Intraventricular septum role in chronic heart failure pathogenesis

Abstract

Aim. To study intraventricular septum (IVS) role in left and right ventricular (LV, RV) contractility among patients with coronary heart disease (CHD) and chronic heart failure (CHF). Material and methods. In total, 117 CHD patients with NYHA Functional Class (FC) I-IV CHF (mean age 58±4,1 years), underwent IV and RV inotropic function assessment by standard balanced biventricular radioventriculography For local myocardial contractility assessment, a unified 16-segment IV and RV model was used. Results. Local LV and RV segmental contractility was analyzed. Segments with local ejection fraction (EF) >50% were regarded as normokinetic, 25-50% - as hypokinetic, and <25% - as akinetic. Total EF in all patients with FC I-II CHF was normal. At the same time, segmental hypo- and akinesia were registered mostly in anterior-septal area of LV and RV. In FC III CHF, LV EF decrease was associated with local IVS akinesia and LV free wall dyskinesia. RV EF was reduced to 38,4±4,8%, associating with local IVS dyskinesia due to pulmonary hypertension. In FC IV CHF, LV EF reached 15,1±4,1%, and RV EF - 25,9±6,8%, with pronounced segmental dys- and akinesia in septal area and free walls of LV and RV Conclusion. In CHD patients with initial CHF, local contractility disturbances were registered in IVS segments. CHF progression was associated with LV and RV EF decrease, as well as with local hypo-, dys-, and akinesia.

Keywords

• intraventricular septum
• local contractility
• diastolic dysfunction
• coronary heart disease
• chronic heart failure
• balanced biventricular radioventriculography