Sequential Remodeling of Cardiac Chambers in Chronic Heart Failure of Ischemic Genesis

Aim A comprehensive evaluation of sequential cardiac chamber remodeling patterns across different ischemic chronic heart failure (CHF) phenotypes using two-dimensional echocardiography (Echo) and strain analysis of the left ventricle (LV), left atrium (LA), and right ventricle (RV). Material and methods Current perspectives on the pathogenesis of CHF emphasize not only LV systolic dysfunction but also the sequential changes in the geometry, mechanics, and strain characteristics of other cardiac chambers. A comprehensive analysis of strain parameters across the LV, LA, and RV provides a more comprehensive insight into remodeling stages and functional alterations in CHF. This study included 96 patients diagnosed with CHF according to current clinical criteria. Patients were classified into phenotypes based on LV ejection fraction (LVEF) following the 2021 European Society of Cardiology (ESC) guidelines. Three groups were established: heart failure with preserved ejection fraction (HFpEF): LVEF ≥50% (n=46); heart failure with mildly reduced ejection fraction (HFmrEF): LVEF 41-49% (n=24); and heart failure with reduced ejection fraction (HFrEF): LVEF ≤40% (n=26). Results In the group with LVEF ≥50%, the mean global longitudinal strain (GLS) was 17.0±2.8%, whereas in those with LVEF 41-49% and ≤40%, values decreased to 12.6±2.1% and 9.4±2.2%, respectively ( p <0.001). A similar trend was observed for GLS measured in the 4-, 2-, and 3-chamber views. LA function assessment using 2D speckle-tracking echocardiography (STE) in the reservoir (LASr), conduit (LAScd), and contractile (LASct) phases also showed a significant reduction in absolute values. Specifically, LASr decreased from 35.5±8.3% (LVEF ≥50%) to 27.5±9.4% (LVEF 41-49%) and 17.8±11.2% (LVEF ≤40%; p <0.001); LAScd dropped from 17.6±5.4% to 12.7±5.8% and 8.8±6.5% (p<0.001); and LASct fell from 18.7±5.9% to 12.5±3.4% and 8.7±4.6% ( p <0.001). These findings reflect progressive LA dysfunction alongside advancing LV systolic dysfunction. RV longitudinal strain parameters were the highest in patients with LVEF ≥50% (RVFWLS: 21.3±4.0%; RVGLS: 18.1±3.2%), decreased in the LVEF 41-49% group (19.9±2.8% and 16.0±2.7%), and reached their lowest levels in the LVEF ≤40% group (RVFWLS: 14.0±4.1%; RVGLS: 10.5±3.1%), with significant intergroup differences ( p =0.001). Conclusion Patients with ischemic CHF exhibited sequential remodeling of the LV, LA, and RV, characterized by a significant increase in functional impairment as the LVEF declines. This trend is evidenced by the progressive deterioration of strain parameters, specifically LV GLS, LA LASr, LASct, LAScd, RVFWLS, RV GLS, when moving from the group with EF ≥50% to groups with EF 40-49% and EF≤40% ( p <0.001 for all comparisons). These findings highlight a strong correlation between strain parameters and hemodynamic shifts in established CHF, reinforcing the clinical utility of STE for objectively quantifying cardiac dysfunction. Consequently, STE serves as a promising non-invasive tool for the detailed assessment of chamber remodeling and the monitoring of myocardial function in patients with CHF across various stages of severity.

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