Russian Heart Failure Journal 2014year Diastolic stress-echocardiography in diagnostics of heart failure with preserved left ventricular systolic function in patients with arterial hypertension

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Diastolic stress-echocardiography in diagnostics of heart failure with preserved left ventricular systolic function in patients with arterial hypertension

Pilant D.A., Lollini V.A.

Keywords: hyperpiesis, heart failure, preserved systolic function, EchoCG

DOI: 10.18087/rhfj.2014.2.1789

Background. In patients with AH and myocardial hypertrophy, high LV myocardial stiffness is in some cases associated with increased LV filling pressure. In turn, the high LV filling pressure may result in development of occult HF with preserved LV systolic function (HF-PSF). EchoCG detection of this condition involves certain challenges. Aim. To study possibilities of tissue Doppler EchoCG (TD-EchoCG) and stress-EchoCG in diagnostics of HF-PSF in patients with grade 2 AH. Materials and methods. 60 patients were evaluated including 45 patients with grade 2 AH complicated with stage I–IIA, NYHA FC I–II HF (main group). The evaluation included EchoCG, TD-EchoCG and stress-Echo-CG. In addition to standard parameters of heart remodeling, the time course of LV diastolic filling index (Е / Е′) was evaluated and the LV diastolic reserve index (DRI) and the mean left atrial (LA) pressure were calculated. Results. LV diastolic dysfunction was found in all AH patients of the main group including 31 (68 %) patients with type 1 and 14 (31 %) patients with type 2. Stress-EchoCG revealed unfavorable time course of parameters indicating the development of HF only in 39 (86 %) patients. Mean values of LV DRI were statistically different (p<0.05) depending on CHF FC, type of LV diastolic dysfunction (LV DD), and LV filling pressure. Regression analysis showed negative correlations of individual DRI values with Е / Е’ (r= –0.78). The LV diastolic reserve changed in a broad range of values from 60 to 0 conv. units with the threshold level for diagnosing HF of 14 conv. units. Conclusion. Stress-EchoCG in combination with TD-EchoCG can be used for early detection of HF-PSF in patients with AH and LV DD; values of DRI <14 conv. units indicate development of HF induced by low LV diastolic reserve.
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Pilant D.A., Lollini V.A. Diastolic stress-echocardiography in diagnostics of heart failure with preserved left ventricular systolic function in patients with arterial hypertension. Russian Heart Failure Journal. 2014;83 (2):83–89

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