Особливості кардіогемодинаміки при хронічній серцевій недостатності з надлишковою масою тіла та ожирінням залежно від функціонального стану нирок

Abstract

Вивчено особливості кардіогемодинаміки при хронічній серцевій недостатності (ХСН) на тлі надлишкової маси тіла та ожиріння залежно від функціонального стану нирок. Встановлено, що при помірній та важкій нирковій дисфункції паралельно збільшенню функціонального класу захворювання, відбувається дилатація камер серця, прогресує концентрична гіпертрофія, кальцинування клапанів, порушення систолічної, діастолічної функції міокарда та формування легеневої гіпертензії. Several researches had demonstrated connection between the kidney dysfunction and worse prognosis in patients with both acute and chronic heart failure (CHF). The aim of research was to study the special features of cardiac hemodynamics at CHF with overweight and obesity depending on functional state of kidneys. Methods. There were examined 347 patients with CHF 0f 1-111 functional class on the background of overweight and abdominal obesity of 1–111 degree and different functional state of kidneys. There was calculated glomerular filtration rate-GFR (on MDRD formula) and carried out Doppler echocardiography for all examined persons. There was used an unpaired Student t-criterion or Mann-Whitney U-criterion depending on the size of sample and distribution of indicators. Results. Concomitant kidney functional state disorder complicates the clinical course of CHF on the background of overweight and obesity. It is demonstrated as an increase of functional class of disease at moderate and heavy kidney dysfunction. It is based on an increase of the degree of dilatation of the left and right atrium, left ventricle (LV) and the more degree of myocardium hypertrophy. The more significant calcination of mitral and aortic valves, the growth of degree of mitral regurgitation takes place. Simultaneously with structural changes in heart there take place functional disorders namely the worsening of contractility of LV and spread of systolic and diastolic myocardium function of 1 type, development of kidney hypertension. The remodeling of myocardium in this category of patients is mainly presented as concentric hypertrophy although at progression of kidney dysfunction the tendency to gradual elevation of excentric hypertrophy of LV takes place. Conclusions: It was established that CHF on the background of overweight and obesity associated with kidney dysfunction is characterized with heavier clinical course, elder age and more representation of women, dilatation of heart chambers, progression of hypertrophy of LV, calcination of valves and complication of mitral regurgitation. There took place a decrease of contractility of LV and spread of systolic and diastolic function by the type of relaxation disorder, kidney hypertension was forming. Among the types of myocardium remodeling the most widespread is concentric hypertrophy of LV that tends to decrease in favor of ecxentric hypertrophy at intensification of kidney dysfunction.