Arterial stiffness in patients with heart failure and preserved ejection fraction 12 months after myocardial infarction

Introduction: The optimal treatment for STEMI prevents postinfarction remodeling and preserves the left ventricular (LV) ejection fraction (EF). However, the number of patients (pts) with congestive heart failure (CHF) continues to increase. New data elucidating pathophysiology of CHF development in pts with preserved LV systolic function remain in great demand. Aim of the study: Assessment of the arterial stiffness in pts with CHF and preserved LV EF 12 months after STEMI. Material and methods: 55 pts with CHF and preserved LV EF (≥45%) 12 months after STEMI were included in cross-sectional study. Average age was 66±9 years. NYHA class I was in 6 patients (11%), 27 (49%) and 22 (40%) patients had NYHA class II and III. Arterial stiffness was assessed by the arterial tonometry. Echocardiography and clinical data were analyzed. The BNP an d NT-pro BNP levels were measured. Results: Among the enrolled pts, 29 (53%) were male, 30 pts (55%) had anterior STEMI 12 months before the study, 44 pts (70%) underwent coronary angiography, PCI was performed in 19 pts (44%), 27 pts (61%) had multivessel coronary disease. Higher degree of BNP and NT-pro BNP increase was associated with higher NYHA classes of CHF. The pulse wave velocity (PWV) was 10.9±2.77 m/sec. The severity of CHF correlated with the levels of BNP (R=0.75; р=0.000000) and NT-pro BNP (R=0.67; р=0.000000). Correlations between PWV, BNP (R=0.29; р=0.02), and NYHA classes (R=0.39; р=0.003) were found. No differences in LV end-diastolic volume, LV end-systolic volume, LV EF, wall motion index, cardiac output, and E/A ratios were found in pts with different functional classes of CHF. The E/E' ratios significantly differed in different NYHA classes (9.1±1.9 vs. 11.0±4.6 vs. 14.1±5.9 for NYHA classes I, II, and III, respectively; p=0.05). Conclusion: The stiffness of great arteries is increased in pts with CHF and preserved LV EF after STEMI. Combination of increased arterial stiffness with mild disturbances in systolic and diastolic functions is a pathophysiological basis of СHF development in pts with preserved LV EF after STEMI.