Echocardiographic Results of Myocardial Revascularization Depending on the Genetic Polymorphism of Inflammatory Cytokines

Introduction: Heart failure – is a clinical syndrome that occurs in response to systolic and/or diastolic myocardial dysfunction, leading to insufficient supply of tissues and organs with oxygen and nutrients. Cardiac fibroblasts are activated under conditions of increased mechanical stress, which is reflected in the dilation of the heart chambers. Under stress, they not only produce an excessive amount of extracellular matrix, but also increase the production of cytokines and stimulate the typical pathogenesis of inflammation.

The study of genes that control the activity of cytokines is one of the important tasks in uncovering the pathogenetic links of the initiation and course of diseases, and identifying predisposition to diseases in the early stages. Knowledge of their role in the pathogenesis of many diseases allows, on the one hand, to predict the risk of developing pathology or the severity of its course, on the other — to individually select specific therapy for a particular patient. It is known that with an unfavorable genetic background, in combination with environmental factors, a pathological phenotype is formed. And interleukin genes have an extremely high degree of polymorphism. So in what combination of genes is the most favorable course of the disease possible and in what case is it fleeting?

Aims: To study the dynamics of the structural and functional state of the myocardium in patients with coronary heart disease during the first year after coronary revascularization, depending on the genetic polymorphism of proinflammatory cytokine genes

Study Design: Observational data.

Place and Duration of Study: Republican specialized scientific practical medical centre of therapy and medical rehabilitation, between January and December 2019.

Methodology: 127 patients with stable forms of coronary heart disease complicated by the development of chronic heart failure, who underwent coronary artery stenting, were examined. All patients were included in the study by echocardiography To assess the structural and functional state of the myocardium, and the genotype of the selected SNP genes IL-1, IL-6 and TNF-alpha with the allocation of minor alleles.

Results: The study showed a lower positive dynamics of the LV myocardial mass index in patients with the IL-6 minor allele and the right ventricular area reduction fraction and LV Tei in patients with the IL-1 minor allele. The TNF-alpha genotype had no significant effect on the processes of myocardial remodeling in CHD patients after revascularization. At the same time, for all three studied genes, a less favorable EchoCG characteristic was preserved during the entire follow-up period in patients carrying the minor allele.

Conclusion: Revascularization, which has an anti-ischemic effect, reduces the activity of the systemic inflammatory response, which explains the more pronounced positive dynamics of EchoCG indicators in patients with an initial high concentration of cytokines and a large number of minor alleles in the genotype of cytokine genes.