The aim – to study clinical characteristics of patients with arterial hypertension, symptoms of heart failure and preserved left ventricular (LV) ejection fraction (EF) depending on the value of E/e´ at rest and after submaximal exercise testing (SET). Material and methods. A prospective study involved 103 patients, average age 65.4±10.8 years, with clinical signs of heart failure, LV EF ≥ 50 % and signs of LV diastolic dysfunction. Echocardiography with tissue Doppler, SET, applanational tonometry were conducted. The level of NT-proBNP was studied. According to E/e´, patients were divided into 3 groups: E/e´ > 13 at rest (group І), E/e´ > 13 after SET (group ІІ), E/e´ < 13 after the SET (group ІІІ). Results. Group І included 64 (62.1 %), group ІІ – 24 (23.3 %), group ІІІ – 15 (14.5 %) patients. Patients were comparable regarding age, gender, frequency of earlier myocardial infarction and the average level of systolic blood pressure. Patients of group І, compared to those in groups ІІ and ІІІ, more often had atrial fibrillation, chronic kidney disease and anemia (all Р<0.01). Frequencies of diabetes mellitus and obesity in group ІІ were larger than in group ІІІ: 12 (50 %) and 4 (26.6 %); Р<0.05) and 15 (62.5 %) and 3 (20 %); Р<0.01), respectively. Severity of heart failure by NYHA was greatest in group І, less – in group ІІ and the smallest – in group ІІІ (all Р<0.01). Group ІІ, compared to group ІІІ, had worse exercise tolerance based on submaximal exercise test duration (7.2±1.7 and 8.6±1.9 minutes, Р<0.01) and power (50.0±19.9 and 68.3±22.0 W, Р<0.02), higher left atrial volume index (LAVI) 38.7±1.2 and 35.3±1.2 ml/m2 Р<0.05, left ventricular myocardial mass index (LVMI) 138.7±13.7 and 128.0±35.1 mg/m2 Р<0.05 and levels of NT-proBNP 422.8±93.8 and 134.3±53.5 pg/ml. Conclusions. Patients with E/e´ > 13 at rest differ from those with E/e´ increase after SET, by decrease of exercise tolerance and higher frequency of comorbidities. In patients with arterial hypertension, heart failure II–III classes NYHA and unchanged E/e´ at rest, its increase more than 13 after SET was noted in 61.5 % patients, and was associated less exercise load, greater frequency of obesity and type 2 diabetes, greater LVMI and LAVI and higher levels of NT-proBNP.
The aim – to determine polymorphisms of the nitric oxide synthase gene -786T>C rs 2070744 and the association of the corresponding genotypes with the severity of left ventricle (LV) diastolic dysfunction (DD), pulmonary hypertension (PH) and elastic properties of the arteries in patients with arterial hypertension (AH) and heart failure (HF) with preserved ejection fraction (EF). Materials and methods. We included 69 patients (pts) with AH and HF with preserved EF (31 female (41.9 %) and 33 male (58.1 %)), aged 67.4±10.2 years; II–III class NYHA, hemodynamically stable. According to Shah’s criteria, the «aging» phenotype was identified in 11 (15.9 %) pts, «obesity» – 14 (20.3 %) pts, «coronary artery disease» – 16 (23.2 %) pts, «pulmonary hypertension» – 17 (24.6 %) pts (with a significant predominance of patients with CC genotype), «arterial hypertension» – 17 (24.6 %) pts. Results and discussion. «Wild» homozygous TT genotype was found in 34 pts (49.3 %, TT group), heterozygous TC genotype – in 21 pts (30.4 %, TC group) and «mutant» homozygous CC genotype – in 14 pts (20.3 %, CC group). The groups did not differ in gender (male 19 or 55.9 %, 12 or 60 % and 11 or 61.1 %, p>0.05) and average age (67.1±8.9, 65.4±10.6 and 64.9±10.3 years p>0.05), and in prevalence of comorbidities. The worst result of 6-minute walk test was in the CC group compared with TT and TC (371.8±77.7, 385.7±85.4 and 314.3±69.1, p>0.05), as well as higher NT-proBNP level (668.1±317.8, 636.9±433.2 and 806.9±369.7, p>0.05), greater LVMI (187.4±37.1, 182.2±25.7 and 195.2±28.5, p>0.05). There was markedly more pronounced DD LV in the CC group compared with TT and TC, according to average e’ (p>0.05) and E/e’ (p>0.05). SPAP was the highest in the CC group (p>0.05), as well as PCWP and TPG (p>0.05). Patients of the CC group had worse elastic properties of arteries according to AIx75 (p>0.001) and PWVc-f (p>0.05), with a decrease in SAC (by 38.2 and 29 % compared to TT and TC (p>0.05) and an increase in Ea, respectively, by 21 and 9 % (p>0.05). According to the cuff test in patients of the CC group, compared with those in the TT and TC groups, worsening of endotelium-dependent vasodilation, respectively by 19.8 and 17.3 % (p>0.05) was revealed. Conclusions. Compared to other polymorphisms, the CC genotype of the NOS3 rs 2070744 gene is associated with greater severity of DD LV, LH and impaired LV diastolic function and elastic properties of systemic arteries, according to pulse wave analysis in patients with AH and HF with preserved EF.
The aim — to determine differences in the structure and function of the heart, arterial stiffness, resistive and pulsative loads and ventricular‑arterial connection in patients with arterial hypertension, confirmed heart failure (HF) and preserved ejection fraction, depending on age and gender.Materials and methods. The study included 115 patients (62 (53.9 %) men and 53 (46.1 %) women, average age — 67.3 ± 9.7 years) with a diagnosis of HF with preserved EF of IIA or IIB stage, II — III functional class according to NYHA, left ventricular (LV) ejection fraction (EF) ≥ 50 % and signs of LV diastolic dysfunction according to transthoracic echocardiography, who were divided into two groups by gender and two groups by age (≥ 65 years and < 65 years). All patients underwent general clinical examination, determination of the level of N‑terminal fragment of brain natriuretic peptide (NT‑proBNP), transthoracic echocardiography, applanation tonometry, test with 6‑minute walk. The frequency of comorbid conditions (non‑cardiac and cardiac) was analyzed.Results and discussion. When analyzing the frequency of cardiac comorbidity, we detected the same frequency of myocardial infarction (MI) and, in particular, Q‑MI in older and younger men, as well as in women (p < 0.05), with a lower incidence of MI in the anamnesis in women than in men in each age group (p < 0.05 — 0.01). The distance of the 6‑minute walk was smaller in the older age groups and in women than in men regardless of age (p < 0.05). A higher NT‑proBNP level was associated with older age and female gender (p < 0.05). Young women had a lower (p < 0.05) and older women had a higher (p < 0.05) incidence of obesity than men with the same frequency of diabetes in all 4 groups (p > 0.05). The glomerular filtration rate was lower in the elderly, and the frequency of anemia in these groups of patients was higher. In women of both age groups it was lower than in men (p < 0.05—0.01) with a correspondingly higher incidence of chronic kidney disease (p < 0.0—0.01). The expressiveness of LV hypertrophy in the mean value of the myocardial mass index of the LV was greater in old age, in women of both age groups it was less pronounced than in men (by 13.2 and 12.7 %, respectively, p < 0.05), and was associated with age deterioration of the diastolic function in women — a decrease in the mean e and DT (by 3.4 and 5.1 %, respectively, p < 0.05) and an increase in diastolic elastance (by 4.1 %, p < 0.05 compared with patients aged < 65 years). High values of diastolic elastance and left atrial volume index (by 4.2 and 10.0 %, p < 0.05) and a lower average level of DT (by 11.7 %, p < 0.05) in these patients confirmed a more pronounced diastolic dysfunction. The systolic pressure in the pulmonary artery was greater in women than in men, both at age < 65 years (by 20.5 %, p < 0.01) and ≥ 65 years (by 19.6 %, p < 0.01). The end‑diastolic LV volume index increased with age only in women (by 10.3 %, p < 0.05) and in both age groups it was smaller than in men (by 18.7 and 6.5 %, respectively, p < 0.05). This could be due to the greater severity of diastolic dysfunction in women, mostly young, as evidenced by their lower impact index (by 14.1 %, p < 0.05). A lesser frequency among women of cases of myocardial infarction could play a certain role. It was associated with greater EF in younger women compared with men (by 4.9 %, p < 0.05). In the absence of differences in brachial and central systolic blood pressure between all groups, the resistive load on the LV according to the mean brachial systolic blood pressure, systemic vascular resistance and Ea in women was higher than in men both at a young age (114.1 ± 9.1 and 94.7 ± 9.4; 1.8 ± 0.2 and 1.5 ± 0.4; 2.48 ± 0.91 and 1.97 ± 0.38, respectively, p < 0.05), and at an older age (106.2 ± 7.7 and 98.6 ± 10.9; 2.2 ± 0.5 and 1.6 ± 0.4; 2.14 ± 0.23 and 1.97 ± 0.39, respectively, p < 0.05), without significant age differences in mean brachial arterial pressure and Ea (p > 0.05) for both sexes. When assessing the pulse load, an increase in the augmentation index was detected, standardized to a heart rate of 75 per 1 min and a pulse wave velocity in older women, compared with older men (24.9 ± 4.3 and 22.4 ± 5.7; 13.04 ± 1.4 and 12.4 ± 1.9, respectively (p < 0.05).Conclusions. Among patients with hypertension and verified HF with preserved EF, in younger women compared with men there was a greater degree of diastolic dysfunction in terms of diastolic elastance, left atrial volume index, DT, an increase in systolic pressure in the pulmonary artery and NT‑proBNP level at the same frequency atrial fibrillation and body mass index. With a greater resistive load on the LV in terms of systemic vascular resistance and Ea, women patients with hypertension and heart failure with preserved EF had a higher pulse load (according to ascending augmentation index standardized to heart rate of 75 per 1 min and pulse wave velocity) than men with comparable central systolic blood pressure, regardless of age.
Національний медичний університет імені О.О. Богомольця, м. Київ 2 Олександрівська клінічна лікарня м. Києва Мета дослідження: оцінювання кардіальної структури, внесок артеріальної та шлуночкової жорсткості у механізм порушення серцевої гемодинаміки та розвиток клінічних симптомів серцевої недостатності зі збереженою фракцією викиду (СНзФв) лівого шлуночка (ЛШ). Матеріали та методи. До проспективного дослідження було залучено 103 гемодинамічно стабільних хворих від 43 до 85 років (середній вік-65,4±10,8 року) з клінічними симптомами та ознаками хронічної серцевої недостатності (ХСН) ІІ-ІІІ ФК, артеріальною гіпертензією не вище 1 ступеня на тлі антигіпертензивної терапії та Фв ЛШ ≥50%, ознаками ДД за даними допплерЕхоКГ. Хворим визначали рівень n-термінального фрагмента попередника мозкового натрійуретичного пептиду (nTproBnP), крім стандартних лабораторних показників. Швидкість поширення пульсової хвилі (каротидно-феморальної) і показники гемодинаміки визначали за допомогою апланаційної тонометрії. За допомогою ЕхоКГ визначали стандартні показники, проводили діастолічний стрес-тест. За наявністю або відсутністю критеріїв діагнозу СНзФв ЛШ за рекомендаціями Європейського Товариства кардіологів (2016) та наявністю або відсутністю Е/е' у спокої >13 у.о у додаток до структурних критеріїв хворих було розподілено на три групи. У групу 1 увійшли хворі з рівнем nTproBnP <125 пг/мл та наявними структурними критеріями, у групу 2-пацієнти зі структурними критеріями з рівнем nTproBnP >125 пг/мл, у групу 3-пацієнти з рівнем nTproBnP >125 мг та показником Е/е' >13 у.о. Результати. До групи 1 (без СН) увійшли 11 (10,6%) пацієнтів, до групи 2-28 (27,18%), до групи 3-64 (62,1%). Ознаки nYHA ІІ ФК були наявні у всіх пацієнтів групи 1 та у 78,5%-групи 2 (р>0,05), тоді як у групі 3 переважала nYHA ІІІ ФК (64,0%) (р<0,01). Рівень nTproBnP прогресивно збільшувався від групи 1 до групи 3 (р<0,01). За даними ЕхоКГ спостерігалося збільшення КДІ і КСІ у пацієнтів групи 3 порівняно з такими у групі 1, що супроводжувалося зменшенням Фв ЛШ (на 11,5%; р<0,05) при прогресивному збільшенні ІммЛШ і ІОЛП (р<0,01). Під час оцінювання показників діастолічної функції ЛШ відзначено збільшення показників активного розслаблення міокарда ЛШ е´ латеральне, е´ септальне та їхнє середнє значення від групи 1 до групи 3 (р<0,01). Під час оцінювання показників брахіального і центрального АТ рівні брахіального і центрального ПАТ у трьох групах не відрізнялися (р>0,05).
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