ABDOMINAL OBESITY IN THE DEVELOPMENT OF CHRONIC HEART FAILURE AFTER MYOCARDIAL INFARCTION

In XXI century the problem of chronic heart failure (CHF) acquired а global socio-economic character. The cardiovascular diseases leading to the development of CHF often occur on the background of metabolic disorders, make a major contribution to the structure of disability and overall mortality in Europe and the Republic of Belarus. One of the conditions that determine a duration and quality of life after myocardial infarction (MI) is concerned with the structural and functional characteristics of the left ventricular (LV).

The objective of the present research was to estimate the influence of abdominal obesity (АО) on some structural and functional characteristics of LV, as well as the development of maladaptive-type LV remodeling and the progression of chronic heart failure in patients after MI.

We examined 91 patient aged from 40 to 63 after MI: 82.4 % – men, 17.6 % – women. Sixty patients with postinfarction cardiosclerosis and AO were included into one group, 31 patients without AO – into another group. After 12 months of follow-up, the proportion of patients with postinfarction cardiosclerosis and AO who developed maladaptive prognostically unfavorable types of postinfarction LV remodeling made up 75.0 % vs. 9.7 % of patients without AO (F = 0.399; p < 0.001). The development of the maladaptive type of postinfarction LV remodeling after 12 months was accompanied by a decrease in myocardial LV contractility, low exercise tolerance as a result of cycloergometric exercise and a six-minute walking test, as well as by an increase in the functional class of CHF and in the number of the deceased among the patients with obesity. 

1. Lopatin Yu. M. The recommendations of the ESC for the diagnosis and treatment of acute and chronic heart failure 2016. Rossiiskii kardiologicheskii zhurnal [Russian Journal of Cardiology], 2017, no. 1, pp. 7–81 (in Russian). DOI: 10.15829/1560–4071–2017–1-7–81)

2. Petrova E. B., Statkevich T. V., Ponomarenco I. N., Mitkovskaya N. P. Left ventricular remodeling due to myocardial infarction: some patogenetic aspects. Voennaya meditsina [Military Medicine], 2015, no. 1, pp. 116–122 (in Russian).

3. Tilg H., Moschen A. R. Role of adiponectin and PBEF/visfatin as regulators of inflammation: involvement in obesity-associated diseases. Clinical Science, 2008, vol. 114, no. 4, pp. 275–288. DOI: 10.1042/CS20070196

4. Petrova E. B., Mit’kovskaya N. P., Statkevich T. V., Kartun L. V. Myocardial infarction on a background of visceral fat type obesity. Kardiologiya v Belarusi [Cardiology in Belarus], 2015, no. 3, pp. 46–66 (in Russian).

5. Polonetskii L. Z., Podpalov V. P., Korneliuk I. V., Mironchik V. V., Stel’mashonok V. V., Polonetskii O. L. Diagnosis and treatment of acute coronary syndromes with ascent and without lift in ST segment on ECG: national recommendations. Minsk, 2010. 64 p. (in Russian).

6. Cornier M. A., Marshall J. A., Hill J. O., Maahs D. M., Eckel R. H. Prevention of overweight/obesity as a strategy to optimize cardiovascular health. Circulation, 2011, vol. 124, no. 7, pp. 840–850. DOI: 10.1161/CIRCULATIONAHA.110.968461

7. Mit’kovskaya N. P., Grigorenko E. A., Kartun L. V. The secretory activity of adipose tissue in the coronary artery disease in patients with metabolic syndrome. Meditsinskii zhurnal [Medical Journal], 2008, no. 4, pp. 43–46 (in Russian).

8. Kershaw E. E., Flier J. S. Adipose tissue as an endocrine organ. Journal of Clinical Endocrinology and Metabolism, 2004, vol. 89, no. 6, рр. 2548–2556. DOI: 10.1210/jc.2004–0395

9. Sierra-Johnson J., Romero-Corral A., Lopez-Jimenez F., Gami A. S., Sert Kuniyoshi F. H., Wolk R., Somers V. K. Relation of increased leptin concentrations to history of myocardial infarction and stroke in the united states population. American Journal of Cardiology, 2007, vol. 100, no. 2, рр. 234–239. DOI: 10.1016/j.amjcard.2007.02.088

10. Luchner A., Möckel M., Spanuth E., Möcks J., Peetz D., Baum H., Spes C., Wrede C.E., Vollert J., Müller R., Katus H., Giannitsis E. N-terminal pro brain natriuretic peptide in the management of patients in the medical emergency department (PROMPT): correlation with disease severity, utilization of hospital resources, and prognosis in a large, prospective, randomized multicentre trial. European Journal of Heart Failure, 2012, vol. 14, no. 3, pp. 259–267. DOI: 10.1093/eurjhf/hfr171

11. Bokeriia L. A., Bokeriia O. L., Averina I. I., Berseneva M. I. Assessment of left ventricular remodeling: a textbook for doctors. Moscow, Nauchnyi tsentr serdechno-sosudistoi khirurgii imeni A. N. Bakuleva Rossiiskoi akademii meditsinskikh nauk Publ., 2009. 36 p. (in Russian).