Oxidative stress is one of the most important mechanisms of cardiovascular diseases, especially in heart failure. Mitochondrial dysfunction and inflammation play a major role in formation of free radicals and antioxidants. The association between oxidative stress, telomere biology and cell senescence plays the key role in cardiovascular pathology development. The paper considers role of pro-oxidant and antioxidant enzymes in heart pathology development. Specifically, the role of such antioxidant enzymes as glutathione peroxidase 3, catalase, and superoxide dismutase is described. The role of gamma-glutamyl transferase is emphasized as its activity increases significantly in cases of heart failure, coronary heart disease, stroke, arterial hypertensions, and arrhythmias. This article is a literature review of the effect of such antioxidants as alpha-tocopherol, ubiquinone, uric acid, and triiodothyronine on development of heart failure and myocardial infarction. A decrease in triiodothyronine concentration is a risk factor for coronary heart disease. High uric acid values in patients with myocardial infarction upon admission to the hospital are associated with a high risk of sudden death. The influence of such minerals such as zinc, copper, magnesium, selenium, potassium, sodium, calcium, and iron on heart failure development has been analyzed. The role of ceruloplasmin as an independent predictor of acute and chronic cardiac disorders cardiac events, mortality, and bad prognosis in patients with heart failure and myocardial infarction is examined. The authors demonstrate the influence of inflammation on heart failure development as well as association of inflammation with oxidative stress.

Aim. To determine the peculiarities of heart failure (HF) development in human immunodeficiency virus (HIV)-infected patients, depending on the blood concentration of C-reactive protein (CRP).Material and methods. This cross-sectional screening clinical trial included 100 patients hospitalized with HIV infection and a history of HF for 28 months. The patients were divided into 2 groups depending on blood CRP concentration. The cut-off point was CRP of 15 mg/l. The first group included 37 HIV-infected patients with HF and blood CRP <15 mg/l, while the second group — 63 HIV-infected patients with HF and CRP concentration ≥15 mg/l. The inclusion criteria were HIV infection and prior HF, stable medical state, taking into account the underlying disease that required hospitalization. The study did not include patients with acute cardiovascular diseases within prior 3 months, acute decompensated and acute heart failure, cancer, infectious diseases, conditions that required surgical intervention. N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined in all patients.Results. Correlation analysis revealed a strong inverse relationship between the blood concentrations of NT-proBNP and CRP (r=-0,639; p<0,005). A ROC curve revealed the most optimal cut-off threshold of 9,8 mg/l (AUC=0,796, p<0,05), which ensures sensitivity of 92,9% (p<0,05) and specificity of 57,6% (p<0,05). The odds ratio (OR) of an increase in NT-proBNP >450 pg/ml, and hence the risk of acute decompensated HF in the presence of a CRP concentration of 1-9,8 mg/l in HIV-infected patients with HF was 44,73 (95% CI=8,62;311,10), while relative risk (RR) — 18,73 (95% CI=4,94;112,94). In the presence of in hospital inflammatory diseases and CRP ≥15 mg/l in HIV-infected patients and prior HF, the RR of acute decompensated HF is reduced by 88% (RR=0,12, 95% CI=0,03-0,33).Conclusion. CRP values from 1 to 9,8 mg/l in HIV-infected patients with HF are predictors of its severity, characterized by a higher incidence of HF with reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy without significant differences with patients who have CRP >9,8 mg/l. CRP concentration >9,8 mg/l in HIV-infected patients and prior HF indicates the development of an inflammatory process, and not a worsening of the HF course.

Aim. To determine the risk factors and diagnostic value of urinary N-terminal probrain natriuretic peptide (NT-proBNP) for verification of heart failure in human immunodeficiency virus (HIV)-infected patientsMaterial and methods. This cross-sectional screening clinical trial included 115 HIV-infected patients who were hospitalized during 24 months. The patients were divided into 2 groups, depending on the data suggestive of HF and the blood and urinary NT-proBNP concentration. So, group 1 included 69 HIV-infected patients with HF symptoms and increased blood and urinary NTproBNP, while group 2 — 46 HIV-infected patients not meeting HF criteria. NTproBNP concentration was determined on Immulite 1000 Immunoassay System (DPC, USA) in blood plasma and frozen urine using Vector Best reagents (Russia).Results. Correlation analysis revealed a significant direct moderate correlation between blood and urinary NT-proBNP in the entire cohort of studied patients (r=0,367; p<0,05). Urinary NT-proBNP ≥8,6 pg/ml ml is diagnostic for HF verification in HIV-infected patients. Significant differences between the groups were obtained in the incidence of ventricular arrhythmias, viral hepatitis B and C, liver cirrhosis, infective endocarditis, other inflammatory diseases, thrombocytopenia, left ventricular (LV) diastolic dysfunction and its severity. In addition, there were differences in LV mass index, left atrial volume index, incidence of LV hypertrophy and left atrial enlargement, concentration of hemoglobin and CD4 cells <200 in 1 µl. The preserved LV ejection fraction was detected significantly more often (p<0,001). Conclusion. In HIV-infected patients, blood plasma and urinary NT-proBNP concentration correlates with each other. Urinary NT-proBNP ≥8,6 pg/ml is diagnostic for HF verification in HIV-infected patients. Risk factors and features of developing HF, estimated by NT-proBNP concentration in frozen urine in HIV-infected patients, are comparable to data obtained from blood plasma NTproBNP.