SIRTUIN-1 (SIRT1) IN THE DIAGNOSIS OF CHRONIC HEART FAILURE COMPLICATED BY ESSENTIAL HYPERTENSION
DOI:
https://doi.org/10.11603/mcch.2410-681X.2023.i2.13969Keywords:
left ventricular hypertrophy, essential hypertension, heart failure, SIRT1Abstract
Introduction. SIRT1 is a promising biomarker in the diagnosis of myocardial remodeling and chronic heart failure (CHF) against the background of essential hypertension (EН). Through a series of signaling molecules, the peptide participates in energy exchange, apoptosis and fibrosis processes, DNA repair, which are important links of hypertensive myocardial damage.
The aim of the study – to evaluate the diagnostic capacity of SIRT1 as a possible indicator of heart structure and function disorders, which determine different clinical phenotypes of CHF, which complicated the course of EН.
Research Methods. To achieve the goal, 190 men aged 40–65 years were examined: 120 patients with EН, including 60 patients with EН and CHF II A stage, who made up the main group of the study, and 70 men of the control group without cardiovascular diseases and left atrial hypertrophy ventricle (LVH). The level of SIRT1 in blood plasma was determined by enzyme immunoassay. All patients with EН had confirmed LVH. CHF phenotypes based on left ventricular ejection fraction (LVEF) were determined in accordance with the ESC recommendations on the diagnosis and treatment of CHF (2021).
Results and Discussion. It was established that the plasma level of SIRT1 in patients with EН is significantly higher than in the control group ((2.41±0.15) ng/ml vs. (1.89±0.09) ng/ml, p<0.05). However, in patients with EH and CHF II A stage, the peptide concentration in blood plasma is significantly lower ((1.55±0.08) ng/ml than in patients with asymptomatic EН (3.27±0.24) ng/ml, p <0.01). It was calculated that the plasma level of SIRT1 below 2.03 ng/ml can be used for auxiliary diagnosis of CHF with a sensitivity of 80.0 % and a specificity of 60.0 %, (AUC=0.78, 95 % CI=0.70-0.87, p=0.041), and the threshold level of the peptide is below 1.66 ng/ml – to identify patients with CHF phenotype with reduced LVEF<50 % among hypertensive men (sensitivity 65.5 % and specificity 70.8 %, AUC=0.76, 95 % CI=0.67–0.84, p=0.043).
Conclusions. Low plasma concentration of SIRT1 is associated with certain variants of hypertensive remodeling of the heart: eccentric LVH, diastolic heart dysfunction of the II stage, dilatation of the left atrium, reduction of LVEF less than 50 %. Limit levels of the plasma concentration of the peptide can be used for auxiliary diagnosis of CHF in hypertensive patients.
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