THE ROLE OF VASODILATION FACTORS IN THE PATHOGENESIS OF CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN IN ATRIAL FIBRILLATION
The purpose of the study is to study the possible role of vasodilation factors in the pathogenesis of chronic heart failure (CHF) in persistent atrial fibrillation (AF) in patients with stable coronary heart disease. Materials and methods. A survey of 86 patients with stable coronary heart disease complicated by CHF II-III FC according to the NYHA classification. There was 1 group - 22 patients with CHF with reduced LV EF ≤ 40.0% and AF; I (comparative group) - 20 patients with CHF with reduced LV EF without AF; 2-nd group - 24 patients with preserved LV EF ≥ 40.1% and AF and II (comparative group) - 20 patients with CHF with preserved LV EF without AF. The content of endothelial nitric oxide synthase (eNOS), nitrites (NO2-) and nitrates (NO3-) was determined. All patients underwent electrocardiographic examination (ECG) for the initial screening of arrhythmias and conduction, diagnosis of focal changes in the ventricular myocardium. Structural and hemodynamic characteristics of the heart muscle were determined by echocardiography.
Results. In the examined patients of the 1st group with CHF of ischemic origin and reduced LV EF ≤ 40.0% and AF in comparison with the 2nd group of patients with CHF with preserved LV EF and AF, a significant increase in the values of ICO, ICD, IMML, the size of LA and a decrease in LV EF (p <0.01), indicating the development of LVH (remodeling) and a decrease in isotropic heart function. When comparing the levels of vasodilation factors in patients with CHF with low LV EF and AF and data from the CHF comparison group without AF, a significant decrease in eNOS by 96.8% (almost twice) and a significant decrease in serum nitrite and nitrate levels (p < 0.01), indicating the development of endothelial dysfunction. Conclusions. In patients with CHF of ischemic origin in the development of persistent forms of AF pathogenetic role is played by a significant decrease in vasodilating factors (content of eNOS, nitrites and nitrates). At decrease in EF of LV ≤ 40,0% there is a significant decrease in vasodilating factors, as a result of disturbance of endothelial function that testifies to need of correction of the revealed changes directed on slowing down of disease progression.
Batalov R.E., Rogovskaya Yu.V., Ryabov V.V. and others. The idiopathic form of atrial fibrillation and the clinical results of radiofrequency ablation. Ross cardiol. Journal. 2014; 12 (116): 7 – 12 [in Russian].
Denesyuk VI, Denesyuk OV, Muzyka NO Left ventricular remodeling in patients with stable angina, complicated by heart failure, with reduced and preserved ejection fraction. Lviv Clinical Bulletin. 2016; 2-3: 8-13 [in Ukrainian].
Denesyuk VI, Muzyka NO The content of vasodilator factors in serum at different degrees of left ventricular systolic diastolic dysfunction in patients with stable angina, complicated by heart failure. Lviv Clinical Bulletin. 2017; 1: 12-15 [in Ukrainian].
Yena LM, Yarosh VA Endothelial function and its relationship to morphological and cardiac function in patients with hypertension complicated by chronic heart failure with preserved left ventricular ejection fraction. Heart and Vessels 2016; 3: 71-76 [in Ukrainian].
Zharinova V.Yu. Clinical prospects of endothelial protection in the treatment of coronary heart failure. Sertsev's insufficiency and comorbidi stan 2017; 2: 18-25 [in Russian].
Kozpolova N.A., Shilova Ya.E., Nikonova Yu.N. et al. The state of the structure and function of the arterial wall in patients with chronic insufficiency against the background of a constant form of atrial fibrillation and assessment of the vasoprotective effect of omega-3 polyunsaturated fatty acids. Cadiology 2013; 3: 15-24 [in Russian].
Mitzio N. New in the management of patients with acute and chronic heart failure: a guideline of the European Society of Cardiology (2016). Medicine review 2016; 3 (41): 14-21 [in Russian].
Muzyka NO. Structural and functional changes of the myocardium and types diastolic left ventricular dysfunction in patients with stable coronary artery disease complicated by heart failure. VNMU Bulletin 2016; 20: 450-453. [in Ukrainian].
Order of the Ministry of Health of Ukraine 15.06.2016 No. 597. Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical assistance atrial fibrillation. [in Ukrainian].
Unified clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care “Stable coronary heart disease”: Order of the Ministry of Health of Ukraine dated March 02, 2016 No. 152 [in Ukrainian].
V. Denesyuk, О. Denesyuk , N. Muzyka. The remodeling оf left atrium and vasodilation factors сhanges in ischemic heart failure. International Journal of Medicine and Medical Research Journal. 2016; 2 (2): 5-9. DOI 10.11603/ijmmr.2413-6077.2016.2.7038
V. Denesyuk, N. Muzyka. The influence of the additional usage of L-arginine on the factors of vasodilation and the clinical data, complicated with cardiac decompensation with reduced and preserved fracture of the left ventricle that patients with stable coronary heart disease have. Asian journal of science and technology. 2017: 8(4): 4689-4692 https://dspace.vnmu.edu.ua/123456789/3949
ESC Guidelines for the diagnosis and treatment of acute and chronic heat failure. The Task Force for the diagnosis and treatment of acute and chronic heat failure of the European Society of Cardiology (ESC). European Heart Journal 2016, https://doi.org/10.1093/eurheartj/ehw128
Copyright (c) 2021 V. I. Denesiuk, O. I. Afanasiuk, O. V. Denesiuk, N. O. Muzyka
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.