Russian Heart Failure Journal 2008year Pathogenetic aspects of chronic heart failure in patients with IHD exacerbation in the setting of arterial hypertension


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2008/

Pathogenetic aspects of chronic heart failure in patients with IHD exacerbation in the setting of arterial hypertension

Kirichuk V. F., Podzemelnikov E. V., Podzemelnikov V. E.

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Urgency. The need for influencing progression of atherosclerosis as a cause for CHF is above any doubt. It is obvious that the renin-angiotensin system plays an important role in maintaining the vascular endothelial function and influences prognosis in cardiovascular diseases. Aim. To study formation of CHF in patients with AH and IHD in relation to the lipid status, vascular and platelet components of the hemostasis system, vasoactive prostanoids and RAAS. Materials and methods. 102 patients with unstable angina (UA) and AH aged 48 to 65 years (mean age 56.5 ± 9.5 years) underwent EEG, echoCG, exercise stress test, coronary angiography (CAG), measurements of plasma renin activity (PRA), plasma aldosterone concentration (PAC), thromboxan, prostacyclin, platelet aggregation and antiaggregation ability of the vascular wall (AAAVW). Based on parameters of lipid metabolism patients were divided into four groups: normolipidemia and lipid metabolism disorders corresponding to IIa, IIb and IV type hyperlipidemia (HLP). Results. Low values of AAAVW were observed in UA patients with type IIb and IV HLP in combination with reduced platelet activity. Increased levels of thromboxan B2 and PRA were associated with decreases in prostacyclin levels, which were most pronounced in type IIа and IIb HLP. Conventional treatment of patients with CHF resulted in AAAVW recovery but AAAVW was reduced in III and IV FC CHF. In the course of CHF development, PAC significantly increased with more severe CHF FC. Positive correlation was demonstrated in IHD exacerbation between prostacyclin levels and AAAVW, levels of aldosterone and thromboxan, levels of aldosterone and prostacyclin, aldosterone level and AAAVW.
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