Features of structural and geometric remodeling of the heart and changes in heart diastolic filling in patients with chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction


  • V. A. Lysenko Zaporizhzhia State Medical University, Ukraine, Ukraine




heart failure, cardiac output, ventricular remodeling


Chronic heart failure (CHF) does not lose its leading position among the problems of cardiovascular disease. Pathological cardiac remodeling combines the processes of hypertrophy and dilatation of cavities and is the main cause of heart failure progression, and consequently results in high cardiac mortality, especially in CHF patients with reduced left ventricular ejection fraction (LV EF). Despite a substantial range of studies on the features of structural and geometric remodeling of the heart, changes in systolic and diastolic function of the ventricles in CHF patients, this issue still presents a challenge and needs to be improved.

The aim of the work – to examine changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic genesis with reduced LV EF.

Materials and methods. The study included 79 patients (men – n = 49; women – n = 30) with CHF of ischemic origin with reduced LV EF, sinus rhythm, stage II AB, NYHA II-IV FC (the main group), and 90 patients with coronary heart disease without signs of CHF (men – n = 40, 44.5 %; women – n = 50, 55.5 %), (the comparison group). The patient groups were age-, sex-, height-, weight-, body surface area-matched. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy).

Results. In CHF patients with reduced LV EF, the following indicators prevailed: EDD LV by 18 % (P = 0.001), LV EDV by 45.8 % (P = 0.001), LV EDV index by 44.6 % (P = 0.001), LV ESD by 44.9 % (P = 0.001), PW by 17.7 % (P = 0.001), LV mass index by 66.6 % (P = 0.001) according to the Penn Convention, and by 62.1 % (P = 0.001) according to the ASE; 16.1 % (P = 0.010) increased RV cavity without changes in its wall thickness. In patients with CHF of ischemic origin with reduced LV EF, the main types of LV geometry were: eccentric (70 %) and concentric (24 %) LV hypertrophy. More than half of the CHF patients with reduced LV EF had significant disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”), a 2.3 times increase (P = 0.001) in E/e’ ratio, a 35 % (P = 0.014) increase in the left atrial volume index and 32 % (P = 0.0001) – in pulmonary capillary wedge pressure (PCWP), increased mean and systolic pressure in the pulmonary artery by 1.5 times (P = 0.002) and 1.6 times (P = 0.0001), respectively.

Conclusions. Structural and geometric remodeling of the left ventricle in patients with CHF of ischemic origin with reduced LV EF occurs due to an increase in LV myocardial mass via thickening of its walls and cavity dilatation (44.6 % (P = 0.001) increase in the LV EDV index), as well as 66.6 % (P = 0.001) increase in LV mass index with the predominance of eccentric (70 %) and concentric hypertrophy (24 %) over other types of LV geometry. Severe disorders of LV diastolic filling (25 % – “restrictive” and 28 % “pseudonormal”) are attributable to the significant increase in end-diastolic pressure in the left ventricle (2.3 times increase (P = 0.001) in E/e´) with the development of postcapillary pulmonary hypertension (1.5 times increase (P = 0.002) in the mean and 1.6 times (P = 0.0001) – in systolic pressure in the pulmonary artery).


Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J., Coats, A., Falk, V., González-Juanatey, J. R., Harjola, V. P., Jankowska, E. A., Jessup, M., Linde, C., Nihoyannopoulos, P., Parissis, J. T., Pieske, B., Riley, J. P., Rosano, G., Ruilope, L. M., Ruschitzka, F., Rutten, F. H., … ESC Scientific Document Group. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 37(27), 2129-2200. https://doi.org/10.1093/eurheartj/ehw128

Butler, J., Fonarow, G. C., Zile, M. R., Lam, C. S., Roessig, L., Schelbert, E. B., Shah, S. J., Ahmed, A., Bonow, R. O., Cleland, J. G., Cody, R. J., Chioncel, O., Collins, S. P., Dunnmon, P., Filippatos, G., Lefkowitz, M. P., Marti, C. N., McMurray, J. J., Misselwitz, F., Nodari, S., … Gheorghiade, M. (2014). Developing Therapies for Heart Failure With Preserved Ejection Fraction: Current State and Future Directions. JACC: Heart Failure, 2(2), 97-112. https://doi.org/10.1016/j.jchf.2013.10.006

Cokkinos, D. V., & Belogianneas, C. (2016). Left Ventricular Remodelling: A Problem in Search of Solutions. European Cardiology Review, 11(1), 29-35. https://doi.org/10.15420/ecr.2015:9:3

Denesyuk, V., Denesyuk, O., & Muzyka, N. 2016. Remodeliuvannia livoho shlunochka u khvorykh na stabilnu stenokardiiu, uskladnenu sertsevoiu nedostatnistiu, zi znyzhenoiu i zberezhenoiu fraktsiieiu vykydu [Left Ventricular Remodeling in Patients with Stable Angina Complicated by Heart Failure with Reduced and Preserved Ejection Fraction]. Lvivskyi klinichnyi visnyk, (2-3), 8-13. [in Ukranian].

Berlot, B., Bucciarelli-Ducci, C., Palazzuoli, A., & Marino, P. (2020). Myocardial phenotypes and dysfunction in HFpEF and HFrEF assessed by echocardiography and cardiac magnetic resonance. Heart Failure Reviews, 25(1), 75-84. https://doi.org/10.1007/s10741-019-09880-4

Voronkov, L. H., Amosova, K. M., Dziak, H. V., Zharinov, O. Y., Kovalenko, V. M., Korkushko, O. V., Nesukai, O. H., Sychov, O. S., Rudyk, Yu. S., & Parkhomenko, O. M. (2017). Rekomendatsii Asotsiatsii kardiolohiv Ukrainy z diahnostyky ta likuvannia khronichnoi sertsevoi nedostatnosti (2017) [Guidelines of the Ukrainian Association of Cardiology for the Diagnosis and Treatment of Chronic Heart Failure (2017)]. Sertseva nedostatnist ta komorbidni stany, (1, dodatok 1), 1-66. [in Ukranian].

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Jr., Colvin, M. M., Drazner, M. H., Filippatos, G., Fonarow, G. C., Givertz, M. M., Hollenberg, S. M., Lindenfeld, J., Masoudi, F. A., McBride, P. E., Peterson, P. N., Stevenson, L. W., & Westlake, C. (2016). 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation, 134(13), e282-e293. https://doi.org/10.1161/CIR.0000000000000435

Gaasch, W. H., & Zile, M. R. (2011). Left Ventricular Structural Remodeling in Health and Disease: With Special Emphasis on Volume, Mass, and Geometry. Journal of the American College of Cardiology, 58(17), 1733-1740. https://doi.org/10.1016/j.jacc.2011.07.022

Lashkul, D. A. (2017). Kliniko-patohenetychni aspekty diahnostyky, likuvannia ta prohnozuvannia khronichnoi sertsevoi nedostatnosti ishemichnoho henezu u khvorykh z dysfunktsiieiu nyrok. (Avtoref. dis. … dokt. med. nauk). [Clinical and pathogenetic aspects of diagnosis, treatment and prediction of ischemic chronic heart failure in patients with renal dysfunction]. (Extended abstract of doctoral thesis). Zaporizhzhia. [in Ukranian].

Muzyka, N. O. Endotelialna dysfunktsiia i remodeliuvannia livoho shlunochka pry sertsevii nedostatnosti u khvorykh z IKhS ta efektyvnist riznykh metodiv likuvannia. (Avtoref. dis. … kand. med. nauk). [Endothelial dysfunction and left ventricular remodeling in coronary artery disease patients with heart failure and the efficacy of various treatments]. (Extended abstract of candidate’s thesis). Ivano-Frankivsk. [in Ukranian].

Bristow, M. R., Kao, D. P., Breathett, K. K., Altman, N. L., Gorcsan, J., 3rd, Gill, E. A., Lowes, B. D., Gilbert, E. M., Quaife, R. A., & Mann, D. L. (2017). Structural and Functional Phenotyping of the Failing Heart: Is the Left Ventricular Ejection Fraction Obsolete? JACC: Heart Failure, 5(11), 772-781. https://doi.org/10.1016/j.jchf.2017.09.009

Lang, R. M., Badano, L. P., Mor-Avi, V., Afilalo, J., Armstrong, A., Ernande, L., Flachskampf, F. A., Foster, E., Goldstein, S. A., Kuznetsova, T., Lancellotti, P., Muraru, D., Picard, M. H., Rietzschel, E. R., Rudski, L., Spencer, K. T., Tsang, W., & Voigt, J. U. (2015). Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 28(1), 1-39.e14. https://doi.org/10.1016/j.echo.2014.10.003

Nauta, J. F., Hummel, Y. M., Tromp, J., Ouwerkerk, W., van der Meer, P., Jin, X., Lam, C., Bax, J. J., Metra, M., Samani, N. J., Ponikowski, P., Dickstein, K., Anker, S. D., Lang, C. C., Ng, L. L., Zannad, F., Filippatos, G. S., van Veldhuisen, D. J., van Melle, J. P., & Voors, A. A. (2020). Concentric vs. eccentric remodelling in heart failure with reduced ejection fraction: clinical characteristics, pathophysiology and response to treatment. European Journal of Heart Failure, 22(7), 1147-1155. https://doi.org/10.1002/ejhf.1632

Heinzel, F. R., Hohendanner, F., Jin, G., Sedej, S., & Edelmann, F. (2015). Myocardial hypertrophy and its role in heart failure with preserved ejection fraction. Journal of Applied Physiology, 119(10), 1233-1242. https://doi.org/10.1152/japplphysiol.00374.2015



How to Cite

Lysenko VA. Features of structural and geometric remodeling of the heart and changes in heart diastolic filling in patients with chronic heart failure of ischemic genesis with reduced left ventricular ejection fraction . Zaporozhye Medical Journal [Internet]. 2021Apr.7 [cited 2024May20];23(1):17-23. Available from: http://zmj.zsmu.edu.ua/article/view/224832



Original research