Structural and geometric heart remodeling in patients with chronic heart failure in the presence of a comorbid condition: gender features
E.V. KHAZOVA1, 2, O.V. BULASHOVA1
1Kazan State Medical University, Kazan
2Kazan (Volga) Federal University, Kazan
Contact details:
Khazova E.V. — PhD (medicine), Associate Professor of the Department of Introduction to Internal Diseases named after Professor S.S. Zimnitsky, researcher at «New Professional Competences in Health Preservation» Laboratory of the Institute of Fundamental Medicine and Biology
Address: 18 Kremlevskaya St., Kazan, Russian Federation, 42008, tel.: +7-905-313-97-10, e-mail: hazova_elena@mail.ru
Structural-geometric remodeling is a complex progressive and maladaptive process that stimulates hypertrophy, dilatation and dysfunction of the left ventricle (LV), potentiating the progression of chronic heart failure (CHF). Despite the general patterns of cardiac remodeling, there are a number of structural, geometric and molecular features of myocardial reorganization, depending, among other things, on the etiology of CHF, the gender of the patient, and the presence of concomitant pathology.
The purpose — is to study the condition of the chambers and the geometry of the LV according to echocardiography in patients with CHF in the presence of concomitant pathology.
Material and methods. 517 patients with CHF of ischemic etiology, of both sexes, were examined. Echocardiographic phenotyping of CHF was carried out, including in the presence of concomitant conditions — chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM).
Results. LV hypertrophy (LVH) was detected in 62.8% of patients with CHF (72.1% of women and 54.7% of men, p < 0.001): normal LV geometry — in 20.3% (26.5% men and 13.1% women, р < 0.001), concentric remodeling — in 16.9%, eccentric and concentric LVH — in 23.2% and 39.7% (50.9% women and 30% men р < 0.001). LVH was detected more often in CHF and CKD than without CKD (p = 0.025), including in 75.6% of women and 57.9% of men (p = 0.009). Normal LV geometry was found in 23.9% of patients with CHF without CKD and 14.9% with CKD (p = 0.015). In CHF combined with CKD, concentric LVH was more often formed (р<0.001). In CHF, LVH was present in 65.1% of patients without COPD and 49.6% with COPD; the differences were significant in men (p = 0.002). In patients with CHF and COPD, concentric remodeling developed more often than in CHF without COPD (p = 0.036), and eccentric LVH was less common (p = 0.025). LVH was more common with CHF and diabetes than without diabetes (p = 0.01); concentric LVH prevailed (p = 0.001).
Key words: chronic heart failure, myocardial remodeling, comorbidity, chronic kidney disease, chronic obstructive pulmonary disease, diabetes mellitus, gender differences.
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