CHRONIC HEART FAILURE IN ELDERLY PATIENTS WITH ISOLATED SYSTOLIC ARTERIAL HYPERTENSION
DOI:
https://doi.org/10.11603/1811-2471.2021.v.i1.12003Keywords:
isolated systolic arterial hypertension, chronic heart failure, preserved ejection fraction, diastolic dysfunction, old ageAbstract
In patients with isolated systolic arterial hypertension (ISAH), the development of chronic heart failure (CHF) leads to a long course of the disease, structural and functional adjustment and impairment of the geometric model of the heart. Age-related changes in the heart of the left ventricle (LV) in elderly patients have a certain contribution to the formation of CHF with preserved ejection fraction (EF). Despite significant advances in the diagnosis and treatment of elderly patients with ISAH, the features of development and criteria for the diagnosis of CHF in this category of patients are currently insufficiently studied.
The aim – to study the features of development and work out criteria for the diagnosis of CHF in elderly patients with ISAH.
Material and Methods. There were examined 134 elderly patients with ISAH. The main group included 91 patients aged 71.1±3.5 years with ISAH, LV EF>50 % and NT-pro BNP level>125 pg / ml. Of them there were 61 women (67 %) and 30 (33 %) men. The comparison group consisted of 43 patients (27 women and 16 men aged 70.4±3.7 years) with ISAH, LV EF>50 % and NT-pro BNP<125 pg/ml. The structural and functional state of the heart was studied using one- and two-dimensional echocardiography. LV and left atrial volume (LV) were calculated by the Simpson method. Transmitter blood flow was assessed according to the recommendations of the European Association of Cardiovascular Imaging and the American Association of Echocardiography. NT-pro BNP in blood plasma was determined by chemiluminescent enzyme-linked immunosorbent assay.
Results. Diastolic dysfunction (DD) was diagnosed in 66 (72.5 %) patients of the main group according to the type of LV relaxation disorder (RD). In 25 (27.5 %) patients with ISAH and CHFpEF diastolic dysfunction (DD) by the type of pseudonormalization (PN) was diagnosed. In all cases, there was a concentric LVH. Regardless of gender, the level of the index of maximum volume of LA (IVLAmax.) exceeded 34 ml/m2. Criteria for the diagnosis of LV CHF in patients with ISAH have been developed: the presence of clinical symptoms of HF at LV EF values>50 %, Nt-pro BNP level>125 pg/ml, concentric LV remodeling variant, mainly concentric LV, LV DD by type RD (E/A<0.8) or PN (E/A>0.8<2.0) and ILAPmax.>34 ml/m2.
Conclusions. The leading pathogenetic factor of heart failure is LV DD.
The range of LV DF disorders depends on the profile of its remodeling. In 66 (73 %) patients with ISAH and CHFpEF, DD was diagnosed by the type of LV RD. In 25 (27 %) patients there were impairments of diastolic filling by PN type. Determining the profile of LV DF disorders in patients with ISAH and CHFpEF is necessary for further differentiated drug correction of DD.
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