PECULIARITIES OF THE STRUCTURAL AND FUNCTIONAL STATE OF THE HEART IN PATIENTS AT DIFFERENT STAGES OF CEREBRAL ATHEROSCLEROSIS

Abstract

Cerebrovascular diseases is one of the most important causes of morbidity and mortality in the adult population. Objective: to conduct a comparative analysis of the morpho-functional changes of the heart, intracardiac and systemic hemodynamics in elderly patients with cerebral atherosclerosis (CA) of 1–3 degree. Materials and methods: 229 patients with cerebral atherosclerosis of 2–3 degree took part in a comprehensive study. The patients were divided into 4 groups: Group 1 – patients with ischemic stroke (IS) in the right hemisphere (RH), Group 2 ­– with IS in the left hemisphere (LH), Group 3 – with cerebral atherosclerosis of 1–2 degree (no IS – comparison group) and Group 4 – a general group of patients who have IS. Design: simple, prospective, non-randomized, with the consistent inclusion of patients. Results and discussion: The compared groups differed statistically significantly by the LA diameter index (ILA), the LV diastolic index (LVIDd), the LV systolic index (LVIDs) and the wall thickness of the left ventricle (LV). Thus, the highest ILA value was observed in patients with CA (1.1 times more than in patients with IS), the highest values of LVIDd and LVIDs – in the group of patients with left-hemispheric localization of IS (1.14 and 1.18 times more, accordingly, than in patients with CA without IS). The minimal thickness of the interventricular septum (IVS) and the posterior wall of the LV was in the group of patients with CA (1.18 and 1.17 times less, respectively, compared with the group of patients with AI, without taking into account the hemispheric localization of IS). Interhemispheric differences were observed only in the assessment of LVIDd, LVIDs, and the thickness of the IVS. So, in patients with left hemispheric localization of IF LVIDd, it was 1.09 times greater, and LVIDs was 1.16 times greater than in patients with right hemispheric IF, while the IVS was 1.15 times thicker in the IS ​​group with the right hemisphere than with left hemispheric localization of IF. In the compared groups, we also observed statistically significant differences in the assessment of the parameters of systemic and intracardiac hemodynamics. So, in patients with CA, the index of the end-diastolic volume (iEDV) was 1.14 times higher and the index of the end-systolic volume (iESV) was 1.09 times less than in patients with IS, while in patients with left-hemispheric localization of IS the lowest ejection fraction and iEDV were observed compared with the group of patients with CA (1.02 and 1.15 times, respectively). Interhemispheric differences were recorded only in terms of the magnitude of the stroke index (SI). Thus, patients with IS in LН SI was 1.2 times more than in patients with IS in RH. In the group of patients with CA and IS, non-dilatational eccentric and concentric hypertrophy of LV (LVH) was most common (37.4 % and 48.1 %–26.0 % and 61.6 %, respectively), but type III was 1.44 times more common in patients with CA, and type V – 1.28 times more often in patients with IS. Eccentric dilated LVH was most often observed in patients with IS – 2.2 times more often than in patients with CA, and concentric dilated LVH was more common in patients with CA – 1.8 times more often than in patients with IS. Interhemispheric differences were observed only in relation to types III and V LVH. Thus, in patients with right hemispheric localization of IF, concentric non-dilated LVH was 1.66 times more common, and in patients with left-hemispheric IF localization – 4.4 times eccentric non-dilated LVH. Conclusions: in patients with CA of 1–3 degree, there were statistically significant differences in the morpho-functional changes in the heart, intracardiac and systemic hemodynamics and LV geometry, and some of these differences were hemispheric.