Heart failure correction in patients with chronic renocardiac syndrome

Type of funding sources: None.

In case of inadequate diagnosis and correction of the basic disease, which triggers the development of chronic heart failure (CHF), left ventricular (LV) remodeling leads to myocardial dysfunction and decompensation. Patients who entered the study EUCLID, demonstrated nephroprotective effect of lisinopril, which reduces the appearance of microalbuminuria.

Study the effectiveness of lisinopril in the correction of CHF in patients with chronic renocardiac syndrome based on a study of LV diastolic function.

59 patients with chronic renocardiac syndrome were investigated. All patients received lisinopril 10-20 mg per day. LV diastolic function was evaluated for Acuson Sequoia-512 before and after treatment.

Changes in the kinetics of myocardial contractility were characterized by high amplitude of the interventricular septum, increased by 20%, end-systolic contractility index by 9.1%, the degree of shortening of the left ventricular size by 11.4%. A significant decrease in the rate of diastolic filling by passive relaxation (E) of 23.4% and a filling rate due to atrial contraction (A) at 20%. Violation of intracardiac hemodynamics as manifested by increasing the restrictive properties of the myocardium, as well as reducing the effectiveness of time and deceleration rate of early LV filling flow by 23.2 and 27.4%, increase and decrease of LV filling time active by reducing atrial 49.9% . Decreased as the time of isovolumic LV relaxation of the heart. During treatment with lisinopril was an increase in ejection fraction (EF) of 16.4% (p=0.004) or 53.2% (49.1, 58.9) to 61.9% (53.4, 68.0 ). The rate of mitral filling period of relaxation (Ve) increased from 0.53 m/s (0.43, 0.58) to 0.56 m/s (90.47, 0.63), or 5.7 % (p=0.039), while maintaining the diastolic filling due to atrial contraction. This has led to the restructuring of diastolic filling of the normal type, which was confirmed by the change of the reflectance upwards: Ratio of Ve/Va to treatment was 1.45 units. (1.02, 1.63), vand during treatment - 1.58 units (1.21, 1.90), or a 9.0% increase (p = 0.013). Equally, there was a decrease IVRT: from 61.9 ms (54.6, 78.8) to 56.4 ms (50.3, 72.4) or 8.9% (p=0.044).

Improvement of LV diastolic function is due to improved myocardial relaxation. ACE inhibitor (lisinopril), as a means of LV remodeling, reduce the degree of diastolic dysfunction by improving myocardial relaxation in patients with chronic renocardiac syndrome.