Clinical and Immunological Parameters in the Diagnostics of Asthenic Syndrome in Patients with Chronic Heart Failure

Abstract

Background: the significance of the asthenic syndrome as one of the most distressing symptoms affecting the clinical outcome of chronic heart failure (CHF), and insufficient understanding of the pathophysiological aspects of asthenia determines the need to study the clinical and biological features of this syndrome in cardiac pathology. Objective: to determine of a number of inflammatory and autoimmune blood parameters in patients with CHF associated with asthenic disorders in comparison with hypertensive disease in relation to clinical and gender-age characteristics of patients. Patients and methods: 62 patients with CHF (study group; 64.4 ± 9.7 years) and 50 patients with hypertensive disease (HD) (comparison group; 55 ± 9.7 years) were examined. Somatic examination included consultation with a cardiologist. Psychometric assessment was performed using the MFI-20 scale and the MLHFQ questionnaire. In patients' blood, leukocyte elastase (LE) activity, α1-proteinase inhibitor (α1-PI), leukocyte inhibitory index (LII), concentration of CRP, IL-6, and levels of antibodies to S-100B and myelin basic protein were determined. Results: patients with CHF characterized by more pronounced manifestations of all dimensional asthenic disorders compared to patients with HD. The deterioration of CHF patients' quality of life was accompanied by the aggravation of asthenic symptoms on all subscales of the MFI-20 scale. In patients with CHF and HD, multidirectional changes in the leukocyte inhibitory index and significant quantitative differences in other immune parameters compared with the normative values were detected. CHF associated with asthenia was characterized by decreased activity of the blood proteolytic system (decrease in LII), a significant increase in the concentration of IL-6, CRP and antibodies to S-100B in the blood of patients compared to comparison group. Negative correlations between LE activity and several dimensions of the MFI-20 scale, and positive correlations between the severity of general asthenia, patient age, and IL-6 and CRP concentrations indicate the involvement of inflammation in the pathophysiology of asthenic disorders in the cardiac pathology discussed. Conclusion: low activity of blood proteolytic system and high level of inflammation are unfavorable factors in the development of asthenia in chronic heart failure. Qualitative and quantitative features of the spectrum of immunological parameters in patients with CHF are correlated with clinical and genderage characteristics and reflect the severity of both cardiological changes and asthenic symptoms.