Diagnostics of heart failure in patients with chronic non-infectious diseases and preserved left ventricular ejection fraction before non-cardiac surgical interventions


DOI: https://dx.doi.org/10.18565/therapy.2021.3.7-13

Dzhioeva O.N., Drapkina O.M.

National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia, Moscow
Abstract. The aim of research was to evaluate the incidence of heart failure with preserved ejection fraction (HFEF) in patients with chronic non-infectious diseases before planned non-cardiac surgery.
Material and methods. In cohort study were analyzed the data of 102 patients (including 43 men; average age was 66 (60; 74) years) with left ventricular (LV) ejection fraction ≥50%, somatically stable, without active complaints at rest, with a subjective estimation of their functional status as satisfactory; they had persistent sinus rhythm at the time of examination. Before surgery, all patients underwent transthoracic echocardiographic examination, diastolic imaging stress test (DST), and assessment of brain natriuretic peptide (BNP) concentration.
Results. At rest, 82,8% of patients showed signs of structural myocardial remodeling: an increase of the LV myocardial mass index in accordance with gender (57,8%), an increase of the end-systolic volume index of the left atrium (34,3%). An increase in systolic pressure in the pulmonary artery at rest was diagnosed in 16%. A decrease of the average speed of movement of the fibrous mitral annulus e’ was determined in 62,7%, while the parameter reflecting the LV filling pressure at rest (E/e’) was increased only in 5,9% of patients. An increase in BNP ≥35 pg/ml was detected in 40,2% of cases. After evaluating the sample in accordance with the specified criteria, we found that 32,3% of patients have instrumental signs of HFEF. At rest, 67.7% of patients did not have any HFEF criteria. After ergometric testing, it was found that 19,7% of the examined persons had clinically significant changes against the background of physical activity. The increase in BNP was assessed after DST and was detected in 63,7% of all observations. When comparing the clinical, instrumental and laboratory criteria for HFEF, at rest 32,3% of patients met the HF criteria, while DST made it possible to diagnose the disease in 52% of examined persons.
Conclusion. In the studied sample of patients before planned non-cardiac surgery, signs of structural myocardial remodeling were found in 82,2% of persons. On the basis of instrumental and laboratory data, 32,3% of patients at rest had the HFEF criteria. DST is a useful diagnostic tool that made it possible to identify almost 1/3 of cases of previously undiagnosed heart failure.
Keywords: heart failure with preserved ejection fraction, non-cardiac surgical interventions, transthoracic echocardiography, diastolic stress test
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Literature


  1. Фомин И.В. Хроническая сердечная недостаточность в Российской Федерации: что сегодня мы знаем и что должны делать. Российский кардиологический журнал. 2016; 8: 7–13. [Fomin I.V. Chronic heart failure in Russian Federation: what do we know and what to do. Rossiyskiy kardiologicheskiy zhurnal = Russian journal of cardiology. 2016; 8: 7–13 (In Russ.)]. doi: https://doi.org/10.15829/1560-4071-2016-8-7-13.

  2. Ponikowski P., Voors A.A., Anker S.D. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37(27): 2129–200. doi: 10.1093/eurheartj/ehw128.

  3. Smilowitz N.R., Redel-Traub G., Hausvater A. et al. Myocardial injury after noncardiac surgery: A systematic review and meta-analysis. Cardiol Rev. 2019; 27(6): 267–73. doi: 10.1097/CRD.0000000000000254.

  4. Hackett N.J., De Oliveira G.S. et al. ASA class is a reliable independent predictor of medical complications and mortality following surgery. Int J Surg. 2015; 18: 184–90. doi: 10.1016/j.ijsu.2015.04.079.

  5. Pieske B., Tschope C., de Boer R.A. et al. How to diagnose heart failure with preserved ejection fraction: the HFA-PEFF diagnostic algorithm: a consensus recommendation from the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Eur Heart J. 2019; 40(40): 3297–317. doi: 10.1093/eurheartj/ehz641.

  6. Rosenberg M.A., Manning W.J. Diastolic dysfunction and risk of atrial fibrillation: a mechanistic appraisal. Circulation. 2012; 126(19): 2353–62. doi: 10.1161/CIRCULATIONAHA.112.113233.

  7. Donal E., Galli E., Fraser A.G. Non-invasive estimation of left heart filling pressures: another nail in the coffin for E/e’? Eur J Heart Fail. 2017; 19(12): 1661–63. doi: 10.1002/ejhf.944.

  8. Al-Naamani N., Preston I.R., Paulus J.K. et al. Pulmonary arterial capacitance is an important predictor of mortality in heart failure with a preserved ejection fraction. JACC Heart Fail. 2015; 3(6): 467–74. doi: 10.1016/j.jchf.2015.01.013.

  9. Rosenkranz S., Gibbs J.S., Wachter R. et al. Left ventricular heart failure and pulmonary hypertension. Eur Heart J. 2016; 37(12): 942–54. doi: 10.1093/eurheartj/ehv512.

  10. Smiseth O.A. Need for better diastolic stress test: twistin’ time is here? Eur Heart J Cardiovasc Imaging. 2018; 19(1): 20–22. doi: 10.1093/ehjci/jex307.

  11. Ha J.W., Oh J.K., Pellikka P.A. et al. Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr. 2005; 18(1): 63–68. doi: 10.1016/j.echo.2004.08.033.

  12. Carliner N.H., Fisher M.L., Plotnick G.D. et al. Routine preoperative exercise testing in patients undergoing major noncardiac surgery. Am J Cardiol. 1985; 56(1): 51–58. doi: 10.1016/0002-9149(85)90565-x.

  13. Sgura F.A., Kopecky S.L., Grill J.P., Gibbons R.J. Supine exercise capacity identifies patients at low risk for perioperative cardiovascular events and predicts long-term survival. Am J Med. 2000; 108(4): 334–36. doi: 10.1016/s0002-9343(99)00465-9.

  14. Fayad A., Ansari M.T., Yang H. et al. Perioperative diastolic dysfunction in patients undergoing noncardiac surgery is an independent risk factor for cardiovascular events: A systematic review and meta-analysis. Anesthesiology. 2016; 125(1): 72–91. doi: 10.1097/ALN.0000000000001132.

  15. Opdahl A., Remme E.W., Helle-Valle T. et al. Determinants of left ventricular early-diastolic lengthening velocity: independent contributions from left ventricular relaxation, restoring forces, and lengthening load. Circulation. 2009; 119(19): 2578–86. doi: 10.1161/CIRCULATIONAHA.108.791681.

  16. Graham R.J., Gelman J.S., Donelan L. et al. Effect of preload reduction by haemodialysis on new indices of diastolic function. Clin Sci (Lond). 2003; 105(4): 499–506. doi: 10.1042/CS20030059.

  17. von Bibra H., Paulus W.J., St John Sutton M. et al. Quantification of diastolic dysfunction via the age dependence of diastolic function – impact of insulin resistance with and without type 2 diabetes. Int J Cardiol. 2015; 182: 368–74. doi: 10.1016/j.ijcard.2014.12.005.

  18. Kasner M., Westermann D., Steendijk P. et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation. 2007; 116(6): 637–47. doi: 10.1161/CIRCULATIONAHA.106.661983.

  19. Kasner M., Westermann D., Lopez B. et al. Diastolic tissue Doppler indexes correlate with the degree of collagen expression and cross-linking in heart failure and normal ejection fraction. J Am Coll Cardiol. 2011; 57(8): 977–85. doi: 10.1016/j.jacc.2010.10.024.

  20. Shah A.M., Claggett B., Kitzman D. et al. Contemporary assessment of left ventricular diastolic function in older adults: The atherosclerosis risk in communities study. Circulation. 2017; 135(5): 426–39. doi: 10.1161/CIRCULATIONAHA.116.024825.


About the Autors

Olga N. Dzhioeva, PhD, senior researcher of the Department of fundamental and applied obesity aspects, National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101000, Moscow, 10/3 Petroverigsky Lane. Tel.: +7 (916) 614-18-21. E-mail: dzhioevaon@gmail.com. ORCID: 0000-0002-5384-3795
Oksana M. Drapkina, MD, professor, corresponding member of RAS, Director of National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Healthcare of Russia. Address: 101000, Moscow, 10/3 Petroverigsky Lane. Tel: +7 (495) 623-86-36. E-mail: ODrapkina@gnicpm.ru. ORCID: 0000-0002-4453-8430

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