2016


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2016/№1

Effect of transient arterial hypotension on prediction for chronic heart failure patients with preserved left ventricular ejection fraction

Serova D. V., Shutov A. M., Serov V. A.
Federal State Budgetary Educational Institution, “Uljyanovsk State University”, L. Tolstogo 42, Uljyanovsk 432017

Keywords: CHF, left ventricular ejection fraction, prognosis

DOI: 10.18087/rhfj.2016.1.2192

Background. At the present time, the effect of occurrence and severity of arterial hypotension (AHyp) episodes on prognosis of CHF patients with preserved LV EF (CHF-PEF) is understudied. Aim. To evaluate the effect of transient AHyp episodes on prognosis of patients with CHF-PEF. Materials and methods. 169 patients with CHF (74 males and 95 females) aged 56.3±10.9 were evaluated. All patients had LV EF >50 %. CHF detection and treatment were performed in accordance with RSSC and SEHF National Guidelines, 2013. FC II CHF was diagnosed in 105 patients and FC III CHF was diagnosed in 64 patients. The major cause for CHF was a combination of IHD and essential hypertension (EH) in 144 patients. Duration of the prospective observation period was 24 months. Composite endpoint included nonfatal MI and CV death. AHyp was diagnosed when office BP was ≤100 / 60 mm Hg. BP measured by 24-h BP monitoring (24-h BPM) was ≤100 / 60 mm Hg for daytime BP and ≤85 / 47 mm Hg for nighttime BP. Transient AHyp was determined as hypotension recorded in at least one BP measurement during 24-h BPM. Results. Office BP measurement revealed AHyp in 16 (9.5 %) patients and 24-h BPM (by mean diurnal values) – in 5 (3 %) patients (χ2=5.08; р=0.02). However, over 24 hours, episodes of transient AHyp were observed in 104 (61.6 %) CHF patients, including episodes of systolic-diastolic AHyp in 54 (32 %) patients. Transient AHyp occurred more frequently in daytime; for SBP, in 18 (10.7 %) patients vs. 2 (1.2 %) patients in nighttime (χ2=11.96; р=0.0005) and for DBP, in 38 (22.5 %) patients vs. 29 (17.2 %) patients, respectively (χ2=1.19; р=0.3). For the observation period, 8 composite endpoints were observed, including 5 deaths and 3 nonfatal MIs. All these 8 patients had transient systolic-diastolic and/or diastolic AHyp. MI and fatal outcomes were absent in CHF patients without AHyp episodes (χ2=4.28; р=0.04). Analysis of nighttime AHyp pronouncement in CHF patients who had composite endpoints showed an increase in time index for nighttime DBP hypotension (21.2±29.3 % vs. 6.0±16.9 %, respectively; р=0.04). Conclusion. In patients with FC II-III CHF-PEF, 24-h BPM detected AHyp episodes in 61.6 % of cases. Risk for development of nonfatal MI and cardiovascular death is increased in CHF-PEF patients with episodes of transient systolic-diastolic AHyp.
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Serova D. V., Shutov A. M., Serov V. A. Effect of transient arterial hypotension on prediction for chronic heart failure patients with preserved left ventricular ejection fraction. Russian Heart Failure Journal. 2016;17 (1):27–33

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