vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1280BMTGSAvestar-1430Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESСравнительный анализ эндокринного профиля и пяти-летней выживаемости мужчин-респондеров сердечной ресинхронизирующей терапии, проживающих в условиях Крайнего Севера и юга Тюменской областиComparative analysis of endocrine profile and five-year survival of cardiac resynchronization therapy male responders residing in conditions of the Far North and south of Tyumen regionhttps://orcid.org/0000-0002-7443-2952ЕнинаТ. Н.EninaT. N.

Енина Татьяна Николаевна

Тюмень, ул. Мельникайте, д. 111

Tatyana Enina

Tyumen, 111 Melnikayte str.

enina@infarkta.nethttps://orcid.org/0000-0001-6251-4179ПетелинаТ. И.PetelinaT. I.

Тюмень, ул. Мельникайте, д. 111

Tyumen, 111 Melnikayte str.

https://orcid.org/0000-0002-4325-2633ШироковН. Е.ShirokovN. E.

Тюмень, ул. Мельникайте, д. 111

Tyumen, 111 Melnikayte str.

РепинаИ. А.RepinaI. A.

Тюмень, ул. Мельникайте, д. 111

Tyumen, 111 Melnikayte str.

https://orcid.org/0000-0002-3620-0659ГапонЛ. И.GaponL. I.

Тюмень, ул. Мельникайте, д. 111

Tyumen, 111 Melnikayte str.

Тюменский кардиологический научный центр, Томский национальный исследовательский медицинский центр Российской академии наукРоссияTyumen Cardiology Research Center, Tomsk National Research Medical Center of the Russian Academy of SciencesRussian Federation202405112024314516Copyright © Енина Т.Н., Петелина Т.И., Широков Н.Е., Репина И.А., Гапон Л.И., 20242024Енина Т.Н., Петелина Т.И., Широков Н.Е., Репина И.А., Гапон Л.И.Enina T.N., Petelina T.I., Shirokov N.E., Repina I.A., Gapon L.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1430Цель

Цель. Оценить эндокринный профиль, биомаркеры сердечной недостаточности, 5-летнюю выживаемость мужчин-респондеров сердечной ресинхронизирующей терапии (СРТ), проживающих на Крайнем Севере (КС) и юге Тюменской области (юТо).

Материал и методы исследования. Пятьдесят шесть мужчин-респондеров СРТ (с уменьшением конечно-систолического объема левого желудочка >15% в ноябре 2020 г) до 65 лет (55,0±7,8 года) разделены на группы: 1 (n=23) - пациенты КС; 2 (n=33) - юТо. В динамике выполнены исследования: эхокардиография (ЭхоКГ), тиреотропный гормон (ТТГ), трийодтиронин (сТ3), тироксин (сТ4), паратгормон (ПТГ), кортизол (КОРТ), тестостерон (TEС), эстрадиол (ЭСТР), дигидроэпиандростерона сульфат (ДГЭАС), прогестерон (ПГН), адреналин (Адр), норадреналин (НАдр), интерлейкины (ИЛ) 6, 10, фактор некроза опухоли альфа (ФНО-α), С-реактивный белок (СРБ), N-концевой фргмент натрийуретического пептида (НУП), миелопероксидаза (МПО), матриксная металлопротеиназа (ММП-9), тканевой ингибитор металлопротеиназ (TИMП-1). Методом Спирмена оценены связи гормонов с ЭхоКГ, биомаркерами, Каплана-Майера - 5-летняя выживаемость, связь с ней изучаемых факторов регрессией Кокса.

Результаты

Результаты. Группы различались частотой радиочастотной аблации атриовентрикулярного соединения (РЧА АВС) (47,8 vs 21,2%; p=0,036). Исходно в 1 группе отмечены большие: правый желудочек (ПЖ), Адр, ФНО-α, СРБ, TИMП-1, КОРТ, ТТГ, сТ4, меньшее сТ3/сТ4. В динамике в группах выявлено обратное ремоделирование сердца; в 1 группе - снижение ТИМП-1, ПГН; во 2 - снижение НУП, ТИМП-1, МПО, ПГН, увеличение TEС, ЭСТР, ФНО-α. Выявлены положительные связи ТТГ, ПТГ и отрицательные ДГЭАС с показателями ЭхоКГ; положительные связи ПГН, КОРТ c ММП-9; ТЕС с НАдр; ЭСТР с ИЛ-10. Пятилетняя выживаемость составила 80,7% vs 83,4% (Log Rank test=0,724), ассоциированная у северян с уровнем ИЛ-6.

Заключение

Заключение. Большие уровни КОРТ, ТТГ, сТ4, меньшие сТ3/сТ4, сопряженные с симпатоадреналовой, иммунной активациями, дисбалансом фиброобразования, большими размерами ПЖ, частотой РЧА АВС у северян отражают синдром арктического напряжения. Модулирующие эффекты СРТ способствовали сопоставимой 5-летней выживаемости в группах, ассоциированной у северян с уровнем ИЛ-6.

Aim

Aim. To evaluate endocrine profile, biomarkers of heart failure, 5-year survival of cardiac resynchronization therapy (CRT) male responders living in the Far North (FN) and the south of Tyumen region (sTr).

Methods

Methods. Fifty-six CRT male responders (with decrease of left ventricular end-systolic volume >15% in November 2020) under the age of 65 (55.0±7.8 years old) were divided into 2 groups: 1(n=23) - FN patients; 2 (n=33) - sTr. Echocardiography (Echo), thyroid-stimulating hormone (TSH), triiodothyronine (fT3), thyroxine (fT4), parathyroid hormone (PTH), cortisol (CORT), testosterone (TES), estradiol (E2), dihydroepiandrosterone sulfate (DHEAS), progesterone (PGN), adrenaline (Adr), norepinephrine (NAdr), interleukins (IL) 6, 10, tumor necrosis factor (TNF-α), C-reactive protein (CRP), NT-proBNP, myeloperoxidase (MPO), matrix metalloproteinase (MMP-9 ), tissue inhibitor of metalloproteinases (TIMP-1) were assessed. Relationship of hormones with Echo, biomarkers was evaluated by Spearman method, 5-year survival - by Kaplan-Meier method, and association of lastmentioned with studied factors - by Cox regression.

Results

Results. Radiofrequency ablation of atrioventricular junction (RFA AVJ) were differed in groups (47.8 vs 21.2%; p=0.036). At the initial stage, in group 1, right ventricle, Adr, TNF-α, CRP, TIMP-1, CORT, TSH, fT4 were greater, fT3/fT4 was lower. In groups, reverse cardiac remodeling was revealed in dynamics; decrease of TIMP-1, PGN in Gr1; decrease of NT-proBNP, TIMP-1, MPO, PGN, increase of TES, E2, TNF-α in Gr2,. Positive associations of TSH, PTH and negative - DHEAS with Echo; positive connections between PGN, CORT and MMP-9; TES with NAdr; E2 with IL-10 were registered. Five-year survival rate was 80.7% vs 83.4% (Log Rank test=0.724), associated with IL-6 level in northerners.

Conclusion

Conclusion. Multihormonal imbalance, manifested by greater levels of CORT, TSH, fT4, lower values of fT3/fT4, accompanied by sympatho-adrenal, immune activation, fibroformation imbalance, higher power of RFA AVJ, indicates greater severity of heart failure, tension of adaptive mechanisms in CRT male responders of FN. CRT modulating effects in groups contributed to comparable 5-year survival associated with level of IL-6 in northerners.

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The authors declare that there are no conflicts of interest present.