PLACE OF VOLUMETRIC LOAD IN ASSESSMENT OF DIASTOLIC RESERVE OF THE LEFT VENTRICLE AND IN PREDICTION OF HEART FAILURE DEVELOPMENT FOR MYOCARDIAL INFARCTION PATIENTS

Aim. To study the role of volumetric load in assessment of diastolic reserve of the left ventricle (LV) and to reveal informative predictors of transmitral diastolic flow for heart failure development in myocardial infarction patients without systolic LV dysfunction.

Material and methods. Totally, 40 males studied with primary Q-wave myocardial infarction without clinical signs of heart failure with the baseline LV ejection fraction 50-55%. Statistical analysis was performed via Excel 5.0. Standard methods of variational statistics were applied: mean values, standard deviation. Significance of differences was assessed with t-criteria by Student.

Results. In patients with myocardial infarction at volume load there were 2 types of transmitral diastolic flow. 1 group — patients, who had ipsidirectional changes of transmitral diastolic flow, as the healthy: significantly increased Е and А (p<0,05), not changed Е/А, shortened IVRT of LV and Tdec (p<0,002). 2 group — patients, who at the load did not develop increase of Е (p>0,05), had significantly increased А by 12% (p<0,002) and hence decreased Е/А (p<0,05), and significantly prolonged IVRT of LV and Tdec (p<0,05); changes did not return to baseline by 5 minutes of recovery period.

Conclusion. 1) load test of VDLT is safe and informative method for DR of LV estimation and for revealing of high risk congestive HF in MI. 2) in patients with decreased DR of LV in VL there is decrease of E, significant increase of A, decrease of E/A and prolongation of IVRT and Tdec, during postinfarction period in 27,3% cases congestive HF does develop. 3) in patients with MI and remaining DR of LV during postinfarction period the congestive HF does not develop.

1. Bojö L, Wandt B, Ahlin NG. Reduced left ventricular relaxation velocity after acute myocardial infarction. Clinical Physiology. 1998 May; 18(3): 195-201. http://dx.doi.org/10.1046/j.1365-2281.1998.00093.x

2. Møller JE, Søndergaard E, Seward JB, et al. Ratio of left ventricular peak E-wave velocity to flow propagation velocity assessed by color M-mode Doppler echocardiography in first myocardial infarction: prognostic and clinical implications. Journal of the American College of Cardiology. 2000 Feb; 35(2): 363-70. http://dx.doi.org/10.1016/S0735-1097(99)00575-6

3. Waggoner AD, Bierig SM. Tissue Doppler imaging: a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function Journal of the American Society of Cardiology. 2001 Dec; 14(12): 1143-52. http://dx.doi.org/10.1067/mje.2001.115391

4. Poulsen SH, Jensen SE, Egstrup K. Longitudinal changes and prognostic implications of left ventricular diastolic function in first acute myocardial infarction. European Heart Journal. 18 (12): 1882-9, 1997 Dec. http://dx.doi.org/10.1016/S0002-8703(99)70416-3

5. Temporelli PL, Giannuzzi P, Nicolosi GL. Doppler-derived mitral deceleration time as a strong prognostic marker of left ventricular remodeling and survival after acute myocardial infarction: results of the GISSI-3 echo substudy. Journal of the American College of Cardiology. 2004 May 5; 43(9): 1646-53 http://dx.doi.org/10.1016/j.jacc.2003.12.036

6. Nikitin NP, Alavi AL. Diastolic dysfunction features during left ventricular remodeling in chronic heart failure. Kardiologiia 1998; 3: 56-62. Russian (Никитин Н.П., Алави А.Л. Особенности диастолической дисфункции в процессе ремоделирования левого желудочка сердца при хронической сердечной недостаточности. Кардиология 1998; 3: 56-62).

7. Dabrowska-Kugacka A, Claeys MJ, Rademakers FE. Diastolic indexes during dobutamine stress echocardiography in patients early after myocardial infarction. Journal of the American Society of Echocardiography. 11 (1): 26-35, 1998 Jan. http://dx.doi.org/10.1016/S0894-7317(98)70117-8

8. Belenkov JuN, Ageev FT, Mareev VJu. Dynamic of diastolic filling and diastolic reserve of left ventricle in patients with chronic heart failure in different kind of treatment: comparative Doppler-echocardiography trial. Kardiologiia 1996; 9: 38-50. Russian (Беленков Ю.Н., Агеев Ф.Т., Мареев В.Ю. Динамика диастолического наполнения и диастолического резерва левого желудочка у больных с хронической сердечной недостаточностью при применении различных типов медикаментозного лечения: сравнительное допплер-Эхокардиографическое исследование. Кардиология 1996; 9: 38-50).

9. Ovchinnikova AG, Ageev FT, Mareev VJu. Methodical aspects in use Doppler echocardiography in left ventricular diastolic dysfunction diagnose. Heart failure. 2000. Vol 1/1. Russian (Овчинникова А.Г., Агеев Ф.Т., Мареев В.Ю. Методические аспекты применения Допплер-эхокардиографии в диагностике диастолической дисфункции левого желудочка. Сердечная недостаточность. 2000. Том 1/1) .

10. Mirrakhimov MM, Baltabaev TB, Beishenkulov MT. Prediction of development heart failure in acute myocardial infarction. Congress on internal medicine of Central Asia’s countries. Tashkent. September 1994: 114. Russian (Миррахимов М. М., Балтабаев Т. Б., Бейшенкулов М.Т. и др. Прогнозирование развития явной сердечной недостаточности при остром инфаркте миокарда. В сб.: Конгресс по внутренней медицине стран Центральной Азии. Ташкент. Сентябрь 1994: 114).

11. Sugano Y, Anzai T, Yoshikawa T, et al. Granulocyte colony-stimulating factor attenuates early ventricular expansion after experimental myocardial infarction. Cardiovascular research. 2005 Feb 1; 65(2): 446-56. http://dx.doi.org/10.1016/j.cardiores.2004.10.008

12. Nikitin NP, Alavi AL, Goloskokova VJu. Process of late heart remodeling in patients after an myocardial infarction and their prognostic implications. Kardiologiia. 1999; 1: 54-8. Russian (Никитин Н.П., Алави А.Л., Голоскокова В.Ю. и др. Особенности процесса позднего ремоделирования сердца у больных, перенесших инфаркт миокарда, и их прогностическое значение. Кардиология 1999; 1: 54-8).

13. Burgess MI, Atkinson P, Ray SG. Restrictive left ventricular filling pattern after myocardial infarction: significance of concomitant preserved systolic function. Echocardiography.2000 Oct; 17(7): 659-64. http://dx.doi.org/10.1046/j.1540-8175.2000.00659.x

14. Nelasov JuN, Kastanali AA. On a question of modification of Canadian consensus guidelines for classifying diastolic dysfunction. Heart failure 2000. Vol 1/1. Russian (Неласов Ю.Н., Кастанали А.А. К вопросу о модификации Канадской классификации диастолической дисфункции левого желудочка. Сердечная недостаточность. 2000. Том 1/1).

15. Podolec P, Rubís P, Tomkiewicz-Pajak L. Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure. Journal of the American College of Cardiology. 2008 Jul; 21(7): 834-40. doi: 10.1016/j.echo.2007.12.008. Epub 2008 Jan 28.