Significance of non-invasive assessment of the enhancing left ventricle filling pressure in patients with arterial hypertension, left ventricle hypertrophy, symptoms of heart failure and the preserved ejection fraction in real life

Objective — to estimate left ventricle filling pressure (LVFP), as indicator of heart failure (HF), in patients with arterial hypertension (AH), symptoms and signs of HF, preserved left ventricle (LV) ejection fraction (EF) according to the ASE/EACVI algorithm (2016) and compare the results with those according to the diagnostic algorithm heart failure with preserved ejection fraction (HFpEF) LV according to the criteria of ESC (2016), taking into account the clinical profile and changes in the structural and functional state of the heart at rest and after submaximal exercise testing (SET).Materials and methods. The study involved 72 patients with AH, clinical symptoms of heart failure (HF) and LVEF ≥ 50 %, sinus rhythm and signs of diastolic dysfunctions (DD) of the LV according to the echocardiogram data. In addition to the standard clinical and laboratory examination, the following assessments were performed: determination of the serum level of NT-proBNP by ELISA, echocardiography (Echo) examination, a test with a six-minute walk and in the case of E/e′ at rest from 9 to 13, diastolic stress test were performed. According to the examination results LV diastolic function and LVFP were determined by recommendations ASE/EACVI (2016) and availability HFpEF according to ESC criteria (2016). Results and discussion. Among 72 patients without AF, the normal LVFP (group 1) was determined in 14 (19.4 %) and increased — in 42 (58.8 %) patients (group 3) could not be determined LVFP 16 (22.2 %) patients (group 2). Patients of all groups did not differ in sex, frequency of MI in history, obesity, concomitant diabetes type 2, COPD, CKD, anemia. Patients of 1 and 2 groups did not differ in the mean values of LV systolic function and its remodeling and LVH frequency (all p > 0.05), in the group of patients with LVFP at rest, LV cavity, LVMI were significantly higher, and LVEF (p < 0.01). According to the results of the stress test in 37 patients with E/e′ at rest < 13 (all patient’s groups 1 and 3, and 7 patients of group 3), E/e′ at SET increased more than 13 in 5 (35.7 %) patients of group 1, 10 (62.5 %) patients of group 2 and 7 (16.6 %) patients of group 3. According to the criteria of the ESC (2016) HFpEF diagnosed in all patients of group 3, with elevated LVFP by algorithm ASE/EACVI (2016), and the 13 (81.3 %) patients of group 2, with an indeterminate LVFP. Conclusions. Elevated LVFP was found in 60 % of patients with AH, symptoms of HF, LVH, and LVEF ≥ 50 %, in which 72.3 % of cases were diagnosed with NYHA III, and 83.3 % had a diagnostic significant increase E/e′ > 13 at rest. Normal LVFP — in 19 %, in 21 % of cases, HFpEF was diagnosed and in 36 % of cases of growth E/e′ > 13 with SET. In patients with indeterminate LVFP, whose frequency was 21 %, the parameters of the structural and functional state of the heart at rest were comparable to those in patients with normal LVFP despite the presence of HFpEF in 86.7 % and E/e′ > 13 with SET in 67 % of them.