Russian Heart Failure Journal 2004year Detection of structural and geometric peculiarities in late postinfarction left ventricular remodeling


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2004/

Detection of structural and geometric peculiarities in late postinfarction left ventricular remodeling

Bokeriya L.A., Buziashvili Yu.I., Kluchnikov I.V., Matskeplishvili S.T., Inozemtseva E.V., Mozhina A.A., Melkonyan A.M.

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Urgency: Geometric peculiarities of postinfarction left ventricular aneurysms (PLVA) permit quite accurate detection of the presence, localization and spread of an aneurysm; differentiation between fibrous and fibrous-muscular cicatricial damage; studying the efficacy of surgical treatment, etc. Aim: Developing an approach to the most complete evaluation of left ventricular (LV) remodeling using echocardiography (echoCG) in patients with PLVA. Materials and methods: A total of 70 patients with PLVA was evaluated. The leading clinical pathology was represented by III–IV Canadian cardiologists’ classification functional class (FC) angina on exertion and rest. We have isolated several groups by aneurysm localization: group 1, anterior aneurysms (n=46), group 2, anterio-posterial aneurysms; (n=15); group 3, posterior aneurysms (n=9); and control group, 20 healthy subjects. Analysis of resting ecoCG included the following parameters: LV end-diastolic size (EDS), LV end-systolic size and wall thickness as measured at the levels of heart base, mid-chambers and apex; LV end-systolic volume (ESV); LV end-diastolic volume (EDV); LV ejection fraction (EF); sphericity factor; LV obliquity; myocardial stress; and the presence of thrombus in the LV cavity. Results: An anterior wall thinning was observed in patients with anterior and anterio-posterior aneurysms already at the middle level. At the apical level, the anterior wall thickness in diastole was 0.46±0.01 cm, 0.71±0.03 cm and 0.48±0.018 cm respectively, in patients with PLVA. Thickness of the anterior wall in diastole significantly differed between patients with anterior, anterio-posterior and posterior PLVA (p<0.001). In patients with anterior PLVA, similar changes occurred also in the ventricular septum (VS). Analysis of sphericity factor at the apical level in systole phase showed that this parameter was significantly increased in patients with PLVA (0.32±0.01, 0.29±0.01, 0.31±0.01) as compared to normal subjects (0.24±0.01) (p<0.001). In the systole phase, the ratio of short axes at the levels of mitral valve and apex was as follows, by PLVA groups: group 1, 1.32±0.02; group 2, 1.27±0.07; group 3, 1.27±0.03. In normal subjects the parameter comprised 1.76±0.05 (p<0.001). In patients with anterior PLVA, anterior wall myocardial stress in diastole was as follows, by levels: basal, 381.4±18.5 units; middle, 472.5±10.8 units; apical 433.6±19.2 units. The level of anterior wall myocardial stress in diastole significantly differed in patients with anterior PLVA and healthy subjects (p<0.001).

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