Comparative analysis of laboratory and instrumental markers of cardiovascular remodeling in patients with arterial hypertension and coronary heart disease in the Far North and temperate climate zones

Background. A comprehensive, integrated assessment of serum biomarkers and modern noninvasive imaging methods reflecting myocardial and vascular remodeling processes can facilitate the early diagnosis of heart failure in patients with arterial hypertension (HTN) and coronary artery disease (CAD) living in the Far North.

Objective. To study the characteristics of laboratory and instrumental parameters reflecting cardiac and vascular remodeling processes in patients with HTN and CAD living in the Far North and temperate climate zones.

Design and methods. In a comparative cohort study, patients with HTN and CHD (n = 99) were divided into two groups based on their place of permanent residence. Group 1 (n = 41) resided in a temperate climate zone, while Group 2 (n = 58) resided in the Far North. Inclusion criterion for the study was left ventricular (LV) ejection fraction > 50 %. All participants underwent assessment of immune inflammation and remodeling biomarkers and transthoracic echocardiography to measure left heart deformation parameters: global LV longitudinal strain and left atrial (LA) reservoir phase strain using spot tracking. Noninvasive hemodynamic and tissue fluid assessment was performed using regional bioimpedance cardiography.

Results. Patients in Group 2 had higher levels of matrix metalloproteinases 2 and 9 (MMP-2, MMP-9), and growth differentiation factor 15 (GDF-15), and a trend toward increased malondialdehyde concentrations. Both groups showed initial signs of impaired diastolic function of the LA, manifested by increased lateral and septal mitral annular velocities and elevated total peripheral resistance. Patients in Group 2 had more pronounced impairment of global LV longitudinal strain. A relationship was found between LV filling pressure (E/eʼ) and arterial compliance in both groups. In Group 2, with an increased number of segments (≥ 3) with impaired LV deformation, decreased LV systolic function and arterial compliance, as well as increased MMP-9 and homocysteine levels, were observed.

Conclusions. Myocardial and vascular remodeling is more pronounced in patients with HTN and CAD in the Far North compared to those living in temperate climates. This is determined by impaired LV longitudinal deformation, higher levels of serum biomarkers of myocardial remodeling and immune inflammation, and an association between arterial compliance and LA strain.

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