Tumor necrosis factor in blood plasm and morphofunctional parameters of the heart in patients with chronic heart failure complicating the course of ischemic heart disease. Changes in response to treatment

Aim. To examine the course of chronic cardiac failure (CCF), morphofunctional parameters of the heart in correlation with activity of cytokine system; to evaluate effectiveness, tolerance and safety of combined CCF treatment including a cardioselective fi-adrenoblocker bisoprolol in patients with CCF FC I-IV having a high plasm level of tumor necrosis factor a (TNF-a). Material and methods. The concentration of TNF-a in plasm of 40patients with IHD complicated by CCF of FC I-IV and ejection fraction under 45% was measured at enzyme immunoassay. The treatment included combined therapy with diuretics, cardiac glycosides, peripheral vasodilators, ACE inhibitors, bisoprolol (group 1) or no bisoprolol (group II). Results. CCF patients with TNF-a had a significally reduced IMT, more frequent episodes of CCF decompensation, longer CCF history, lower EF and threshold exercise intensity. In group I patients all these parameters improved. Conclusion. CCF patients with elevated plasm levels of TNF-a showed a severe course of the disease, low IMT, abnormal myocardial contraction and exercise tolerance. The addition of bisoprolol to combined treatment of the above patients improves their clinical condition, morphological parameters of the heart and exercise tolerance.