Aim. To study the effects  of spironolactone  and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure (HF).Material and methods. We examined 131 patients  with coronary artery disease  and NYHA class  I-III HF. Patients  were randomized  into groups depending  on HF class: class I (n=31), class II (n=51) and class III (n=49).Results. The study revealed that the clinical course  of HF and LV diastolic dysfunction are associated with an increased  level of neurohormones  and are characterized by significantly high levels of aldosterone  and norepinephrine  in patients  with a restrictiveLV diastolic dysfunction. A correlation was found between  the level of neurohormones  (aldosterone  and norepinephrine)  and heart  remodeling parameters:  an inverse correlation with an ejection fraction (r=-0,68, r=-0,61,  respectively) and a direct correlation with LV  end-diastolic volume (r=0,58, r=0,66, respectively). Long-term treatment  with spironolactone  and eplerenone had a positive effect, reducing the level of mentioned neurohormones. In patients with class II HF, both drugs had a positive effect on the level of aldosterone  and norepinephrine, reducing them by 26,6% and 20,2% in the spironolactone  group and by 28,4% and  24,6% in the eplerenone group,  respectively.  In patients with class  III  HF, the decrease in aldosterone  level was more pronounced  in those taking eplerenone than spironolactone:  32,1% vs 20,2%, respectively.Conclusion. In patients  with HF, combination therapy with the inclusion of spironolactone  significantly reduced  the level of neurohormones mainly in patients with class II HF and, to a lesser extent, in those with class III HF. This suggests that combination therapy with spironolactone is less effective than with eplerenone in relation to neurohormones’  levels.

Aim. To study the relationship between the level of the N-terminal prohormone of brain natriuretic peptide (NTproBNP) and aldosterone in serum, cardiovascular remodeling parameters with the degree of chronic heart failure (CHF) and kidney dysfunction (KD).Material and methods. Fifty two patients with coronary artery disease with CHF of I (19 patients), II (21) and III (12) functional classes (FC) were examined. All patients underwent echocardiography with assessment of systolic function and structural-geometric parameters of the left ventricle (LV), blood flow study at the level of the common carotid artery (CCA) with the determination of the thickness of the intim-media complex, velocity parameters of blood flow, resistance (RI) and pulsation (PI) indexes, estimated glomerular filtration rate (eGFR) by CKD-ЕРI method, the level of NTproBNP and aldosterone in serum. The patients were divided depending on the eGFR elvel: 30< eGFR ≤60 ml/min/1,73 m2 — 14 patients, eGFR >60 ml/min/1,73 m2 — 38 patients.Results. Patients with II FC CHF had the medium-high NTproBNP and aldosterone values. Subjects with FC III CHF had high levels of NTproBNP and aldosterone. A correlation relationship was found between the NTproBNP, aldosterone and ejection fraction (EF) levels (r=-0,70 and r=-0,72, respectively), between the NTproBNP, aldosterone and enddiastolic LV velocity (r=0,78 and r=0,70, respectively). There was a significant thickening of the carotid intima-media complex and a decrease in the blood flow velocity and an increase in vascular resistance with increasing CHF. We also noted a significant difference in the maximum end-diastolic velocity in patients with eGFR ≤60 ml/min/1,73 m2 compared with this indicator in patients with eGFR >60 ml/min/1,73 m2.Conclusion. In patients with CHF, a significant increase in NTproBNP and aldosterone levels is associated with FC of CHF, LV systolic dysfunction and KD. The interrelation of cardiovascular remodeling indicators with the degree of CHF and KD was revealed.

Aim. To study the signs of kidney dysfunction in chronic heart failure (CHF).Material and methods. We included 96 patients with postinfarction cardiosclerosis and CHF with the age of 40–60 years. Patients were divided into two groups by functional class (FC) of CHF according to NYHA. In all patients the levels of serum creatinine and MDRD glomerular filtration rate (GFR), urine alanine transferase, aspartat transferase, alkaline phosphatase and cholinaestherase by spectrophotometric method were measured.Results. In 33,3% of patients with II FC NYHA and in 66,67% with III FC NYHA we found GFR less than 60 ml/min/1,73 sq.m. Investigation of fermenturia levels in those according to renal functioning showed more prevalent increase of urine enzymes in lower GFR, in whom the patients with III FC NYHA consisted 66,67%. The level of ALT was 39% (p<0,01) higher and AP 35% (p<0,001) higher comparing to subjects without renal dysfunction.Conclusion. In patients with chronic heart failure as the diseases progresses there is kidney dysfunction developing with the decrease of GFR, increase of resdual nitrogen and enzimes in urine. Enzyme levels testing in urine of CHF patients can be a part of diagnostic approach to kidney dysfunction diagnostic at earlier stages.

Ташкентская медицинская академия. Ташкент; 2 Республиканский специализиpованный научнопрактический медицинский центp теpапии и медицинской реабилитации. Ташкент, Узбекистан Цель. Изучить взаимосвязь между процессами ремоделирования сердца и дисфункцией эндотелия у больных с хронической сердечной недостаточностью (ХСН). Материал и методы. Обследованы 103 больных с постинфарктным кардиосклерозом. Все больные были разделены на 3 группы по функциональному классу (ФК) ХСН: I группу составили 28 больных c ХСН I ФК, II группу-46 больных II ФК и III группу-29 больных с III ФК по классификации NYHA. Всем больным проводили эхокардиографию, допплерографию плечевой аpтеpии. Результаты. Постинфарктное ремоделирование левого желудочка (ЛЖ) приводило не только к структурной перестройке ЛЖ, сопровождаемой дилатацией полости, истончением стенок полости, снижением сократительной способности миокарда, но и к изменению геометрической формы ЛЖ. Снижение сократительной способности миокарда ЛЖ сопровождалось нарушением эндотелий-зависи-мой вазодилатации сосудов, характеризующихся увеличением пульсативного и резистивного индексов, снижением чувствительности плечевой артерии к напряжению сдвига. Заключение. У больных ХСН процессы ремоделирования сердца сопровождались ремоделированием сосудов, характеризующимся нарушением функциональных и гуморальных показателей дисфункции эндотелия. Ключевые слова: хроническая сердечная недостаточность, ремоделирование сердца, дисфункция эндотелия.

Aim. To compare the losartan and lisinopril influence on glomerular and tubular markers rates of renal dysfunction in I-III functional class (FC) chronic heart failure (CHF). Material and methods. Totally 92 patients studied with I-III FC CHF. First group (I) consisted of 47 patients taking losartan as addition to standard treatment for 6 months; second group (II) — 45 patients took lisinopril. All patients underwent glomerular filtration rate estimation (MDRD GFR) and enzymes levels in urine: alanine transaminase (ALT), aspartat transaminase (AST), alkaline phosphanase (AP). Results. The results showed that GFR <60 ml/min in I and II groups was found in 18 (38,3%) and 17 (37,8%) patients, resp. Baseline data analysis of urine enzymes that characterize functional condition of renal tubules, showed that in GFR <60 ml/min patients there is significant (p<0,05) increase of ALT, AST, AP in urine: for I group patients by 45,2%, 31,8%, 78,2%, resp., and for II group — 43,6%, 33,5%, 73,9%, resp., comparing to the patients with GFR >60 ml/min. Six month treatment with inclusion of losartan and lisinopril led to decrease of enzymes levels in urine to increase of GFR comparing to baseline. Conclusion. GFR and the level of fermenturia are the early predictors of tubular epitelium in kidneys, and can be treated as early predictors of renal dysfunction in CHF. Six month treatment with losartan and lisinopril increases GFR and significantly decreases fermenturia, hence improving the condition of tubular epithelium and showin nephroprotective effect.