Abstract
The aim of the study: to identify predictors of the development of heart failure (HF) in the early period after surgical correction of aortic regurgitation according to stress echocardiography.
Material and methods. 57 patients were examined (34 men and 23 women) aged 18 to 80 years (the average age of patients was 56 ± 15 years). 20 (35%) patients were diagnosed with aortic insufficiency, 37 (65%) with aortic stenosis. This paper presents an analysis of 20 patients with various etiologies of aortic valve insufficiency: 17 (85%) men and 3 (15%) women aged 18 to 80 years (the average age of patients was 51 ± 18 years). At the preoperative stage, clinical and instrumental examinations were carried out: electrocardiogram, echocardiography, stress echocardiography (with calculation of contractile reserve by ejection fraction, shock volume and global longitudinal deformation of the left ventricle), cardiorespiratory test, control of the biomarker of brain natriuretic peptide, diagnostic coronarography. Patients with coronary heart disease were excluded from the study. Patients underwent aortic valve replacement surgery. After surgery, patients were examined 6–8 days before discharge from the hospital. The combined endpoints of the early postoperative period were: deterioration of the clinical status (edema, shortness of breath, hydrothorax), development of heart failure with a decrease in the ejection fraction (less than 50%), prolonged stay in intensive care due to the development or decompensation of heart failure, cardiotonic support of more than 2 cardiotonic drugs, including adrenaline, death. Based on these endpoints, groups are identified: 1 – complicated patients, 2 – uncomplicated.
Results. Of the examined patients with aortic regurgitation 7 (35%) people had a complicated course of heart failure in the early postoperative period. Initially, before surgery, the absence of contractile reserve in terms of ejection fraction was observed in 6 patients, of which 3 (50%) patients had a complicated course of the early postoperative period. Contractile reserve was detected in 14 people, of whom 4 (28%) developed heart failure (p = 0.38). The absence of contractile reserve for global longitudinal deformation of the left ventricle was observed in 8 patients, of whom 6 (75%) patients had a complicated course after surgery. Contractile reserve was present in 12 patients, of which 1 (8%) patient had a complicated postoperative period (p = 0.0001).
Conclusion. The contralateral reserve for global longitudinal deformation of the left ventricle had a high predictive value in the development of nonfatal postoperative complications – HF in the early period after surgical correction of the defect.
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About the authors
- Iman M. Patsoeva, Cardiologist; ORCID
- Irina I. Averina, Dr. Med. Sci., Senior Researcher, Cardiologist; ORCID
- Marina Yu. Mironenko, Cand. Med. Sci., Head of Department, Ultrasound Diagnostician; ORCID
- Lyudmila A. Glushko, Cand. Med. Sci., Head of Group, Functional Diagnostician; ORCID
- Sergey A. Donakanyan, Dr. Med. Sci., Head of Department, Cardiovascular Surgeon; ORCID
