Structural and functional state of left ventricular myocardium in patients with stage II hypertension depending on galectin-3 and aldosterone levels
The analysis of structural and functional state of the left ventricular myocardium was conducted in the article, which concerned the determination of the general morphological and functional echocardiographic parameters of the heart according to the existing recommendations of the American Echocardiographic Society and the European Society of Cardiovascular Imaging; assessment of the relative dimensions/volumes of the LA (left atrium); determination of the structural-geometric remodeling variant of the left ventricular (LV) according to Ganau (1992) also determining the functions of the heart valves in patients with stage II 1-3 degrees hypertension, of different age and gender depending on plasma levels of galectin-3 and aldosterone. Determined the end-systolic (mm) and end-diastolic dimensions of the LV (mm), the thickness of the interventricular septum (mm) and the posterior wall of the LV (mm) in diastole, aortic diameter (AD, mm), size right atrium (RA, mm) and right ventricle (RV, mm), anterior-posterior size of the left atrium (LA, mm) and its index (ILA, mm/m2), LA volume (LPV, ml) and ejection fraction left ventricle (FV globe, %) by the modified Simpson method. LV mass (LVM, g) was estimated by the Penn Convention formula, and LVM index (LVM, g / m2) as the ratio of LVM to body surface area using the Du Bois nomogram (m2). The EchoCG in color Doppler mode measured the early (Ve) and late transmittal (Va) (m\s), their ratio (Ve\Va), the early LF filling time (DT), and the isovolumic LF relaxation time (IVRT) (ms). Statistical processing of the study results was performed using standard methods using the StatSoft Statistica v application package. 12.0 as recommended. In the case of quantitative values, the results were presented as medians and interquartile ranges (25 and 75 percentiles), in the case of relative values, as percentages (%). Comparison of the quantitative values in the groups was performed using the U-Mann-Whitney and Kruskal-Wallis ANOVA test, the relative values by the criterion χ2. A difference of p<0.05 was considered plausible. The obtained data demonstrate that relatively high levels (RH) of both galectin-3 (>2.4 pg/ml) and aldosterone (>325 pg/ml) are identified with significant morphological and functional changes in heart parameters, namely: worse structural-geometric remodeling of LV (increase in cases of concentric hypertrophy (CH) and decrease in cases with normal geometry (NG) of LV). In order to exclude the fact of cross-influence of neurohormones on echocardiographic parameters of the heart, the alignment of the groups in terms of aldosterone and galectin-3 levels was conducted. The analysis turned to be optimal in groups with galectin-3 level of ->2.0 and ≤2.0 pg/ml and aldosterone level of - >290 and ≤290 pg/ml. As a result, it was detected that galectin-3 has a greater pathophysiological effect than aldosterone on such indices as: an increase in aortic diameter; increase in right and left heart chambers dimensions; LVMMI (left ventricular myocardial mass index) value and increase in systolic, diastolic myocardial stress, increase in the number of cases with CH (concentric hypertrophy) and decrease in cases with normal geometry (NG) of LV. Aldosterone level is associated with an increase in dimension/volume indices of LA, calculated per patient’s body area.
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