“To study the main mechanisms in the development of chronic cardiac insufficiency in adolescents with myocardium pathology”
(research supervisor – Doctor of Medical Sciences, professor L.F. Bogmat, 2007−2009 yrs)
The carried out research topic enabled the authors to determine the role of remodelling processes in the cardio-vascular system and activation of the regulatory system in the development of systolic dysfunction in children and adolescent with various forms of myocardium pathology.
Object of study: chronic cardiac insufficiency (CCI) in adolescents aged 10-18 with myocardium pathology (MP).
Objective: improving the methods of prophylaxis of the CCI progress in children and adolescent with various cardiac pathologies on the basis of determining the character of changes in the neurohumoral regulatory systems, the process of inflammation , and remodeling of the cardiovascular system.
Methods: clinical, ECG, doppler-echocardio-and vascularography, stress-echoCG, biochemical, radioimmunologic, and immunofermental.
Theoretical and practical results: it has been established that in children with MP the signs of CCI progressing include: desadaptive restructuring of the heart with expansion of the left ventricle (LV) and the left atrium cavities, an increased amount of residual blood at systole, a progressing decrease in the struck and minute volumes of the heart and in the LV ejection fractions. In children who had inflammatory pathologies of the myocardium said signs were registered in 55.17% of cases, and in children with dysplastic cardiomyopathy and cardiac rhythm disorders those signs were registered in 38 to 40% of cases. In 57.14% of the patients there was revealed an endothelial dysfunction, which contributed to deterioration of the compensatory capacity of the vascular system and to intensification to cardiovascular disorders. It was shown that deterioration of the systolic function of the heart and the progress of the CCI took place against the background of activation of the renin-angiotensin-aldosterone regulatory system (RAAS) and endotheline-1 of the blood. A negative dynamics of the myocardium functional capacity is also accompanied by increased levels of proinflammatory cytokines, activation of free-radical processes (increased levels of oxidative protein modifications), inadequate response of the antioxidant systems, and by reduced variability of cardiac rhythm and the quality of life. There was developed a regressive model for prognostication of the CCI progress in children with the heart pathologies, the model including the indices for neurohumoral regulation (epinephrine, norepinephrine, cortisol, renin, angiotensin-II, and plasma aldosterone). The prognostic values of individual humoral factors have been specified, as well as the role of morphofunctional characterisrics of the heart, and a decrease in the cardiac rhythm variability in the progress of systolic dysfunction of the myocardium in children.
Novelty: it has been convincingly proved that in children with the myocardium pathology negative dynamics of the morphofunctional parameters of the heart is accompanied by activation of the neurohumoral regulation systems( SAS, RAAS, endotheline-I), increased levels of proinflammatory cytokines, oxide modifications of proteins, and by a changed content of cyclic nucleotides. A prognostication model of the CCI progress in children with different heart pathologies has been worked out.
Effectiveness: prevention of CCI progress.
Fields of application: pediatric cardiorheumatology, pediatrics.
