Structural-Functional Cardiac Parameters in Patients with Chronic Ischemic Heart Disease Combined with Overweight and Obesity: Predictors of Survival

Obesity is associated with structural and functional cardiac changes in patients with ischemic heart disease. The aim of our study was to analyze structural-functional parameters of the myocardium in patients with chronic IHD combined with overweight and obesity and to determine predictors of acute cardiovascular events. Methods. This study involved 85 male patients aged 36-78 years (median 57 years) diagnosed with chronic IHD: stable angina and prior myocardial infarction. The diagnosis of IHD was based on clinical examinations, laboratory investigations, electrocardiography, echocardiography, exercise testing, coronary angiography. According to echocardiography the sizes of the heart chambers in diastole, left ventricular hypertrophy and geometric remodeling have been determined. We carried out complex examination with following long-term observation (during 12-36 months) and analysis of cases of acute cardiovascular events (acute coronary syndrome, stroke, peripheral thrombosis) in patients with chronic IHD combined with overweight and obesity. Statistical analysis was done using Statistica for Windows 5.0 program. Survival curves during 36 months were calculated by the Kaplan-Meier method, significant difference between the groups was determined by Cox's F-test and Hehana-Wilcoxon test. Results. We divided patients into two groups: a group 1 – 16 (19%) patients with IHD and acute cardiovascular events and a group 2 – 69 (81%) patients with IHD without acute events. The patients of two groups did not differ significantly in presence of stable angina, previous Q-infarction, severity of heart failure of functional class IІ-III, arrhythmia, arterial hypertension 3 grade, diabetes mellitus and in management. The patients of two groups did not differ significantly in structural-functional parameters. According to results of correlation analysis a significant correlation has been found between left ventricular mass index and functional class of heart failure (τ=+0,442, р<0,0001), left ventricular ejection fraction (τ=-0,383, р<0,0001), left ventricle end-diastolic diameter (τ=+0,493, р<0,0001), the size of the left atrium (τ=+0,327, р<0,0001) and right ventricle (τ=+0,152, р=0,04). In our study left ventricular hypertrophy did not influence essentially on patients' free-from-events survival. Retrospective analysis of prognostic value of all structural and functional parameters showed that left ventricular eccentric hypertrophy was the significant predictor of future acute cardiovascular events in patients with chronic IHD combined with overweight and obesity. The cumulative proportion survival in patients with left ventricular eccentric hypertrophy was 58,2%, whereas in patients with left ventricular concentric hypertrophy – 85,1%, in patients with normal left ventricular geometry – 83,3%, in patients with concentric remodeling – 73,3%. There were significant differences between normal left ventricular geometry and left ventricular eccentric hypertrophy (Cox's F-test, p=0,01; Hehan-Wilcoxon test, р=0,04). We revealed also that ejection fraction <45%, left atrium diastolic diameter ≥4.2 сm, were significant predictors of worse survival patients with IHD. Conclusions. We revealed that left ventricular eccentric hypertrophy, dilatation of the left atrium and systolic dysfunction are the most informative predictors of worse survival patients with IHD combined with overweight and obesity, which is important to consider in diagnostic process and treatment.