To access this material please log in or register

Register Authorize

Features of structure and function myocardial remodeling in relation to the etiological cause of chronic heart failure

Klester E. B., Plinokosova L. A., Lychev V. G., Klester K. V.
State Budgetary Educational Institution “Altay State Medical University” of the RF Ministry of Health Care, Prospekt Lenina 40, Barnaul, Altay Territory

Keywords: myocardial remodeling, chronic obstructive pulmonary disease, CHF, EchoCG

DOI: 10.18087/rhfj.2014.6.1962

Background. In the Russian population, arterial hypertension (AH) is the major etiological factor of CHF (88 %) while CHF is induced by chronic obstructive pulmonary disease (COPD) in every tenth patient. At present, the contingent of patients with combined cardiorespiratory conditions is continuously growing. Aim. To perform a comparative study of major regularities in left and right heart remodeling during CHF development in patients with COPD and AH. Materials and methods. Comprehensive clinical observation was conducted on 163 patients including 55 patients with COPD (group I), 48 patients with COPD+AH (group II), and 60 patients with AH (group III). The inclusion criterion was the presence of CHF. In evaluation of gender distribution, the majority of patients were men (65–69 %). Mean age of group I patients was 61.5±0.67, group II – 63.4±0.39, and group III – 62.1±0.61. Patients of groups I and II had mild and moderate obstructive disease; patients of groups II and III mostly had grade II AH. Mean CHF FC was 2.2±0.06 in group I, 2.6±0.06 in group II, and 2.4±0.05 in group III (pI–II; pII–III <0.05). Results. LV EF was statistically significantly higher in patients of group I than group II. Systolic dysfunction (LV EF <45 %) was observed in 14.5 % of group I patients. In patients of group II, the rate of low LV EF was significantly higher, 31.3 % (c2=4.19; р=0.04). 35 (63.6 %) patients with COPD had type I diastolic dysfunction. In group II, 17 (35.4 %) patients had type 1 LV diastolic dysfunction; 21 (43.7 %) patients – type 2 (pseudonormal); and 11 (22.9 %) patients – type 3 transmitral flow spectrum. 78.3 % patients with AH had diastolic disorders of both LV and (to a lesser degree) right ventricle (RV). Conclusion. LV and RV remodeling processes were observed in groups I, II and III. The most pronounced increase in size and wall thickness, increase in LV myocardium mass, and decrease in LV pump function were observed in group II (patients with combined cardiovascular and respiratory disease).
  1. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33 (14):1787–847.
  2. Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П. и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Журнал Сердечная Недостаточность. 2013;14 (7):379–472.
  3. Liu L, Eisen HJ. Epidemiology of heart failure and scope of the problem. Cardiol. Clin. 2014 Feb;32 (1):1–8.
  4. Беленков Ю. Н., Мареев В. Ю., Агеев Ф. Т. и др. Истинная распространенность ХСН в Европейской части Российской (исследование ЭПОХА, госпитальный этап). Журнал Сердечная Недостаточность. 2011;12 (2):63–9.
  5. Grzywa-Celińska A, Szmygin-Milanowska K, Dyczko M et al. Comorbidity of chronic heart failure and chronic obstructive pulmonary disease. Pol Merkur Lekarski. 2013 Nov;35 (209):251–3.
  6. Böhm M, Pogue J, Kindermann I et al. Effect of comorbidities on outcomes and angiotensin converting enzyme inhibitor effects in patients with predominantly left ventricular dysfunction and heart failure. Eur J Heart Fail. 2014 Mar;16 (3):325–33.
  7. Cavaillès A, Brinchault-Rabin G, Dixmier A et al. Comorbidities of COPD. Eur Respir Rev. 2013 Dec;22 (130):454–75.
  8. Lang RM, Bierig M, Devereux RB и др. Рекомендации по количественной оценке структуры и функции камер сердца. Российский кардиологический журнал. 2012;3 (95 Прил 1):1–28.
  9. Meysman M, Pipeleers-Marichal M, Geers C et al. Severe right heart failure in a patient with chronic obstructive lung disease: a diagnostic challenge. Indian J Chest Dis Allied Sci. 2013 Jul-Sep;55 (3):159–62.
  10. Caram LM, Ferrari R, Naves CR et al. Association between left ventricular diastolic dysfunction and severity of chronic obstructive pulmonary disease. Clinics (Sao Paulo). 2013 Jun;68 (6):772–6.
  11. Baydoun H, Khoueiry G, Ghandour Z, Olkovsky Y. From right to left heart failure: an unexpected transition. Heart Lung. 2014 Jan-Feb;43 (1):41–4.
  12. Beghé B, Verduri A, Bottazzi B et al. Echocardiography, spirometry, and systemic acute-phase inflammatory proteins in smokers with COPD or CHF: an observational study. PLoS One. 2013 Nov 11;8 (11):e80166.
  13. Visca D, Aiello M, Chetta A. Cardiovascular function in pulmonary emphysema. Biomed Res Int. 2013;2013:184678.
  14. Seeger W, Adir Y, Barberà JA et al. Pulmonary hypertension in chronic lung diseases. J Am Coll Cardiol. 2013 Dec 24;62 (25 Suppl): D109–16.
  15. Abdirahman I, Haddad T, Dwivedi G. The prognostic role of right ventricular function in left ventricular disease in the setting of cardiac resynchronization therapy. Curr Opin Cardiol. 2014 Mar;29 (2):185–91.
  16. Friedberg MK, Redington AN. Right versus left ventricular failure: differences, similarities, and interactions. Circulation. 2014 Mar 4;129 (9):1033–44.
  17. Pechlivanidis G, Mantziari L, Giannakoulas G et al. Effects of renin-angiotensin system inhibition on right ventricular function in patients with mildessential hypertension. J Renin Angiotensin Aldosterone Syst. 2011 Sep;12 (3):358–64.
  18. Cuspidi C, Negri F, Giudici V et al. Impaired midwall mechanics and biventricular hypertrophy in essential hypertension. Blood Press. 2010 Aug;19 (4):234–9.
  19. Peperstraete B. Management of comorbidities in heart failure. Rev Med Brux. 2013 May-Jun;34 (3):154–62.
  20. Miller J, Edwards LD, Agustí A et al. Comorbidity, systemic inflammation and outcomes in the ECLIPSE cohort. Respi Med. 2013 Sep;107 (9): 1376–84.
  21. Müllerova H, Agusti A, Erqou S, Mapel DW. Cardiovascular comorbidity in COPD: systematic literature review. Chest. 2013 Oct;144 (4):1163–78.
  22. Шойхет Я. Н., Клестер Е. Б. Артериальная гипертензия у больных хронической обструктивной болезнью легких в сочетании с ишемической болезнью сердца. Терапевтический архив. 2008;80 (9):13–7.
  23. Głuszek J. Ischaemic heart disease and hypertension in patients with chronic obstructive pulmonary disease and obstructive sleep apnoea. Pneumonol Alergol Pol. 2013;81 (6):567–74.
  24. Calder L, Tierney S, Jiang Y et al. Patient safety analysis of the ED care of patients with heart failure and COPD exacerbations: a multicenter prospective cohort study. Am J Emerg Med. 2014 Jan;32 (1):29–35.
  25. Minasian AG, van den Elshout FJ, Dekhuijzen PN et al. COPD in chronic heart failure: less common than previously thought? Heart Lung. 2013 Sep-Oct;42 (5):365–71.
Klester E. B., Plinokosova L. A., Lychev V. G. et al. Features of structure and function myocardial remodeling in relation to the etiological cause of chronic heart failure. Russian Heart Failure Journal. 2014;15 (6):355–360

To access this material please log in or register

Register Authorize
Ru En