Structural and Functional Features of Left Ventricle in Patients With Heart Failure, Coronary Heart Disease and Thyrotoxicosis

Abstract

Aim. This study was designed to determine the structural and functional features of left ventricle in patients with heart failure, coronary heart disease and thyrotoxicosis.Materials and methods. 85 patients aged 58.3±5.6 years were divided into 3 groups: the main one – 25 patients with coronary heart disease (CHD), chronic heart failure (CHF) II-III functional classes (FC) and thyrotoxicosis, average age –59.23±3.81; the 1st comparison group – 30 patients with CHD and CHF FC II-III without thyroid dysfunction, the average age – 57.6±2.73; the 2nd comparison group – 30 patients with thyrotoxicosis without concomitant cardiovascular diseases (CVD), the average age – 45.4±3.51. The structure and function of the thyroid gland were examined in all patients. The echocardiographic (EchoCG) examination was performed to evaluate the structural and functional indicators of the left ventricle (LV).Results. The LV pathologic remodeling in patients of the main group is represented by two types: concentric left ventricle hypertrophy (CLVH) and eccentric left ventricle hypertrophy (ELVH), CLVH was more common than in patients without thyroid dysfunction but with CHF and CHD (84.0%, р=0.01). The LV myocardium contractility was reduced in patients of both groups with CHF, the values of the ejection fraction corresponded with the intermediate type of HF, there was no significant difference between the indices (p = 0.1). The main group had significantly more pronounced decrease in the ratio of the blood flow velocity of early diastolic filling of the LV and the maximal atrial systolic velocity (E / A) − 0.63 and the increase in the isovolumic relaxation time (IVRT) – 84.69 ms in comparison with the indicators of the CHD and CHF patients without thyroid dysfunction (p = 0.021, p = 0.034).Conclusion. For patients with CHF, CHD and thyrotoxicosis, predominance of LV remodeling according to the type of CLVH (84.0% of cases) is typical as well as a moderate decrease in the contractility of the LV and a more pronounced diastolic dysfunction. It determines the structural and functional features of the left ventricle in patients with CHF with this comorbidity.

Clinical, pathogenetic, and diagnostic features of heart failure in patients with coronary heart disease and thyrotoxicosis

“…В литературе достаточно подробно описано влияние тиреоидных гормонов на структурно-функциональные показатели сердца при гиперфункции щитовидной железы, однако сохраняет актуальность изучение особенностей ремоделирования сердца у полиморбидных больных с тиреотоксикозом [15]. В настоящем исследовании определены особенности структурно-функционального ремоделирования левых отделов сердца при наличии сопутствующего тиреотоксикоза у пациентов с ХСН ишемического генеза: достоверно более низкие значения индексированных линейных и объемных параметров ЛЖ, развитие ДДЛЖ I типа в 100% случаев, более частая встречаемость КГЛЖ по сравнению с показателями у пациентов с ХСН без патологии щитовидной железы, что обусловлено влиянием избытка тиреоидных гормонов и, прежде всего, гиперактивацией симпатического звена ВНС [16].…”