NEW ALGORITHM FOR DETERMINING THE REMODELLING OF THE HEART IN CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract

Objectives. To develop an algorithm for determining the remodelling of the heart in chronic heart failure with preserved ejection fraction (HFpEF). Material and methods. In 2017-2019, on the basis of the Healthcare Institution «1st City Clinical Hospital» in Minsk, a one-stage (cross-sectional) comparative clinical and instrumental study of a stratified random sample consisting of 175 patients aged 71.0 (64.0; 78.0) years was performed. In 2019-2021, the State Institution «Minsk Scientific-Practical Center of Surgery, Transplantation and Hematology» performed an independent reproductive (examination) clinical and instrumental study of a stratified random sample, which included 129 patients aged 64.5 (58.0; 70.0) years. Criteria for inclusion in the study: sinus rhythm; essential arterial hypertension; chronic ischemic heart disease; HFpEF; the presence of voluntary informed consent of the patient to participate in the study. Exclusion criteria: primary mitral regurgitation, mitral stenosis, mitral valve repair or replacement, congenital heart defects, cardiomyopathies, acute and chronic respiratory diseases. Echocardiography and 2D Speckle Tracking were performed using ultrasound devices Siemens Acuson S1000 (Germany), Vivid E9 (GE Healthcare, USA). Results. An algorithm for determining heart remodelling in HFpEF is based on the concept of a comprehensive, targeted echocardiographic assessment of the leading risk factors, pathofunctional mechanisms of the heart failure development, structural, functional abnormalities, intracardiac and pulmonary hemodynamics, contains scientifically based ultrasound signs characterized by high diagnostic efficiency. The application of the 2D Speckle Tracking echocardiography technology in the algorithm is aimed at determining subthreshold systolic ventricular dysfunction, mechanical dispersion and myocardial dyssynergy. Conclusions. The developed algorithm for determining heart remodelling in HFpEF is characterized by reproducibility and high accuracy (93.8%), as has been shown in an independent examination sample, which makes it possible to recommend its practical use in the clinical and instrumental determination of HFpEF.