Endothelial Dysfunction as a Factor in the Pathogenesis of Chronic Heart Failure of Various Genesis

The objective of the research was to study the pathogenetic role of the levels of endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP) in the development of endothelial dysfunction (ED) in patients with preserved and lost renal function. Materials and methods. The study involved 86 patients: Group I included 42 patients with arterial hypertension and chronic heart failure (CHF) IIA FC ІІІ; Group II consisted of 44 patients with terminal chronic kidney disease (stage V CKD) with concomitant CHF IIA FC ІІІ who were on treatment by outpatient program hemodialysis (HD). Results. In patients of Group II the levels of ET-1 and inflammatory markers were significantly higher than those in the comparison and control groups (p< 0.001 and p< 0.001). In patients of Group I there was a direct moderate correlation between TNF-alpha and ET-1 (r=0.48; p< 0.05) and between CRP and ET-1 (r=0.56; p< 0.05). In Group II, the relation between TNF-alpha and ET-1 was significantly stronger (r=0.58; p< 0.05); between the levels of CRP and ET-1 it was weaker (r=0.37, p< 0.05). Increased levels of ET-1, TNF-± and CRP affected the development of ED in both groups. Conclusions. It was found that CRP levels of TNF-alpha, ET-1 in patients on HD were significantly different from the same data in patients with preserved renal function, which is clearly associated with more pronounced signs of inflammation and ED in a cohort of dialysis patients. The impact of TNF-± in the development of ED in both groups was proved. Despite the higher level of CRP in patients with stage V CKD being corrected by HD with CHF, this biomarker had less impact on the prognosis of ED than in the general population of patients with CHF.