| Abstrakt: |
Our objective in this study was to compare particular features of pathogenesis of diastolic dysfunction of the right ventricle (RV) in patients with arterial hypertension (AH), stable exertional angina, and myocardial infarction of the left ventricle (LV) and to establish diagnostic significance thereof. As many as 429 AH patients presenting with different clinical forms of ischemic heart disease (IHD) were examined. Of these, 209 patients presented with stage I to III AH, 105 had functional class (FC) I-III stable exercise-induced angina, 115 patients had acute LF myocardial infarction (MI) verified by clinical findings, changes in ECG, and time-course of activity of myocardial enzymes. The control group was 30 essentially healthy subjects with no signs of cardiovascular and respiratory affections. All examinees underwent Doppler echocardiography as recommended by the American Society of Echocardiography. Measured in the above series were LV wall relative thickness, LV ejection fraction (EF) as recommended by L. Teichholz et al., LV isovolumetric relaxation time (IVRT), peak velocities of early (E) and atrial (A) filling of the heart's ventricles, E/A ratio, early diastolic filling deceleration time (DT) for both transmitral and transtricuspid flows, acceleration time of systolic flow in the pulmonary trunc as an indirect indicator of pressure in it. In AH patients, there was a close direct correlation between indices for filling of both ventricles (E/A ratio, E-wave DT and IVRT) but no significant correlation between indices for RV diastolic function and dimensions of left chambers or LV EF. In AH patients, disturbances in the diastolic function of the heart were at their greatest in eccentric hypertrophy of the myocardium when in the presence of pseudonomal and restrictive indices for LV filling "pseudonormalization" of the transtricuspid flow was being formed. In stable angina and MI, it was LV systolic dysfunction and pulmonary diastolic dysfunction that proved to play a major part in the development of RV diastolic dysfunction, its indices correlating significantly with heart failure and stable angina functional classes. |
