The associations of cytokines and gens polymorphisms of ß-adrenoceptors in patients with heart failure and some thyroid pathology (literature review and own observations).

OBJECTIVE: Aim: To analyze the role of cytokines in the progression of heart failure (HF) in patients with concomitant pathology of the thyroid gland. PATIENTS AND METHODS: Materials and Methods: The systematization of literature data on the role of cytokines in the progression of HF in patients with concomitant thyroid pathology (TP) was carried out. The results of our own research were presented. CONCLUSION: Conclusions: The final chapter in the history of the role of cytokines in the progression of HF has not yet been written. Further studies, including genetic ones, are necessary. The patients with HF have higher levels of TNFß and IL-6, and a lower concentration of IL-4, compared to the control group. Patients with a fatal outcome of the disease, in contrast to those who survived for two years, have an increased level of TNFß. In patients with concomitant TP, who had repeated hospitalization, a lower level was registered, compared to that under conditions of a more favorable course of heart failure. Concentrations of cytokines in the blood of patients with HF are associated with gene polymorphisms of the ß-adrenoreceptor system: the C-allele of the Gly389A polymorphism of the ß1-adrenoceptor gene leads to a decrease in the risk of increasing TNFα; IL-1α increases in the presence of the A-allele of the Ser49Gly polymorphism of this gene. In patients with HF and concomitant thyroid pathology, the risk of IL-6 growth increases in homozygous (C) patients for the Ser275 polymorphism of the ß3 subunit of the G-protein.

Use of beta-blockers in patients with heart failure - unresolved issues.

The analysis of literature data reflecting the issues of the mechanisms of action of beta-blockers in patients with heart failure are present. The heart failure has many variants. With each of these options, the concentration of catecholamines and the sensitivity of beta receptors change differently. The effectiveness of beta-blockers also differs in this. The beta-adrenergic receptors genes polymorphisms also affect the efficacy and safety of beta-blockers. The comorbidities also affect to the action and efficacy of beta-blockers in patients with heart failure. When using beta-blockers in patients with heart failure, there are still many unresolved questions: What is the best reference point for titration of drugs - dose or heart rate; what effects do these drugs have in heart failure with a preserved left ventricular ejection fraction? How do beta-blockers affect the course of heart failure in patients with comorbid thyroid pathology, taking into account their pharmacological properties and their effect on the activity of peripheral deidinases?

The effect of beta-blockers on a course of chronic heart failure in patients with a low triiodothyronine syndrome.

OBJECTIVE: The aim: The aim is to study the effect of ß-ABs in patients with LT3 S on the course of HF. PATIENTS AND METHODS: Materials and methods: 354 patients with HF on a background of post-infarction cardiosclerosis were included in the 2-yeared follow-up study. LT3 S was diagnosed at 89 (25.1%) patients. The levels of thyroid-stimulating hormone, free T3f and T4f, and reversible T3 were determined. The echocardioscopy was performed. RESULTS: Results: Patients with HF in combination with LT3 S have a heavier functional class by NYHA, greater dilatation of the left heart cavities, less myocardial contractility, a higher frequency of atrial fibrillation and re-hospitalization. The use of ß-ABs in patients with HF without LT3 S leads to a likely decrease in hospitalization frequency, while in patients with LT3 S it has an opposite effect. The frequency of rehospitalization increases with an excess of ß-ABs dose > 5 mg (equivalent to bisoprolol). At these patients a decrease in serum T3 level and negative dynamics of parameters of intracardiac hemodynamics are observed. CONCLUSION: Conclusions: The use of ß-ABs in patients with LT3 S leads to an increase in re-hospitalization at a dose over 5.0 mg (equivalent to bisoprolol). In these patients there is a decrease in serum T3, an increase in T4 level; and the ejection fraction decrease; and heart cavities size increase.