2017

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2017/№8

Diffusion Capacity of the Lung and Maladaptive Post-Infarction Remodeling of the Heart

Karetnikova V. N.1,2, Katsuba M. V.1, Polikutina O. M.1, Slepynina Y. S.1, Barbarash O. L.1
1Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia
2Kemerovo State Medical University, Kemerovo, Russia

Keywords: myocardial infarction; diffusing capacity of the lung for carbon monoxide (DLCO); myocardial remodeling

DOI: 10.18087/cardio.2017.8.10013

Objective. To assess the association of the lowering of diffusion capacity of the lung and maladaptive remodeling of the heart in a year after myocardial infarction (MI). Materials and Methods. We included into this study 107 patients with ST elevation MI (STEMI). Examination of all patients on 7–12 th days included echocardiography (echoCG), spirography, body plethysmography, and determination of lung diffusion capacity. After one year of observation in 87 patients (81.3%) we performed echocardiogram in dynamics. Results. After 1 year signs of maladaptive remodeling were detected in 25 patients (28.7%). The group of patients with remodeling had clinically significantly lowered parameters of lung diffusion function: diffusion capacity corrected for hemoglobin (DLCOcor) by 30% (p=0.001) and diffusing capacity for carbon monoxide/alveolar volume (DL/VA) by 21% (p=0.001). A mathematical model for prediction of maladaptive cardiac remodeling was obtained by the method of multivariate discriminant analysis. Univariate analysis showed that the reduction of DLCOcor was associated with 3.5-fold elevation of the risk of maladaptive remodeling in one year after STEMI. After adjustment for risk factors this risk rose up to 13.7-fold. Conclusion. Reduction of lung diffusion capacity below 80% of the predicted value on the 12-th day of STEMI was associated with 13.7-fold increase of the risk of detection of maladaptive remodeling of the heart after one year. Independent predictors of cardiac maladaptive remodeling were the number of diseased coronary arteries, reduced DLCO and the presence of myocardial remodeling during acute phases of myocardial infarction.
  1. Pfeffer J.M., Pfeffer M.A., Mirsky I. et al. Progressive ventricular dilatation and diastolic wall stress in rats with myocardial infarction and failure. Circulation 1982;66 (S2):51–66.
  2. Galiuto L., Gabrielli F.A., Lanza G.A. et al. Influence of left ventricular hypertrophy on microvascular dysfunction and left ventricular remodelling after acute myocardial infarction. Eur J Echocardiogr 2010;11 (8):677–682. doi: 10.1093/ejechocard/jeq041.
  3. Volkova I. I. Remodeling of the heart and blood vessels in ischemic heart disease. Patologija krovoobrashhenija i kardiohirurgija 2010;4:96–99. Russian (Волкова И. И. Ремоделирование сердца и сосудов при ишемической болезни сердца. Патология кровообращения и кардиохирургия 2010;4:96–99).
  4. Nechesova T. A., Korobko I. Ju., Kuznecova N. I. Left ventricular remodeling: pathogenesis and evaluation methods. Medicinskie novosti 2008;11:7–13. Russian (Нечесова Т. А., Коробко И. Ю., Кузнецова Н. И. Ремоделирование левого желудочка: патогенез и методы оценки. Медицинские новости 2008;11:7–13).
  5. Abdullaev R. Ja., Nikonov V. V. Features of early remodeling of the left ventricle and left atrium in patients with acute myocardial infarction. http://www.emergencymed.org.ua. Russian (Абдуллаев Р. Я., Никонов В. В. Особенности раннего ремоделирования левого желудочка и левого предсердия у больных с острым инфарктом миокарда. http://www.emergencymed.org.ua).
  6. Goldberg L.R. Stage B heart failure: management of asymptomatic left ventricular systolic dysfunction. Circulation 2006;113:2851–2860.
  7. Peruckij D. N., Makeeva T. I., Konstantinov S. L. Basic concepts of post-infarction remodeling of the left ventricle. Nauchnye vedomosti. Serija Medicina. Farmacija 2011;14 (10):51–59. Russian (Перуцкий Д. Н., Макеева Т. И., Константинов С. Л. Основные концепции постинфарктное ремоделирования миокарда левого желудочка. Научные ведомости. Серия Медицина. Фармация 2011;14 (10):51–59).
  8. Loboz-Grudzień K., Kowalska A., Brzezińska B. et al. Early predictors of adverse left ventricular remodelling after myocardial infarction treated by primary angioplasty. Cardiol J 2007;14 (3):238–245.
  9. Andrea R., Lopez-Giraldo A., Falces C. et al. Lung function abnormalities are highly frequent in patients with heart failure and preserved ejection fraction. Heart Lung Circ 2014;23:273–279. doi: 10.1016/j.hlc.2013.08.003.
  10. Ruda M. Ja. Diagnosis and treatment of patients with acute myocardial infarction with ST elevation ECG segment. Kardiovaskuljarnaja terapija i profilaktika 2007;6 (8):415–500. Russian (Руда М. Я. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Кардиоваскулярная терапия и профилактика 2007;6 (8):415–500).
  11. Van de Werf F., Bax J., Betriu A. et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008:29:2909–2945.
  12. Mareev V. Ju., Ageev F. T., Arutjunov G. P. et al. National guidelines PRAs, the RKO and RNMOT for the diagnosis and treatment of chronic heart failure (fourth revision). Serdechnaja nedostatochnost’ 2013;7:379–472. Russian (Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность 2013;7:379–472).
  13. Quanjer P.H., Tammeling G.J., Cotes J.E. et al. Lung volumes and forced ventilatory flows. Report Working Party Standardization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society. Eur Respir J 1993;16, Suppl:5–40.
  14. Pellegrino R., Viegi G., Brusasco V. et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948–968.
  15. Mancini DM. Pulmonary factors limiting exercise capacity in patients with heart failure. Prog Cardiov Dis 1996:6:347–370.
  16. Tsukimoto K., Mathieu-Costello O., West J.B. Pulmonary microvascular permeability. Responses to high vascular pressure after induction of pacing-induced heart failure in dogs. Circ Res 1995:77:317–325.
  17. West J.B., Mathieu-Costello O. Structure, strength, failure and remodelling of the pulmonary gas barrier. Ann Rev Physiol 1999:61:543–572.
  18. Pardaens K., Cleemput J.V., Vanhaeke J., Fagard R.H. Peak oxygen uptake better predicts outcome than submaximal respiratory data in heart transplant candidates. Circulation 2000:101:1152–1157.
  19. Robbins M., Francis G., Pashkow F.J. et al. Ventilatory and heart rate response to exercise. Better predictors of heart failure mortality than peak oxygen consumption. Circulation 1999:100: 2411–2417.
  20. Ryabov V. V., Sokolov А. А., Ryabova T. R ., Markov V. A. The effect of modern reperfusion therapy of myocardial infarction on structural and functional changes in heart. Тоmsk 2010; 252p. Russian (Рябов В. В., Соколов А. А., Рябова Т. Р., Марков В. А. Структурно-функциональная перестройка сердца в условиях современной реперфузионной терапии инфаркта миокарда. Томск 2010;252 с.).
  21. Bortnyj N. A., Kramnoj I. E., Kinoshenko Ju. T. et al. Left ventricular remodeling and principles of radiation diagnosis of heart failure in patients with myocardial infarction. Medicina neotlozhnyh sostojanij 2006;3:88–90. Russian (Бортный Н. А., Крамной И. Е., Киношенко Ю. Т. и др. Ремоделирование левого желудочка и принципы лучевой диагностики сердечной недостаточности у больных инфарктом миокарда. Медицина неотложных состояний 2006;3:88–90).
  22. Guazzi M., Gatto H., Giusti G. et al. Pathophysiology of cardiorenal syndrome in decompensated heart failure: role of lung-right heart-kidney interaction. Int J Cardiol 2013;169 (6):379–384. doi: 10.1016/j.ijcard.2013.09.014.
  23. Zaliaduonyte-Peksiene D., Simonyte S., Lesauskaite V. et al. Left ventricular remodelling after acute myocardial infarction: Impact of clinical, echocardiographic parameters and polymorphism of angiotensinogen gene. J Renin Angiotensin Aldosterone Syst 2014;15 (3):286–293. doi: 10.1177/1470320312471228.
  24. Bolognese L., Neskovic A.N., Parodi G. et al. Left ventricular remodeling after primary coronary angiography: patterns of left ventricular dilatation and long-term prognostic implications. Circulation 2002;106 (18):2351–2357.
  25. Chilingarjan A. L. Structural and functional reorganization of the left ventricle and atrium in myocardial infarctions of various localization. Medicinskaja nauka Armenii NAN RA 2008;4:98–106. Russian (Чилингарян А. Л. Структурно-функциональная перестройка левого желудочка и предсердия при инфарктах миокарда различной локализации. Медицинская наука Армении НАН РА 2008;4:98–106).
  26. Koveshnikova T. A. Cardiac remodeling in chronic heart failure in patients with ischemic heart disease. Medicinskij zhurnal 2007;1:52–53. Russian (Ковешникова Т. А. Ремоделирование сердца при хронической сердечной недостаточности у больных ишемической болезнью сердца. Медицинский журнал 2007;1:52–53).
  27. Iversen K.K., Kjaergaard J., Akkan D. et al. ECHOS Lung Function Study Group. The prognostic importance of lung function in patients admitted with heart failure. Eur J Heart Fail 2010;12 (7):685–691. doi: 10.1093/eurjhf/hfq050.
Karetnikova V. N., Katsuba M. V., Polikutina O. M., Slepynina Y. S., Barbarash O. L. Diffusion Capacity of the Lung and Maladaptive Post-Infarction Remodeling of the Heart. Kardiologiia. 2017;57(8):20–27.

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