cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2024.11.n2794cardio-2794Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESПредикторы ремоделирования левого желудочка при хронической сердечной недостаточности ишемической этиологииLeft Ventricular Remodeling Predictors in Chronic Heart Failure of Ischemic Etiologyhttps://orcid.org/0000-0002-2161-2140АгеевА. А.AgeevA. A.

Ассистент кафедры Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского

Аssistant professor at the Department of Hospital Therapy №1

anton.ageev1945@gmail.comhttps://orcid.org/0000-0003-4778-7755КожевниковаМ. В.KozhevnikovaM. V.

Профессор кафедры Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского

Ph.D. of Medical Sciences, Professor at the Department of Hospital Therapy  №1 

kozhevnikova-m@inbox.ruhttps://orcid.org/0009-0006-9295-1891ТюринаД. А.TyurinaD. A.

Студентка 6 курса ИКМ ФГАОУ ВО Первый МГМУ им. И.М.Сеченова МЗ РФ (Сеченовский Университет)

 

6th year graduate student at the Institute 

dasha.tyurina.01@bk.ruhttps://orcid.org/0000-0003-2873-704XКоробковаЕ. О.KorobkovaE. O.

Доцент кафедры Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского

Associate professor at the Department of Hospital Therapy №1 

eokor25@mail.ruhttps://orcid.org/0000-0001-7938-1763КондратьеваТ. Б.KondratievaT. O.

Доцент кафедры Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского

Ph.D. of Medical Sciences, Associate professor at the Department of Hospital Therapy №1 

kondrat_tb@mail.ruhttps://orcid.org/0000-0001-6554-3936ШестаковаК. М.ShestakovaK. M.

Заведующая лабораторией, Старший научный сотрудник Института трансляционной медицины и биотехнологии Научно-технического парка биомедицины

Ph.D. of Pharmaceutical Sciences, Head of the Laboratory, Senior Researcher at the Institute of Translational Medicine and Biotechnology of the Scientific and Technical Park of Biomedicine of Sechenov University

kshsochi2014@gmail.comhttps://orcid.org/0000-0002-7309-8913МоскалёваН. Е.MoskalevaN. E.

Заместитель руководителя центра Института трансляционной медицины и биотехнологии Научно-технического парка биомедицины

Ph.D. of Biological Sciences, Deputy Head of the Center of the Institute of Translational Medicine and Biotechnology of the Biomedicine Scientific and Technical Park of Sechenov University

nemoskaleva@gmail.comhttps://orcid.org/0000-0002-2240-2903МаркинП. А.MarkinP. A.

Заведующий лабораторией Института трансляционной медицины и биотехнологии Научно-технического парка биомедицины

Ph.D. of Pharmaceutical Sciences, Head of the Laboratory of the Institute of Translational Medicine and Biotechnology of the Scientific and Technical Park of Biomedicine of Sechenov University

markin_p_a@staff.sechenov.ruХабароваН. В.KhabarovaN. V.

Ассистент кафедры Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского 

Ph.D. of Medical Sciences, Assistant professor at the Department of Hospital Therapy №1 

khabarova_n_v@staff.sechenov.ruhttps://orcid.org/0000-0002-9032-1558АпполоноваС. А.AppolonovaS. A.

Руководитель центра Института трансляционной медицины и биотехнологии Научно-технического парка биомедицины

Ph.D. of Chemical Sciences, Associate professor at the Department of Pharmacology

appolosa@yandex.ruhttps://orcid.org/0000-0002-3014-6129БеленковЮ. Н.BelenkovYu. N.

Академик РАН, профессор, заведующий кафедрой Госпитальной терапии №1 ИКМ им. Н.В. Склифосовского

Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Head of  the Department of Hospital Therapy №1 

ynbelenkov@gmail.comФГАОУ ВО «Первый Московский государственный медицинский университет имени И. М. Сеченова» (Сеченовский Университет) Минздрава РФ, МоскваРоссияSechenov First Moscow State Medical University, MoscowRussian Federation2024301120246411106116Copyright © Kardiomag, 20242024KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2794Цель

Цель. Определение метаболомных и структурно-функциональных маркеров отдаленного ремоделирования левого желудочка (ЛЖ) у пациентов с хронической сердечной недостаточностью (ХСН) ишемической этиологии и фракцией выброса (ФВ) ЛЖ <50 %.

Материал и методы

Материал и методы. В проспективное исследование включены 56 пациентов с ХСН ишемической этиологии III–IV функционального класса по классификации NYHA (средний возраст 66±7 лет) и 50 пациентов с ишемической болезнью сердца (ИБС) без признаков ХСН (69 [64; 73,7] лет). У всех участников определяли концентрацию 19 аминокислот, 11 продуктов кинуренинового катаболизма триптофана, 30 ацилкарнитинов с различной длиной цепи. Далее в анализе использовались те метаболиты, которые показали статистические различия между группами сравнения. С помощью эхокардиографии оценивали ремоделирование полости ЛЖ на момент включения пациентов с ХСН в исследование и через 6 мес наблюдения. Для данной когорты с учетом статистически значимых эхокардиографических параметров и метаболитов производили оценку предикторов отдаленного ремоделирования полости ЛЖ.

Результаты

Результаты. У пациентов с ХСН ишемической этиологии преимущественно (81 %) представлены патологические расчетные типы ремоделирования ЛЖ (концентрическая и эксцентрическая гипертрофия – 46 и 35 % соответственно), однако данная классификация имеет ограничения при описании указанной когорты. Кроме того, в этой группе концентрации аланина, пролина, аспарагина, глицина, аргинина, гистидина, лизина, валина, индолил-3‑уксусной и индолил-3‑пропионовой кислот, С16-1‑ОН, С16‑ОН были статистически значимо (p<0,05) ниже, а уровни большинства средне- и длинноцепочечных ацилкарнитинов – выше, чем у больных ИБС без признаков ХСН. На обратное ремоделирование полости ЛЖ при ХСН ишемической этиологии в отдаленном периоде (6 мес) влияет изменение толщины межжелудочковой перегородки (отношение шансов – ОШ 19,07; 95 % доверительный интервал – ДИ 1,76–206,8; p=0,006), уровня антраниловой кислоты (ОШ 19,8; 95 % ДИ 1,01–387,8; p=0,019) и аспарагина (ОШ 8,76; 95 % ДИ 1,07–71,4; p=0,031).

Заключение

Заключение. Наличие у пациентов с ХСН ишемической этиологии толщины межжелудочковой перегородки более 13,5 мм, концентрации антраниловой кислоты более 0,235 мкМ / л или уровня аспарагина менее 135,2 мкМ / л по истечении 6 мес наблюдения влияет на достижение ими обратного ремоделирования полости ЛЖ.

Aim      To identify metabolomic and structure and function markers of remote left ventricular (LV) remodeling in patients with chronic heart failure (CHF) of ischemic etiology and LV ejection fraction (EF) <50%.

Material and methods  This prospective study included 56 patients with 3-4 NYHA functional class CHF of ischemic etiology (mean age, 66±7 years) and 50 patients with ischemic heart disease (IHD) without signs of CHF (69 [64; 73.7] years). Concentration of 19 amino acids, 11 products of kynurenine catabolism of tryptophan, 30 acylcarnitines with different chain lengths were measured in all participants. The metabolites that showed statistical differences between the comparison groups were then used for the analysis. Echocardiography was used to assess LV cavity remodeling at the time of the CHF patient inclusion in the study and after 6 months of follow-up. Predictors of long-term LV cavity remodeling were assessed for this cohort taking into account statistically significant echocardiographic parameters and metabolites.

Results Patients with CHF of ischemic etiology, predominantly (81%) had pathological calculated types of LV remodeling (concentric and eccentric hypertrophy, 46 and 35%, respectively). However, this classification had limitations in describing this cohort. In addition, in this group, the concentrations of alanine, proline, asparagine, glycine, arginine, histidine, lysine, valine, indolyl-3-acetic acid, indolyl-3-propionic acid, C16-1-OH, and C16-OH were significantly (p<0.05) lower, and the concentrations of most medium- and long-chain acylcarnitines were higher than in patients with IHD without signs of CHF. The long-term (6 months) reverse remodeling of the LV cavity in CHF of ischemic etiology was influenced by changes in the interventricular septum thickness (hazard ratio, HR, 19.07; 95% confidence interval, CI, 1.76-206.8; p=0.006) and concentrations of anthranilic acid (HR 19.8; 95% CI 1.01-387.8; p=0.019) and asparagine (HR 8.76; 95% CI 1.07-71.4; p=0.031).

Conclusion      The presence of an interventricular septum thickness of more than 13.5 mm, anthranilic acid concentrations of higher than 0.235 μM/l, or an asparagine concentration of less than 135.2 μM/l in patients with CHF of ischemic etiology after 6 months of follow-up affects their achievement of LV cavity reverse remodeling.

 

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The authors declare that there are no conflicts of interest present.