Диагностические возможности предшественника натрийуретического пептида у больных с сердечной недостаточностью ишемической этиологии до и после операции реваскуляризации миокарда

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Abstract

Objective. The aim of the study was to assess the application of cardiac failure marker - predictor of cerebral natriuretic peptide in patients with chronic cardiac failure of ischemic etiology in pre- and postoperative period and to analyze the influence of surgical myocardial revascularization on peptide level in serum of patients with ischemic heart disease.

Material and methods. The study included 129 male patients with ischemic heart disease complicated by chronic heart failure Class I - IV. We used the following methods of study: electrocardiography, echocardiography, treadmill stress-test, coronary angiography, Holter monitoring of electrocardiogram to assess the temporary parameters of heart rhythm variability, determining the variability of heart rhythm, evaluating the predictors of natriuretic peptides in serum.

Results. The analysis showed that the increased level of natriuretic peptide predictors was associated with the advanced heart failure functional class. Statistically significant elevation of concentration of natriuretic peptide predictors was noted in patients with postinfarction cardiosclerosis and left ventricular aneurysm as compared to the group of patients without aneurysms and infarction. Statistically significant positive correlation ratio between predictors of natriuretic peptides levels and many parameters of echocardiography were obtained during the analysis. Considering cardiosurgical specifity of the Center the authors assessed predictors of natriuretic peptides levels dynamics following various versions of myocardial revascularization. Statistically significant growth of natriuretic peptides levels dynamics was revealed early after coronary artery bypass grafting under cardiopulmonary bypass in spite of improvement of many a clinical instrumental parameters. In the group of patients who had undergone coronary artery bypass grafting without cardiopulmonary bypass hormone growth was not only statistically inauthentic but insignificant as well. Statistically significant peptide content decrease was noted in the group of patients who had undergone coronary artery stenting.

Conclusion. Natriuretic peptide predictor is a reliable marker allowing one to diagnose not only heart failure of III - IV functional class but during earlier stages as well. At the same time in the early postoperative period following coronary artery bypass grafting under extracorporeal circulation the authors noted significant growth of this value associated with the absence of heart failure progression symptoms which is very likely determined by development of the system inflammatory syndrome following cardiopulmonary bypass use and makes it impossible application of natriuretic peptide as a diagnostic marker for this category of patients.

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Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery