Types Of Left Ventricular Remodeling Research Articles

Role of cardiac magnetic resonance imaging in assessing the risk of various myocardial remodeling types in left ventricular noncompaction: genetic analysis data

Aim. To analyze contrast-enhanced cardiac magnetic resonance imaging (MRI) in patients with phenotypic manifestations of left ventricular non-compaction (LVNC) and related genetic mutations, as well as to determine the relationship between mutations and types of left ventricular (LV) remodeling and with a number of other morphological and functional cardiac parameters.Material and methods. From the registry of patients with LVNC and their relatives, patients with morphological signs of LVNC and 4 related mutations (MYH7, MYBPC3, TTN, and desmin genes (DES, DSG2, DSP and DSC2)). All patients underwent contrast-enhanced cardiac MRI, based on which the type of LV remodeling was determined.Results. The study included 44 patients who, according to genetic analysis, had mutations in sarcomeric genes responsible for LVNC development. In each patient, the type of LV remodeling was determined based on cardiac MRI results. We found that if patients with LVNC have mutations in the MYBPC3 and TTN genes, the chance of LV dilatation remodeling is significantly higher. On the contrary, in the presence of a DES gene mutation, the probability of this LV remodeling is lower, and milder morphological manifestations of LVNC are noted.Conclusion. The combination of cardiac MRI data and genetic analysis improves the morphological and functional stratification of patients with LVNC.

Evaluation of Fibrosis Markers as a Potential Method for Diagnosing Non-Obstructive Coronary Artery Disease in Patients with Stable Coronary Artery Disease

Aim. To study the levels of fibrosis markers in patients with stable coronary artery disease (CAD) and various types of coronary artery (CA) lesions (obstructive and non-obstructive), to identify possible differences for diagnosing the types of coronary obstruction.Material and methods. The observational study included three groups of patients: with non-obstructive (main group, coronary artery stenosis <50%; n=20) and obstructive (comparison group, hemodynamically significant coronary artery stenosis according to the results of coronary angiography; n=20) CAD and healthy volunteers (control group; n=40). Transforming growth factor beta 1 (TGF-β1) and matrix metalloproteinase 9 (MMP-9) levels were measured in plasma by enzyme immunoassay. According to the results of echocardiography, all patients included in the study were divided into four groups depending on the type of myocardial remodeling.Results. TGF-β1 levels were significantly higher in patients with obstructive CAD (p=0.008) than in patients with non-obstructive CAD and healthy volunteers (p <0.001). There were no significant differences between the main and control groups (p>0.05). There were no statistically significant differences in TGF-β1 levels depending on the type of left ventricular remodeling (p=0.139). The maximum level of MMP-9 was in the group with obstructive coronary disease and significantly differed from the main group (p <0.001) and the control group (p=0.04).Conclusio. The maximum levels of TGF-β1 and MMP-9 were found in the group with obstructive coronary artery disease. The levels of these biomarkers in the main group were statistically different from the values obtained in the control group. Thus, considering the pathogenesis of the development of non-obstructive CAD, the use of fibrosis markers TGF-β1 and MMP-9 may be promising for diagnosing the severity of CA obstruction.

CONSTITUTIONAL FEATURES IN MEN WITH DIFFERENT TYPES OF LEFT VENTRICULAR REMODELING AND HAVE CORONARY HEART DISEASE

Purpose. The study of constitutional features in men with various types of left ventricular remodeling, having a comorbid association of arterial hypertension with coronary heart disease.
 Materials and methods. We examined 57 men with isolated arterial hypertension and 115 men with arterial hypertension combined with coronary artery disease. The standard method of anthropometric research used, followed by the determination of constitutional types, as well as the determination of types of geometric LV remodeling according to ultrasound examination of the heart.
 Results. The constitutional features of the frequency of unfavorable types of remodeling in men of the examined groups revealed. The largest group among the examined men, both with isolated arterial hypertension and with arterial hypertension in combination with coronary artery disease, consisted of representatives of the muscular and abdominal type of constitution. The presence of left ventricular remodeling detected in 91.2% of the examined men with isolated hypertension and in 89.6% of men with hypertension in combination with coronary artery disease. At the same time, both among men with isolated hypertension and men with hypertension in combination with coronary heart disease, the most common type of geometry was concentric left ventricular hypertrophy. It found that in all constitutional types, patients with concentric left ventricular hypertrophy were more common.
 Conclusion. Left ventricular hypertrophy was more common in all constitutional types in men of both groups. Normal geometry of the left ventricle more often observed in men with isolated arterial hypertension of the thoracic constitutional type, and among men with arterial hypertension in combination with coronary artery disease - of the muscular type.

GENDER FEATURES OF STRUCTURAL-GEOMETRIC REMODELING OF THE LEFT VENTRICLE IN PATIENTS WITH MYOCARDIAL INFARCTION WITHOUT ELEVATION OF ST SEGMENT

Recently, there has been a tendency to increase the incidence of myocardial infarction without elevation of the ST segment, which, according to some data, accounts for about half of all registered MI. The main problem with this type of infarction is that the long-term prognosis in these patients remains unsatisfactory, and mortality one year after the catastrophe is equal to or even higher than mortality from ST-segment elevation myocardial infarction, which encourages continued predictors of unfavorable prognosis.
 Objective: to determine the gender characteristics of the structural and geometric remodeling of the left ventricle in patients with myocardial infarction without ST segment elevation.
 Materials and methods. We conducted a comprehensive study of 200 patients with acute myocardial infarction without ST-segment elevation (NSTEMI) aged 38 to 80 (mean 62.0 ± 0.71, median 62 and interquartile range 55 and 70). The structural and functional state of the myocardium and types of left ventricular remodeling according to transthoracic echocardiography were studied.
 Results. Analysis of the obtained data shows that echocardiographic parameters in patients with NSTEMI depending on gender did not reveal significant differences between different groups. The exception was the size of the right atrium, which was significantly higher in the group of men compared to women with comparable values of the size of the right ventricle and the ratio of the size of the left to the right atrium. Analysis of the nature of structural and geometric remodeling of the left ventricle in general by groups showed that almost half of the subjects registered concentric hypertrophy of the left ventricle. Concentric left ventricle remodeling was observed in one third of patients and in other patients - normal geometry and eccentric left ventricle hypertrophy. Thus, it was found that concentric models of left ventricle – concentric hypertrophy and concentric remodeling – were registered in the vast majority of patients with NSTEMI. The latter can be explained by a significant proportion of hypertension which was identified by us in most patients and, of course, contributed to the development of concentric models of left ventricle.
 Analysis of the nature of structural and geometric remodeling of the left ventricle depending on gender showed that in the group of men, compared with women, there was a significant increase in the incidence of concentric remodeling. At the same time, in women, compared with men, there was a significant increase in cases of more severe types of structural remodeling - concentric and eccentric hypertrophy.
 Thus, we found that gender differences in echocardiographic parameters in patients with NSTEMI relate exclusively to indicators of structural and geometric remodeling of the left ventricle. Signs of concentric and eccentric left ventricular hypertrophy predominate in women, and indicators of normal geometry and concentric left ventricular remodeling in men. This distribution of types of remodeling indicates a more severe course and unfavorable prognosis of NSTEMI in women.

ХАРАКТЕРИСТИКА СОСТОЯНИЯ МИОКАРДА И ПРОФИБРОТИЧЕСКИХ ФАКТОРОВ ПРИ РАЗВИТИИ ГИПЕРТОНИЧЕСКОГО СЕРДЦА

Introduction. Myocardial damage caused by arterial hypertension is manifested by changes in myocardial geometry and mass, as well as increased content of collagen and fibrous tissue in the myocardium. Excessive accumulation of collagen in myocardium is the result of imbalance between proteolytic enzymes such as matrix metalloproteinases 1 (MMP-1) and tissue inhibitors of matrix metalloproteinase 1 (TIMMP-1), high content of transforming growth factor β1 (TFG-β1), which was found in fibroblasts and macrophages. Aim. The aim of the study was to investigate the role of MMP-1 activation, its tissue inhibitor TIMMP-1 and TGF-β1 in blood in the development of myocardial fibrosis in locomotive train workers with arterial hypertension. Material and methods. 82 patients with arterial hypertension and 20 virtually healthy control subjects were examined. The patients of the analyzed groups underwent evaluation of the data of daily blood pressure monitoring, echocardiographic examination, based on which the types of left ventricular remodeling, the content of matrix metalloproteinase 1 and its tissue inhibitor activity, the level of transforming growth factor β1 in blood serum were identified. Calculation of the volume fraction of interstitial collagen was performed. Results and discussion. The study established statistically significant signs of structural changes in the left ventricular myocardium, which primarily indicated its marked left ventricular hypertrophy against the background of arterial hypertension due to chronic pressure overload. Statistically significant increase of all levels of serum markers of collagen metabolism was revealed in patients with arterial hypertension in comparison with the control group. Patients with arterial hypertension have a restructuring of the intercellular matrix components and imbalance in the MMP-1/TIMMP-1 system characterized by a shift of the collagen balance towards fibrosis (increase of THF-β1, TIMMP-1 level, decrease of MMP-1/TIMMP-1 52 ВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 14, вып. 6ОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ ratio and increase of interstitial collagen volume fraction). Significant increase of interstitial collagen volume fraction index in the group of patients with arterial hypertension comparing to the control group also indirectly indicates high intensity of interstitial collagen genesis in myocardium of these patients. Conclusion. In arterial hypertension, serum levels of THF-β1, MMP-1, and TIMMP-1 increase, which indirectly indicates an increase in myocardial collagen content.

Clinical significance of the determination of natriuretic peptides in diastolic dysfunction of the left ventricle in patients with type 2 diabetes mellitus

Objective: of article was to study the level of cerebral natriuretic peptide in patients with type 2 diabetes mellitus with diastolic dysfunction and with various types of left ventricular remodeling. Materials and methods: 256 patients with type 2 diabetes mellitus (DM) who had moderate arterial hypertension (AH) and no clinical signs of chronic heart failure were examined. The control group consisted of 30 practically healthy persons, comparable in age and sex with the examined patients. All patients were determined the concentration of brain natriuretic peptide (BNP) in blood plasma. The structural and functional parameters of the heart were determined by echocardiography in B- and M-modes according to the standard technique. Results: in patients with type 2 diabetes and diastolic dysfunction, the BNP concentration was 156 (84; 228) pg / ml, in patients without diastolic filling disorders — 24 (12; 38) pg / ml. The highest BNP values were found in the subgroup of patients with a restrictive type of transmitral flow. Also, BNP values were higher in the group of patients with concentric and eccentric left ventricular (LV) hypertrophy. Conclusion: in all patients with type 2 diabetes and concomitant moderate hypertension, even in the absence of clinical signs of CHF, there is an increase in the BNP level compared to the control group. The highest BNP values were observed in patients with severe diastolic dysfunction and unfavorable variants of LV remodeling.

Динамика ремоделирования левого желудочка у больных артериальной гипертензией с сахарным диабетом 2-го типа и ожирением под влиянием одногодичной комбинированной терапии

Актуальность. Патологическое ремоделирование левого желудочка (ЛЖ) у больных артериальной гипертензией (АГ) с сахарным диабетом (СД) 2-го типа и ожирением ассоциируется со значительным повышением сердечно-сосудистого риска и требует ранней и адекватной медикаментозной коррекции. Материалы и методы. В исследование включены 38 больных АГ 2-й степени с субкомпенсированным СД 2-го типа и абдоминальным ожирением (АО). Обследование проводили до и после одногодичной терапии блокатором рецепторов ангиотензина ІІ олмесартаном и антагонистом кальция лерканидипином в сочетании с аторвастатином и метформином. Результаты. У больных выявлена высокая частота патологических типов ремоделирования ЛЖ (концентрическая и эксцентрическая гипертрофия ЛЖ (ГЛЖ) (50 и 37 % соответственно) с развитием его диастолической дисфункции в 89 % случаев. Комбинированная терапия способствовала достоверному снижению выраженности ГЛЖ и частоты диастолической дисфункции. Выводы. Длительное применение олмесартана и лерканидипина в сочетании с аторвастатином и метформином у больных АГ с СД 2-го типа и АО является эффективным методом торможения прогрессирования патологического ремоделирования ЛЖ.

Assessment of the state of intracardiac hemodynamics and myocardial remodeling in women with gonarthritis, hypertension and overweight

Abstract. The problem of comorbidity is one of the most pressing problems of modern medicine. The presence of arterial hypertension and overweight in patients with gonarthritis is associated with an earlier development of target organ damage and subsequent cardiovascular accidents. In order to assess intracardiac hemodynamics and types of myocardial remodeling in women with gonarthritis, hypertension and overweight, depending on their combinations, from 2018 to2021, a prospective study of 198 patients of the rheumatology department of the «City Hospital № 10» (Zaporizhzhia) was carried out. According to the results of the study, it was found that the presence of comorbid pathology in the form of arterial hypertension and overweight in female patients with gonarthritis negatively affects the contractile function of the heart, which is confirmed by a decrease in the main indicators of systolic function of the left ventricle; the specified combination of diseases leads to the formation of prognostically unfavorable types of left ventricular remodeling.

Familial left ventricular noncompaction: phenotypes and clinical course. Results of the multicenter registry

To analyze and demonstrate various phenotypes in patients with familial left ventricular noncompaction (LVNC). In 2013 was created a multicenter registry of LVNC patients. On its basis 30 families with a familial LVNC were selected. 30 LVNC families were selected from the register. From a total of 115 people (probands and relatives) in 71 (61.7%) LVNC was diagnosed (30 probands and 41 relatives with non-compact myocardial criteria). The most common type of remodeling in patients was the dilated type (DT) (n=30), the isolated LVNC with preserved ejection fraction (EF) was slightly less common (n=23), and the hypertrophic type (GT) was detected in 8 patients. 4 patients were diagnosed with the isolated LVNC with a reduced EF. 3 patients were with a combination of non-compact myocardium with congenital heart disease and with a combination of DT and GT (DT+GT). During the analysis of cases a combination of different phenotypes in the same family was observed. The largest number of families was diagnosed with a combination of DT and the isolated LVNC with preserved EF. The development of cardiovascular complications was associated with DT. Family cases of LVNC had different types of myocardial remodeling and variants of clinical course. In one family a combination of different types of left ventricular remodeling is possible. DT is associated with the most severe clinical manifestations. The clinical picture of the isolated LVNC with preserved EF, is the most favorable, but in rare cases, serious clinical manifestations were observed.

Combined influence of diabetes mellitus and obesity on left ventricle remodeling in hypertensive patients

The aim of the study was to evaluate the effect of type 2 diabetes mellitus (T2DM) and obesity influence on the left ventricular (LV) remodeling peculiarities in hypertensive patients. Materials and methods. In total, 327 patients, aged 38–74 years, were comprehensively examined. The enrolled patients were divided into 4 groups in dependence of the presence of associated disease: the 1st group – n = 87 hypertensive patients with T2DM combined with obesity, the 2nd group – n = 71 hypertensive patient with T2DM and the 3rd group – n = 65 hypertensive patients with obesity; the comparison group consisted of 74 patients with essential hypertension (EH) but without obesity or diabetes. Echocardiography was performed according to the standard method of H. Feigenbaum to estimate the LV parameters. HbA1c was determined by turbidimetric method. Serum glucose levels were determined by ELISA. Results. When comparing the three patient groups with those who had only EH, the most significant influence was found in combined influence of T2DM and obesity on the development of unfavorable type of LV remodeling with values of χ2 = 29.371 and Pearson's contingency coefficient (C) ‒ 0.393 (P < 0.05). The presence of concomitant T2DM without obesity had a significant moderate relationship with the development of unfavorable LV geometry, χ2 = 11.029 and C ‒ 0.266 (P < 0.05), which indicates a much smaller impact on the process compared to the polymorbid effect of T2DM with obesity. Comparison of patients with a combination of EH and obesity with those who had only EH did not show a significant effect of concomitant obesity on the development of unfavorable types of LV geometry with values of χ2 and C: 0.529 and 0.062, respectively (P > 0.05). Conclusions. Essential hypertension with type 2 diabetes mellitus and obesity polymorbidity, but not in combination with type 2 diabetes mellitus or obesity alone, has the most significant association with hypertrophic types of LV remodeling. The co-existence of type 2 diabetes mellitus and obesity in hypertensive patients leads to the development of predominantly LV concentric hypertrophy.

Relationship between plasma aldosterone and left ventricular structure and function in patients with heart failure with preserved ejection fraction

Aim. To study the relationship between plasma aldosterone level and left ventricular (LV) structure and function in heart failure with preserved ejection fraction (HFpEF).Material and methods. This prospective study included 158 patients (58 men and 100 women, mean age, 62,3±7,4 years) with compensated HFpEF. Patients had no history of primary aldosteronism and did not use the mineralocorticoid receptor antagonists during the last 6 weeks. The plasma aldosterone was determined by enzyme immunoassay in all patients and the severity of structural and functional cardiac changes was assessed. The concentration of 40160 pg/ml was considered the reference values. Assessment of cardiac structure and function was carried out using transthoracic echocardiography.Results. According to the laboratory results, all patients were divided into two groups: group 1 — 99 (62,7%) patients (95% confidence interval (CI), 55,0-70,0%) with normal aldosterone levels; group 2 — 59 (37,3%) patients (95% Cl, 30,0-45,0%) with hyperaldosteronism. End-diastolic volume, left atrial volume, LV mass index, severity of LV diastolic dysfunction and the prevalence of concentric hypertrophy were significantly higher in group 2 patients compared with group 1 (p<0,05 for all). Blood aldosterone levels positively correlated with E/e’ (r=0,63, p<0,001). Regression analysis, adjusted for age and comorbidity, demonstrated that plasma aldosterone levels were closely associated with E/e’ (odds ratio, 3,42; 95% CI, 1,65-9,64, p=0,001) and LV concentric hypertrophy (odds ratio, 1,12; 95% CI, 1,08-3,16, p=0,042).Conclusion. The development of secondary hyperaldosteronism in patients with HFpEF is an independent predictor of LV diastolic dysfunction and unfavorable prognostic types of LV remodeling.

Особенности ремоделирования миокарда у пациентов различных возрастных групп через 6 месяцев после перенесенного инфаркта миокарда

Objective. To assess the nature of changes in the types of myocardial remodeling of the left ventricle in patients of middle, elderly and senile age with acute ST-segment elevation myocardial infarction within 6 months after successful revascularization. Materials and methods. The study included 132 patients with a diagnosis of acute ST-segment elevation myocardial infarction, in combination with arterial hypertension who were divided into 3 groups depending on age: middle-aged pa-tients (45- 59) – 48 people, elderly patients (60-74) – 44 people, senile patients (75-89) – 40 people. The type of left ventricular remodeling was assessed by determining the relative wall thickness and mass index of the left ventricular myocardium with doppler echocardiography in the first 12 hours after the onset of anginal syndrome, and after 6 months. All patients underwent percutaneous coronary intervention. Results. It was found that initially with the development of acute myocardial infarction, senile patients more often had eccentric left ventricular hypertrophy (in 25%) than patients of middle (6%) and elderly age (11%). After 6 months, in middle-aged patients, the type of remodeling eccentric hypertrophy increased to 14%, in the elderly – up to 23%, in senile patients – up to 50%. Conclusion. In patients who have undergone acute myocardial infarction against the background of traditional therapy and rehabilitation, there are changes in the types of left ventricular myocardial remodeling: eccentric hypertrophy increases in middle age up to 14%, in the elderly – up to 23%, in senile age – up to 50%.

The types of left ventricular remodeling in patients with rheumatoid arthritis

Studying the factors leading to a pathological change in the cardiac structure in patients with rheumatoid arthritis (RA) can contribute to improvement in early diagnosis and to prevention of premature mortality from cardiovascular events.Objective. To study the types of left ventricular (LV) remodeling in patients with RA, by taking into account traditional cardiovascular risk factors, and to assess the clinical and immunological features of RA and the impact of drug therapy.Patients and methods. The investigation enrolled 74 RA patients who underwent assessment of echocardiography findings, by determining the type of LV remodeling, traditional cardiovascular risk factors, clinical and immunological features of the disease, as well as the current drug therapy.Results and discussion. Eccentric LV hypertrophy (ELVH) (n=33 (44.59%)) and concentric LV hypertrophy (CLVH) (n=34 (45.95%)) occurred at almost the same frequency among the pathological types of LV remodeling in patients with RA. Higher DAS28 values (p<0.0001) were noted in ELVH than in CLVH. There were also positive correlations of EHLH with ESR and CRP level (r= 0.51, p<0.0001; r=0.48, p=0.0001, respectively). The higher values of systolic blood pressure (p=0.0002), body mass index (p=0.01), patient age (p=0.0001), and the incidence of dyslipidemia (p= 0.008) were established in CVLH than in ELVH. LV diastolic dysfunction (DD) was detected much more frequently in RA patients with CLVH than in those with ELVH (p=0.01). The DD parameters (peak A, E/A) correlated with the degree (r=0.5, p<0.0001; r=-0.5. p<0.0001) and stage of hypertension (r=0.54, p<0.0001; r=-0.48, p=0.0001, respectively), as well as with peak A and traditional risk factors, such as patient age (r=0.52, p<0.0001), and high-density lipoprotein cholesterol levels (r=-0.48, p=0.0001).Conclusion. Most patients with RA had signs of LV hypertrophy; moreover, ELVH was closely linked with disease activity, whereas CLVH was related to the traditional risk factors.

Predictors of heart failure in patients with major beta-thalassemia

Cardiomyopathy by loading the myocardium with iron is the cause of heart failure in patients with major beta-thalassemia. In these patients, cardiac systolic function remains normal for a long time, but when signs of heart failure appear, death may occur in the first year, so it is necessary to identify parameters to predict the patient's progress and prognosis.Materials and methods. We enrolled 62 patients with beta-thalassemia major (30 men and 32 women), mean age 29.9 ± 7.3 years. 32.2% of patients had disorders of carbohydrate metabolism, 12.9% associated hypothyroidism, and the mean ferritin was 1060.9 ± 856.6 ng / ml. Patients were evaluated echocardiographically, using tissue doppler technique to assess systolic and diastolic function. Myocardial mass was calculated using standard formulas and the type of left ventricular remodeling (LV) was thus obtained. Depending on the ferritin level, choosing the threshold value of 1000ng / ml, a group subanalysis of the ultrasound parameters of cardiac systolic and diastolic function was performed.Results. All patients had LV ejection fraction above 50% (LVEF), but longitudinal LV systolic dysfunction was observed in 19.3% of patients. Also in patients with serum ferritin values ​​above 1000ng / ml, the parameters of longitudinal systolic function of LV are affected, paradoxically the average value of LVEF being higher in these patients. About a quarter of patients had diastolic dysfunction, but 40.3% had elevated LV filling pressures. We noticed that the batch with ferritin over 1000 ng / ml associated increased LV filling pressures. The evaluation of the function of the right ventricle by tissue Doppler (S wave at the level of the free wall VD) was statistically significantly correlated with the hemoglobin value and we obtained pathological values ​​(S VD <11.5 cm / s) especially in the group with ferritin over 1000ng / ml. We noticed the presence of morphological abnormalities of LV, by increasing myocardial mass and the appearance of LV remodeling, 31% of patients showed severe forms, especially eccentric remodeling. It was observed that there is a risk of negative remodeling of the left ventricle in the group of those with ferritin above 1000ng / ml.Conclusions. The study proves that the evaluation of the systolic and diastolic function of the left and right ventricle by tissue Doppler ultrasound is much more accurate in the early detection of myocardial dysfunction. Ferritin levels above 1000ng / ml have been associated with impaired cardiac function parameters. Also, the remodeling of the left ventricle observed in this group of patients may be the first sign of heart failure.

P1572 The role of 3D echocardiography in the evaluation of left ventricular remodeling

Abstract Purpose to assess the left ventricular (LV) remodeling with using transthoracic 3D Echo and MRI in young athletes. Materials for the period from October 2015 to April 2018, 88 athletes (61 men and 27 women) were examined. Mean age was 20.8 ± 3.9 years. Group A (professionals) – 65 athletes (4 or more training days a week, experience in sports for at least 7 years, the presence of at least the 1st sports category). Group B (Amateurs) – 23 athletes (3 or less training days a week). By types of loads were identified 4 groups: 1st - high-static, low-dynamic (climbing); 2nd - medium-static, medium-dynamic (volleyball, Rugby, sports dancing); 3rd - medium-static, high-dynamic (badminton, orienteering, hockey); 4th - high-static, high-dynamic (triathlon, water polo, rowing). Methods 2D-, 3D-Echo was performed on Vivid E9 XDclear 4D (GE, USA). With the help of software package for processing 3D arrays (4D auto LVQ and 4D Strain and LV-mass) in automatic and semi-automatic mode was obtained end diastolic and end systolic volumes (EDV, ESV), ejection fraction (EF) and LV mass. The device was used for MRI - Avanto (Siemens) - 1.5 T, using: sensors for breathing and synchronization with ECG, standard surface coil Body Matrix. Visualization of the mobile myocardium was carried out by SSFP protocols in standard two-and four-chamber view, as well as on the short axis. In addition, the black-blood Protocol was performed in axial projection for visualization of mediastinal organs and chest. Evaluation of the results was performed on a workstation Syngo Via VB10B (Siemens) using a worker thread MR Cardiac analisis. Results There were significant differences in the types of loads (p < 0.001): 22% of men in Group B had 1st type, 2nd type - 78% of men and 93% of women in group B, 3rd type - 45% of men and 36% of women in group A, 4th type - 39% of men and 21% of women in group A. In the evaluation of LV remodeling and its relationship with the type of loads revealed significant differences (p < 0.01): 87.5% had LV remodeling (95.4% - aggregate type load 1, 2, 3), 6.8% - concentric remodeling (21.7% of all type 4), and 4.5% eccentric hypertrophy (8.7% of all type 4), 1.1 per cent of concentric hypertrophy (4.4% of all type 4). Consequently, most athletes with loads of type 4 had different types of LV remodeling. Comparing 3D Echo and MRI, high-grade positive correlations were obtained in indicators: EDV (R 0.82, p < 0.0001), ESV (R 0.80, p < 0.0001), LV mass (R 0.85, p < 0.0001), as well as moderate positive the index of EDV (R 0.54, p < 0.037) and unreliable for the EF. Conclusions three-dimensional visualization allows to carry out a reliable assessment of the volumetric parameters of the heart chambers, comparable with MRI data and to identify the signs and type of LV remodeling. Requires further study of the performance of 3D Echo in athletes, given the lack of normative data on the modern stage.

Масса миокарда левого желудочка и ее связь с вариабельностью ритма сердца у пациентов с церебральным атеросклерозом и сахарным диабетом 2-го типа

Вопросы взаимосвязи кардиальной и церебральной патологии вызывают несомненный интерес у врачей различных специальностей, динамично расширяясь. Цель работы — выявить взаимосвязи между массой миокарда левого желудочка (ММЛЖ) и показателями вариабельности ритма сердца (ВРС) у пациентов с церебральным атеросклерозом (ЦА) 1-3-й стадий, в т. ч. и с сахарным диабетом 2-го типа (СД2). Материал и методы. В комплексном клинико-инструментальном исследовании приняли участие 229 пациентов с ЦА 1-3-й степени. Пациентов распределили на 2 группы: І — с ЦА 1-2-й степени (без ишемического инсульта — группа сравнения); ІI — общая группа пациентов, перенесших ишемический атеротромботический инсульт (ИИ). Результаты. Сравниваемые группы статистически значимо различались по показателям толщины стенок левого желудочка (ЛЖ). Так, значения минимальной толщины межжелудочковой перегородки (МЖП) и задней стенки ЛЖ (ЗСЛЖ) были в группе пациентов с ЦА в 1,18 раза и 1,17 раза меньше соответственно по сравнению с показателями группы пациентов с ИИ. Для выявления взаимосвязей проведен корреляционный анализ с расчетом коэффициента ранговой корреляции Спирмена. В общей группе пациентов, перенесших ИИ, установлена только обратная корреляционная связь между показателями ММЛЖ и НЧ/ВЧ% (r= –0,30), а в группе пациентов без ИИ с ЦА 1-2-й стадии связейустановлено не было. Выводы. У пациентов с ЦА 1-2-й степени и СД2 толщина МЖП и ЗСЛЖ достоверно меньше, а концентрический недилатационный тип ремоделирования ЛЖ встречается значимо чаще по сравнению с пациентами, перенесшими ИИ, что свидетельствует прежде всего о том, что перенесенный инсульт самостоятельно не является предиктором последующих кардиоваскулярных событий. Наличие обратной корреляционной связи между ММЛЖ и соотношением симпатической/парасимпатической компонент ВРС у постинсультных пациентов с СД2 и отсутствие таковой у пациентов с начальными проявлениями ЦА и СД2 свидетельствует о более выраженных физиологических взаимосвязях и менее выраженной автономии вегетативной нервной системы после значимого кардиоваскулярного события у пациентов с проявлениями ЦА.

The effect of left ventricular remodeling on the longitudinal myocardial kinetics of both heart ventricles in patients with arterial hypertension and cardiovascular risk factors

The aim – to study the longitudinal kinetics of the left, right ventricles and interventricular septum (IVS), depending on the type of left ventricular (LV) remodeling in patients with arterial hypertension (AH) in combination with additional cardiovascular risk factors with preserved LV contractility, as well as to determine the correlation of changes in the right ventricular systolic and diastolic parameters estimated with the tissue pulsed-wave Doppler imaging (TDI) with the same indices of the LV and IVS.Materials and methods. The study included 71 patients (average age – 54) with essential AH (68 % men) with a normal LV ejection fraction. The patients had the obese stage 1, combined hyperlipidemia, 29.6 % of patients had type II diabetes, 33.8 % were smokers. The patients were distributed into 4 groups depending on the types of remodeling: 1 – normal geometry (12.7 %); 2 – concentric remodeling (47.9 %); 3 – concentric hypertrophy (35.2 %); 4 – eccentric hypertrophy (4.2 %). TDI of the left and right ventricles and IVS was performed, systolic and diastolic TDI indices were determined, and the index of isovolumic myocardial acceleration (IVA) was calculated for the right ventricle (RV).Results and discussion. The type of LV concentric hypertrophy negatively affects the longitudinal myocardial kinetics of LV and IVS in the study group. The early diastolic velocity Em and the systolic velocity Sm were significantly decreased for the LV and IVS, the late diastolic velocity Am was decreased for the IVS and the E/Em for LV ratio was notably increased. Among the diastolic RV TDI indices only the deceleration time DTEm was significantly longer in LV concentric remodeling and concentric hypertrophy, than in its normal geometry. The IVA index was decreased in changing the type of LV geometry from normal to eccentric hypertrophy, indicating worsening of the RV longitudinal myocardial systolic function. There was a close correlation between diastolic and systolic TDI indices of the RV and IVS, which potentially indicated the importance of IVS in the mechanism of interventricular interaction and its effect on the RV function. The reliable dependence of systolic and diastolic RV TDI indices on the LV contractility was established.Conclusions. The type of LV remodeling, especially concentric hypertrophy, negatively affects the longitudinal myocardial kinetics of both ventricles in patients with AH in combination with additional cardiovascular risk factors. IVA can be a sensitive diagnostic criterion in the detection of early myocardial disorders of the RV systolic function with the changes of the LV geometry in this category of patients. Indices of RV longitudinal myocardial kinetics are closely dependent on changes in the function of IVS, which has a leading role in the formation of interventricular interaction.

TARGET TREATMENT OF PRIMARY ALDOSTERONISM AFFECTS CARDIAC WORK AND BIOENERGETICS

Objective: We hypothesized that hyperaldosteronism along with renin suppression can induce an energetically inefficient cardiac mechanical work in humans. Design and method: To test this hypothesis we investigated the LV mechanical efficiency by measuring myocardial mechano-energetic efficiency (MEE) and its modification after target treatment in patients with PA and essential hypertension (EH) with normal LV ejection fraction, in comparison with age-matched healthy control subjects (HS). Left ventricular (LV) dimension and systolic function, stroke volume (SV), stroke work (SW), and cardiac output (CO) were also estimated at baseline, and after adrenalectomy or medical treatment. MEE was estimated by echocardiographic SV (z-derived)/(heart rate x 0.6) and normalized for LV mass (MEEi ml/s x g). Results: We recruited 178 PA patients (age 51 ± 11 years), 78 EH patients (age 55 ± 14 years) and 60 HS (age 54 ± 11 years). At baseline, both PA and EH patients showed similarly increased LV dimension, LV mass, SV, SW and similarly reduced MEEi (PA 0.86 ± 0.2, EH 0.91 ± 0.2) compared with HS (1.07 ± 0.2, p < 0.0001). Among PA patients, those with eccentric LVH showed higher MEEi (1.06 ± 0.2 vs 0.78 ± 0.2, p < 0.0001), SV (96 ± 22 vs 81 ± 14, p < 0.0001), and CO (6.6 ± 0.1 vs 5.4 ± 0.1, p = 0.002) than those with concentric LVH. By regression analysis plasma aldosterone concentration, systolic blood pressure (BP) and body mass index (BMI) were identified as predictors of MEEi. At follow up surgically treated PA and EH showed a significant reduction of BP, LV mass and rate of LVH (PA 48% vs 69% at baseline, p = 0.001; EH 54% vs 65% at baseline, p < 0.05) and SW, and increase of arterial compliance and (not significant) of MEEi. Surgically treated PA showed also a reduction of SV (75 ± 19 vs 82 ± 16 at baseline, p < 0.0001) and CO (5.1 ± 1.4 vs 5.6 ± 1.3 at baseline, p = 0.001), not observed in medically treated PA patients. Conclusions: The lower myocardial mechano-energetic efficiency of PA patients with concentric than with eccentric LVH suggests a more detrimental effect of the former type of LV remodeling. Importantly, at follow-up LV mechano-energetic efficiency improved more in surgically-treated than in medically treated PA patients despite similar BP reductions.

Left ventricular structural changes and anthropometric markers of myocardial remodeling in overweight and obese children

Objective . The aim of the study was to investigate the anthropometric correlates of left ventricular (LV) structural changes in school-age children (10–17 years old) with overweight and obesity in comparison with children of similar age with normal body weight living in St Petersburg. Design and methods. In the study, according to inclusion criteria, 112 children of 10–17 years old (71 boys) were included, the average age was 14,0 ± 2,1 years. Three groups were identified: 60 (54 %) children (41 boys) with obesity, 26 (23 %) children (16 boys) with overweight and 26 (23 %) children (14 boys) in the control group. All children underwent anthropometry (height and weight, head, chest, waist, thighs, wrist, shoulder, shin and hip circumference, lower segment length, umbilical point, leg length, head height) with calculation of body mass index (BMI), overweight percent, waistto-hip ratio and waist-to-height ratio. Echocardiography was performed according to a standard procedure with calculation of LV mass (LVM), LV mass index (LVMI). On the percentile tables grades of LVM and LVMI were allocated. The relative wall thickness was calculated, and the LV geometry phenotypes were determined. Results. Echocardiography LV dimensions (posterior wall thickness, interventricular septal thickness, diastolic and systolic LV diameter), as well as LVM and LVMI were higher in obese children compared to control group children. LV hypertrophy (LVH) developed in 42,3 % overweight children and in 58,3 % obese children. Normal LV geometry was found in 73,1 % children with normal body weight, concentric remodeling — in 19,2 % cases, and 7,7 % children had eccentric LVH. In the overweight children group, normal LV geometry was determined in 34,5 %, concentric remodeling — in 7,7 %, concentric LVH — in 19,2 %, and eccentric LVH — in 38,6 %. In obese children, the distribution of various types of LV remodeling was as follows: 23,3 % / 3,3 % / 15 % / 58,4 %, respectively. We found a stronger correlation between LVM and body surface area, thigh circumference and shoulder circumference, and LVMI with BMI, overweight percent, shoulder circumference and lower segment length. The waist circumference is less associated with LVH in children. Conclusions. Since childhood, overweight and obesity are risk factors for LVH and the development of various LV geometry phenotypes. Anthropometric markers of myocardial remodeling is an affordable way of early cardiovascular risk stratification in overweight and obese children.

STRUCTURAL AND FUNCTIONAL CHANGES OF MYOCARDIUM IN WOMEN WITH OSTEOPOROSIS IN COMBINATION WITH ISCHEMIC HEART DISEASE

The aim of our study was to determine the characteristics of structural and functional changes of myocardium and aorta by echocardiography in women with ischemic heart disease (IHD) cause-specific from the presence of osteoporosis. Materials and methods. We examined 170 postmenopausal women aged from 57 to 78. Inclusion criteria: female gender, age over 50 years, the presence of menopause, the presence of IHD. Exclusion criteria: endocrine system diseases, severe heart failure, respiratory insufficiency, secondary osteoporosis. Postmenopausal osteoporosis was diagnosed according to the Clinical Recommendations for the Prevention and Management of Osteoporosis Patients (2016). All women were divided into 2 groups: group 1 – 72 women with proven diagnosis of osteoporosis and IHD, group 2 – 98 patients with isolated IHD (comparison group). IHD was represented by 2 forms: angina pectoris and postinfarction cardiosclerosis. The frequency of postinfarction cardiosclerosis was not statistically different between groups. Also the groups were comparable in age, weight, body-weight index, levels of peripheral (office) blood pressure. Results. In women with osteoporosis and IHD we revealed higher values of interventricular septum thickness (p = 0.034), left ventricle posterior wall (p = 0.004), and the relative thickness of left ventricular posterior wall (p = 0.0038). An increasing rate of left ventricular hypertrophy was observed in patients with combination of osteoporosis and IHD – 51.4 % versus 39.8 % in women with IHD without osteoporosis (p = 0.002). Osteoporosis was associated with a higher incidence of diastolic left ventricular dysfunction: 90 % versus 70.4 %, as well as with pathological types of left ventricular remodeling (p = 0.01); concentric remodeling type dominated among women with combined pathology (p = 0.09). A higher incidence of aorta calcification 1.86 times (p = 0.00013) and calcified aortic stenosis (13.8 % versus 4.08 %; p = 0.02) were noted in patients with osteoporosis. Conclusion. We found that osteoporosis in postmenopausal women was associated with an increasing of heart remodeling parameters, an increasing of diastolic dysfunction frequency and pathological types of left ventricle geometric remodeling with prevalence of concentric type remodeling. Patients with osteoporosis had a higher prevalence of aortic calcification and calcified aortic stenosis.