Abdominal obesity and postinfarction cardiosclerosis: cardiometabolic continuum in the development of chronic heart failure

Abstract

The aim of the study was to evaluate the influence of abdominal obesity (АО) on left ventricular myocardium (LV) postinfarction remodeling, readaptation to physical exertion and the course of chronic heart failure in patients of working age with newly diagnosed large-focal myocardial infarction (MI). Methods. At the first stage of the study we examined 318 patients of working age who were admitted to hospital with the diagnosis of acute coronary syndrome during the calendar year. According to the selected criterion (newly diagnosed large-focal MI) 91 patients of working age were included and examined in the study: 82.4% (n = 75) – males, 17.6% (n = 16) – females. The main group included 60 patients with AO, the comparison group consisted of 31 patients without AO. These groups were matched by sex, age, localization of ischemic damage, types of reperfusion therapy and drug therapy tactics in the postinfarction period. Design: a prospective, comparative study with a follow-up period of 36 months. Examination of patients which included questioning, taking a case history, clinical examination, laboratory and instrumental investigations (echocardiography of the heart) and a six-minute walking test was conducted in the acute MI period (10±2 days), 1st (30±2 days), 6th (180±2 days) and 12th (364±2 days) months of postinfarction follow-up period. The levels of adiponectin, leptin and the N-terminal fragment of proBNP (NT-proBNP) were determined for all patients. In addition, the information on the state of health was obtained to reveal repeated coronary events in patients with postinfarction cardiosclerosis 36 months after the onset of the disease. Results. After 12 months of follow-up the proportion of patients with postinfarction cardiosclerosis and AO who developed maladaptive prognostically unfavorable types of postinfarction LV remodeling made up 75.0% vs. 9.7% of patients without AO (F = 0.399; p < 0.001). The development of maladaptive type of postinfarction LV remodeling after 12 months was accompanied by a diastolic dysfunction (84.6% vs. 58.1% of patients without AO (χ 2 = 7.24; р < 0.01), decrease in myocardial LV contractility < 50% (78.8 % vs. 19.4 % of patients without AO (χ 2 = 28.0; p < 0.001), low exercise tolerance as a result of a six-minute walking test, as well as increase in the functional class of CHF and in the number of the deceased among the patients with obesity.