Ryndina N. Neurohormonal activation and its participation in formation of myocardial changes in patients with chronic heart failure аnd obesity.

Object of the study: chronic heart failure (CHF) with abdominal obesity (AO). Purpose of the research: an increase in the therapy efficacy for CHF patients with accompanying AO больных ХСН АО based on the revealing of the part of insulin-like growth factor I (IGF-I) and brain natriuretic peptide (BNUP) in the processes of the heart remodeling and the choice of the optimum scheme of pathogenetic treatment. Methods of the research: general clinical, anthropometric, immunoenzyme, instrumental, statistical ones. Theoretical and practical results: the analysis of the research results enables therapeutists and cardiologists to prefer a combination of angiotensin-converting factor inhibitors with angiotensin II receptor antagonists, when administering therapy for patents with CHF accompanied by AO because of a positive effect on metabolic indices. The devised method for prognosticating the development of ventricular fibrillation (VF) and the method for diagnosing types of remodeling in CHF patients with AO can be used at therapeutics and cardiology departments in order to improve diagnosis. It is advisable to use a concentration of BNUP in patients with AO as a marker of decompensation of CHF adaptation mechanisms. Novelty: it was revealed for the first time that the development of CHF in patients with accompanying AO was peculiar for an exhaustion of the system of natriuretic peptides against a background of high values of homeostatic model assessment (HOMA). Ranked structures of difference degrees in the indices of haemodynamics, carbohydrate, lipid metabolism in CHF patients depending upon the presence of AO were presented. A positive relationship was found out between HOMA and BNUP in CHF patients with the normal body weight, thereby pointing out adequate compensatory mechanisms. Against a background of a rise in HOMA in AO patients, the plasma concentration of BNUP decreased; this fact demonstrated an exhaustion of CHF adaptation mechanisms. It was investigated that more expressed processes of myocardial hypertrophy in CHF patients with AO, versus cases without AO, were caused by a higher activity of IGF-I as a result of the stimulating effects of insulin against a background of insulin-resistance. It was revealed that a higher level of IGF-I up to 437 ng/ml in CHF patients with AO was in favour of concentric remodeling, the concentric hypertrophy was associated with an increase of IGF-Iup to 490 ng/ml. The presence of IGF-I in blood serum at the level of 433.7 ng/ml in CHF patients with AO prognosticated the development of VF. Degree of introduction: results of the research were introduced in the work of the Institute of Medical Radiology and Dergachi Central District Hospital, as it is confirmed by acts on introduction. Results of the thesis were included into the syllabus for training students and interns specializing in Internal Medicine at Departments of Internal Medicine No. 2, Clinical Immunology and Allergology of Kharkiv National Medical University. Sphere of application: medicine, therapy.