Russian Heart Failure Journal 2015year Features of left ventricular remodeling and development of chronic heart failure in patients with obliterating arteriosclerosis of the lower extremities and essential hypertension

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Features of left ventricular remodeling and development of chronic heart failure in patients with obliterating arteriosclerosis of the lower extremities and essential hypertension

Strutynsky A. V., Gorbacheva E. V., Baranov A. P., Buzin A. G., Trishina V. V., Golubev Yu. Yu., Golubeva G. Yu., Baranova A. A.
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: obliterating arteriosclerosis of the lower extremities, myocardial remodeling, CHF

DOI: 10.18087/rhfj.2015.2.2053

Background. According to data of population studies, the presence of obliterating arteriosclerosis of the lower extremities (OALE) considerably increases the risk for severe cardio- and cerebrovascular complication and development of acute cerebrovascular disease (ACVD), MI and CHF, which develop in such patients significantly more frequently than ischemic complications of lower limb arteries themselves. Meanwhile the current literature almost lacks information about features of structural geometric and functional heart remodeling in patients with ACVD and CHF in combination with essential hypertension (EH). Aim. To study features of LV remodeling and CHF development in patients with ACVD and to evaluate some factors that influence this process. Materials and methods. The study included 60 patients with stage 2 EH without signs of ACVD (group 1) and 78 patients with clinical and instrumental signs of OALE and grade II–III chronic arterial insufficiency of the lower extremities (CAILE) according to A. V. Pokrovsky in combination with stage 2 EH (group 2). The used standard methods included EchoCG study, 24‑hour Holter ECG monitoring, 24‑hour BP monitoring, and quantitative measurement of proinflamatory cytokines (TNF-α and IL-6) in blood plasma. Results. In patients of group 2 with OALE and EH, the process of LV remodeling was associated with a significant increase in left ventricular myocardial mass (LVMM) (to 232.4±3.3 g), high incidence of signs for concentric LV hypertrophy (LVH) (57.5–86.8 % of patients), and a considerable increase in general peripheral vascular resistance (GPVR) with preserved, normal LV dimensions and EF. Pronounced type I LV diastolic dysfunction (Е / А, 0.8–0.78) was also observed; it was associated with moderate increases in left atrial dimensions and pulmonary artery systolic pressure (PASP). The degree of these changes correlated with CAILE severity, clinical signs of CHF, incidence and degree of LV myocardium changes and disturbed rhythm and conductance The features of LV remodeling observed in patients with OALE and ES were to a considerable degree related with severity of signs for multifocal atherosclerosis with damaged aorta, peripheral and coronary arteries, incidence of IHD detection, and overactivation of proinflammatory cytokines (TNF-α and IL-6), whereas increased BP was probably less important. Conclusion. Development of CHF in patients with ACVD and EH is based on disturbances of LV systolic function induced by a pronounced increase in LVMM and formation of concentric LVH, which prevents adequate LV diastolic filling and provides increased LV and LA EDP.
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Strutynsky A. V., Gorbacheva E. V., Baranov A. P. et al. Features of left ventricular remodeling and development of chronic heart failure in patients with obliterating arteriosclerosis of the lower extremities and essential hypertension. Russian Heart Failure Journal. 2015;16 (2):73–80

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