Miroshnichenko A. Chronic heart failure with preserved left ventricular systolic function : the mechanism of it's progression and the possibility of correction

The scientific work is dedicated to the problem of effectiveness of chronic heart failure treatment with preserved systolic function, depending on the functional state of kidneys by assessing the effectiveness of ? blocker nebivalol. The further development of problems is found in the studying of mechanisms of chronic heart failure in this embodiment on the basis of hemodynamic studies cardiohemodynamics, functional state of the endothelium, urine protein compounds and the degree of proteolysis of fibronectin. In this scientific work we prove the role of the functional state of the endothelium, microalbuminuria as a factor in the development and progressing of chronic heart failure. Additional indicators of kidney disorders were identified on the basis of studying the protein composition of urine, the level of 1 acid glycoprotein, fibronectin, and the degree of fragmentation. The formation function of kidneys was confirmed to be associated with deterioration of endothelial function with increasing range of proteins in the urine. It was found that the barrier of kidneys in patients with chronic heart failure with preserved systolic function is over than the conventional option of albumin and molecular mass can be 120 - 140 kDa. For the first time it was demonstrated that the use in the treatment of chronic heart failure with preserved systolic function ? blocker nebivalol with additional effects vasodilation has a positive effect on function of kidneys, implemented through the mechanism of improving endothelial function and reduction of microalbuminuria. It was detected that this effect is expressed mostly during the initial changes in the functional state of kidneys in the range of glomerular filtration rate <90?60 ml/min/1,73 м2.