Object of the study: acute myocardial infarction. Purpose of the study: development of the concept for optimizing treatment of acute myocardial infarction, prognosis and preven-tion of heart failure on the basis of the study of neurohumoral dis-orders and structural-functional myocardial changes of the left ventricle in patients during an acute period of the illness. Methods of the investigation: general clinical; immunoenzyme: spectrofluorometric, spectrophotometric, enzymatic; instrumental: standard ECG, daily ECG monitoring, quantitative echocardio-scopy. Theoretical and practical results: the obtained results facilitate optimization of diagnosis and therapeutic measures in AMI. New ways for assessment of the risk of developing AMI complications were elaborated; they are based on the analysis of objective pa-rameters demonstrating thrombocytic-vascular and plasma hemo-stasis disorders which characterize the course of the illness in each particular case. Additional markers of the coronary artery impair-ment were revealed, they showing disorders in the cytokine bal-ance. A hemostasiological control over the efficacy of drug ther-apy and prevention of AMI complications was suggested; its use made it possible to objectify the dynamics of thrombocyte and en-dothelial dysfunctions, timely and qualitatively diagnose pre-thrombotic states, and administer adequate therapy. The purpose-fulness of early administration of ACEi in the therapy of patients with AMI was pathogenetically substantiated; criteria for therapy efficacy were established, they considering changes in the blood humoral spectrum and central hemodynamics indices, schemes for using ACE inhibitors and cardioselective beta blockers in patients with AMI depending upon the localization and depth of the im-pairment focus and the state of the myocardium contractility. Novelty: peculiarities in the changes of the endothelial dysfunc-tion indices, those of the activation of immunoinflammatory mechanisms, thrombocytic-vascular hemostasis and activity of anumber of regulatory systems in the development of AMI were revealed; a relationship between the endothelial dysfunction indi-ces, activation of the sympathoadrenal and kallikrein-kinin sys-tems, expression of antiinflammatory cytokines and clinical mani-festations of AMI was shown. The state of neuron-mediators and expression of antiinflammatory cytokines with respect to the proc-esses of an early postinfarction remodeling of the left ventricle, their effect on the development of HF and life-threatening ar-rhythmias in patients with AMI were assessed. New mechanisms of the action of ACEi were studied in view of correction of endothelial dysfunction in AMI, a possibility to pre-vent development of the left ventricle remodeling under the effect of the therapy using ACEi and beta blockers was shown. Methods of differential therapy for patients with AMI were developed. Criteria of the efficacy of the given therapy and recommendations for optimizing the treatment with regard for the clinical course of the illness were suggested, the role and place of ACEi and beta blockers in the treatment of AMI patients were established. On the basis of the significance assessment of some indices as prognostic signs characterizing the patient's state on his referral to the hospital, as well as those which contain information about the course of the prehospital period of the illness, the use of the procedure of a staged regression analysis and a correlation analysis made, a mathematical algorithm was obtained for determining a prognostic coefficient, which makes it possible to learn the outcome of the illness at the time of the patient's hospitalization. Ways for prognosing heart failure in patients with AMI on the basis of the use of noninvasive criteria and neurohumoral parameters and indices, characterizing the systolic function of the left ventricle, were developed. Degree of introduction: results of the research were introduced into the work of the Department of Resuscitation and Intensive Care, the Infarction Department of Malaya Institute of Therapy of the Academy of Medical Sciences of Ukraine (Kharkiv), the Cardiology Department and the Department of Resuscitation and Intensive Care of Kharkov City Clinical Hospital No. 27, the Infarction Department of Kharkov City Clinical Hospital No. 25, the Cardiology Department of Kharkov Hospital No. 28, the Infarction Department of Kharkov City First Aid Hospital No. 4, it being confirmed by introduction acts (13), and to the pedagogical process of the Department of Hospital Therapy and Clinical Pharmacology of Kharkiv State Medical University of the Ministry of Health of Ukraine. Materials of the dissertation were used for preparing lectures at the courses of probation and information at Malaya Institute of Therapy of the Academy of Medical Sciences of Ukraine. Methodical recommendations for doctors of therapy and cardiology inpatient and polyclinic depart-ments "The use of ACE inhibitors in treating patients with acute myocardial infarction" were published. Sphere of application: medicine, cardiology.
