Functional myocardial condition in chronic heart failure with concomitant obesity
DOI:
https://doi.org/10.14739/2310-1237.2014.1.25200Keywords:
Chronic heart failure, functional myocardial condition, obesityAbstract
Abstract. 145 patients with CHF of II functional class, with normal weight, overweight and abdominal obesity I-III degrees were examined. Functional left ventricle myocardial condition in CHF depending on the degree of excess weight was studied. The peculiarities of diastolic and systolic left ventricular function depending on the availability of overweight and obesity were revealed.
Actuality. Chronic heart failure (CHF) is the most common complication of almost all cardio-vascular diseases. Despite significant achievements in the direction of the medical and surgical treatment of such patients, the prevalence of CHF not only has not decreased, but continues to increase.
Although the role of systolic dysfunction of LV (SDLV) is indisputable today it is clear that CHF with preserved ejection fraction (EF) occurs (13% to 74%). Studies concerning the prognosis of CHF with preserved PE and SDLV have contradictory results. Some of them demonstrated improved survival with preserved LV EF, other - the same performance regardless of LV EF. It is established that CHF with preserved LV EF is the most common form of the disease and more than half of all patients. The frequency of CHF with preserved LV EF progressively increases with age, and the prognosis is as adverse as in patients with SDLV.
One of the main factors of progression and negative outcomes of CHF today is abdominal obesity. Along with the structural changes of the heart obesity affects systolic and diastolic myocardial function.
Research objective: to evaluate the functional myocardial condition in CHF of II functional class with abdominal obesity of different degree.
Material and methods: 145 patients with CHF of II functional class were examined. Etiological factors of CHF development were hypertensive disease, chronic forms of CAD and the combination of these pathologies.
The diagnosis of CHF was established according to the WHO criteria, the European society of cardiology and the Association of cardiologists of Ukraine, and classified according to functional classification of New York Heart Association (NYHA) (6 minutes walking test). Overweight and abdominal obesity were diagnosed basing on the WHO criteria, the degree and abdominal (visceral) type of obesity were graded according to the common metric indices.
Criteria for inclusion into the study were: the patient's consent to participate in the study, CHF of II functional class (NYHA) resulting from hypertensive disease, chronic forms of CAD and the combination of these pathologies in patients with normal weight, overweight and abdominal obesity of I-III degree.
According to the aim of the research four groups of patients with CHF of II functional class (NYHA) were formed. The I group included 15 patients with normal body weight, the II group was formed of 36 patients with overweight, in the III group there were 48 subjects with obesity of the I degree. The IV group consisted of 48 patients with obesity of II-III degree, due to the lack of significant differences in studied indicators. The control group consisted of 12 patients with normal body weight and without CHF. All patients underwent echocardiography using ultrasonic scanner "SONOACE" 8000 SE. M- and B-scan modes were used.
Conclusions:
1. In CHF of II functional class I type of diastolic dysfunction takes place in most cases where prevalence is greatest among patients with overweight and obesity.
2. Systolic dysfunction in CHF of II functional class is observed in a minority of patients, and the rate increases with the degree of overweight, and is maximal in a significant obesity.
References
Savchenko V. Vykorystannia diuretykiv v likuvanni pacientiv z CHF [Using of diuretics at treatment of patients with CHF]. Materialy mezhdunarodnoi konferencii s uchastiem L.G.Voronkova I professora G.P.Arutyunova provedennoy 15 oktyabria 2013. Na baze NNC «Institut kardiolohii im. M.D.Strazheska» NAMN Ukrainy. Serdechnaia nedostatochnost 2013; 5: 79-85.
Manoilenko T.S., Reven`ko I.L., Handzyuk V.A. Kornatskyi Yu.V. (2011) Racionalni osoblyvosti rivnia zdorov`ia narodu Ukrainy (analityo-statystychnyi posibnyk) [Rational features of health level at people of Ukraine (analytical-statistic manual)]. Nacionalnyi naukovyi centr «Instytut kardiologii imeni akad. M.D.Strazheska»: 211 [In Ukrainian].
Boichak M.P. (2004). Pochatkova serceva nedostatnist` pry hostrych ta hronichnych zahvoryuvann`ah miokarda: mehanizmy formuvannia porushen` vnutrishnyo-sercevoi hemodyamiky, ob`yektyvizacia diagnostiki ta prognozuvannia perebigu [Initial heart failure at acute and chronic diseases of myocardium: formation of abnormalities of intra cardiac hemodynamic, objectifications of diagnosis and motion prognosis]. Extended abstract of Doctors thesis. Kyiv. NMU [In Ukrainian].
Voronkov L.G. Patient with CHF in Ukraine: analyze all population, were examined at first national slice investigation UNIVERSE. Serdechnaia nedostatochnost 2012; 1: 8-13.
Abel E.D., Litwin S.E., Sweeney G. Cardiac Remodelling in Obesity. Physiol. Rev. 2008; 8: 389 – 419.
Peter W. F.,Wilson; Ralph B. D’Agostino, Lisa Sullivan. Overweight and Obesity as Determinants of Cardiovascular Risk. The Framingham Experience. Arch. Intern. Med. 2002; 162: 1867-1872.
Wang T.J., Parise H., Levy D., D’Agostino R.B. Sr. Obesity and the risk of new-onset atrial fibrillation. J. Am. Med. Assoc. 2004: 92; 2471–2477.
Iacobellis G., Leonetti F. Epicardial adipose tissue and insulin resistance in obese subjects. J. Clin. Endocrinol. Metab. 2005: 90; 6300–6302.
Grandi A.M., Zanzi P., Piantanida E., Gaudio G. Obesity and left ventricular diastolic function: noninvasive study in normotensives and newly diagnosed nevertreated hypertensives. Int. J. Obes. Relat. Metab. Disord. 2000: 24; 954–958.
Iacobellis G. True uncomplicated obesity is not related to increased left ventricular mass and systolic dysfunction. J. Am. Coll. Cardiol. 2004: 44; 2257–2258.
Otto ME, Belohlavek M, Khandheria B, Gilman G, Svatikova A, Somers V. Comparison of right and left ventricular function in obese and nonobese men. Am. J. Cardiol. 2004: 93; 1569–1572.
Abel E.D. Myocardial insulin resistance and cardiac complications of diabetes. Curr. Drug Targets Immune Endocr. Metabol. Disord. 2005: 5; 219–226.
Di Mario U., Leonetti F. Influence of excess fat on cardiac morphology and function: study in uncomplicated obesity. Obes. Res. 2002: 10; P. 767–773.
Otto M.E., Belohlavek M., Khandheria B., Gilman G., Svatikova A., Somers V. Comparison of right and left ventricular function in obese and nonobese men. Am. J. Cardiol. 2004: 93; 1569–1572.
Pascual M., Pascual D.A., Soria F. Effects of isolated obesity on systolic and diastolic left ventricular function. Heart 2003. 89; 1152–1156.
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