RESUMO
PURPOSE: to evaluate the state of the structure and function of the arterial wall in patients with chronic heart failure (CHF) of ischemic etiology in combination with persistent atrial fibrillation (AF) AF and the dynamics of their changes during therapy with omega-3 polyunsaturated fatty acids (omega-3 PUFA). MATERIAL AND METHODS: in the first phase in order to identify characteristics of a CCF and the restructuring of the arterial wall 120 patients with coronary artery disease and chronic heart failure II-III functional class (FC) were included in the study, then were divided into two equal groups according to the presence of persistent AF. In the second phase patients with CHF and persistent AF were randomized into 2 groups of 30 people to determine the vasoprotective effect of omega-3 fatty acids compared with the standard treatment of CHF. The duration of treatment was 6 months. To assess the conductive and damping functions of arteries comprehensive sfigmopletizmografiyu was carried out. To assess the state of the arteries collagen matrix we determined the level of tissue inhibitor of matrix metalloproteinases type I (TIMP-1) by enzyme immunoassay. RESULTS: in patients with chronic heart failure of ischemic etiology in combination with persistent AF we revealed more severe functional impairment of the arterial wall, characterized by an increase in pulse wave velocity in carotid-femoral segment (p=0.037), the aorta (p<0.001), indexes CAVI1 (p less or equal 0.001) and augmentation (p=0.049; p<0.001) in the absence of differences in the group of patients with heart failure and sinus rhythm in terms of structural changes in collagen matrix- TIMP-1. The progress of CHF against the background persistent AF was characterized by higher levels of atrial natriuretic peptide with prevalence of diastolic dysfunction, while the more frequent co-morbidities (hypertension, diabetes mellitus type 2, stroke/transient ischemic attack), and risk factors. Inclusion in the treatment of patients with chronic heart failure of ischemic etiology and persistent AF omega-3 fatty acids provides reliable vasoprotective effect by suppressing the abnormal collagen formation on the dynamics of TIMP-1 (p<0.001) and improving the elastic properties of the arterial wall to the dynamics of high-speed data and indexed blood flow the arterial tree (p<0.001), with the exception of ankle-brachial indexes. CONCLUSION: structurally functional remodeling of the arterial wall in patients with chronic heart failure of ischemic etiology and persistent AF has a definite pattern of forming. Omega-3 fatty acids have a vasoprotective effect, providing improving elastic properties of the arteries by preventing fibrosis.