthy women (mean age 45±1,7 years) (р=0,127). Examination and treatment of patients with SSC was performed according to the guidelines. Instrumental diagnostics included cardiac US, chest X-ray, pulmonary high-resolution computed tomography. Results. SSC patients, as compared to control group, demonstrated significant increase of end-diastolic left ventricular size, septal thickness, left ventricular mass and mass index. End-diastolic and end-systolic left ventricular size was significantly greater in patients with diffuse pulmonary fibrosis than with basal pulmonary fibrosis. Conclusion. Our data indicate significant changes in the structural and functional parameters of the heart in SSC and their relationship with the progression of pulmonary pathology.

Features of Cardiac Remodeling, Associated With Blood Pressure and Fibrosis Biomarkers, Are Frequent in Subjects With Abdominal Obesity

Incidence and prevalence of abdominal obesity (AO) are growing exponentially. Subjects with AO are at higher risk of developing heart failure. The purpose of the study was to investigate early changes in cardiac and arterial structure and function and extracellular matrix biomarkers in normotensive healthy subjects with AO. Subjects with AO and age- and sex-matched controls underwent echocardiography, MRI (cardiac remodeling index), carotid intima-media thickness, pulse wave velocity, and blood fibrosis biomarkers measurements. We enrolled 87 subjects with AO and 53 controls. Although normotensive, subjects with AO had higher systolic blood pressure (BP; 122±11 versus 116±11 mm Hg; P=0.003), left ventricular mass (94±24 versus 84±21 g; P=0.034), and cardiac remodeling index (0.67±0.16 versus 0.60±0.10 g/mL; P=0.026) but unchanged carotid intima-media thickness and pulse wave velocity. Diastolic dysfunction (E' <10 cm/s) could be detected in 38% of subjects with AO (4% in controls). Left ventricular remodeling, as assessed by cardiac remodeling index, was positively and independently associated with higher BP (systolic BP and mean arterial pressure but not diastolic BP) and AO. Higher BP, AO, and procollagen-III-N-terminal peptide (≥2.4 ng/mL) concentrations (odds ratio, 4.15 [1.42-12.2]; P=0.01) were positively associated with diastolic dysfunction. Early cardiac structural remodeling, fibrosis, and diastolic dysfunction were detectable in healthy subjects with AO. Higher BP, procollagen-III-N-terminal peptide, and AO were independently associated with early cardiac structural and functional changes. It is to be investigated whether in subjects with AO, an early BP reduction, even if normotensive, combined with weight loss may avoid adverse cardiac remodeling and protect against progression to heart failure.

Ремоделювання серця та зміни загальної гемодинаміки в підлітків з артеріальною гіпертензією

Мета даного дослідження — встановлення особливостей ремоделювання серця та змін загальної гемодинаміки в підлітків з артеріальною гіпертензією залежно від маси тіла. Матеріали та методи. Проведено комплексне обстеження 102 юнаків 13–18 років з АГ, серед яких 32 підлітки з АГ та нормальною масою тіла, 23 — з АГ й надлишковою масою тіла (НМТ) та 47 — з АГ та ожирінням I–II ступеня. Фізичний розвиток дітей оцінювався з використанням антропометричних параметрів (зріст, маса тіла, окружність талії (ОТ) та стегон (ОС)) та обчисленням індексу маси тіла (ІМТ, кг/м2). ІМТ оцінювали за номограмами з урахуванням віку і статі. Нормальним вважався ІМТ, що знаходився на рівні між 15-м і 85-м перцентилем. Показники ІМТ між 85-м і 97-м перцентилем розцінювалися як надлишок маси тіла, а вище 97-го перцентиля — як ожиріння. Критерієм абдомінального ожиріння вважалася окружність талії, що дорівнювала 94 см і більше для юнаків віком понад 16 років і більше 90-го перцентиля для дітей до 15 років (IDF 2007). Функціональний стан серцево-судинної системи вивчався за допомогою ультразвукового дослідження серця в М- і В-режимах із використанням датчика 3,5 мГц на апараті Sonoline-SL1 фірми Siеmens за стандартною методикою, що рекомендована Асоціацією спеціалістів з ехокардіографії.Результати та їх обговорення. Єдиним антропометричним показником у підлітків виділених груп, за яким вони не розрізнялись між собою, був зріст. Середні значення ІМТ у пацієнтів з АГ і НМТ та АГ й ожирінням знаходилися в межах від 26,55 ± 0,35 кг/м2 до 31,98 ± 0,67 кг/м2 на відміну від хворих із АГ і нормальною масою тіла, у яких цей показник знаходився на рівні 22,21 ± 0,35 кг/м2 (р &lt; 0,001). Установлено статистично значущу відмінність середніх показників індексу ОТ/ОС у пацієнтів з АГ та ожирінням та у хворих з АГ та НМТ (р &lt; 0,001). Збільшення вище від норми показника ОТ понад 94 см для юнаків віком понад 16 років і більше 90-го перцентиля для дітей до 15 років виявлено у 20,0 ± 7,7 % випадків лише серед юнаків з АГ та ожирінням, ОТ в них знаходилася в межах від 93 до 128 см.При оцінці параметрів серця встановлено такі особливості: у групі юнаків з АГ та ожирінням порівняно з групою контролю відбувалось вірогідне збільшення діаметра кореня аорти (р &lt; 0,05), розширення лівого передсердя (р &lt; 0,05), дилатація порожнини лівого шлуночка (ЛШ) (р &lt; 0,05). Задня стінка лівого шлуночка (р &lt; 0,01) та міжшлуночкова перегородка (р &lt; 0,01) також були вірогідно товщими, унаслідок чого відбувався приріст маси міокарда ЛШ (р &lt; 0,05) та збільшення відносної товщини стінки лівого шлуночка (р &lt; 0,05). У групі підлітків з АГ та НМТ зареєстровано вірогідне потовщення міокарда лівого шлуночка, як задньої стінки лівого шлуночка (р &lt; 0,01), так і товщини міжшлуночкової перегородки (р &lt; 0,01), у результаті чого відбувалось збільшення індексу маси міокарда лівого шлуночка (р &lt; 0,1), вірогідний приріст відносної товщини стінки лівого шлуночка (р &lt; 0,01) та істотне збільшення діаметра аорти (р &lt; 0,05). Звертає на себе увагу розширення порожнини правого шлуночка як у групі з НМТ, так і в юнаків з ожирінням (р &lt; 0,01; р &lt; 0,01). У групі підлітків з АГ та нормальною масою тіла параметри серця мали лише тенденцію до збільшення, але не досягали рівня достовірності в порівнянні з групою контролю.При індивідуальній оцінці параметрів серця виявлено, що концентрична гіпертрофія лівого шлуночка зареєстрована в 1 (3,13 %) підлітка з АГ з нормальною масою тіла, у 4 (17,39 %) юнаків з АГ та НМТ та в 7 (14,89 %) — з АГ та ожирінням. Ексцентрична гіпертрофія лівого шлуночка виявлена у 3 (13,04 %) обстежених з АГ із НМТ та в 11 з АГ на тлі ожиріння (23,40 %). Дилатацію порожнини ЛШ виявлено в 9 (28,12 %) хворих з АГ з нормальною масою тіла, у 14 (60,88 %) — з АГ та НМТ та у 22 (46,80 %) юнаків з АГ на тлі ожиріння. Таким чином, у підлітків з АГ і НМТ відбувається бівентрикулярне ремоделювання серця з переважно концетричною гіпертрофією міокарда лівого шлуночка на відміну від підлітків з АГ і ожирінням, де ремоделювання серця відбувається з формуванням ексцентричної гіпертрофії, переважно за рахунок міжшлуночкової перегородки. Звертає на себе увагу формування в обох групах підлітків (із надмірною масою та ожирінням) ознак діастолічної дисфункції міокарда ЛШ та значна дилатація кореня аорти.