“To work out the technology of treatment for children with chronic cardiac insufficiency”
(research supervisor – Doctor of Medical Sciences, professor L.F. Bogmat, 2010−2012 yrs)
Object of study: chronic heart insufficiency (CHI) in children of 12-18 years with myocardial pathology and myocardium systolic dysfunction.
Objective: to improve the treatment methods at the CHI initial stages based on defining some changes in the cardiac morphofunctional characteristics, factors of neurohumoral and immunoinflammatory activation, and quality of life features.
Methods: clinical, ECG, echo +Doppler echo-CG, tests with exercise load (stress-echo-CG and the Six-Minutes-Walk Test), ECG daily monitoring, biochemical, radioimmunologic, immunoenzymatic, and evaluation of life quality according to SF-36 questionnaire.
Theoretical and practical results: It has been shown that therapy including inhibitors of angiotensin-converting enzyme (iACE) has a positive impact on the morphological characteristics of the heart in adolescents with CHI subclinical stage. Such an impact is accompanied by a significant decrease in the RAAS and SAS activity (reduced levels of urinary catecholamine excretion and plasma angiotensin-II & aldosterone content) and in the proinflammatory link (IL-1 , IL-6, and TNF ), as well as by positive changes of the heart rate variability. Against the background of the treatment course with cardiometabolic agents there is registered lack of positive changes in morphological and functional parameters of the heart, the SAS and RAAS activity remains high (increased urinary norepinephrine excretion and plasma angiotensin-II and serum aldosterone levels), there are also registered elevated levels of proinflammatory cytokines (IL-1 and TNF ) and an increased timing of heart rate variability. An improved quality of life according to the scales "general health status" and "mental health" has been observed in patients regardless of the treatment complex . Indications for application iACE and cardiometabolic agents (Trimetazidin, Thiotriasolin, and Cardonat) are established for children with systolic dysfunction. A technology for the treatment of CHI initial stages has been worked out for children with myocardial pathology taking into consideration cardiac morphofunctional characteristics, neurohumoral regulation findings, and quality of life features.
Novelty: Modified indications regarding prescription of iACE are first determined for their use in children with myocardial pathology. Their effectiveness and the efficacy of the prescribed cardiometabolics application are estimated in adolescents with systolic dysfunction.
Effectiveness: Implementation of the differential treatment principles in children with CHI initial signs and the latent myocardial systolic dysfunction will contribute to restoring the heart functional capacity and preventing CHI development, as well as maintaining physical activity of adolescents with myocardial pathology.
Fields of application: medicine, pediatrics, pediatric cardiorheumatology, and family medicine.
