THE ROLE OF ENDOGENOUS INTOXICATION AND OXIDATIVE STRESS IN THE PROGRESSION OF CHRONIC HEART FAILURE

Abstract

Introduction. Chronic heart failure (CHF) is one of the most frequent and severe progressive diseases of the cardiovascular system. The aim of the study was to determine the nature and strength of correlations between markers of endogenous intoxication, lipid peroxidation, intoxication indices, and clinical-hemodynamic parameters in patients with CHF, taking into account the stage of the disease. Methods. A total of 39 patients with stage I–IIB CHF and 10 practically healthy individuals were examined. Methods included the analysis of complaints and clinical status, general clinical and biochemical blood tests, determination of integral hematological indices, levels of middle-weight molecules (MWM), circulating immune complexes, pro-inflammatory cytokines, and evaluation of lipid peroxidation indicators and antioxidant enzyme activity. Statistical analysis was performed using correlation analysis and Student's t-test. Results and Discussion. Numerous statistically significant correlations were established between markers of endotoxicoses, oxidative stress, and clinical indicators of CHF. As the disease progressed, the strength and number of correlations increased. In stage I, immune-inflammatory relationships predominated; in stage IIA, a systemic intoxication syndrome was formed; whereas in stage IIB, the closest correlations were found between markers of endotoxicoses, TNF-α, malondialdehyde (MDA), and ejection fraction (EF), which was accompanied by deterioration of myocardial contractile function and hemodynamic parameters. Conclusions. Significant correlations between markers of endogenous intoxication (EI), lipid peroxidation, and clinical-hemodynamic parameters were established in patients with CHF. With the progression of the disease, an increase in the strength and number of statistically significant relationships is observed, indicating the growth of systemic inflammation and endotoxicoses. In stage IIB CHF, the closest negative correlations were found between TNF α, MDA, MWM, and EF, confirming their role in the development of myocardial dysfunction. Intoxication indices are informative integral indicators of systemic inflammation and can be considered as additional laboratory markers of the severity and progression of CHF.