INFLUENCE OF AORTAL STENOSIS ON MANIFESTATIONS OF CHRONIC RHEUMATIC HEART DISEASE

Aim. Evaluation of aortic stenosis (AS) effect on the clinic of chronic rheumatic heart disease (RHD). Materials and Methods. A total of 114 patients with RHD were examined – 20 men (17.5%) and 94 women (82.5%). According to the results of echocardiography, patients were divided into a group with aortic stenosis – 38 patients and without AS – 76 people. External respiration function was assessed using a Spirolab II spirometer. The functional class (FC) of chronic heart failure (CHF) was determined using the 6-minute walk test. SF-36, KCCQ, MHFLQ. Anxiety and depression were studied by HADS, CES-D and STAI. Results. The distance of the 6-minute walk test in the groups did not differ significantly: without AS 291.49±45.03 m, with AS 278.35±14.43 m. In terms of echocardiography, the pressure in the tricuspid valve (41.66±3.23 mmHg) and the larger dimensions of the right ventricle (2.75±0.09 cm) were higher in the RHD group without AS. And in those studied with RHD with AS, left ventricular dilatation (LVED 6.65±0.20 cm, LVES 4.70±0.12 cm) and hypertrophy (IVS 1.35±0.03 cm, LVPW 1.26±0.02 cm). These differences were on the background of slightly different sizes of the area of the mitral orifice: RHD without AS – 1.99±0.13 cm2 and RHD with AS – 2.03±0.39 cm2. In terms of spirometry, obstructive and restrictive values were obtained in the RHD group with AS: FVC less by 10.04%, and VC by 15.94%. The quality of life was reduced in both groups, but the AS did not make an additional contribution to the deterioration of the quality of life. For SF-36, the mental component of health was 39.20±1.31, the physical component was 35.74±0.82. The overall clinical KCCQ score was 47.61±2.74, and the functional status was 21.27±1.48. Specific for CHF MHFLQ – 44.51±2.61. In terms of anxiety and depression, there was mild depression and anxiety in both groups, but there was no significant difference between the groups. Conclusion. In the absence of a difference in the area of the mitral orifice, the presence of AS in patients with RHD leads not only to an increase in left ventricular hypertrophy and dilatation, but also to a decrease in pressure indicators on the tricuspid valve and right ventricular size. According to the spirometry values, obstructive and restrictive indicators were significantly reduced in the group with AS. Additional effects of the AS on the indicators of quality of life, anxiety and depression are not received.