To access this material please log in or register

Register Authorize

Factors associated with dilatation of the left ventricle in CHD patients

Yaroslavskaya E. I., Kuznetsov V. A., Pushkarev G. S.

Keywords: left ventricle dilatation, coronary heart disease

DOI: 10.18087/rhfj.2012.4.1652

Relevance. Ishemic cardiomyopathy is traditionally linked with remodelling of myocardial tissue after myocardial infarction in the network of whitch dylatation syndrome is marked out. In this paper, we tried to find out what can promote the dilatation of LV in CHD patients without past MI. Objective. Reveal the factors associated with LV dilatation in CHD patients without past MI. Materials and methods. 2 443 patients with CHD (at presence of hemodynamically significant coronary stenoses according to coronary angiography – more than 50 % artery lumen) without acute or anamnestic MI was sel ected fr om the “Register of the performed coronary angiography surgeries”©. The study also excluded persons with heart diseases. The patients were divided into the following groups: 50 patients with moderate or apparent LV dilatation (LV end diastolic diameter 60 mm and more) and 1992 patients without LV dilatation (LV end diastolic diameter 55 mm and less). Results. The comparison of clinical functional parameters of the groups showed that patients with LV dilatation had DM (22.2 % vs. 10.8 %, р=0.008) more often, higher HF FC (III) after NYHA (34.1 % vs. 9.7 %, р<0.001) and heart rhythm disturbances (70.6 % vs. 22.0 %, р<0.001), myocardial mass index (129.4±28.6 vs. 184.4±34.8 g / m², р<0,001) was higher and LVEF (41.9±10.3 vs. 60.7±4.9 %, р=0.001) was lower. However, they had more seldom severe (III–IV) exertional angina FC (39.5 % vs. 55.8 %, р=0.033), multiple coronary stenoses (3 and more vessels) (24.5 % vs. 37.7 %, р=0.05) and lesions of a diagonal branch (2.2 % vs. 15.7 %, р=0.041) less often. Multivariant analysis showed independent connection of left ventricular dilatation with heart rhythm disturbances, smaller quantity of the affected coronary arteries, decreased LVEF, increased myocardial mass index. Conclusion. Factors associated with LV dilatation in CHD patients without past MI are heart rhythm disturbances, smaller quantity of the affected coronary arteries, decreased LVEF, myocardial mass index. Nonischemic component may be present in the mechanism of LV dilatation in such patients.
  1. Senthilkumar A, Majmudar MD, Shenoy C et al. Identifying the Etiology: A Systematic Approach Using Delayed-Enhancement Cardiovascular Magnetic Resonance. Heart Fail Clin. 2009;5 (3):349–367.
  2. Кузнецов В. А, Зырянов И. П., Колунин Г. В. и др. «Регистр проведенных операций коронарной ангиографии». Свидетельство о государственной регистрации базы данных № 2010620075, зарегистрировано в Реестре базы данных 1 февраля 2010 г.
  3. Акчурин Р. С., Васюк Ю. А., Карпов Ю. А. с др. Национальные рекомен­дации по диагностике и лечению стабильной стенокардии. 2008 г. Кардио­васкулярная терапия и профилактика 2008;7 (6) (приложение 4):40с.
  4. Руда М. Я., Голицын С. П., Грацианский Н. А. Диагностика и лечение больных острым инфарктом миокарда с подъемом сегмента ST электрокардиограммы. Кардиоваскулярная терапия и профилактика. 2007;6 (8) (приложение 1):415–500.
  5. Шиллер Н., Осипов М. А. Клиническая эхокардиография, второе издание. – М.: Практика, 2005. – 344c.
  6. Devereux RB, Alonso DR, Lutas EM et al. Echocardiographic assessment of left ventricular hypertrophy comparison to necropsy findings. Am J Cardiol. 1986;57 (6):450–458.
  7. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317 (17):1098.
  8. Fang JC, Aranki S. Diagnosis and management of ischemic cardiomyopathy. Available at: http://www.uptodate.com / contents / diagnosis-and-management-of-ischemic-cardiomyopathy.
  9. Hunt SA, Abraham WT, Chin MH et al. 2009 focused update incorporated into the ACC / AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation / American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119 (14):e391–479.
  10. Felker GM, Shaw LK, O’Connor CM. A standardized definition of ische­mic cardiomyopathy for use in clinical research. J Am Coll Cardiol. 2002;39 (2):210–218.
  11. Клиническое руководство по ультразвуковой диагностике под редакцией Митькова В. В. – М., «Видар», 1998. Том 5. – 360с.
  12. Фейгенбаум Х. Эхокардиография. 5‑е изание. – М., Видар. 1999. – 511.
  13. Valensi P. Silent coronary artery disease in diabetic patients. New guidelines. Rev Med Liege. 2005;60 (5-6):531–535.
  14. Nguyen MT, Cosson E, Valensi P et al. Transthoracic echocardiographic abnormalities in asymptomatic diabetic patients: Association with microalbuminuria and silent coronary artery disease. Diabetes Metab. 2011;37 (4):343–350.
  15. Kronmal RA, McClelland RL, Detrano R et al. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2007;115 (21):2722–2730.
  16. Badran HM, Mostafa A, Serage A et al. Arterial mechanics in ischemic versus nonischemic cardiomyopathy: clinical and diagnostic impact. Echocardiography. 2009;26 (7):785–800.
  17. Wagner A, Mahrholdt H, Thomson L et al. Effects of time, dose, and inversion time for acute myocardial infarct size measurements based on magnetic resonance imaging-delayed contrast enhancement. J Am Coll Cardiol. 2006;47 (10):2027–2033.
  18. McCrohon JA, Moon JC, Prasad SK et al. Differentiation of heart fai­lure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation. 2003;108 (1):54–59.
  19. Casolo G, Minneci S, Manta R et al. Identification of the ischemic etio­logy of heart failure by cardiovascular magnetic resonance imaging: diagnostic accuracy of late gadolinium enhancement. Am Heart J. 2006;151 (1):101–108.
  20. Krittayaphong R, Boonyasirinant T, Saiviroonporn P et al. Late gadolinium enhancement from cardiac magnetic resonance in ischemic and non-ischemic cardiomyopathy. J Med Assoc Thai. 2011;94 (Suppl 1):S33–38.
  21. Schwarz ER, Schaper J, vom Dahl J et al. Myocyte degeneration and cell death in hibernating human myocardium. J Am Coll Cardiol. 1996;27 (7):1577–1585.
  22. Olivetti G, Abbi R, Quaini F et al. Apoptosis in the failing human heart. N Engl J Med. 1997;336 (16):1131–1141.
  23. Roberts WC, Siegel RJ, McManus BM. Idiopathic dilated cardiomyopathy: analysis of 152 necropsy patients. Am J Cardiol. 1987;60 (16):1340–1355.
  24. Bello D, Shah DJ, Farah GM et al. Gadolinium cardiovascular magnetic resonance predicts reversible myocardial dysfunction and remodeling in patients with heart failure undergoing beta-blocker therapy. Circulation. 2003;108 (16):1945–1953.
  25. Uretsky BF, Thygesen K, Armstrong PW et al. Acute coronary fin­dings at autopsy in heart failure patients with sudden death: results from the assessment of treatment with lisinopril and survival (ATLAS) trial. Circulation. 2000;102 (6):611–616.
  26. Schuster EH, Bulkley BH. Ischemic cardiomyopathy: a clinicopathologic study of fourteen patients. Am Heart J. 1980;100 (4):506–512.
  27. Мовесянц М. Ю., Иванов В. А., Трунин И. В. и др. Избирательная тактика стентирования бифуркационных стенозов коронарных артерий. Кардиология и сердечно-сосудистая хирургия. 2008;6:31–34.
Yaroslavskaya E. I., Kuznetsov V. A., Pushkarev G. S. Factors associated with dilatation of the left ventricle in CHD patients. Russian Heart Failure Journal. 2012;13(4):195-199

To access this material please log in or register

Register Authorize
Ru En