Abstract
There is a growing interest in the early detection of signs of myocardial dysfunction, especially in comorbid patients for timely prevention of progression of disease, reducing the risk of complications, improving their quality of life. The aim of the work was to optimize the diagnosis of myocardial dysfunction in men, residents of Podillya, taking into account the plasma concentration of brain natriuretic peptide (BNP) and polymorphism of the corresponding gene under conditions of comorbidity of essential hypertension (EH) with left ventricular hypertrophy (LVH) and type 2 diabetes mellitus (T2D). We examined 211 men: 79 persons without the signs of cardiovascular diseases, 62 patients with EH 2 and chronic heart failure (CHF) 0-I functional classes (FC) according to NYHA Classification and 70 – with EH 2 combined with T2D and CHF FC I-II. The examination included the determination of plasma concentration of BNP, the brain natriuretic peptide gene polymorphism (polymorphic locus T-381C), indices of doppler-echocardiography. The mathematical processing was performed using the standard statistical package Statistica 10. During the study, we calculated the primary statistical indicators, identified differences between groups on statistical grounds, made correlation and discriminant analysis. Diastolic dysfunction (DD) of the left ventricle (LV) was diagnosed in 45.16% of patients in the group with EH 2, and 90% in the group of comorbid patients. It was determined that men, residents of Podillya, with presence and absence of T2D, have dominating T381C genotype of the BNP gene (p>0.05). Lower plasma concentration of BNP that is peculiar for homozygous T381T genotype, in comparison with carriers of allele C of BNP gene and the average values of this biomarker in patients with DD may affect its informativeness in the diagnosis of myocardial dysfunction and requires a lower level of diagnosis. Appropriate borderline levels of BNP were determined for early diagnosis of DD in carriers of polymorphic variants of the BNP gene in men, residents of Podillya, with comorbid course of EH 2 and T2D. It is recommended to determine the genotype of the corresponding gene (polymorphic locus T-381C) and plasma level of BNP and focus on the calculated borderline levels of BNP to optimize the diagnosis of myocardial dysfunction in comorbid patients with EH 2 and T2D. For carriers of the T381T genotype it is ≥55.57 pg/ml, for carriers of the C allele (heterozygous T381C and homozygous C381C) of the BNP gene it is ≥69.13 pg/ml.
Highlights
In today's world, the W orld Health Organization has identified the prevention and treatment of chronic noncommunicable diseases as a priority project of the second decade of the XXI century, aimed at improving the quality of life of the world's population [12]
It is generally accepted that the early preclinical manifestation of heart disease in essential hypertension (EH) and type 2 diabetes (T2D) on the background of left ventricular hypertrophy (LVH) is the development of Diastolic dysfunction (DD), which is considered as a basis for further formation of chronic heart failure (CHF) with preserved ejection fraction [17], which is detected by echocardiography
The development of left ventricle (LV) DD is the first stage of CHF formation in patients with EH, but with
Summary
In today's world, the W orld Health Organization has identified the prevention and treatment of chronic noncommunicable diseases as a priority project of the second decade of the XXI century, aimed at improving the quality of life of the world's population [12]. Due to the high increase in prevalence, comorbid conditions need special attention, including the combined course of essential hypertension stage 2 (EH 2) and type 2 diabetes (T2D) [20]. It is generally accepted that the early preclinical manifestation of heart disease in EH and T2D on the background of LVH is the development of DD, which is considered as a basis for further formation of CHF with preserved ejection fraction [17], which is detected by echocardiography. In order to improve the individual strategy for the prevention of CHF at the stage of reversible changes in the comorbid course of EH and T2D, there is an urgent need to involve additional effective diagnostic biomarkers of myocardial dysfunction
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