#485 Studying the features of heart remodeling processes depending on the degree of renal dysfunction
Authors: Korakulova Zilola , Atahodjayeva Gulchehra 
Published: May 2024

Abstract

Background and Aims
Chronic kidney disease (CKD) and heart failure (HF) affect many people worldwide and both diseases remain associated with considerable morbidity and mortality. Aim of the study was to features of changes in cardiac remodelling parameters depending on the degree of kidney dysfunction.

Method
A comprehensive examination of 105 patients with coronary heart disease (CHD) with functional class I-III and chronic heart failure (CHF) was carried out, assessing the clinical condition, exercise tolerance, left ventricular remodelling processes, and the functional state of the kidneys. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n=51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n=54) The average age of patients in group I was 58.77 ± 0.94 years, in group II 61.3±0.68 years and 62.14 ± 0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n = 51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n = 54) The average age of patients in group I was 58.77±0.94 years, in group II 61.3 ± 0.68 years and 62.14±0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years.

Results
The progression of the severity of CHF with eGFR ≤60 ml/min/1.73 m2 was accompanied by an increase in LV volume parameters, pronounced structural changes, as well as a pronounced degree of LV dilatation. At the same time, in the group of patients with FC III CHF, there was an increase in ESR by 26.8% (p &lt; 0.001) and EDV by 10.64% (p &lt; 0.01) in relation to the data of group I with FC I CHF. Analysis of the parameters of LV systolic function (SV and EF), as well as fractional shortening of the LV in systole, showed that in group II there was a significant decrease in LVEF, SV and Fs% in patients with class II CHF by 10.7%, 14.4% and by 9.0% (p &gt; 0.05) in relation to the data of CHF I FC. In patients with FC III CHF, there was also a pronounced decrease in EF by 28.8% (p &lt; 0.01) and Fs% by 31.75% (p &lt; 0.001) in relation to the FC I CHF data. Analysis of diastolic function indicators in patients with CHF with GFR ≤60 ml/min. Severe disturbances in LV diastolic function are observed in the group of patients with FC II CHF, where there is an increase in the maximum rate of late atrial filling (RA) by 25.1% (p &lt; 0.001) and a significant decrease in the maximum rate of early filling of the left ventricle (PE) compared to study group I by 12.6% (p &gt; 0.05).

Conclusion
The results of the analysis of indicators of the sizes of the LV and LA cavities, as well as the LV walls, established the peculiarity of structural and geometric changes in the left parts of the heart in patients with FC I-III CHF (increase in LVMM by 10.25%; p &lt; 0.001) in relation to data with eGFR&gt;60 ml/min/1.73 m2. A decrease in the level of LVEF in patients with eGFR ≤60 ml/min/1.73 m2 is evidence of the role of the severity of DP in reducing systolic function in patients with CHF (EF by 25.4% and Fs% by 11.2% (p &lt; 0.001)).
2. Analysis of diastolic function indicators in patients of group II with eGFR ≤60 ml/min/1.73 m2 showed an increase in the maximum rate of early left ventricular filling (PE) by 13.25% (p &lt; 0.001), which led to an increase in E/ and by 20.5% in patients with CHF eGFR ≤60 ml/min/1.73 m2 compared to CHF with eGFR&gt;60 ml/min/1.73 m2 (p &lt; 0.001).