Structural and functional characteristics of the heart in patients with "constrictive", "pseudo-normal" and "restrictive" types of the left ventricular diastolic dysfunction

Abstract

To study structural functional characteristics of the heart in patients with various types of abnormalities of diastolic function (DF) based on data obtained at stress echocardiography (stress EchoCG) and echocardiographic indexes of myocardial deformation. Materials and methods. We included in this study 110 patients with hypertensive disease (HD), clinically manifest chronic heart failure (CHF), and abnormal DF of the left ventricle (LV) in the absence of coronary artery stenosis. All patients underwent standard clinical and laboratory examination, EchoCG with measurement of 3-dimensional global longitudinal strain (GLS), and stress EchoCG on treadmill with evaluation of DF parameters. Results. In the group with abnormal relaxation in patients with E/e' >13 left atrial (LA) passive emptying fraction and distensibility index (27.1±14.5 and 127.8±96.1 %, respectively) were significantly smaller than in other patients of this group (34.8±14.2 207.7±86.8 %, respectively; p<0.05). Analogous pattern was observed in the group with transitional type of DF abnormality: patients with E/e' >13 during exercise had lower LA passive emptying fraction and distensibility index (p<0.05). In patients with E/e' >13 during exercise, degree of reduction of LV contractility was similar irrespective of type of DF abnormality. In patients with different degrees of DF derangements (abnormal relaxation, transitional or restrictive type) E/e' >13 during exercise was accompanied by similar lowering of mitral annular systolic velocity at rest (7.1±1.58, 6.9±1.13, and 6.79±0.93 cm/s, respectively). There were also no significant differences between these groups in values of 3-dimensional GLS (-11.2±1.5,-10.4±0.94, and-11.8±1.97 %, respectively). Conclusion. Elevation of LV filing pressure during stress EchoCG evidence for non-homogeneity of groups of patients with different degrees of DF abnormalities, presence of deeper structural-functional changes of the cardiovascular system, accompanied by reduction of myocardial contractility as well as LA reservoir and pump function. The use of stress EchoCG for evaluation of parameters of myocardial deformation allows to improve diagnostics of CHF in patients with preserved LV ejection fraction and directs to determination of criteria of preclinical manifestations of CHF.