The Relationship of Indicators of Endothelial Function and Myocardial Fibrosis With the Severity of Coronary Atherosclerosis in Patients With Chronic Heart Failure Who Have Had a Myocardial Infarction

Highlights The severity of coronary atherosclerosis associated with a deterioration in the deformational properties of the myocardium, disturbances in microcirculation, as well as an increase in inflammatory and profibrotic biomarkers. Abstract Aim. To study the relationship between the severity of coronary atherosclerosis, endothelial dysfunction and myocardial fibrosis in patients with chronic heart failure who have had a myocardial infarction. Methods. 96 patients with chronic heart failure hospitalized in the acute period of myocardial infarction were included. All participants underwent: echocardiographic examination with assessment of left ventricular ejection fraction (LVEF) and global longitudinal strain, laser doppler flowmetry, assessment of biomarker levels (CRP, sST2, NTproBNP, VEGF), coronary angiography. Results. According to coronary angiography results, multivessel coronary artery disease was identified in 58 (60.4%) patients, and left main coronary artery (LMCA) involvement was found in 20 (20.8%). The severity of coronary atherosclerosis was associated with a decrease in LVEF (R = –0.31, p = 0.002), global longitudinal strain (R = –0.73, p < 0.001), amplitude-frequency parameters of microcirculation, volume of regulatory mechanisms, and coefficient of variation of microcirculation (R = –0.3, p = 0.003), as well as an increase in the degree of left ventricular diastolic dysfunction (R = 0.31, p = 0.002), capillary blood flow reserve (R = 0.29, p = 0.005), concentrations of CRP (R = 0.32, p = 0.002), NT-proBNP (R = 0.71, p < 0.001), and sST2 (R = 0.77, p < 0.001). Inverse relationships were identified between the number of affected coronary arteries and LVEF (R = –0.23; p = 0.027), coefficient of variation of microcirculation (R = –0.36, p < 0.001), and amplitude of microcirculation oscillations in the neurogenic range (R = –0.24, p = 0.019). Patients with LMCA stenosis had lower LVEF, amplitudes of oscillations in the neurogenic and myogenic ranges, as well as higher capillary blood flow reserve values. Conclusion. The results of the study indicate a relationship between the severity of coronary atherosclerosis and changes in hemodynamics at the microcirculatory level, fibrotic remodeling of the myocardium, and concentrations of biomarkers such as CRP, NT-proBNP, and sST2.