The presence of metabolic syndrome (MS) significantly increases the risk of developing cardiovascular diseases leading to chronic heart failure (CHF).
OBJECTIVE
To develop a complex of clinical and laboratory methods for assessing the severity of CHF, burdened with MS.
MATERIAL AND METHODS
In 37 patients suffering from CHF without MS (the 1st group) and 37 patients suffering from CHF with MS (the 2nd group), the values of markers of lipid metabolism (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol), lipid transport system were studied (apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB)), visceral adipose tissue (leptin, adiponectin, resistin), markers of myocardial damage (highly sensitive cardiac troponin (hscTn)), inflammation (highly sensitive C-reactive protein (hsCRP)), functional myocardial insufficiency (N-terminal fragment of the brain natriuretic peptide precursor (NT-proBNP) and stimulating growth factor expressed by gene 2 (ST2)) and their mutual correlations. The ranking of the level of the studied laboratory parameters was carried out, which is an additional effective method of monitoring the development of CHF in patients with MS.
RESULTS
The ranking of lipid metabolism and lipid transport system indicators turned out to be the most effective for the ApoB/ApoA1 ratio. The indicators of the lipid transport system more effectively reflected the severity of CHF, the ApoB/ApoA1 ratio was especially significantly different, which in patients with CHF with MS was 1.6 times higher than in patients with CHF without MS. When comparing the values of the leptin/adiponectin ratio ranks and clinical outcomes of CHF, it was revealed that out of 22 patients who had improved CHF in the outcome of hospitalization, 18 patients had zero rank, 4 patients — rank 1. Out of 4 patients with CHF without MS who died during hospitalization or within 6 months after hospitalization, all had ranks 1-3; of the 7 deceased CHF patients with MS, all had a grade of 2-3 leptin/adiponectin ratio. The concentration of the four most significant markers was studied, which were attributed to the group characterizing damage to the heart muscle or coronary syndrome — hsCRP, hscTn, NT-proBNP and ST2. For three markers — hsCRP, NT-proBNP and ST2 — a significant increase was registered in comparison with the reference values adopted for these laboratory parameters. For these markers, a tendency has been established to increase the level in patients with a more severe degree of CHF (functional class IV (FC) compared with FC III) and in patients with CHF with MS compared with patients with CHF without MS. The same 3 markers had a pronounced tendency to the highest values in patients who died within 6 months after the study.
CONCLUSION
The results of ranking the level of the studied laboratory markers suggest the possibility of their use as a predictor of various outcomes of CHF and MS.
