Russian Heart Failure Journal 2014year Risk factors for diastolic heart failure in patients with ischemic heart disease


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2014/№1

Risk factors for diastolic heart failure in patients with ischemic heart disease

Sergeeva S. S., Novozhilova N. V., Kuznetsova T. Yu

Keywords: diastolic CHF, coronary heart disease, preserved systolic function, risk factors


DOI: 10.18087/rhfj.2014.1.1871

Background. Chronic HF with preserved systolic function (CHF-PSF) is a common disease with an indistinct clinical picture and unfavorable prognosis. These facts dictate a need for early, active detection of the disease before the development of irreversible myocardial alterations and systolic dysfunction. Aim. To analyze risk factors (RFs) for CHF-PSF in IHD patients. Materials and methods. 97 IHD patients with signs and symptoms of suspected CHF were evaluated. Mean age was 59.03±9.4 years (68 males, 70 %). The evaluation included ECG, EchoCG, tissue dopplerography (TD), and coronary angiography. CHF-PSF was diagnosed by an algorithm (symptoms; clinical and objective signs; specific indexes of TD mode, primarily diastolic raise of LV base (Em); and brain natriuretic peptide (BNP) level if indicated). Results. In patients with signs of diastolic dysfunction, the diagnosis of CHF-PSF was confirmed by TD and BNP in 71 % of cases. Patients were divided into 3 groups: group 1 (38 patients, 39 %) included patients with IHD and CHF-PSF; group 2 (15 patients, 16 %) consisted of patients with excluded CHF; and group 3 (44 patients, 45 %) included IHD patients with systolic HF (SHF). LV hypertrophy (LVH) was observed in 76, 60 and 52 % of patients in the respective groups. LV dilatation with eccentric myocardial remodeling rather than LVH was more typical for patients of the SHF group than for patients with CHF-PSF (76 and 52 %, p=0.02). Patients with CHF more frequently had a history of myocardial infarction (MI) (47 % in group 2 and 95 % in group 3; p=0.0001). 74 % of patients CHF-PSF had a history of MI. 32, 13 and 34 % of patients, respectively (p>0.05), had a history of diabetes mellitus. CHF was significantly more frequently associated with stem and 3‑vessel coronary artery disease than with 2- and 1‑vessel coronary artery disease (71 and 91 % in groups 1 and 3 vs. 7 % in group 2, р=0.0001; 91 % in the SHF group and 71 % in the CHF-PSF group; р=0.02). Stem coronary artery disease was significantly more frequently detected in patients with CHF than in IHD patients without CHF (29, 0, 30 %, p=0.02). Conclusion. The study demonstrated an advantage of TD in detecting CHF-PSF. Severity of coronary atherosclerosis, LVH and a history of MI were RFs of CHF-PSF in IHD.
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Sergeeva S. S., Novozhilova N. V., Kuznetsova T. Yu. Risk factors for diastolic heart failure in patients with ischemic heart disease. Russian Heart Failure Journal. 2014;15(1):3–8.

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