ASSESSMENT OF ENDOTHELIAL DYSFUNCTION ON THE PROCESSES OF MYOCARDIAL REMODELING IN CORONARY HEART DISEASE, AGGRAVATED BY TYPE 2 DIABETES

The purpose of the study. To study the effect of endothelin-1 and endothelial growth factor on the development of endothelial dysfunction and processes of myocardial remodeling in patients with coronary artery disease. Materials and methods: During the study, all patients and representatives of CG included in the study were examined, during which the structural and functional state of the myocardium (echocardiography - EchoCG) and the features of the functional state of the endothelium (endothelium-dependent vasodilation test, concentration of VEGF and ET-1) were studied. Results: Ischemic myocardial remodeling is characterized by dilation of the heart cavities, spherical deformation of the LV cavity, thinning of the walls, an increase in LVEF, and an increase in the time to achieve an effective pressure gradient between chambers (Tei). Structural and functional remodeling of the myocardium is accompanied by a decrease in regional and global contractility of the left and right ventricles, as well as a violation of active diastolic relaxation, and the formation of postcapillary pulmonary hypertension. Factors associated with LV systolic dysfunction in patients with coronary heart disease are LV remodeling and dilation (HR=3.02, p<0.001), three-vessel coronary lesion (HR=3.48, p<0.001), VEGF concentration in venous blood above 654 pg/ml (HR=3.44, p<0.001), concentration of ET-1 in venous blood is higher than 1.95fmol/L (HR=2.33, p<0.01). Conclusions: In patients with coronary artery disease with myocardial remodeling, the concentration of VEGF and ET-1 is more than 10 times higher than the values typical for healthy individuals. The concentration of VEGF and ET-1 in venous blood correlates with the severity of pathological myocardial remodeling and the degree of EDV impairment.