Dynamics of Indicators of Structural and Functional State of the Heart in the Post-Infarction Period Depending on the Presence of Decompensated Heart Failure
Echocardiographic indicators in decompensated heart failure demonstrate a high prevalence of structural and hemodynamic abnormalities. In the patients with decompensated heart failure in the early and late post-infarction period, echocardiographic indicators were found to significantly differ from those recorded in the patients without heart failure. Thus, reduced ejection fraction, increased end-diastolic volume and end-diastolic dimension indicate left ventricular systolic dysfunction and left ventricular cavity dilation. Since echocardiography of the heart and the pulmonary artery enables real-time estimation of cardiac filling, signs of systolic dysfunction and pulmonary congestion, it may serve as a predictor of decompensated heart failure development in the early and late post-infarction period.
The objective of the research was to determine the main echocardiographic indicators in terms of rapid monitoring of deterioration in the main parameters of left ventricular overload for early diagnosis of decompensated heart failure, as well as structural and geometric remodeling of left ventricular myocardium in the early and late post-infarction period.
Materials and methods. There were examined 160 patients with acute myocardial infarction. Depending on the development of decompensated heart failure in the early and late post-infarction period, the patients were divided into two subgroups being homogeneous by age and gender.
Results. The results obtained indicated significant hemodynamic changes in the patients with decompensated heart failure in the post-infarction period. They included significantly lower values of ejection fraction indicating left ventricular systolic dysfunction and the signs of left ventricular cavity dilation as evidenced by the increase in left ventricular end-diastolic volume and end-diastolic dimension. The tendency for an increase in left ventricular posterior wall thickness and interventricular septal thickness, as well as left ventricular myocardial mass, left ventricular myocardial mass index and left ventricular radius to wall thickness ratio indicated concentric left ventricular remodeling.
Conclusions. Modern management of patients with decompensated heart failure should be guided by an objective value of left ventricular ejection fraction as it plays a key role in selecting management strategy for this cohort of patients since a significant reduction in this parameter indicates cardiac decompensation. Pulmonary artery pressure and concentric left ventricular hypertrophy play a significant role in cardiac failure development as well.
Kovalenko VM, Nesukai OH, Titov YeYu et al. Optimization of the diagnosis of heart failure with preserved left ventricular ejection fraction in patients with essential hypertension using speckle-tracking echocardiography. Ukraiinskyi kardiolohichnyi zhurnal. 2015;5:43-49. [published in Ukrainian]
Kuryata AV, Kushnir YuS. Direct influence on the ischemic myocardium: studied and new opportunities. Ukraiinskyi kardiolohichnyi zhurnal. 2016;3:85-93. [published in Russian]
Nascimento B, Brant L, Moraes D, Ribeiro A. Global health and cardiovascular disease. Ukraiinskyi kardiolohichnyi zhurnal. 2016;(4):123-133. [published in Ukrainian]
Yermak OS, Kravchun PH, Ryndina NH, Rynchak PI. Copeptіn, MRproADM and cardiac hemodynamyc indicators in patients with acute myocardial infarction depending on obesity occurrence. Bukovinian Medical Herald. 2016;1(73):65-68. [published in Ukrainian]
Chiew W, Chen S, Iyngkaran P. Cardiac imaging in heart failure with comorbidities. Curr Cardiol Rev. 2017;13(1):63-65. DOI: https://doi.org/10.2174/1573403X12666160803100928 [PMCid:PMC5324322]
van Riet EE, Hoes AW, Wagenaar KP et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18:242-252. DOI: https://doi.org/10.1002/ejhf.483 [PMid:26727047]
Kalogeropoulos AP, Georgiopoulou VV, Gheorghiade M, Butler J. Echocardiographic evaluation of left ventricular structure and function: new modalities and potential applications in clinical trials. J Card Fail. 2012;18:159-172. DOI: https://doi.org/10.1016/j.cardfail.2011.10.019 [PMid:22300785]
Gupta VA, Nanda NC, Sorrell VL. Role of Echocardiography in the Diagnostic Assessment and Etiology of Heart Failure in Older Adults: Opacify, Quantify, and Rectify. Heart Fail Clin. 2017;13(3):445-466. DOI: https://doi.org/10.1016/j.hfc.2017.02.003 [PMid:28602365]
Martens P, Nijst P, Mullens W. Current approach to decongestive therapy in acute heart failure. Curr Heart Fail. 2015;12:367-378. DOI: https://doi.org/10.1007/s11897-015-0273-5 [PMid:26486631]
Marti CN, Georgiopoulou VV, Kalogeropoulos AP. Acute heart failure: patient characteristics and pathophysiology. Curr Heart Fail Rep. 2013;10:427-433. DOI: https://doi.org/10.1007/s11897-013-0151-y [PMid:23918642 PMCid:PMC3823818]
Marwick TH. The role of echocardiography in heart failure. J Nucl Med. 2015;56(6):31-38. DOI: https://doi.org/10.2967/jnumed.114.150433 [PMid:26033901]
Papadimitriou L, Georgiopoulou VV, Kort S, Butler J, Kalegeropoulos. Echocardiography in acute heart failure: current perspectives. J Card Fail. 2016;22:82-94. DOI: https://doi.org/10.1016/j.cardfail.2015.08.001 [PMid:26277267]
Ponikowski P, Voors AA, Anker SD et all. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200. DOI: https://doi.org/10.1002/ejhf.592 [PMid:27207191]
Strаnad M, Prosen, Borovnik LV. Bedside lung ultrasound for monitoring the effectiveness of prehospital treatment with continuous positive airway pressure in acute decompensated heart failure. Eur J Emerg Med. 2016;23(1):50-55. DOI: https://doi.org/10.1097/MEJ.0000000000000205 [PMid:25222428]
Van Riet EE, Hoes AW, Wagenaar KP et al. Epidemiology of heart failure: the prevalence of heart failure and ventricular dysfunction in older adults over time. A systematic review. Eur J Heart Fail. 2016;18:242-252. DOI: https://doi.org/10.1002/ejhf.483 [PMid:26727047]
Yancy CW, Jessup M, Bozkurt B et al. American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines ACCF/AHA guideline for the management of heart failure. Circulation. 2013;128:240-327. DOI: https://doi.org/10.1161/CIR.0b013e31829e8807 [PMid:23741057]
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