THE DIAGNOSIS OF DIASTOLIC HEART FAILURE IN PATIENTS WITH CHRONIC KIDNEY DISEASE

THE AIM of the investigation was to make a comparative analysis of two approaches to the diagnosis of diastolic chronic heart failure in patients with chronic kidney disease at the predialysis stage by means of exclusion of the systolic dysfunction and by a compulsory confirmation of a diastolic dysfunction by the method of Doppler echocardiography. PATIENTS AND METHODS. Ninety two predialysis patients (48F, 44M, mean age 49.8±13.9 years) having chronic kidney disease of the IIV stage according to NKF Guidelines (2002) were examined. All the patients had clinical symptoms of chronic heart failure (CHF). Echocardiography and Doppler echocardiography were fulfilled by the same investigator. The diastolic dysfunction was diagnosed according to the state of the transmitral flow and the velocity of spreading the early diastolic flow of the left ventricle by color Mmode Doppler echocardiography. RESULTS. Hypertrophy of the left ventricle was diagnosed in 70 (76.1%) patients. Ejection fraction was lower than 45% in 7 (7.6%) patients, 68 (73.9%) patients had the diastolic dysfunction. In 15 (16.3%) patients the diagnosis of CHF was excluded after examination, the clinical symptoms were due to other causes (anemia etc). CONCLUSION. The diagnosis of diastolic CHF in patients with chronic kidney disease by exclusion of the systolic dysfunction only leads to hyperdiagnostics of CHF. So, in patients with the saved systolic function it is necessary to control the diastolic function by the method of Doppler echocardiography including additional measures for normal and pseudonormal types of transmitral blood flow.

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