Features of development of diastolic heart dysfunction in patients with comorbid pathology depending on the functional state of the kidney

Abstract

The development of complications of diabetes mellitus and hypertension, in particular kidney and heart damage, mutually reinforcing each other, not only affect the quality of life, but also significantly reduce its average duration. One of the common problems in patients with comorbid pathology is the high prevalence of chronic heart failure. Very often chronic heart failure develops with a preserved left ventricular ejection fraction. These changes are associated with the diastolic phase of the heartbeat - diastolic dysfunction. The features of the development of diastolic dysfunction in patients with type 2 diabetes in combination with hypertension depending on the functional state of the kidneys were studied. After the initial examination, depending on the functional state of the kidneys, all examined patients were divided into three groups: first group consists of 25 patients with type 2 diabetes without signs of nephropathy; second group consists of 23 patients with type 2 diabetes with normal glomerular filtration rate and albuminuria; third group consists of 20 patients with type 2 diabetes with decreased glomerular filtration rate and albuminuria. The control group consisted of 20 healthy patients. To study the state of the heart, transthoracic echocardio­graphy was performed on a ULTIMA PA ultrasound machine (Radmir, Ukraine) with a sectoral phased transducer with a frequency range of 2-3 MHz, according to the standard technique according to the recommendations of the American Echocardiographie Society. The data obtained confirm the need for prevention, early diagnosis, clarification of mechanisms and adequate treatment of diastolic dysfunction in diabetic nephropathy patients even before the onset of renal failure. Structural changes in cardiomyocytes activate the processes of apoptosis, enhancing the production of extracellular matrix, and contribute to the formation of myocardial fibrosis. Fibrous changes lead to the progression of impaired contractile function and an increase in the stiffness of the left ventricle walls, which leads to diastolic and systolic dysfunction and the development of heart failure. Diastolic myocardial function in diabetic nephropathy is complicated with the progression of the disease. Keywords: diabetes mellitus, hypertonic disease, diabetic nephropathy diastolic dysfunction, chronic kidney disease.