Rudenko T. Optimization of treatment of patients with chronic heart failure of ischemic origin in combination with type 2 diabetes mellitus on the basis of studying markers of fibrotic galectin-3, matrix metalloproteinase-1

The thesis is devoted to the development of methods for optimizing the diagnosis and treatment of patients with chronic heart failure of ischemic origin in combination with type 2 diabetes mellitus by evaluating myocardial dyssynchrony due to the development of fibrosis and its markers - galectin-3 and matrix metalloproteinase-1. The features of the presence of myocardial dyssynchrony on the clinical course of CHF of ischemic origin with concomitant type 2 DM, which lead to a violation of morph-functional parameters of the heart with the progression of diastolic dysfunction and myocardial remodeling are determined. The change in the levels of markers of galactine-3, MMP-1 in serum of blood, depending on the presence of DM and their association with the markers of inflammation was revealed. In order to improve the diagnosis, an automated system for diagnosing myocardial dyssynchrony in patients with CHF of ischemic genesis and concomitant type 2 DM on the basis of the analysis of echocardiographic and electrocardiographic parameters was developed. The influence of mineralocorticoid receptor antagonists on myocardial dyssynchrony is demonstrated. Therapy with the addition of an antagonist of the mineralocorticoid receptors - eplerenone in patients with CHF of ischemic origin with a preserved left ventricular ejection fraction and associated type 2 DM with manifestations of myocardial dyssynchrony in one month of treatment improves hemodynamic indices, reduces the rates of inter- and intraventricular myocardial dyssynchrony.