ROLE OF GENDER SPECIFICS IN MYOCARDIAL REMODELLING, CARDIOVASCULAR COMPLICATIONS DEVELOPMENT AND EFFICACY OF PHARMACOTHERAPY IN HEART FAILURE PATIENTS AFTER CARDIAC SURGERY

Abstract

Aim. To assess gender influence on myocardial remodelling, pharmacotherapy efficacy and complications development in chronic heart failure patients (CHF) post cardiac surgery.Material and methods. In the study, 87 patients included, both genders, with CHF, who had been planned for cardiac surgery. All underwent standard investigations and CHF treatment, as other pathologies. Myocardium specimens from the right atrium appendage (RAA) were collected during surgery, investigated with general histology, immune histochemistry (expression of MMP-9, TIMP-1 and р38αMAPK) methods. For the evaluation of treatment influence on myocardium, intervention groups were selected: enalapril and metoprolol, perindopril and amlodipine (Prestance®, “Les Laboratoires Servier”, France). In all participants, at 10-14 day post surgery, the rate of complications was evaluated, by groups. At least one complication led to selection the participant as adverse in-hospital outcome. The relations were studied, of post-surgery complications with EchoCG data and morphological changes in LAA myocardium, taken the gender and left ventricle ejection fraction (LVEF).Results. In cardiac surgery group with heart failure and preserved LVEF (HFpEF) with the increase of CHF functional class, normal LVEF remained, and there was worsening of the LV diastolic function. In HFpEF males there was decrease of EF with transition to “grey zone” by III functional class, and eccentric remodeling predominated with unchanged diastolic function. In HF mid-range EF group, regardless of gender, there was eccentric LV remodelling. In RAA myocardium of women there was lower grade of myocardial fibrosis and mononuclear areas of infiltration, and there was higher rate of cardiovascular as extracardiac complications. High grade of MMP-9 in RAA revealed in the group of HF mid-range EF and adverse outcome, regardless gender, and increased expression of р38αMAPK in females of thisgroup. In perindopril and amlodipine group there was lower grade of MMP-9 and р38αMAPK expression.Conclusion. The study demonstrated gender differences in remodelling of myocardium in HFpEF patients. This makes to consider female gender, HF midrange EF, MMP-9 expression in RAA myocardium, as prognostic markers of surgery adverse outcome. Combination of perindopril and amlodipine demonstrated protective influence on myocardium, with more prominent effect in females.

Keywords

• heart failure
• remodelling
• cardiac surgery
• gender
• matrix metalloprotease-9
• pharmacotherapy