2017

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2017/№2

Arrhythmias in patients with chronic heart failure and preserved ejection fraction

Konovalova T. V., Perepech N. B.
Federal State Budgetary Educational Institution of Higher Education "Saint-Petersburg State University ", 7/9 University Embankment, St.-Petersburg, 199034

Keywords: diastolic heart failure, echocardiography, heart rhythm disturbances, ventricular extrasystoles, atrial fibrillation

DOI: 10.18087/rhfj.2017.2.2314

Background. Heart rhythm disorders take an important place among causes of death in patients with CHF and preserved LV EF (CHF-PEF). Aim. To study the structure of arrhythmias in patients with CHF-PEF and to determine the relationship of arrhythmia incidence with EchoCG parameters. Materials and methods. As a part of a retrospective study, clinical and statistical analysis was performed for case reports of 205 hospitalized patients (mean age, 68.3±11.0) with CHF-PEF (LV EF > 50%). EchoCG was performed for all patients; in 159 patients, LV diastolic function was evaluated in the pulsed-wave mode with measurement of early (E) and late (A) diastolic filling peak velocities, E/A ratio, and DT. ECG Holter monitoring (HM) was performed in 110 patients; supraventricular and ventricular arrhythmias (VA) were recorded. VA were evaluated using the classification of ventricular extrasystole (VE) by B. Lown and M. Wolf (1971) modified by M. Ryan et al. (1975). Results. According to data of ECG HM, VE was observed in 83 (75.5%) patients with CHF-PEF. 43 (39.1%) patients had grade I VE, 2 (1.8%) patients – grade II VE, 19 (17.3%) patients – grade III VE, 11 (10.0%) patients – grade IVa VE, 4 (3.6%) patients – grade IVb VE, and four (3.6%) patients – grade V VE. High-grade VE was observed in 38 (34.5%) patients. 59 (28.8%) patients had atrial fibrillation (AF): 35 (17.1%) patients had paroxysmal AF, 9 (4.4%) patients had persistent AF, and 15 (7.3%) had permanent AF. Compared to patients without arrhythmias, patients with high-grade VE had lower LV EF values (Simpson) and higher values of LV end-diastolic volume, end-systolic volume, end-diastolic relaxation, and end-systolic relaxation, myocardial mass index, and in the presence of AF – relatively large left atrial (LA) anteroposterior diameter, LA index, pulmonary artery systolic pressure (PASP) and E/A (p<0.05). The presence of AF statistically significantly correlated with severity of diastolic dysfunction (DD) (p=0.05). Conclusion. Approximately one-third of patients with CHF-PEF had high-grade VE and/or AF. Development of AF was associated with the presence of pulmonary hypertension, LA dilatation, more severe DD, and VA was associated with increased size and mass of LV myocardium.
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Konovalova T. V., Perepech N. B. Arrhythmias in patients with chronic heart failure and preserved ejection fraction. Russian Heart Failure Journal. 2017;18 (2):94–101

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