Rational Pharmacotherapy in Cardiology

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Aim. To study the combination and contribution of risk factors (age, hypertension (HT), obesity, diabetes mellitus, chronic kidney disease (CKD), length of illness) leading to the formation of chronic heart failure (CHF) with preserved ejection fraction (EF).

Material and methods. The study included 100 hypertensive patients (aged 40 to 80 years) with concomitant obesity or diabetes or CKD. Patients were divided into 4 groups depending on the presence of one major and/or several concomitant diseases. Echocardiography, assessment of large arterial vessels stiffness indices (SI m/s, CAVI m/s), and determination of small muscle arteries tonus (RI%) were performed in all patients.

Results. Remodeling of the left ventricle (LV) and left atrial (LA) was observed in all patients with comorbid status, as well as reduction in diastolic function. The LV myocardial mass index in the first group was 117.2±31.4 g/m2, in the second one – 125.9±27.4 g/m2, in the third group – 121.5±15.6 g/m2 and in the fourth one – 126.1±11.5 g/m2. A significant increase in the LA volume index was founded in the first group  – 33.4±3.9 ml/m2, in the second one – 39.6±9.1 ml/m2, in the third group – 38.1±5.2 ml/m2 and in the fourth one – 39.8±6.6 ml/m2 (р<0.05). The parameters reflecting the rigidity of large arterial vessels (SI m/s, CAVI m/s) also exceeded the threshold values in each group; significant differences SI were between the first and fourth, second  and fourth groups  (р<0.05), CAVI between the first and third groups  (р<0.05). A significant correlation was found between CAVI and age (r=0.63), which indicated an increase in arterial stiffness with age.

Conclusions. In the formation of CHF with preserved EF, additional factors enhance the changes associated with LV remodeling and LA overload. These changes occur with a progressive decrease in LV diastolic function and increase in myocardial stiffness. HT and obesity are the main contributors to the development of CHF with preserved EF. Remodeling of the LV, LA and vascular system in CHF with preserved EF develop simultaneously.

About the Authors

M. V. Kurkina
Russian Medical Academy of Continuing Vocational Education
Russian Federation

Maria  V. Kurkina – MD, Postgraduate Student, Chair of Therapy and Adolescent Medicine.

Barrikadnaya ul. 2/1, Moscow, 123242

A. G. Avtandilov
Russian Medical Academy of Continuing Vocational Education
Russian Federation

Alexander G. Avtandilov – MD, PhD, Professor, Head of Chair of Therapy and Adolescent Medicine.

Barrikadnaya ul. 2/1, Moscow, 123242

I. A. Krutovcev
Russian Medical Academy of Continuing Vocational Education
Russian Federation

Igor A. Krutovcev – MD, PhD, Assistant, Chair of Therapy and Adolescent Medicine.

Barrikadnaya ul. 2/1, Moscow, 123242


1. Lindenfeld J., Albert N. M., et al. Comprehensive heart failure practice guideline. J Card Fail. 2010; 16:e1-194. doi:10.10.1016/j.cardfail.2010.04.004.

2. Mareev V.Yu., Danielyan MO, Belenkov Yu.N. On behalf of the EPOCH-O-CHF study group. Comparative characteristics of patients with CHF, depending on the size of the ejection fraction according to the results of the Russian multicenter study EPOCHA-O-CHF: again about the problem of CHF with preserved systolic function of the left ventricle. Zhurnal Serdechnaja Nedostatochnost'. 2006;4:164-71. (In Russ.) [Мареев В.Ю., Даниелян М.О., Беленков Ю.Н. От имени рабочей группы исследования ЭПОХАО-ХСН. Сравнительная характеристика больных с ХСН в зависимости от величины фракции выброса по результатам российского многоцентрового исследования ЭПОХА-О-ХСН: снова о проблеме ХСН с сохраненной систолической функцией левого желудочка. Журнал Сердечная Недостаточность. 2006; 4:164-71]. doi:10.18087/rhfj2015.1.2038.

3. Vasan R.S., Benjamin E.J., Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995; 2: 1565-74. doi:10.1016/0735-1097 (9500381-9).

4. Lopez B., Gonzalez A., Ravassa S., Circulating biomarkers of myocardial fibrosis. Journal of the American College of Cardiology. 2015; 65(22):2449-56.

5. Barry A. Borlaug, Margaret M. Redfield. Diastolic and Systolic heart failure phenotypes of the heart failure syndrome. Circulation. 2011;123(18):2006-14. doi: 10.1161/circulationaha.110.954388.

6. Kitzman D.W., Nicklas B., Kraus W.E., et al. Skeletal muscle abnormalities and exercise intolerance in older patients with heart failure and preserved ejection fraction. Am J Physiol Heart Circ Physiol. 2014;306:H1364-70. doi: 10.1152/ajpheart.0004.2014.

7. Kitzman D.W., Upadhya B., Vasu S. What the dead can teach the living: the systemic nature of eart failure with preserved ejection fraction. Circulation. 2015;131:522-4. doi:10.1161/circulationaha.114.014420.

8. Mohammed S.F., Borlaug B.A., Roger V.L., et al. Comorbidity and Ventricular and Vascular Structure and Function in Heart Failure with Preserved Ejection Fraction: A Community Based Study. Circulation. 2012; 5(6):669-71. doi: 10.1161/circheartfailure.112.968594.

9. Paulus W, Tschope C. A Novel Paradigm for Heart Failure with Preserved Ejection Fraction: Comorbidities Drive Myocardial Dysfunction and Remodeling Through Coronary Microvascular Endothelial Inflammation. J Am Coll Cardiol. 2013; 62:263-271. doi: 10.1016/j.jacc.2013.02.092.

10. Vasan R.S., Levy D. Defining diastolic heart failure: a call for standardized diagnostic criteria. Circulation. 2000;101:2118-21.

11. Zile M.R., Gaasch W.H., Carroll J.D., et al. Heart failure with a normal ejection fraction: is measurement of diastolic function necessary to make the diagnosis of diastolic heart failure. Circulation. 2001;104:77982.

12. Burkhoff D., Maurer M.S., Packer M. Heart failure with a normal ejection fraction: is it really a disorder of diastolic function? Circulation. 2003;107:656-8.

13. Yancy C.W., Jessup M., Bozkurt B., et al. 2013 ACCF/AHA Guideline for the management of heart-failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62:e147-e239. doi:10.1161/Cir.0b013e31829e8776.

14. Solomon S., Zile M., Pieske B., et al. The angiotensin receptor neprilysin inhibitor LCZ696 in heart failure with preserved ejection fraction: a phase 2 double-blind randomised controlled trial. Lancet. 2012;380:1387-95. doi:10.1016/S0140-6736(12)61227-6.

15. Rigolli M., Whalley G.A. Heart failure with preserved ejection fraction. Journal of Geriatric Cardiology. 2013;(10):369-76. doi:10.3969/j.issn.1671-5411.2013.04.001.

16. Maurer M.S. Heart Failure with Preserved Ejection Fraction: Persistent Diagnosis, Therapeutic Enigma. Curr Cardiovasc Risk Rep. 2011;5(5):440-9. doi:10.1007/s12170-011-0184-2.

17. Devereux R.B., Alonso D.R., Lutas E.M. et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;7(6):450-8.Х.

18. Lang R.M., Bierig M., Devereux R.B., et al. Chamber Quantification Writing Group; American Society of Echocardiography’s Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63. doi: 10.1016/j.echo.2005.10.005.

19. Ganau A., Devereux R.B., Roman M.J. et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol. 1992;19:1550-8.

20. Gaasch W.H., Zile M.R. Left ventricular structural remodeling in health and disease: with special emphasis on volume, mass, and geometry. J Am Coll Cardiol. 2011;58:1733-40. doi:10.1016/j.jacc.2011.07.022.

21. Safar M.E., London G.M. The arterial system in human hypertension. In: Swales J.D., ed. Textbook of hypertension. London: Blackwell Scientific;1994. P.85-102.

22. Svishchenko E.P., Matova E.A., Mishchenko L.A. Diastolic LV dysfunction in patients with essential hypertension: the possibility of correction with valsartan. Arterial'naja Gipertenzija. 2012; 22 (2): 39-46. (In Russ.) [Свищенко Е.П., Матова Е.А., Мищенко Л.А. Диастолическая дисфункция ЛЖ у больных гипертонической болезнью: возможности коррекции с помощью валсартана. Артериальная Гипертензия. 2012;22(2):39-46].

23. Rivas-Gotz C., Manolios M., Thohan V., Nagueh S.F. Impact of left ventricular ejection fraction on estimation of left ventricular filling pressures using tissue Doppler and flow propagation velocity. Am J Cardiol. 2003;91:780-4. doi:10.1016/s0002-9149(02)03433-1.

24. Kosobyan EP, Yarek-Martynova IR, Parfenov AS, Bolotskaya LL, Shestakova MV Evaluation of the state of endothelial function and rigidity of the arterial wall in patients with type 1 diabetes at different stages of diabetic nephropathy. Saharnyj diabet. Diagnostika, kontrol ', lechenie. 2011; 3: 55-9. (In Russ.) [Кособян Е.П., Ярек-Мартынова И.Р., Парфенов А.С., Болотская Л.Л., Шестакова М.В. Оценка состояния эндотелиальной функции и ригидности артериальной стенки у больных сахарным диабетом 1 типа на разных стадиях диабетической нефропатии. Сахарный диабет. Диагностика, контроль, лечение. 2011;3:55-9].

25. Pinto A., Tuttolomondo A., Casuccio A. et al. Immuno-inflammatory predictors of stroke at follow-up in patients with chronic non-valvular atrial fibrillation. Clin Sci (London). 2009;116:781-9. doi:10.1042/cs20080372.

26. Mikhin V.P., Boldyreva Yu.A., Chernyatina M.A., Gromnatsky M.I. The condition of stiffness parameters of the vascular wall in patients with arterial hypertension on the background of complex therapy with cytoprotectors and sartans. Arhiv Vnutrennej Mediciny. 2015;25(5):40-4. (In Russ.) [Михин В.П., Болдырева Ю.А., Чернятина М.А., Громнацкий М.И. Состояние параметров жесткости сосудистой стенки у больных артериальной гипертонией на фоне комплексной терапии цитопротекторами и сартанами. Архив Внутренней Медицины. 2015;25(5):40-4].

27. Drapkina O.M., Fadeeva M.V. Vascular age as a risk factor for cardiovascular disease. Arterial'naja Gipertenzija. 2014; 20 (4): 224-31. (In Russ.) [Драпкина О.М., Фадеева М.В. Сосудистый возраст как фактор риска сердечно-сосудистых заболеваний. Артериальная Гипертензия. 2014;20(4):224-31]. doi:10.18705/1607-419х-2014-20-4-224-231.

28. Kawaguchi M., Hay I., Fetics B., Kass D.A. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction. Circulation. 2003;107:714-20. doi:10.1161/01.cir.0000048123.22359.А0.

For citation:

Kurkina M.V., Avtandilov A.G., Krutovcev I.A. THE ROLE OF FACTORS AFFECTING THE FORMATION OF CHRONIC HEART FAILURE WITH PRESERVED EJECTION FRACTION. Rational Pharmacotherapy in Cardiology. 2017;13(5):615-621. (In Russ.)

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