Affiliation:
1. Pirogov Russian National Research Medical University
Abstract
The index of global left ventricular function (LV IGF) is an imaging marker with pronounced prognostic properties in relation to the development of adverse cardiovascular events and death, determined on the basis of data from both magnetic resonance imaging (MRI) of the heart and echocardiographic examination (EchoCG). Companion indicator (companion) LV IGF (LV IGFC) is a marker obtained from the average quadratic value of the sum of the impact and global LV volume, designed to overcome the limitations of LV IGF due to its calculation formula.The aim. To evaluate the prognostic significance of LV IGF and its companion in patients aged 60 years and older with CHF and type 2 diabetes mellitus observed in outpatient settings.Material and methods. The study included 215 outpatient patients: 110 (51.2%) men and 105 (48.8%) women aged 72 (67; 78) years with CHF IIa–III stage II–IV FC. And LVH (in %) was calculated using the formula: EG LV = (KDO LV–CSR LV)/[0.5=(UP TO LV+CSR LV)+(MMLJ/1.05)]=100. IGFC LJ = {(KDO LJ-CSR LJ)2+[0.5×(BDO LJ+CSR LJ)+(MMLJ/1.05)]2}0.5. The duration of the observation period was 29 (20; 36) months.Results. LV IGF as a whole amounted to 20.6 (16.9; 23.2)%. LV IGF as a whole amounted to 313.8 (262.8; 400.0) ml. Depending on the presence or absence of DM, patients were divided into two groups: 68 patients with DM (group 1); 147 patients without DM (group 2). During the follow–up period of 29 (20; 36) months, 122 (56.7%) patients were hospitalized: in group 1–32 out of 68 (47.1%) patients; in group 2–90 out of 147 (61.2%) patients. The threshold value of LV IGF for predicting hospitalization due to CVD decompensation in group 1 patients was 21.4% or lower (area under the curve [PPK] 0.677±0.065, 95% CI 0.549–0.805, p=0.012; sensitivity 68.8%, specificity 61.1%); LV IGFC – 300.3 ml or more (PPK 0.666±0.067, 95% CI 0.535–0.797, p=0.019; sensitivity 62.5%, specificity 61.1%). There was a high rate of hospitalization due to CVD decompensation in group 1 with LV IGF of 21.4% or less (among patients with LV IGF of ≤21.4%, 59.5% of patients were hospitalized, more than 21.4% –32.3%) (OR 3.08, p<0.05); with LV IGFC of 300.3 ml or more (among patients with LV IGFC ≥300.3 ml, 58.8% of patients were hospitalized, less than 300.3 ml – 35.3%) (OR 2.62, p>0.05).Conclusion. The threshold value of LV IGF for predicting decompensation of cardiovascular disease with subsequent hospitalization in patients 60 years and older with CHF and DM was ≤21.4%; LV IGF was ≥300.3 ml. The data obtained allow us to consider LV IGF, LV IGFC, as well as their combination as markers of an unfavorable prognosis in older patients with CHF and DM at the outpatient stage.