[Factors influencing left ventricular diastolic function in elderly patients with chronic heart failure].

The purpose of the study was to define factors influencing the diastolic left ventricular (LV) function in elderly patients with chronic heart failure (CHF). Ninety-seven I to IV functional class CHF patients aged 65 to 88 (mean age 76.6+/-5.1 yr), 61 women and 36 men, were examined. CHF was caused by coronary artery disease in 22 (22.7%) patients, by arterial hypertension in 14 (14.4%) patients, and by both in 61 (62.9%) patients. Fourteen (14.4%) patients had type 2 diabetes. Hemoglobin level lower than 130g/l in men or 120g/l in women was considered anemia. Glomerular filtration speed (GFS) was calculated using Cockcroft-Gault formula. EchoCG and Doppler EchoCG were performed in all patients. LV hypertrophy (LVH) was revealed in 90 (92%) of the patients; 52patients had concentric L VH and 38 patients had eccentric LVH. Ejection fraction was less than 45% in 17 (17.5%) patients. Isovolemic relaxation time (IVRT) was over the normal limit in 73 (75.3%) patients; the time of early diastolic flow slowing (DT) changed in different directions and was 211.2+/-55.6 msec. A type of transmitral blood flow with relaxation disorder was found in 58 (59.8%) patients, a pseudonormal type was revealed in 32 (33%), and a restrictive type was found in 7 (7.2%) of patients. The study found a reverse independent correlation between hemoglobin level and the speed of LV filling during atrial systole. An independent correlation between the degree of renal dysfunction (GFS) and disorder of LV relaxation was found: the lower GFS, the longer IVRT and DT. Thus, in addition to age and structural changes in the heart, factors that have adverse effects on diastolic filling parameters are anemia, lowered renal function, and the level of systolic and diastolic pressure.

[Renal dysfunction and anemia in old patients with diastolic cardiac failure].

AIM: To study the effects of renal functional insufficiency and anemia on clinical symptoms and diastolic filling of the left ventricle in aged patients with chronic diastolic cardiac failure (CDCF). MATERIAL AND METHODS: We examined 116 patients (69 females, 47 males) with CDCF (ejection fraction > 45%) of functional class I-IV aged 65-86 (76.4 +/- 5.2) years. Anemia was diagnosed in men with hemoglobin under 130 g/l, in women--under 120 g/l. Glomerular filtration rate (GFR) was calculated by Cockcroft- Gault formula. RESULTS: GFR < 60 ml/min/1.73 m2 was observed in 42 (36.2%) patients; anemia--in 33 (28.4%) patients, combination of anemia with subnormal renal function--in 21 (18.1%). Left ventricular hypertrophy was diagnosed in 101 (87.1) patients. Type of transmitral circulation with impaired relaxation, pseudonormal and restrictive was detected in 80 (69%), 29 (25%) and 7 (6%) patients, respectively. There is a direct correlation between hemoglobin content and GFR (r = 0.33; p < 0.01). Functional class of CDCF in anemic patients and anemia combination with subnormal GFR was higher than in patients free of anemia. It was established that the less GFR rate is the longer is the time of isovolumic relaxation of the left ventricle; the lower hemoglobin the greater is the velocity of early diastolic filling. CONCLUSION: In aged patients with CDCF diastolic filling depends not only on age, heart rate, structural changes of the heart but also on reduced renal function, anemia, systolic arterial pressure.