Yermak О. Optimization of diagnostics and treatment of patients with acute myocardial infarction and obesity considering copeptin's and proadrenomedulin's levels.

Dissertation is devoted to increasing the efficiency of diagnosis and treatment of patients with acute myocardial infarction and concomitant obesity based on an assessment of imbalance of vasoconstrictor and vasodilator mediators by copeptin's and mіd-regional pro-adrenomedullin's investigation, and the study of their prognostic significance in the development of unfavorable course of acute myocardial infarction. The study shows that the presence of obesity in patients with acute myocardial infarction is associated with copeptin's hyperactivity in 2,3 times under inappropriate increase (in 1,5 times) of vasodilator's level - mіd-regional pro-adrenomedullin (MRproADM) at the appropriate level of troponin I comparing with patients without obesity. Changes in the morpho-functional parameters, that show the dilation of the left atrium and the left ventricular, increased levels of triglycerides, low density lipoproteins, total cholesterol in parallel with the degree of obesity in patients with acute myocardial infaction. Using of zofenopril as a part of standart therapy was accompanied by a predominance of positive effects compared with enalapril by reducing the level of end systolic volume at 5,51 %, total cholesterol by 4,1 %, low density lipoproteins by 5,1%, copeptin by 6,96 %, increasing of ejection fraction by 4,92 % and high density lipoproteins by 17,9 %. Copeptin's concentration more than 150,5 ng/mL shows predictor properties in occurance of recurrent myocardial infarction in patients with obesity. MRproADM's increased concentration more than 700 ng/ml is associated with the development of acute heart failure in comorbidity of acute myocardial infarction and obesity.