Ushkvarok L. Pathogenetic approaches to the choice of rational pharmacotherapy of chronic heart failure with the stored systolic function of the left ventricle.

Object of the study: CHF with preserved systolic function of the left ventricle. Purpose of the study: To work out therapeutic regimens and system of individual prognosis of their efficacy in patients with chronic heart failure with preserved systolic function of the left ventricle based on determining the character of activation of renin-angiotensin-aldosterone and sympatho-adrenal systems, immune inflammation and apoptosis processes, disorders in endothelial function depending on the degree of preserved function of the left ventricle. Methods of the investigation: Clinical, biochemical, in-strumental (echocardioscopy, Doppler echocardioscopy, test with reactive hyperemia), morpho-functional, statistical. Theoretical and practical results: Differentiated therapy of CHF with preserved systolic function of the left ventricle based on determining the role of activation of various homeostatic systems of the organism in pathogenetic processes of forming and progress of CHF was worked out. The findings of the research suggest that it is important to consider both the state of homeostatic systems of the organism and LFEF at choosing therapeutic regiments in pa-tients with CHF. The criteria of development and progress of CHF were worked out. It was proven that monitoring of indices of apoptosis processes activation in patients with CHF with preserved systolic function of the left ventricle could be used as early markers of reduction of LV systolic function and LV remodeling progress. Application of the developed algorithm of differentiated selection of effective regimen of therapy in patients with CHF with preserved function of the LV allows improving the treatment efficacy by 25%. The conducted research contributes to development of main approaches to treatment of CHF with pre-served systolic function of the LV. Novelty: For the first time, the difference in activation of such neurohumoral systems as SAS (noradrenalin, adrenalin) and RAAS (angiotensin II, aldosterone), proteinase system and their inhibitors in development endothelial function, activation of cytokines and apoptosis factors in patients with CHF depending on the degree of preservation of systolic function of the LV in the groups of patients with EF=41-49% and EF ?50% was shown. It was determined that predictors of CHF development at preserved systolic function of the left ventricle are such neurohumoral parameters as noradrenalin, endothelin-1, IL-1?, IL-4, IL-6, tonin, calpains, proteinase inhibitors (?-1-IP, ?-2-MG). For the first time it was revealed that a differential feature of pathophysiological processes in CHF with EF=41-49% vs CHF with EF ?50% is activation of apoptosis processes and RAAS and interconnected activation of these processes. Degree of introduction: The findings of the research were intro-duced to the work of clinical departments of Institute of Therapy named after L.T. Malaya (AMS of Ukraine) (Kharkiv), hospitals of Kharkiv, Vinnitsa, Dnipropetrovsk, Iivano-Frankivsk, Kyro-vograd, Luhansk, Lviv, Mykolaiv, Poltava, Kherson, Chernihiv regions of Ukraine. Methodological recommendations approved by Ministry of Health of Ukraine “Treatment of arterial hypertension and prevention of its complications in therapeutic practice: data of evidence based medicine” (2006) and “Chronic heart failure in the work of family physician: the role of angiotensin II antagonists” (2006) were published. Sphere of application: medicine, cardiology.