Object of the study: Chronic heart failure (HF) due to coronary artery disease (CAD). Purpose of the study: To optimize the diagnosis and treatment of CAD patients with chronic HF basing on the study of endothelial (ЕТ-1, 6-keto-PGF1?, cAMP, cGMP) and inflamamtory (CRP, TNF?, IL-1?,IL-6) and influence on their level of drugs - ACE inhibitor, enalapril, angiotensin II receptor blocker, losartan and ?-adrenoblocker, metoprolol. Methods of research: General clinical methods: history taking, study of the objective data, findings of blood and urine analysis, daily diuresis, lipid blood spectrum, C-reactive protein, radioimmunological, immunoenzyme, densitometric research. Theoretical and practical results: Basing on the performed research diagnostic criteria of endothelial dysfunction and inflammatory processes in HF. The importance of determining endothelin-1, CRP, TNF?, IL-1?, IL-6 for evaluation of the functional state of chronic HF was substantiated. The criteria of use of PAAC effect modulators and ?-adrenoblockers in chronic HF were worked out; they allow to improve the functional state of the endothelium and reduce the intensity of inflammation. ACE inhibitor, enalapril, and angiotensin-2 receptor blocker is preferable for the correction of the state of the inflammatory process and endothelium dysfunction and ?-adrenoblocker metoprolol in class II and IV HF beginning from the early stages of HF. Novelty: Characteristic signs of endothelium dysfunction and inflammatory process activation were studied in CAD, beginning from the early stages of the disease development. It was revealed that dysbalance in the system of endothelial regulator mechanisms in class III-IV HF manifested by activation of vasopressor systems (endothelin-1 and cAMP level elevation at moderate production of prostacyclin and considrerable reduction of NO, integral parameter of which is cGMP. Specificity of inflammatory mechanisms activation in CHF marked by increased C-reactive protein amount in the blood and inflammatory cytokines TNF1?, IL-1?, IL-6, inflammatory process inductors as well as their dependence on the HF FC were proven proven. The intensity of inflammation in chronic HF progresses with the disease course, activation of TNF1? is reached in class III HF; IL-1? - in class III and IV HF, and IL-6 in all functional classes of HF. Specificity of the effect of ACE inhibitor enalapril and an-giotensin II receptor blocker losartan on the function of endotheliu was proven. Degree of introduction: The findings of the research were introduced into the work of medical establishments of Kharkiv and Kharkiv region (sanatorium Roscha), Sumy (Regional Hospital, City Clinical Hospital No. 5). Sphere of application: medicine, cardiology.
