PROGNOSTIC VALUE OF BIOMARKERS IN PATIENTS WITH ISCHEMIC HEART FAILURE

Abstract

Modern clinical recommendations of medical associations attach great importance to the improvement of methods of early diagnosis, prevention and individualized treatment of heart failure (HF). It is assumed that biological markers that reflect different pathophysiological stages of HF retain their value as a powerful tool for diagnosing acute and chronic HF, stratifying patients into high-risk groups for the occurrence and progression of the specified pathology, and as a probable predictor of treatment effectiveness. Along with this, the levels and prognostic value of serum biomarkers in patients with HF of different etiologies at different stages of treatment remain unclear.The purpose. To study the prognostic value of biomarkers in patients with HF of ischemic origin.Material and methods. 398 were examined with HF aged 45-65 years (54.3±7.2 years. All 398 patients with HF were divided into two groups. The 1st group included 219 (55%) patients who did not have re-hospitalization (RG) due to HF decompensation during the year of observation. The II group consisted of 179 (45%) patients with PG. 226 (56.8%) patients had a permanent form of atrial fibrillation (AF), 102 (25.6%) had type 2 diabetes. Among the examined - 198 (49,7%) women and 200 (50,2%) men. A standardized echocardiographic study was performed to determine the left ventricular ejection fraction (LV EF) and LV dimensions during hospitalization. The levels of thyroid-stimulating hormone, free T3, free T4, blood glucose, glycated hemoglobin, galectin-3, ST-2, BNP, NT-proBNP were determined. The ratios: ST-2 / Galectin-3 (UO), NT-proBNP / BNP (UO), NT-proBNP / ST-2 (UO) and NT-proBNP / Galectin-3 (UO) were calculated. During 1 year, patients were observed, taking into account the presence of repeated hospitalization (RG) due to HF decompensation, mortality. Patients were divided into two groups. The 1st group included 219 (55%) of patients who did not have re-hospitalization (PG) due to HF decompensation. II group - 179 (45%) patients with PG.Results. Compared to patients with a favorable short-term course of the disease, patients with HF of ischemic genesis, who had PG during the year of observation, have HF III and IV PK according to NYHA, diabetes mellitus, and a permanent form of AF more often; higher heart rate, serum levels of galectin-3 (by 11.1%), NT-proBNP (by 31.8%), higher values of NT-proBNP / BNP (by 40.6%) and NT-proBNP / ST- 2 (by 21.1%), but a smaller value of the ST-2 / Galectin-3 ratio (by 9.3%), as well as a higher risk of death during the first year (OR = 3.81). The risk of PG increases when the level of NT-proBNP > 652.6 pg/ml is reached and the ratios: ST-2/Galectin-3 ≤ 17.95 IU, NT-proBNP / BNP > 10.17 IU and NT-proBNP / ST-2 > 13.79 UO. The level of ST-2 > 41.37 ng/ml is prognostically significant for the one-year death of patients within a year.Conclusions. In patients with HF of ischemic genesis, the ratio of NT-proBNP / BNP has a greater prognostic significance regarding the risk of re-hospitalization, compared to NT-proBNP and NT-proBNP / ST-2.