Aim. Monitoring of concentrations of modern biomarkers to evaluate the efficacy of long‑term treatment of patients after acute decompensated HF (ADHF).Materials and Methods. The study included 100 patients with severe decompensated FC II–IV CHF and LV EF <40 % due to IHD, DCMP or AH. At discharge from the hospital, patients were divided into groups of low (NT‑proBNP<1400 pg / ml) (control, n=30) and high (NT‑proBNP≥1400 pg / ml) risk (n=70). Patients at high risk were randomized to two treatment groups, a group of NT‑proBNP monitoring (NPM) (n=35) and a group of standard therapy (n=35). At the end of the study, noncompliant patients were isolated from these two groups into a separate group (n=10). The aim of the treatment was decreasing the NT‑proBNP concentration to less than 1000 pg / ml and / or ≥50 % of the baseline level. In addition to the soluble suppression of tumorigenicity 2 (sST2) receptor, concentrations of copeptin, neutrophil gelatinase associated lipocalin (NCAL), galectin 3, and high‑sensitivity troponin T were measured at discharge from the hospital (baseline) and at three and 6 months of treatment.Results. The strongest correlations were found between changes in concentrations (Δ%) of NT‑proBNP, copeptin, and sST2 and changes in CHF FC, 6‑min walk distance, CCS, quality of life, LV EF, and Е / Е’ (р<0.001). The incidence of cardiovascular events was directly related with the degree of decrease and / or increase in biomarker concentration. Patients of the NPM group had the lowest risk of adverse clinical outcome upon a decrease in NT‑proBNP <988.5 pg / ml at 6 months of treatment or > 50 % of the baseline level at discharge from the hospital. For these patients, the mean Δ% was 60.7±8.5 % for NT‑proBNP, 34.03±17.6 % for sST2, and 32.41±8.8 % for copeptin [OR at 95 % CI 0.08 (0.02–0.36), р <0.0001]. A significant increase in the risk for cardiovascular events was observed only at a considerable increase in NT‑proBNP >50 % [OR at 95 % CI 3.8 (1.13–13.0), р=0.03], and the highest incidence of cardiovascular events was observed in the group of noncompliant patients (110 %). Besides NT‑proBNP, to significantly decrease the risk of cardiovascular events, it was necessary to achieve a decrease in sST2 concentration to less than 30 ng / ml or by more than 24.9 % (Δ%) at the end of followup [ОR (95 % CI: 0.1 (0.02–0.5), р=0.004].Conclusion. Among the modern biomarkers, changes in NT‑proBNP, sST2, and copeptin concentrations most accurately reflect changes in the clinical and functional status, quality of life, and EchoCG parameters in HF patients during long‑term monitoring. The lowest risk for adverse clinical outcomes was observed in post‑decompensation patients with a decrease in NT‑proBNP <988.5 pg / ml after 6 months of treatment or ≥50 % of baseline upon discharge from the hospital. The sST2 concentration has to be reduced by more than 24.9 % of baseline and less than 30 ng / ml in the course of long‑term treatment after decompensated HF.

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Обзорная статья посвящена значению определения концентраций натрийуретических пептидов (НУП) и нового биомаркера sST2 для диагностики, оценки прогноза и лечения пациентов с сердечной недостаточностью. В статье обсуждаются слабые и сильные стороны этих биомаркеров и их место в современных рекомендациях. Подробно изложены результаты исследований, в которых продемонстрирована высокая прогностическая ценность sST2 у пациентов c острой декомпенсацией сердечной недостаточности и стабильной хронической сердечной недостаточностью (ХСН). Обоснованы возможность использования sST2 для стратификации риска и оценки эффективности лечения у больных с ХСН и его преимущество по сравнению с НУП. Обсуждены основные исследования, посвященные проблеме лечения больных с ХСН под контролем концентрации НУП, и детально проанализированы причины неудач работ, в которых не удалось показать превосходство НУП-управляемой терапии над стандартным подходом к лечению. Приведены теоретические предпосылки эффективности использования для этой цели sST2.

П ервые данные литературы о кардиомиопатии (КМП) такоцубо появились в 90-х гг. прошлого века, но до настоящего времени многие вопросы патогенеза, диагностики и лечения этого заболевания остаются открытыми. Установлено, что до 90 % случаев КМП такоцубо встречается у женщин в постменопаузе. Пусковым фактором КМП такоцубо обычно служит эмоциональ-ный (примерно 27 % случаев) или физический стресс (38 %) [1]. Развитие КМП такоцубо описано также у пациентов с субарахноидальным кровоизлиянием, ишемическим инсультом, феохромоцитомой, желудочнокишечными и другими заболеваниями [2-8]. Основной гипотезой патогенеза КМП такоцубо является аномальное повышение уровня катехоламинов, сопровождаю-

The review aims to appraise the value of determining the concentrations of the new biomarker sST2 for assessing prognosis and monitoring treatment effectiveness of patients with decompensated heart failure during an episode of decompensation and during long-term follow-up after discharge from the hospital. The article analyses in detail the expedience of sST2 measurement in a patient with ADHF on admission and discharge from the hospital and the changes in the biomarker level during the period of active treatment for risk-stratification in patients, presents the optimal threshold values of sST2, which should be oriented when selecting patients with high and very high risk. The importance of subsequent monitoring of the marker concentration during long-term observation in emphasized to predict the risk of death, HF re-decompensation / HF rehospitalization. The potential benefits of choosing sST2 as the optimal marker for serial measurement during long-term follow-up, as well as evaluating the treatment effectiveness in patients with HF, compared to the “classical” variant - natriuretic peptides are shown.