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Left ventricle diastolic function in chronic heart failure patients with reduced ejection fraction. Connection with the clinical picture

Uskova O. V., Gendlin G. E., Reznik E. V., Storokhakov G. I.
State Budgetary Educational Institution of Higher Professional Education, “N.I. Pirogov Russian National Research Medical University” of the RF Ministry of Health Care, Ostrovityanova 1, Moscow 117997

Keywords: left ventricle diastolic dysfunction, ace inhibitors, CHF

DOI: 10.18087/rhfj.2012.3.1700

Relevance. A share of patients with CHF and systolic dysfunction of the left ventricle have a combined failure of both systolic and diastolic functions. Objective. Investigation of remodeling and diastolic properties in patients with low ejection fraction (EF) and LV dilatation. Evaluation of relaxation and filling dysfunction contribution to the clinical presentation and survival rate of CHF patients. Materials and methods. 60 patients with IHD (ischemic heart disease), dilatation and ischemic cardiomyopathy, arterial hypertension (AH) and LV dilatation, EF 40 % and III–IV functional class (NYHA) of CHF were examined. The control was composed of 15 people not affected by cardiovascular diseases. The echocardiographic study with M- and B- regimes, impulse and wave Doppler included evaluation of major remodeling parameters: wall thickness, LV diameter and volumes, RA space, EF value, impulse and heart indices, values of diastolic filling. The gravity of clinical symptoms was evaluated in accordance with the developed questionnaire. Results. Statistically significant differences in major group patients were observed in spacious and speed values of filling as compared to those in control group patients – increase of the LV volume ratio in the moment of the first third of diastole to the final diastolic volume (84.0±8.28 % versus 55.7±15.6 %, р<0.0005), reduction of the relaxation fraction in the first third of diastole (13.5±7.52 % versus 35.6±16.7 %, р<0.01), contraction of duration of the quick filling phase (0.199±0.046 sec versus 0.231±0.032 sec, р<0.05) and its early period (0.056±0.017 sec versus 0.068±0.015 sec, р<0.05). CHF patients older than 60 were characterized by reduction (р=0.05) of the average LV filling rate in the whole period of quick filling phase as compared to patients of other age groups (246.4±94.9 ml / sec versus 317.1±149.7 ml / sec) and greater intensity of dyspnea. ACEI treatment (Perindopil) in 3 months lead to reduction of end-systolic volume, growth of EF and left ventricular filling pressure. Conclusion. The analysis of diastole dysfunction in patients with systolic CHF testifies to the fact that it to a greater share associated and is a consequence of systolic dysfunction and LV dilatation. The diastolic function is related to one of the major clinical symptom – dyspnea, and the intensity of the latter in elderly patients corresponds to lower LV compliance.
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Uskova O. V., Gendlin G. E., Reznik E. V. et al. Left ventricle diastolic function in chronic heart failure patients with reduced ejection fraction. Connection with the clinical picture. Russian Heart Failure Journal. 2012;13(3):132-137

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