Evolution of some echocardiographic parameters in ischemic and hypertensive cardiomyopathies during compensation of chronic congestive heart failure
Abstract
In chronic congestive heart failure, the cardiopathy determines the congestive syndrome and may trigger morphologic and functional reactions to the congestive syndrome variations. This study makes a comparative analysis of echocardiographic changes (2D, continuous, pulsed and tissue Doppler) recorded in the decompensated and in the compensated moments of chronic congestive heart disease, in ischemic and hypertensive cardiomyopathies. The study was performed in 16 patients with ischemic cardiomyopathy and 20 patients with hypertensive cardiomyopathy.
In ischemic cardiomyopathy, having a dilatative pattern, the correction of the congestive syndrome was associated with highly significant decreases of the systolic and diastolic left ventricle (LV) diameters and volumes. Cardiac output, apparently normal or slightly increased, experienced a highly significant lowering, mainly by a highly significant heart rate decrease. The beat volume decreased insignificantly. The ejection fraction, severely impaired, did not increase significantly.
In hypertensive cardiomyopathy, highly significant decreases of LV diameters and volumes after the correction of the congestive syndrome were also found. A highly significant cardiac output decrease was determined by a highly significant decrease in heart rate; LV ejection fraction remained severely impaired. Left ventricular diameters were significantly higher in ischemic, than in hypertensive cardiomyopathy. The percentage decreases of diastolic and systolic left ventricular diameters and volumes were similar in both of the cardiomyopathies.
The LV longitudinal shortening was higher in hypertensive than in ischemic cardiomyopathy, in both the decompensated and compensated moments of heart fai-lure, probably as an expression of a higher longitudinal ventricular function in hyper-tensive patients. A similar degree of severity of LV diastolic dysfunction was found in both cardiomyopathies. After heart failure compensation, improvement of diastolic dysfunction was higher in the ischemic than in the hypertensive cardiomyopathy.