INTERRELATION BETWEEN PERSISTENT NECROSIS OF CARDIOMYOCYTES AND PROGNOSIS IN PATIENTS WITH CHRONIC HEART FAILURE

Abstract

Background. Chronic heart failure (CHF) progression is accompanied by remodeling of muscular, collagen and vascular elements of myocardium. This can lead to increase in serum concentrations of myocardial lesion markers (cardiac troponin I (TrI) and myoglobin) which seem to correlate with poor prognosis in patients with CHF. Aim. To estimate correlations between cardiac TrI, myoglobin, creatine phosphokinase MB-fraction (MB-CPK) serum concentrations and disease severity and prognosis in CHF patients. Material and methods. Fifty eight patients with CHF of different etiology were included into the study. Physical examination, clinical and biochemical blood assays, chest X-ray study, echocardiography and ECG daily monitoring (initially and at the end of the study) were carried out. TrI and myoglobin levels were estimated by immunoenzymometric assay. The follow-up period was 6 months. The following end points were used: CHF worsening caused hospital admission, acute myocardial infarction, and lethal outcome. Results. Mean TrI and myoglobin concentrations equaled 0.04 [0.02; 0.06] ng/ml and 62.95 [35.86; 77.28] μg/l, respectively. Demographic characteristics of patients (gender, age) did not influence these markers levels. TrI concentration correlated with CHF severity: it was significantly higher in patients with CHF of functional class (FC) III-IV than in those with CHF of FC I-II (p<0.001). Negative correlation was revealed between TrI level and ejection fraction (p<0.001). TrI concentration was significantly higher in patients with life-threatening ventricular arrhythmia than in patients without it (p=0.001). Besides, TrI level was significantly higher in patients with registered end points than in those with stable CHF course (p=0.001). Conclusion. TrI correlates with CHF severity and probably has prognostic value in these patients.