rpcardioRational Pharmacotherapy in CardiologyРациональная Фармакотерапия в Кардиологии1819-64462225-3653«SILICEA-POLIGRAF» LLC10.20996/1819-6446-2009-5-5-7-16rpcardio-706Research ArticleORIGINAL STUDIESОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯEFFECT OF MITRAL REGURGITATION ON CHRONIC HEART FAILURE COURSE AND STRUCTURE-FUNCTIONAL HEART STATEВЛИЯНИЕ ВЫРАЖЕННОСТИ МИТРАЛЬНОЙ РЕГУРГИТАЦИИ НА ТЕЧЕНИЕ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ И СТРУКТУРНО-ФУНКЦИОНАЛЬНОЕ СОСТОЯНИЕ СЕРДЦАЛаринаВ. Н.LarinaV. N.

117997 Москва, ул.Островитянова, д.1

Ostrovitianova ul. 1, Moscow, 117997

larinav@mail.ruБартБ. Я.BartB. Y.

117997 Москва, ул.Островитянова, д.1

Ostrovitianova ul. 1, Moscow, 117997

МихайлусоваМ. П.MikhaylusovaM. P.

117997 Москва, ул.Островитянова, д.1

Ostrovitianova ul. 1, Moscow, 117997

МамцевБ. Н.MamtsevB. N.

117997 Москва, ул.Островитянова, д.1

Ostrovitianova ul. 1, Moscow, 117997

Российский Государственный Медицинский УниверситетРоссияRussian State Medical UniversityRussian Federation20091001201655716Copyright © Larina V.N., Bart B.Y., Mikhaylusova M.P., Mamtsev B.N., 20162016Ларина В.Н., Барт Б.Я., Михайлусова М.П., Мамцев Б.Н.Larina V.N., Bart B.Y., Mikhaylusova M.P., Mamtsev B.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.rpcardio.online/jour/article/view/706Aim

Aim. To evaluate chronic heart failure (CHF) course, functional and structural heart changes in patients with functional mitral regurgitation (MR) of various degrees.

Material and methods

Material and methods. A total of 104 outpatients (60-85 y. o.) with CHF of functional class II-IV by NYHA and functional MR of I-II degrees and MR of III-IV degrees were included into the study groups.

Results

Results: Patients in both groups were comparable in sex, age, CHF duration, body mass index, systolic and diastolic blood pressure, clinical state by the clinical state scale, quality of life, anxious and depressive status. The majority of patients with MR III had significant left ventricle (LV) systolic dysfunction (p=0,029), severe CHF course (p=0,034), received furosemide (p=0.004) and digoxin (p=0,004). They had significant increase in end-diastolic dimension (p<0,001), end-systolic dimension (p<0,001), left atrium (p=0,004), end-diastolic volume (p<0,001), end-systolic volume (p<0,001), pulmonary artery pressure (p<0,001), decrease in LV relative wall thickness (p=0,021) and LV ejection fraction (p<0,001). Patients of this group were hospitalized because of CHF decompensation and ischemic heart disease exacerbation more often (p=0,045).

Conclusion

Conclusion. MR can be considered as one of sensitive predictors of LV geometry and function alteration in CHF patients and play an important role in symptoms development.

Цель

Цель. Выявить особенности клинического течения хронической сердечной недостаточности (ХСН) и структурно-функционального состояния сердца у больных ХСН с различной степенью выраженности митральной регургитации (МР).

Материал и методы

Материал и методы. Наблюдали 104 больных ХСН II-IV функционального класса по NYHA в возрасте от 60 до 85 лет с относительной МР 3-й степени и выше и с МР 1-2-й степени.

Результаты

Результаты. Пациенты обеих групп были сопоставимы по полу, возрасту, продолжительности ХСН, индексу массы тела, уровню систолического и диастолического артериального давления, клиническому состоянию по ШОКС, качеству жизни и степени выраженности тревожного и депрессивного статуса. Большинство пациентов с МР 3-й степени имели выраженную систолическую дисфункцию левого желудочка (ЛЖ) (р=0,029), тяжёлое течение ХСН (р=0,034), принимали фуросемид (р=0,004) и дигоксин (р=0,004). У них имелись значимое увеличение конечно-диастолического размера (p<0,001), конечно-систолического размера (p<0,001), левого предсердия (ЛП) (р=0,004), конечно-диастолического объема (p<0,001), конечно-систолического объема (p<0,001), давления в лёгочной артерии (p<0,001), уменьшение относительной толщины стенки ЛЖ (p=0,021) и фракции выброса ЛЖ. (p<0,001). Также пациентов этой группы чаще госпитализировали по поводу декомпенсации ХСН и обострения ишемической болезни сердца (р=0,045).

Заключение

Заключение. МР у пациентов с ХСН может рассматриваться в качестве одного из чувствительных предикторов изменений геометрии и функции ЛЖ и играет немаловажную роль в развитии клинической симптоматики. 

хроническая сердечная недостаточностьмитральная регургитацияchronic heart failuremitral regurgitationReferencesFann J.I., Ingels N.B. Jr, Miller D.C. Pathophysiology of Mitral Valve Disease. In: Cohn LH, ed. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2008. P.973-1012.Fann J.I., Ingels N.B. Jr, Miller D.C. Pathophysiology of Mitral Valve Disease. In: Cohn LH, ed. Cardiac Surgery in the Adult. New York: McGraw-Hill, 2008. P.973-1012.Ngaage D., Schaff H. Mitral valve surgery in non-ischemic cardiomyopathy. J Cardiovasc Surg (Tori￾no) 2004;45(5):477-86.Ngaage D., Schaff H. Mitral valve surgery in non-ischemic cardiomyopathy. J Cardiovasc Surg (Tori￾no) 2004;45(5):477-86.Enomoto Y., Gorman J.H. 3rd, Moainie S.L. et al. Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling. J Thorac Cardiovasc Surg 2005;129(3):504-11.Enomoto Y., Gorman J.H. 3rd, Moainie S.L. et al. Surgical treatment of ischemic mitral regurgitation might not influence ventricular remodeling. J Thorac Cardiovasc Surg 2005;129(3):504-11.Bizzi С., Malfatto G., Branzi G. et al. Diastolic dysfunction and functional mitral regurgitation are the main determinants of abnormal cardiopulmonary stress test in elderly patients with systolic heart failure. Eur J Heart Fail Suppl 2007; 6: 37-38.Bizzi С., Malfatto G., Branzi G. et al. Diastolic dysfunction and functional mitral regurgitation are the main determinants of abnormal cardiopulmonary stress test in elderly patients with systolic heart failure. Eur J Heart Fail Suppl 2007; 6: 37-38.Mirabel M., Iung B., Baron G. et al. What are the characteristics off patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 2007;28(11):1358-65.Mirabel M., Iung B., Baron G. et al. What are the characteristics off patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J 2007;28(11):1358-65.Cioffi G., Tarantini L., De Feo S. et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. Eur J Heart Fail 2005;7(7):1112-7.Cioffi G., Tarantini L., De Feo S. et al. Functional mitral regurgitation predicts 1-year mortality in elderly patients with systolic chronic heart failure. Eur J Heart Fail 2005;7(7):1112-7.Belenkov U.N., Mareev V.U. Principles of heart failure rational treatment. M.: Media Medica; 2000 / Беленков Ю.Н., Мареев В.Ю. Принципы рационального лечения сердечной недостаточности. М.: Медиа Медика; 2000 (in Russian).Belenkov U.N., Mareev V.U. Principles of heart failure rational treatment. M.: Media Medica; 2000 / Беленков Ю.Н., Мареев В.Ю. Принципы рационального лечения сердечной недостаточности. М.: Медиа Медика; 2000 (in Russian).Rector T., Kubo S., Cohn J. Patients self assessment of their congestive heart failure. Part 2: content, reliability, and validity of a new measure, the Minnesota living with heart failure questionnaire. Heart Failure 1987;3:198-209.Rector T., Kubo S., Cohn J. Patients self assessment of their congestive heart failure. Part 2: content, reliability, and validity of a new measure, the Minnesota living with heart failure questionnaire. Heart Failure 1987;3:198-209.Guyatt G.H., Thompson P.J., Berman L.B. et al. How should we measure function in patients with chronic heart and lung disease? J Chronic Dis 1985;38(6):517-24.Guyatt G.H., Thompson P.J., Berman L.B. et al. How should we measure function in patients with chronic heart and lung disease? J Chronic Dis 1985;38(6):517-24.Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361-70.Zigmond A.S., Snaith R.P. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6):361-70.Levey A.S., Coresh J., Greene T. et al. Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53(4):766-72.Levey A.S., Coresh J., Greene T. et al. Chronic Kidney Disease Epidemiology Collaboration. Expressing the Modification of Diet in Renal Disease Study equation for estimating glomerular filtration rate with standardized serum creatinine values. Clin Chem 2007;53(4):766-72.Levey A.S., Bosch J.P., Lewis J.B. et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461-70.Levey A.S., Bosch J.P., Lewis J.B. et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130(6):461-70.Shiller N, Osipov M.A. Clinical echocardiography. M.: Praktika; 2005 / Шиллер Н., Осипов М.А. Клиническая эхокардиография. М.: Практика; 2005 (in Russian).Shiller N, Osipov M.A. Clinical echocardiography. M.: Praktika; 2005 / Шиллер Н., Осипов М.А. Клиническая эхокардиография. М.: Практика; 2005 (in Russian).Lamas G.A., Mitchell G.F., Flaker G.C. et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Circulation 1997;96(3):827-33.Lamas G.A., Mitchell G.F., Flaker G.C. et al. Clinical significance of mitral regurgitation after acute myocardial infarction. Circulation 1997;96(3):827-33.Koelling T., Aaronson K., Cody R. et al. Prognostic sighnificance of mitral regurgitation and tricuspidal regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002;144(3):524-9.Koelling T., Aaronson K., Cody R. et al. Prognostic sighnificance of mitral regurgitation and tricuspidal regurgitation in patients with left ventricular systolic dysfunction. Am Heart J 2002;144(3):524-9.McGinley J.C., Berretta R.M., Chaudhary K. et al. Impaired contractile reserve in severe mitral valve regurgitation with a preserved ejection fraction. Eur J Heart Fail 2007;9(9):857-64.McGinley J.C., Berretta R.M., Chaudhary K. et al. Impaired contractile reserve in severe mitral valve regurgitation with a preserved ejection fraction. Eur J Heart Fail 2007;9(9):857-64.Bott-Flugel L., Weig H.J., Uhlein H. et al. Quantitative analysis of apoptotic markers in human endstage heart failure. Eur J Heart Fail 2008:10(2):129-32.Bott-Flugel L., Weig H.J., Uhlein H. et al. Quantitative analysis of apoptotic markers in human endstage heart failure. Eur J Heart Fail 2008:10(2):129-32.Belenkov Yu.N., Mareev V.Yu. Cardiovascular continuum. Serdecnaya nedostatochnost 2002;3(1):7- 11 / Беленков Ю.Н., Мареев В.Ю. Сердечно-сосудистый континуум. Сердечная недостаточность 2002;3(1):7-11. (in Russian).Belenkov Yu.N., Mareev V.Yu. Cardiovascular continuum. Serdecnaya nedostatochnost 2002;3(1):7- 11 / Беленков Ю.Н., Мареев В.Ю. Сердечно-сосудистый континуум. Сердечная недостаточность 2002;3(1):7-11. (in Russian).De Winter O., Van de Veire N., Van Heuverswijn F. et al. Relationship between QRS duration, left ventricular volumes and prevalence of nonviability in patients with coronary artery disease and severe left ventricular dysfunction. Eur J Heart Fail 2006;8(3):275-7.De Winter O., Van de Veire N., Van Heuverswijn F. et al. Relationship between QRS duration, left ventricular volumes and prevalence of nonviability in patients with coronary artery disease and severe left ventricular dysfunction. Eur J Heart Fail 2006;8(3):275-7.Grande-Allen K.J., Borowski A.G., Troughton R.W. et al. Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements: an extracellular matrix and echocardiographic study. J Am Coll Cardiol 2005;45(1):54-61.Grande-Allen K.J., Borowski A.G., Troughton R.W. et al. Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements: an extracellular matrix and echocardiographic study. J Am Coll Cardiol 2005;45(1):54-61.Grande-Allen K.J., Barber J.E., Klatka K.M. et al. Mitral valve stiffening in end-stage heart failure: Evidence of an organic contribution to functional mitral regurgitation. J Thorac Cardiovasc Surg 2005;130(3):783-90.Grande-Allen K.J., Barber J.E., Klatka K.M. et al. Mitral valve stiffening in end-stage heart failure: Evidence of an organic contribution to functional mitral regurgitation. J Thorac Cardiovasc Surg 2005;130(3):783-90.Kumanohoso T., Otsuji Y., Yoshifuku S. et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 2003;125(1):135-43.Kumanohoso T., Otsuji Y., Yoshifuku S. et al. Mechanism of higher incidence of ischemic mitral regurgitation in patients with inferior myocardial infarction: quantitative analysis of left ventricular and mitral valve geometry in 103 patients with prior myocardial infarction. J Thorac Cardiovasc Surg 2003;125(1):135-43.Lehmann K.G., Francis C.K., Dodge H.T. Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group. Ann Intern Med 1992;117(1):10-7.Lehmann K.G., Francis C.K., Dodge H.T. Mitral regurgitation in early myocardial infarction. Incidence, clinical detection, and prognostic implications. TIMI Study Group. Ann Intern Med 1992;117(1):10-7.Bursi F., Enriquez-Sarano M., Nkomo V.T. et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation 2005;111(3):295-301.Bursi F., Enriquez-Sarano M., Nkomo V.T. et al. Heart failure and death after myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation 2005;111(3):295-301.Ling L.H., Enriquez-Sarano M., Seward J.B. et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996;335(19):1417-23.Ling L.H., Enriquez-Sarano M., Seward J.B. et al. Clinical outcome of mitral regurgitation due to flail leaflet. N Engl J Med 1996;335(19):1417-23.Messika-Zeitoun D., Bellamy M., Avierinos J.F. et al. Left atrial remodelling in mitral regurgitation-- methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. Eur Heart J 2007;28(14):1773-81.Messika-Zeitoun D., Bellamy M., Avierinos J.F. et al. Left atrial remodelling in mitral regurgitation-- methodologic approach, physiological determinants, and outcome implications: a prospective quantitative Doppler-echocardiographic and electron beam-computed tomographic study. Eur Heart J 2007;28(14):1773-81.Desjardins V.A., Enriquez-Sarano M., Tajik A.J. et al. Intensity of murmur correlates with severity of valvular regurgitation. Am J Med 1996;100(2):149-56.Desjardins V.A., Enriquez-Sarano M., Tajik A.J. et al. Intensity of murmur correlates with severity of valvular regurgitation. Am J Med 1996;100(2):149-56.Rich M. Heart Failure in the oldest patients: the impact of comorbid conditions. Am J Geriatr Cardiol 2005;14(3):134-41.Rich M. Heart Failure in the oldest patients: the impact of comorbid conditions. Am J Geriatr Cardiol 2005;14(3):134-41.Yu D.S., Lee D.T., Woo J., Thompson D.R. Correlates of psychological distress in elderly patients with congestive heart failure. J Psychosom Res 2004;57(6):573-81.Yu D.S., Lee D.T., Woo J., Thompson D.R. Correlates of psychological distress in elderly patients with congestive heart failure. J Psychosom Res 2004;57(6):573-81.Sullivan M., Levy W.C., Russo J.E., Spertus J.A. Depression and health status in patients with advanced heart failure: a prospective study in tertiary care. J Card Fail 2004;10(5):390-6.Sullivan M., Levy W.C., Russo J.E., Spertus J.A. Depression and health status in patients with advanced heart failure: a prospective study in tertiary care. J Card Fail 2004;10(5):390-6.Smith O.R., Michielsen H.J., Pelle A.J. et al. Symptoms of fatigue in chronic heart failure patients: clinical and psychological predictors. Eur J Heart Fail 2007;9(9):922-7.Smith O.R., Michielsen H.J., Pelle A.J. et al. Symptoms of fatigue in chronic heart failure patients: clinical and psychological predictors. Eur J Heart Fail 2007;9(9):922-7.Kovalenko V.N., Nesukai E.G. Uncoronary heart diseases. Kiev: Morion; 2001 / Коваленко В.Н., Несукай Е.Г. Некоронарогенные болезни сердца. Киев: Морион; 2001 (in Russian).Kovalenko V.N., Nesukai E.G. Uncoronary heart diseases. Kiev: Morion; 2001 / Коваленко В.Н., Несукай Е.Г. Некоронарогенные болезни сердца. Киев: Морион; 2001 (in Russian).Amigoni M., Meris A., Thune J.J. et al. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function. Eur Heart J 2007;28(3):326-33.Amigoni M., Meris A., Thune J.J. et al. Mitral regurgitation in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both: prognostic significance and relation to ventricular size and function. Eur Heart J 2007;28(3):326-33.Pérez de Isla L., Zamorano J., Quezada M. et al. Functional mitral regurgitation after a first non-STsegment elevation acute coronary syndrome: contribution to congestive heart failure. Eur Heart J 2007;28(23):2866-72.Pérez de Isla L., Zamorano J., Quezada M. et al. Functional mitral regurgitation after a first non-STsegment elevation acute coronary syndrome: contribution to congestive heart failure. Eur Heart J 2007;28(23):2866-72.D'Cruz I.A., Shroff S.G., Janicki J.S. et al. Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle. J Am Soc Echocardiogr 1989;2(6):408-14.D'Cruz I.A., Shroff S.G., Janicki J.S. et al. Differences in the shape of the normal, cardiomyopathic, and volume overloaded human left ventricle. J Am Soc Echocardiogr 1989;2(6):408-14.Otto C.M. Clinical practice. Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001;345(10):740-6.Otto C.M. Clinical practice. Evaluation and management of chronic mitral regurgitation. N Engl J Med 2001;345(10):740-6.Belenkov Yu.N., Mareev V.Yu., Ageev F.T. Chronic heart failure. Selected lectures by Cardiology. M.:GEOTAR-Media; 2006. / Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Хроническая сердечная недостаточность. Избранные лекции по кардиологии. М.: ГЭОТАР-Медиа; 2006 (in Russian).Belenkov Yu.N., Mareev V.Yu., Ageev F.T. Chronic heart failure. Selected lectures by Cardiology. M.:GEOTAR-Media; 2006. / Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т. Хроническая сердечная недостаточность. Избранные лекции по кардиологии. М.: ГЭОТАР-Медиа; 2006 (in Russian).

The authors declare that there are no conflicts of interest present.