Sheiko S. Structural-functional state of the heart in patients of elderly age with chronic heart failure and cardio-renal syndrome: diagnostics and therapy

It was proved that predictor of CRS development in elderly patients with CHF is an early decrease of glomerular filtration rate on the background of not only decreased cardiac output but in condition of preserved hemodyna- mics in the presence of manifested endothelial dysfunction and activity of systemic inflammation. In elderly pati- ents with CHF and CRS as compared with the patients without CRS, pathologic changes of the left ventricle in the form of dominating of excentric type in its systolic dysfunction and concentric type of remodeling in preserved ejection fraction of the LV are more expressed. Concept as for the role of systemic hemodynamic disorders in CHF with CRS progressing connected with remodeling of the the left atrium,LV,progredient course of diastolic and SD LV and participation of biomarker of non-active N-terminal natriuretic peptide was proposed. Rregularities of structural-functional remodeling and sequence of changes of reservoir,pumping and conduit function of LA were determined. On the background of expressed ED and systemic immune-inflammatory activation disregulation of erythropoiesis has a polyvector direction. Level of ERP in case of CHF with CRS increases in proportion to the growth of the functional class of CHF and correlates closely with the growth of tumor necrosis factor-alpfa and С-reactive protein.In case of hypoerythropoietinemia a reverse correlative link between ERP and TNF-alpfa was determined.It was demonstrated Clinical efficacy and positive impact on structural-functional state of the heart and cardio-renal interrelations of a complex medicamental therapy of CHF with nebivolol as a beta-blocker and differential usage of ERP agents,iron and arginin was demonstrated.