Системска инфламација предизвикана од коморбидитети и ехокардиографски утврдена дијастолна дисфункција кај срцева слабост со сочувана ежекциона фракција кај стари лица

Abstract

Introduction: The treatment of chronic heart failure reached significant progress within the last decades. However, the progress is mainly limited only to patients with reduced ejection fraction, and recently to those with medially reduced ejection fraction, while the heart failure with preserved ejection fraction remains enigma even beside significant morbidity and mortality. One of suggested hypotheses is that comorbidities cause systemic inflammation, coronary microvascular dysfunction and oxidative stress, which lead to myocardial fibrosis, stiffness of myocytes and, at the end to diastole dysfunction and heart failure with preserved ejection fraction. In literature, within the last decade, it has been proved that the circulating biomarkers, measured with highly sensitive, specific and repeated investigations, would have more and more important role in heart failure for assessment of the patient’s risk ant the therapeutic targeting. The purpose of the investigation: To prove the role of systemic, with low degree inflammation present in the most common comorbidities which follow the old age, in occurring of diastole dysfunction and the heart re-modelling as one of the causes for occurring the heart failure with preserved ejection fraction. Material and methods: Clinically prospective average study, which included 124 patients, aged above 65 years, out of which 85 patients were in the investigated group, which completed the criteria for existence of heart failure with preserved ejection fraction and present comorbidities, and 39 patients – control group. It was used Minnesota Living With Heart Failure Questionnaire, partially adaptable for the age group above 65 years of age, as well as Questionnaire for clinical state of the patient. Diastole dysfunction and the heart re-modelling were proved by means of transthoracic color Doppler echocardiography, using the recommended criteria of ASA/ESC. The extant of the heart failure was assessed according to functional classification (NYHA). IL-6, and hs-CRP, were analyzed in samples of venous peripheral blood in the private biochemical laboratory "Synlab" in Skopje. Results: The values of the investigated inflammation mediators hs-CRP and IL-6 from peripheral blood significantly differed among the old individuals with CCcF and comorbidities compared to the control group. However, the applied statistical methods mostly showed a direct correlation of inflammation mediators with the parameters of diastole dysfunction and heart re-modelling, which has been characteristic for heart failure with preserved ejection fraction. Conclusion: Our investigation went in favor to the hypothesis that the chronic, with low degree of inflammation present in the most frequent comorbidities in the old age, brought to increased atheromatosis, diastole dysfunction and heart remodelling, being characteristic for heart failure with preserved ejection fraction in old people. This led to conclusion that this type of heart failure should be viewed more as systematic disease connected to comorbidities.