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"Emergency medicine" 6 (61) 2014

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The course of heart failure at patients with mitral valve disease

Authors: Zhadan A., Zedginidze E.

Categories: Medicine of emergency

Sections: Clinical researches

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Materials and methods.

In our study we examined 66 patients who underwent prosthetic mitral valve about mitral stenosis (31 patients) and mitral regurgitation (35 patients). The median age was 58,1 ± 11,1 years. The sex distribution was as follows: 27 women and 39 men. In 26 patients a valve lesion formed as a result of rheumatism, 6 - infective endocarditis, 28 patients had degenerative changes in the mitral valve, the rest of patients - the etiologic agent is unknown.

Analysis of comorbidity showed that hypertension was observed in 20 patients, diabetes in 5 patients, ischemic heart disease in 7 patients, myocardial infarction was observed in 2 patients, stroke in 3 patients, thyroid disease in 3 people, kidney disease in 2 patients, COPD 2 patients. Pulmonary hypertension was diagnosed in 22 patients. The study excluded patients with comorbidities that could significantly affect the prognosis of the disease. Before the surgical treatment of 59 % of patients had I-II f. c. of heart failure (HF), 39 % - III f. c, 8 % - IV f. c. by NYHA. 6 months after surgery HF III f. c. persisted in 15 patients. In 47 patients (71 %) was atrial fibrillation (AF). Patients were treated with medical therapy as recommended by the Ukrainian Society of Cardiology for the treatment of chronic heart failure (ACE inhibitors / sartans, beta-blockers, aldosterone antagonists, diuretics).

To assess the functionality of all patients before and 6 months after surgery a 6-minute walk test was performed. Of the statistical methods used in the correlation analysis using the Spearman rank correlation, two-sample Student's t-test.

Results.

It was perfomed a correlation analysis using the Spearman rank correlation between the presence of severe heart failure at 6 months after surgery and the presence of preoperative comorbidities such as hypertension, AF, ischemic heart disease, diabetes, pulmonary hypertension. The highest correlation coefficient was obtained between the severity of heart failure and the presence of pulmonary hypertension (0.85), and the presence of atrial fibrillation (0.75). In this connection, further analysis was conducted indicators patients after their distribution in the subgroup, with or without the above-mentioned complications.

Test results with a 6-minute walk test conducted before surgical treatment, showed the following values traversed distance: 235 ± 99 m in the subgroup of patients without PH and 150 ± 65 m in the subgroup of patients with pulmonary hypertension. After 6 months, a statistically significant increase in this parameter was noted only in the subgroup of patients without PH - to 445 ± 106 m (p < 0.05), while in the presence of PH, this rate was only 200 ± 93 m. Similar results were obtained when the distribution of the patients into subgroups according to the presence / absence of atrial fibrillation. Baseline performance test with a 6-minute walk test were similar: 226 ± 74 m in the absence of AF and 211 ± 107 m in patients with atrial fibrillation. At 6-month statistically significant (p <0.05) increase in this parameter was observed only in the subgroup of patients without AF - 486 ± 68 m. Parallel subgroup value of the distance traveled by patients for 6 minutes, was equal to 357 ± 151 m.

Average heart rate in patients with AF is equal to 100,1 ± 19,2 beats / min before surgery and 75,9 ± 12,3 beats / min after surgery. In a parallel group, respectively 93,17 ± 13,4 beats / min and 60,4 ± 4,7 beats / min.

Interesting results were obtained in the analysis of the functional class of heart failure in these subgroups (with or without AF). Baseline NYHA functional class of heart failure on average was equal to 2,89 ± 0,4 and 2,86 ± 0,4 in the subgroups, respectively. 6 months after prosthetic MC in patients with AF degree HF decreased to 2,15 ± 0,3 in the average for the group, and in the absence of the disruptions - to 1.14. About a third of patients (32 %) with atrial fibrillation at 6 months after the intervention had class III f. c. by NYHA.

The presence of hypertension, ischemic heart disease and diabetes history had no effect on the severity of the manifestations of heart failure at 6 months after mitral valve replacement.

Comparing our results with data from European studies, it should be noted more mitral stenosis in our population. Other than that, not being able to assess the long-term prognosis and mortality of patients, it can be seen that the factors that negatively were joined on the degree of heart failure in our study, and predictors of death in the European registries are the same - pulmonary hypertension, atrial fibrillation, heart failure severity of preoperative .

Conclusion.

Surgical treatment of patients with mitral valve disease have a positive impact, appears to reduce the class of HF and improvementof results of test with the 6-minute walk, but in some cases, the positive trend was not observed. Factors associated with the absence of the positive impact of surgical correction of the clinical manifestations of heart failure are atrial fibrillation and pulmonary hypertension.


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