Heart failure (HF) remains a major problem in the modern healthcare system, which is a significant cause of hospitalizations, disability and mortality among the population. Left ventricular (LV) ejection fraction (EF) remains one of the main criteria for distribution HF patients into groups and on which the tactics of observation and treatment depend. The European Society of Cardiology distinguishes HF with preserved EF, HF with mid‑range EF, and HF with a reduced EF. Recently, to assess the risks, scientists have divided patients with HF into the following phenotypes according to the left ventricular ejection fraction: stable HF with preserved EF, stable HF with a reduced EF, HF with an increase in EF and HF with a decrease in EF. It has been proven that the lowest mortality rate in the HF group with an increase in EF is 17 %, and the highest mortality rate in the HF group with a decrease in EF is 43 %. From this point of view, special attention is drawn to the HF with mid‑range EF group, since the left ventricular ejection fraction in patients of this group changes more actively than in others (according to studies, after 1 year, the left ventricular ejection fraction increased in 44 % of patients, and decreased in 16 % of cases). To predict changes in the left ventricular ejection fraction, it is promising to determine the levels of biomarkers in the blood. It is known that NT‑proBNP is the most studied and informative cardiac biomarker. Its level in blood plasma correlates with the left ventricular ejection fraction, but focusing only on it is impossible to predict changes in the left ventricular ejection fraction. Moreover, the accuracy of NT‑proBNP determination in the diagnosis and prediction of heart failure is only 75 — 80 %. Other most researched biomarkers, such as galectin‑3, sST‑2, GDF‑15, and high‑sensitivity troponins, separately from each other, were ineffective in predicting changes in left ventricular ejection fraction. Therefore, a multi‑marker forecasting strategy is gaining popularity. The article talks about chronic heart failure (CHF), gives its definition and classification by the left ventricular ejection fraction. A review of modern studies demonstrating the relevance of predicting changes in left ventricular ejection fraction is given, data on the main promising cardiac biomarkers, such as NP, galectin‑3, sST‑2, GDF‑15 and highly sensitive troponins, their advantages and disadvantages in diagnosis and risk stratification in patients with CHF. Including the results of studies of furin, which is a pro‑BNP‑convertase and a promising cardiac biomarker as a component of a multimarker model for predicting the course of heart failure.
Objective: To investigate the association between tumor necrosis factor alfa (TNFa), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and polymorphism of the M235T of the ATG gene in hypertensive patients with heart failure with preserved ejection fraction (HFpEF). Design and method: The main group of eighty-four patients (51 females and 33 males; mean age 62,7 ± 8,0 years) with HFpEF and arterial hypertension. Sixty-eight patients and eighteen healthy persons were carriers of 235T allele (MT+TT genotypes), sixteen patients had MM genotype of M235T polymorphism of ATG, determined by using of polymerase chain reaction. Levels of NTproBNP and TNFa were determined by enzyme-linked immunosorbent assay (ELISA) using «NTproBNP-BEST-ELISA» (Russia) and «TNFa-ELISA-BEST» (Russia), respectively. All statistical tests were 2-tailed and p < 0,05 was considered statistically significant and performed in Statistica 10.0. Results: The significant difference in the level of TNFa in hypertensive patients with HFpEF depending on the different genotypes of M235T polymorphism of ATG was not found. Although the serum NTproBNP level increased in patients with MT+TT genotypes compared with patients with MM genotype (Table 1). Conclusions: The presence of T allele of M235T polymorphism of ATG in hypertensive patients with HFpEF was independently associated with increased level of NTproBNP
Objective — to assess the impact of coronaviral diseases 2019 (COVID‑19) on the general state, laboratory and clinical indicators of patients with chronic heart failure (HF) with moderately reduced left ventricular ejection fraction (mrEF) and to investigate activity of furin. Materials and methods. A comprehensive examination involved 72 patients with HF with mrEF (main group) and 18 apparently healthy individuals (control group). The main group was divided into two subgroups: 36 subjects had COVID‑19 history, and 32 subjects without COVID‑19 history. The mean age of patients was (63.6±4.1) years. All study participants underwent anthropometric (height, weight, BMI), laboratory (clinical blood analysis, biochemical blood analysis with determination of AST, ALT, creatinine, glucose, lipid spectrum, potassium, sodium and magnesium, ELISA with determination of glycated hemoglobin, NT‑proBNP and furin), instrumental (EchoCS, ECG) examinations and surveys to assess the quality of life (EQ‑5D‑5L). Statistical processing of the obtained results was carried out using the SPSS v.19.0 statistical program package. Results. In the group of patients with a history of coronavirus infection compared to the patients without COVID‑19 history the following findings were established: significantly higher blood serum levels of NT‑proBNP (1002.79±215.94 pg/ml and 405.37±99.06 pg/ml, respectively, p‑value 0.01), uric acid (429.08±27.01 mmol/l vs. 354.44±28.75 mmol/l, p‑value 0.04) and a lower furin to NT‑proBNP ratio (0.87±0.26 and 1.38±1.16, p‑value 0.05). Results of EQ‑5D‑5L questionnaire demonstrated significant deterioration of quality of life indicators (64.21±3.04 points vs. 72.81±1.82 points by VAS, p‑value 0.02); higher indicators of left ventricular myocardial mass (LVMMi) (157.39±6.14 g/m2 and 138.68±6.02 g/m2, p‑value 0.03), dimensions of the left (43.74±0.95 mm and 41.12±0.85 mm, p‑value 0.04) and right atrium (40.76±1.23 mm and 37.75±0.85 mm, p‑value 0.04). Conclusions. Coronavirus infection in patients with heart failure with moderately reduced left ventricular ejection fraction resulted in the disorders of intracardiac hemodynamics and persistent negative structural changes of the heart. The ratio of furin to NT‑proBNP serum levels can be used to determine the impact of the HF syndrome itself on the patients’ subjective assessment of their quality of life.
The aim: to evaluate the probable impact of type 2 diabetes on quality of life, clinical, biochemical and ultrasonographic parameters in patients with HFwmrLVEF and associations between them. Materials and methods: the study included 68 patients with HFwmrLVEF, including 36 patients with concomitant DM type 2 and 32 patients without type 2 DM, and 18 healthy individuals. All study participants underwent anthropometric (height, weight, BMI), laboratory (clinical blood test, biochemical blood test to determine ACT, ALT, creatinine, glucose, lipid spectrum, potassium, sodium and magnesium, ELISA to determine glycated hemoglobin and NT-proBN ), instrumental (EchoC, ECG) surveys and surveys to assess quality of life (EQ-5D-5L). Statistical processing of the obtained results was performed using the statistical software package SPSS v.19.0. Results: between the group of patients with HFwmrLVEF with concomitant type 2 DM and the group with HFwmrLVEF without type 2 DM according to the results of the study there is a significant difference in quality of life in carbohydrate metabolism, NT-proBNP, BMI and echocardiographic data. Conclusions: patients with HFwmrLVEF with concomitant type 2 DM compared with patients with HFwmrLVEF without type 2 DM had significantly worse carbohydrate metabolism, significantly higher mean serum NT-proBNP concentration, higher LVMM and iLVMM in transthoracic E quality of life according to the results of the EQ-5D-5L questionnaire in the absence of a significant difference in age and LVEF between groups. In addition, there was a stronger correlation between NT-proBNP and iLVMM in patients without type 2 DM and no correlation between NT-proBNP and LVMM in patients with concomitant type 2 DM, which may be due to certain influence of type 2 DM on the process of pro-BNP conversion
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