ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2023-1-41-50ssmu-5130Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSПрогностическая роль резерва миокардиального кровотока у больных с сердечной недостаточностью с сохраненной фракции выбросаPrognostic value of myocardial flow reserve in patients with heart failure with preserved ejection fractionhttps://orcid.org/0000-0002-2285-6438КопьеваК. В.KopevaK. V.

Копьева Кристина Васильевна – кандидат медицинских наук, науч. сотрудник, отделение патологии миокарда

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

kristin-kop@inbox.ruhttps://orcid.org/0000-0002-1311-0378МальцеваА. Н.MaltsevaA. N.

Мальцева Алина Николаевна – аспирант, лаборатория радионуклидных методов исследования

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

maltseva.alina.93@gmail.comhttps://orcid.org/0000-0003-4019-3735ГраковаЕ. B.GrakovaE. V.

Гракова Елена Викторовна – доктор медицинских наук, вед. науч. сотрудник, отделение патологии миокарда

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

gev@cardio-tomsk.ruhttps://orcid.org/0000-0003-0883-466XМочулаА. В.MochulaA. V.

Мочула Андрей Викторович – кандидат медицинских наук, ст. науч. сотрудник, лаборатория радионуклидных методов исследования

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

mochula.andrew@gmail.comhttps://orcid.org/0000-0002-9886-0695СолдатенкоМ. В.SoldatenkoM. V.

Солдатенко Михаил Владимирович – кандидат медицинских наук, науч. сотрудник, отделение ультразвуковой и функциональной диагностики

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

able99@mail.ruhttps://orcid.org/0000-0001-9640-2028КалюжинВ. В.KalyuzhinV. V.

Калюжин Вадим Витальевич – доктор медицинских наук, профессор, зав. кафедрой госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины

634050, Томск, Московский тракт, 2

2, Moscow Trakt, Tomsk, 634050

https://orcid.org/0000-0002-1513-8614ЗавадовскийК. В.ZavadovskyK. V.

Завадовский Константин Валерьевич – доктор медицинских наук, зав. отделом лучевой диагностики

634012, Томск, ул. Киевская, 111а

111а, Kievskaya Str., Tomsk, 634012

konstzav@gmail.comНаучно-исследовательский институт кардиологии, Томский национальный исследовательский медицинский центр Российской академии наукРоссияCardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of SciencesRussian FederationСибирский государственный медицинский университетРоссияSiberian State Medical UniversityRussian Federation2023190420232214150Copyright © Копьева К.В., Мальцева А.Н., Гракова Е.B., Мочула А.В., Солдатенко М.В., Калюжин В.В., Завадовский К.В., 20232023Копьева К.В., Мальцева А.Н., Гракова Е.B., Мочула А.В., Солдатенко М.В., Калюжин В.В., Завадовский К.В.Kopeva K.V., Maltseva A.N., Grakova E.V., Mochula A.V., Soldatenko M.V., Kalyuzhin V.V., Zavadovsky K.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/5130Цель

Цель. Изучение роли параметров миокардиального кровотока (MBF) и резерва миокардиального кровотока (MFR) у пациентов с сердечной недостаточностью с сохраненной фракцией выброса (СНсФВ) и необструктивным поражением коронарных артерий (КА) в стратификации риска прогрессирования СНсФВ в течение 12 мес наблюдения.

Материалы и методы

Материалы и методы. В исследование включено 58 пациентов с необструктивным поражением КА и СНсФВ (ФВЛЖ 62 [58; 66]%). С помощью динамической CZT-SRECT оценивали показатели MFR, MBF в покое (rest-MBF) и при нагрузке (на фоне введения стресс-агента аденозинтрифосфата, stress-MBF). Уровни NT-proBNP определяли с помощью иммуноферментного анализа. Параметры диастолической дисфункции измеряли с помощью двумерной трансторакальной эхокардиографии. Систолическая глобальная продольная деформация ЛЖ (GLS) оценивалась с помощью 2D-speckle tracking.

Результаты

Результаты. Через 12 мес наблюдения больные ретроспективно были разделены на две группы: в группу 1 (n = 11) вошли больные с неблагоприятным течением СНсФВ, в группу 2 (n = 47) – с благоприятным. В группе 1 уровень NT-proBNP был выше в 3,8 раза, чем в группе 2 (284,5 [183,42; 716,73] и 1071,4 [272,4; 2168,1] пг/мл соответственно). Значения MFR были ниже в группе 1 на 45,4% (p < 0,001), чем в группе 2 (1,19 [0,86; 1,55] vs 2,18 [1,7; 2,55] соответственно). Уровни rest-MBF были выше на 23,6% (р = 0,046), а stress-MBF ниже на 28,2% (p = 0,046) в группе 1, чем в группе 2. При проведении многофакторного регрессионного анализа уровни NT-proBNP (отношение шансов (ОШ) 3,23; p = 0,008), GLS (ОШ 2,27; p = 0,012) и MFR (ОШ 8,09; p < 0,001) оказались независимыми предикторами неблагоприятного течения СНсФВ. По данным ROC-анализа, уровни MFR ≤1,62 (AUC = 0,827; p < 0,001), GLS ≤–18 (AUC = 0,756; p = 0,002) и NT-proBNP ≥760,5 пг/мл (AUC = 0,708; p = 0,040) можно рассматривать в качестве маркеров неблагоприятных исходов. Однако комбинированное определение NT-proBNP с MFR обладало большей значимостью (AUC 0,935; p < 0,001) в стратификации риска по сравнению с мономаркерной моделью, тогда как добавление GLS не увеличивало значимость анализа.

Заключение

Заключение. Уровни NT-proBNP, GLS и MFR могут использоваться в качестве неинвазивных маркеров неблагоприятного течения СНсФВ у пациентов с необструктивным поражением КА, при этом комбинированное определение NT-proBNP и MBF увеличивает прогностическую значимость анализа.

Aim

Aim. To study the prognostic value of myocardial blood flow (MBF) and myocardial flow reserve (MFR) parameters in patients with heart failure with preserved ejection fraction (HFpEF) and non-obstructive coronary artery disease (CAD) in risk stratification of HFpEF progression during a 12-month follow-up.

Materials and methods

Materials and methods. The study included 58 patients with non-obstructive CAD and HFpEF (LVEF 62 [58; 66]%). Dynamic CZT-SRECT was used to evaluate MFR and MBF at rest (rest-MBF) and stress (stress-MBF). NT-proBNP levels were determined by the enzyme immunoassay. Diastolic dysfunction parameters were measured using 2D transthoracic echocardiography. Left ventricular systolic global longitudinal strain (GLS) was assessed using 2D speckle tracking.

Results

Results. After a 12-month follow-up, the patients were retrospectively divided into 2 groups: group 1 (n = 11) included patients with an unfavorable course of HFpEF, group 2 (n = 47) encompassed patients with a favorable course of the disease. In group 1, the level of NT-proBNP was 3.8 times higher than in group 2 (284.5 [183.42; 716.73] and 1,071.4 [272.4; 2,168.1] pg / ml, respectively). MFR values in group 1 were lower by 45.4%

(p < 0

(p < 0.001) than in group 2 (1.19 [0.86; 1.55] vs. 2.18 [1.7; 2.55], respectively). In group 1, rest-MBF levels were higher by 23.6% (p = 0.046) and stress-MBF was lower by 28.2% (p = 0.046) than in group 2. The multivariate regression analysis revealed that NT-proBNP levels (odds ratio (OR) 3.23; p = 0.008), GLS (OR 2.27; p = 0.012), and MFR (OR 8.09; p < 0.001) were independent predictors of adverse outcomes in HFpEF. Based on the ROC analysis, MFR levels ≤ 1.62 (AUC = 0.827; p < 0.001), GLS ≤–18 (AUC = 0.756; p = 0.002), and NT-proBNP

≥ 760

≥ 760.5 pg / ml (AUC = 0.708; p = 0.040) may be considered as markers of adverse outcomes. However, the combined determination of NT-proBNP and MFR had a greater significance (AUC 0.935; p < 0.001) in risk stratification compared with the monomarker model, while the addition of GLS did not increase the significance of the analysis.

Conclusion

Conclusion. Levels of NT-proBNP, GLS, and MFR may be used as non-invasive markers of an adverse course of HFpEF in patients with non-obstructive CAD, while the combined determination of NT-proBNP and MBF increases the prognostic value of the analysis.

 

 

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The authors declare that there are no conflicts of interest present.