Impact of Endothelial Dysfunction and Myocardial Fibrosis on Outcomes in Patients With Chronic Heart Failure After Myocardial Infarction

Chronic heart failure (CHF) is currently one of the main causes of mortality. Its prevalence is predicted to increase as the population ages. In the Russian Federation, over the period from 1998 to 2017, this figure increased from 6.1 to 8.2%, and CHF of functional class III–IV - from 1.8 to 3.1%. Today, a promising direction for determining the prognosis of CHF and its further clinical course is the study of predictors that reflect the pathogenesis of heart failure. Endothelial dysfunction is an independent predictor of the risk of cardiovascular events. Today, it is becoming more obvious that myocardial fibrosis plays a significant role in the pathogenesis of CHF in patients with MI. MF is correlated with increased arrhythmias, hospitalization, and mortality in heart failure. There are two main histological forms of reactive fibrosis, interstitial and perivascular, which often coexist. Interstitial fibrosis is associated with chronic stressors. Perivascular fibrotic tissue is rich in inflammatory cell infiltrate and is more pronounced in conditions with predominant endothelial damage. Differentiating the effects of interstitial and perivascular fibrosis is difficult because these processes usually coexist.