Changes in the arterial bed kinetics in patients with coronary artery disease and arterial hypertension during the development of chronic heart failure

Objective: to identify specific features of biomechanics of the systemic circulation arteries in patients with coronary artery disease and arterial hypertension during the development of chronic heart failure. Materials and methods. We performed examination of 152 patients after myocardial infarction with or without arterial hypertension (AH) and stage I or stage IIA chronic heart failure (CHF), functional class (f.c.) II. All study participants underwent computed sphygmography of the carotid, ulnar, radial, femoral, anterior tibial arteries, and foot arteries at rest. Results. We observed significantly increased duration of the inflow phases in the a.carotis in patients with stage I CHF of II f.c. only in the case of AH. The CHF progression was accompanied by shortening of the inflow phases in all
patients. The results of investigation of the peripheral arteries biomechanics demonstrated an increase in the duration of inflow
phases and a decrease in the duration of outflow phases along with CHF progression. We also revealed an increased duration of several phases associated with propulsive activity of the arterial wall in patients with AH (mainly with I stage CHF of II f.c.) compared to those with normal blood pressure. The speed and power parameters of the peripheral arteries biomechanics declined along with increasing CHF severity in all patients after myocardial infarction regardless of AH throughout the whole vascular cycle. Patients with AH
and stage I CHF of II f.c. were found to have elevated speed and power parameters of the peripheral arteries kinetics during the phases of smooth muscle contractile activity comparing with patients without AH. Conclusions: 1. The changes in the biomechanics of the systemic circulation arteries (detected at the first stages of CHF development and reflecting the process of their remodeling) ensure the adaptive effect in patients with coronary artery disease and arterial hypertension. 2. The CHF progression is associated with impaired propulsive activity of the arterial bed, which increases the severity of clinical manifestations and is an independent mechanism for the development of decompensation.

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Features of remodeling of the left ventricle in patients who have suffered myocardial infarction during chronic heart insufficiency formation

The article assesses the morphofunctional changes in the left ventricle of the heart in patients who underwent myocardial infarction with the development of chronic heart failure. 100 patients with myocardial infarction with chronic heart failure of stage I of the functional class II by NYHA (group 1) and chronic heart failure IIa of stage II of the functional class of NYHA (group 2) were examined. With the help of computer echocardiography in all patients, the morphofunctional parameters of the left ventricle were evaluated depending on the severity of chronic heart failure. With Stage I Stage II CHF. According to NYHA, the growth of both linear indices (ICRR by 15.5% (p = 0.0004), ICDD by 32.3% (p = 0.0004) and volume indices – by 40% (p = 0.00075 ), ICSI by 106.2% (p = 0.00067) of LV parameters. Along with this, an increase in IMI was detected by 31.7% (p = 0.0004), and also by 98% (0.00002) of IH and a 13.9% increase in LR (p = 0.02). The ejection fraction, the shortening fraction, and the rate of shortening of the circular fibers of the myocardium were significantly decreased with respect to control by 24% (p = 0.001), 22% (P = 0.02) and 16% (p = 0.03), respectively, but remained generally within the normal range. Violation of filling processes was noted mainly in a non-restrictive manner. In the 2nd group there was a further increase in LV linear and volume parameters, but there was no proportional thickening of its walls: the OTC index decreased significantly both in comparison with the norm by 19.4% (p = 0.02) and with the value in the group 1 at 21.6% (p = 0.045), the hypertrophy index – with 1 group at 13% (p = 0.01), the ratio of BWW / MM ml / g increased to 0.77 ml / g (in the control 0.63 Ml /
g). Among the pathological types of filling, the amount of restrictive variant increased. It was established that with stage I CHF, I fc NYHA in patients who underwent MI, mainly compensatory hypertrophy and LV dilatation is formed without significant violations of its contractile function. Violation of the process of LV filling by a non-restrictive type predominates. Development of CHF IIa of stage II f. Is accompanied by a progressive expansion of the LV cavity without proportional wall thickening, a decrease in the effectiveness of systolic contraction, an increase in myocardial stress, an increase in the severity of diastolic disorders with predominance of a prognostically unfavorable restrictive type of filling. Violation of the LV filling process precedes its systolic dysfunction.

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