Rak L. Chronic cardiac insufficiency as a consequence of myocardium inflammatory and dysplastic lesions in children: mechanisms of development, diagnosis, and treatment substantiation

The thesis is devoted to improving diagnosis and prophylaxis of the development of subclinical variants at chronic cardiac insufficiency (CCI) in children and adolescents with myocardium pathology by studying the cardiovascular system functional state and processes of the heart remodeling, as well as by defining endothelial function and the state of neurohumoral regulatory systems (NRS). In children suffering from myocardial pathology (MP) both of inflammatory and noninflammatory genesis processes of the heart remodeling were proved to take place together with a decrease in its pumping and contractile functions against the background of activation of renin-angiotensin-aldosterone system, an increase in proinflammatory CD95/Fas cytokines levels, and activation of protein peroxidation which reflected mechanisms of CCI formation. CCI diagnostic model which allows to reveal children with cardiovascular system pathology and with the initial signs of the disease, as well as an algorithm for diagnosing latent systolic dysfunction were worked out in our study. Morphofunctional, neurohumoral and biochemical criteria of CCI development were determined in children with MP. The necessity for prescription of immunosuppressive therapy with iAPF was substantiated for children with subclinical CCI against the background of MP of both inflammatory and noninflammatory genesis.