Hemodynamic Features in Patients with Chronic Heart Failure and Preserved Ejection Fraction

The aim of the study was to determine the clinical features and hemodynamics in patients with CHF with preserved ejection fraction depending on age.

Methods: retrospective analysis of 198 patients with heart failure and preserved ejection fraction. The average EF (M ± m) - (63,8 ± 6,3)%. 53.5% were males (n=106), 46,5% - females (n=92). Patients were divided into 3 groups according to age: 1st - 40-59 years old (n=74), 2nd - 60-75 (n=73), 3rd - >75 years old(n=51). Indicators of hemodynamics were assessed by echocardiographic examination on the unit «VIVID 3», GE Medical Systems - USA at B, M, 2D, CFM, PW - pulse sensor modes 3 S (3,5 MHz) in the left lateral position. Measurements were carried out according to the recommendations of the American Society of echocardiography. Statistic processing was conducted using the methods of biostatistics implemented in the software package STATISTICA v.6.1.

Results: Hypertension was diagnosed among 169 patients (85.4%). 17 (23%) patients from the first group had a myocardial infarction in anamnesis (over six months), 23 (31.5%) - in the second group and 12 (23.5%) - in the third group. Conduction (block) were in 11 (14.9%) patients from the first group, in 5 (6.8%) - from the second group and in 11 (21.6%) from the third group. Extrasystole was in 11 (14.9%) patients from the first group, in 15 (20.5%) from the second group and in 7 (13.7%) from the third group. Atrial fibrillation was detected in 6 patients (8.1%) from the first group, in 17 (23.2%) from second group, in 7 (13.7%) from the third group. Level of indicators such as myocardial infarction history, extrasystole, atrial fibrillation increases with age, but the highest in the age 60-75 years.

Significant structural and functional changes in key indicators of cardiac hemodynamics were observed among patients with CHF with preserved ejection fraction from different age groups. It was found that significantly increases with age those indicators as average pulmonary artery pressure (21.4±7mmHg in the 1^st and 33.2mmHg in the 3^rd group), and frequency of registration changes aortic root (83.8% in the 1^st and 96% in the 3^rd group). According to age significantly the size of left atrium (3.8±0.4sm in the 1^st and 4.4±0.4sm in the 3^rd group) was increased (p <0.05). But, further analyzing hemodynamic showed that they vary differently with age. Thus, the second group of patients in the range of 60-75 years compared with patients of the first group was significantly raised end-systolic volume (LV ESV) to 21.3% (p <0.05) and end-systolic size (LV ESS) on 41.8% (p <0.05). However, in the age group over 75 years registered a further increase in LV ESV and LV ESS. Growing up with LV ESV and LV ESS may indicate a poor prognosis in the age group 60 to 75 years.

Conclusion: Significant structural and functional changes of hemodynamics were found in patients with CHF and preserved ejection fraction depending on age which may indicate a poor prognosis in this category patients