Left Ventricular Remodeling in Patients with Stable Angina Complicated by Heart Failure with Reduced and Preserved Ejection Fraction

Abstract

Introduction. Chronic heart failure is one of the most common and serious diseases of cardiovascular system, resulting in permanent disability and significantly reducing the length and quality of life. Purpose of the study to find out the features of left ventricular remodeling in patients with stable angina of II-III functional class depending on the reduction or preserving of left ventricular ejection fraction. Materials and research methods. To achieve this objective was conducted a full clinical examination of 153 patients with CHF (105 men and 48 women, average age of patients being 68,80 ± 0,90 years) who were treated separately at the cardiology department for patients with arrhythmias of Vinnytsia Regional Clinical Center for Treatment and Diagnostics of cardiovascular diseases. All the patients were divided into 2 groups: first group consisted of patients with stable angina of II-III FC and heart failure with reduced LV EF (n = 47); second group – patients with stable angina of II-III FC and HF with preserved LV EF (n = 106). The control group comprised 30 healthy individuals. Results of the investigation and their discussion. In the examined patients with stable angina of II-III FC with HF of I-III FC with reduced LV EF (1 group) according to the results of echocardiography compared with healthy people was determined a significant increase in size of left atrium, the final systolic size, end- diastolic size, end-systolic volume, end-diastolic volume, end-systolic index volume, stroke volume, the thickness of the back wall of the left ventricle, interventricular septum thickness, left ventricular myocardial mass index, relative LV wall thickness (p < 0.01) and a significant decrease in ejection fraction (p < 0.01), indicating the presence of structural and functional changes in the myocardium and reduced inotropic function of the heart. In the examined patients with stable angina with heart failure of I-III FC (2 group) with preserved LV EF by echocardiography results were defined similarly structural and functional changes in the left ventricle. However, it is important that as a result of a comparison of echocardiographic indicators of patients of surveyed groups 1 and 2 were found the following changes: a significant increase in the size of left atrium, the final systolic size, end diastolic size, end systolic volume, end-diastolic volume index, end-systolic volume index, end-diastolic volume, index of left ventricular mass, relative wall thickness of the left ventricle (p < 0.01) and a significant decrease in ejection fraction (p < 0.01) in the presence of heart failure with reduced LV EF. In the examined patients with reduced and preserved LV EF prevailed a concentric LVH. In the examined patients with heart failure with reduced LV EF prevailed III (significant) degree of LVH (p < 0.01). However, in patients with heart failure with preserved LV EF in most cases were determined II (moderate) or less III (significant) degree of LVH (p < 0.01). The results indicate that the examined patients with reduced LV EF heart remodeling is due to more and more significant increase of the degree of LVH and cardiac remodeling, which has an adverse prognostic significance. Conclusions. A deeper study and understanding of left ventricular remodeling in chronic heart failure of ischemic origin enables a more accurate description of the disease and provides an adequate medical care to patients suffering from stable angina of II-III functional classes, complicated by heart failure with reduced and preserved left ventricular ejection fraction.

Keywords

• cardiac remodeling
• chronic heart failure
• reduced left ventricular ejection fraction