Butynets Z. Changes in functional state of the endothelium in chronic heart failure in elderly patients with coronary heart disease, ways of correction.

The present thesis is devoted to the study of endothelial function by determining the local markers of endothelial damage: vasculotropic autoantibodies to eNOS, TrM-03 PPAR-a, ANCA and vascular-motor endothelial function in elderly patients with CHF. The study involved 135 subjects, including apparently healthy elderly people: 15 subjects aged 60 to 74 years (of these, 11 men and 4 women); 30 patients with IHD: stable angina of effort stage II FC without CHF aged 60 to 74 years (including 15 men and 15 women) and 90 patients with CHF II-A NYHA stage II-III FC and СHD: stable angina of effort stage II FC aged 60 to 74 years (including 55 men and 35 women). This work shows that, as in the elderly patients with CHF, endothelial function depends on the NO-synthesizing activity; in order to improve endothelial function, it is necessary to use drugs L-arginine and triflusal. Use of L-arginine appears to improve the NO-synthesizing activity of the endothelium and contributes to a decrease in autoantibodies eNOS in 60% of elderly patients with CHF. It has been shown that addition of L-arginine and triflusal to standard CHF therapy improves endothelial function by providing a substrate for nitric oxide synthesis, reduces the titer of antibodies to eNOS, TrM-03 PPAR-a, ANCA, reduces platelet aggregation, improves the rheologic features of blood. Based on the results obtained, practical recommendations have been developed for the use of triflusal and L-arginine in the treatment of elderly patients with CHF.