[Influence of Loading Dose Of Atorvastatin on the Risk of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction].

Aim      This retrospective cohort study focused on evaluating the incidence of contrast-induced nephropathy (CIN) associated with administration of an atorvastatin loading dose (80 mg) prior to invasive coronary angiography (CAG) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods  This retrospective cohort study included 386 patients with STEMI. The patients were divided into two groups: intervention group (n=118) and control group (n=268). Patients in the intervention group, at the stage of admission to the catheterization laboratory, were administered a loading dose of atorvastatin (80 mg, p.o.) immediately before access (introducer placement). The endpoints were development of CIN, which was determined by increased serum creatinine 48 h following the intervention by at least 25% (or 44 µmol/l) of baseline value. In addition, in-hospital mortality and incidence of CIN resolution were assessed. To adjust the groups for dissimilar characteristics, a "pseudorandomization" method was used by comparing propensity scores.Results The incidence of CIN was significantly lower in the intervention group than in the control group (10.5 % vs. 24.4 %; p=0.016) with the odds for the CIN development lower than in the control group (odds ratio (OR) 0.36; 95 % confidence interval (CI), 0.16-0.85). Creatinine concentrations returned to the baseline value in 7 days more frequently than in the control group (66.3 % vs. 50.6 %, respectively; OR, 1.92; 95 % CI, 1.04-3.56; p=0.037). In-hospital mortality was higher in the control group but did not differ significantly between the groups.Conclusion      ~Administration of atorvastatin 80 mg to STEMI patients immediately before CAG was associated with a reduced risk of CIN and a higher likelihood of serum creatinine returning to the values at admission by day 7.

[Нospital outcomes of coronary artery bypass grafting in patients with coronary heart disease with previous percutaneous coronary intervention].

AIM: Evaluation of the frequency hospital cardiovascular events in groups of patients with stable angina who underwent percutaneous coronary interventions (PCI) with stenting of the arteries before coronary bypass surgery, or who did not have previous myocardial revascularization. MATERIALS AND METHODS: The 120 patients with stable angina who underwent routine coronary artery bypass grafting were examined. Group composition: Men 80.8%, age 587.6, duration of coronary heart disease 65.7 years, history of myocardial infarction (MI) 77.5%. Arterial hypertension was present in 92.5%, diabetes mellitus in 12.5% of patients. Multivessel coronary artery disease in 72.5% of patients. 28 (23.4%) patients had previously undergone PCI with stenting of the coronary arteries. The period from PCI to coronary bypass surgery was 2032.6 months. Coronary bypass surgery on-pump was performed in 88.3%, coronary bypass surgery on off-pump in 11.7%. The number of distal anastomoses ranged from 1 to 4. RESULTS: There were no differences in clinical and angiographic indicators, pharmacotherapy, and operation characteristics between the groups of patients who were subjected to or did not have PCI before coronary bypass surgery. There were no differences between the analyzed groups of patients in the frequency of cardiac death (0 and 1.1%, p=0.58), non-fatal MI (3.6% and 9.8%, p=0.29), stroke (0 and 1.1%, p=0.58), acute heart failure (11.7% and 34.8%, p=0.06), the number of patients with paroxysms of atrial fibrillation (28.6% and 17.4%, p=0.94), the proportion of patients with resternotomies (3.6% and 3.3%, p=0.94) and gastrointestinal bleeding (3.6% and 4.3%, p=0.86). CONCLUSION: PCI with coronary artery stenting, prior to coronary bypass surgery, does not affect the frequency of post-operative hospital cardiovascular and hemorrhagic complications.

Risk Factors and Hospital Outcomes of Acute Kidney Injury in Patients Operated on for an acquired Valvular Heart Disease.

Aim      To determine predictors of acute kidney injury (AKI) related with surgeries for correction of acquired valvular heart disease (HD) and to evaluate the incidence of in-hospital complications in patients with postoperative AKI.Material and methods  This study included 62 patients after surgery for correction of acquired valvular HD (mean age, 61±10.9 years) with a disease duration of 11±5.3 years. NYHA functional class (FC) 1 chronic heart failure (CHF) was observed in 1.6 % of patients, FC 2 in 64.5 %, and FC 3 in 33.9 %.17.7% of patients had chronic kidney disease (CKD). Coronary lesions of ≥50 % of vascular lumen were detected in 27.4 % of patients. Surgical correction of mitral valvular disease was performed in 32 cases, aortic valvular disease in 36 cases, tricuspid valvular disease in 8 cases, and combined operations for correction of valvular disease and coronary bypass in 8 cases. Creatinine concentrations were measured according to the Jaffe method; glomerular filtration rate (GFR) was estimated with the CKD-EPI equation. AKI was diagnosed based on KDIGO (2012) criteria.Results The AKI incidence related with surgeries for correction of valvular HD was 16.1 % (8.1 % of patients had stage 1 AKI, 3.2 % had stage 2 AKI, and 4.8 % had stage 3 AKI), and 3.2% required kidney replacement therapy. AKI was associated with the presence of CKD at baseline (р=0.044), development of hemopericardium requiring drainage (р=0.012), more pronounced coronary lesions (in the AKI group: stenoses from 50 to 70 % in 20% of patients, from 70 to 90 % in 30 % of patients, and ≥90 % in 0 %; without AKI: from 50 to 70 % in 13.4 % of patients, from 70 to 90 % in 3.8 %, and ≥90 % in 5.8 % of patients, respectively; р=0.032). Probability of postoperative AKI significantly increased with the development of hemopericardium requiring drainage. Patients with postoperative AKI compared to persons without AKI had higher mortality (20 % and 0 %; р=0.001), greater incidence of decompensated CHF (40 and 9.6 %; р=0.012) and hemopericardium requiring drainage (30 and 1.9 %; р=0.012).Conclusion      The development of postoperative AKI is associated with CKD at baseline, more pronounced coronary injury, and hemopericardium requiring drainage.

[Prognostic value of acute cardiorenal syndrome in patients with acute cardiac pathology].

AIM: To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI. MATERIALS AND METHODS: In a prospective study included 863 patients, of which 141 with ADCHF, 446 - non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 - ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes. RESULT: During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % - NSTE-ACS, 10,9 % - STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % - STEMI and 21,4 % - NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158-873,976), р<0,001) and STEMI (OR 95 % 5,395 (2,451-11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95 % 1,875 (0,221-15,930), р=0,565) and NSTE-ACS (OR 95 % 1,199 (0,421-3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg / l (OR 95 % 5,763 (1,338-24,819), р=0,019), GFR<45 ml / min initially at admission to hospital (OR 95 % 76,593 (1,193-36,446), p=0,031), age>75 years (OR 15,933 (1,020-248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476-7,146), p=0,003), female gender (OR 95 % 2,321 (1,190-4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777-60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051-2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193-5,517), р=0,016). CONCLUSION: In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml / min, AU more than 30 mg / l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.

[Clinical and prognostic value of the residual activity of platelets in patients with acute coronary syndrome without st segment elevation].

AIM: To study clinical prognostic value of residual platelet activity in patients with acute coronary syndrome without ST segment elevation. MATERIAL AND METHODS: The study included 120 patients with acute coronary syndrome without ST segment elevation (NSTE ACS) with coronary artery stenting. Testing of residual reactivity of platelets in the subjects was carried out after loading doses of  aspirin and P2Y12-inhibitors.Patients were divided into two groups comparable in gender and age: with low residual reactivity of platelets (LRR), n=90 and with high residual reactivity of platelets (HRR), n=30. Between the groups a comparative assessment of clinical-laboratory and instrumental indicators, development of a combined end point (ischemic events) and bleeding during follow-up (16 ± 6 months). RESULTS: The group with HRR was initially heavier: patients with angina pectoris of functional class III, atrial fibrillation, myocardial infarction, was a higher risk on the GRACE (202,6±11 vs. 148,6±7, р=0,03),increased levels of Troponin T (70,0 vs. 45,5%, р=0,02), acute occlusion in the coronary arteries (66,6 vs. 42,4%, р=0,02).The combined endpoint was more often reported in patients with HRR (40 vs. 20,7%, р=0,04). Patients with ADP-aggregation of platelets in the range 0-1 Om had a greater risk of developing hemorrhagic events (17,1 vs. 2,1%, RR 8,05 CI: 1,1-59,9, р=0,01). CONCLUSION: In patients with NSTE ACSHRR after loading doses of aspirin and P2Y12-inhibitor was associated with the development of repeated atherothrombotic events. Very low LRR was associated with the development of bleeding.

[The importance of modern high - sensitivity troponin tests in the diagnosis of myocardial infarction without ST-segment elevation].

The literature review presents the characteristics of modern high - sensitivity tests for detection of Tn (hs - cTn) in the blood and the results of large studies on the diagnosis of non segment elevation myocardial infarction (nonSTEMI) using hs - cTn. The results of these studies served as the basis for the development of three - and one - hour diagnostic algorithms nonSTEMI, presented in the recommendations of the European Society of Cardiology 2012 and 2015 and also in fourth Universal Definition of Myocardial Infarction 2018.

[Contrast-Induced Acute R enal Injury After Percutaneous Coronary InterventionI in Patients With ST-Segment Elevation Myocardial Infarction].

AIM: To assess frequency and prognostic value of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We included in this prospective observational study 233 patients with STEMI. Duration of follow-up was 6 months. During this period, we traced development of CI-AKI with subsequent analysis of relation of CI-AKI to STEMI outcomes. RESULTS: CI-AKI was registered in 29.6% of patients. Hospital mortality was 14.5 and 6.1% among patients with and without CI-AKI, respectively (p=0.037). Mortality from cardiovascular causes during the follow-up period was 17.4 and 7.3%, respectively (p=0.021). CI-AKI was associated with increase of risk of death during hospitalization (odds ratio 2.6, 95% confidence interval 1.033-6.592, p=0.042). The development of CI-AKI was associated with glomerular filtration rate.

[Predictors of acute heart failure in patients with ST-segment elevation myocardial infarction of the electrocardiogram after PCI].

BACKGROUND: Despite the PCI in patients with ST-segment elevation myocardial infarction (STEMI) the development of acute heart failure (AHF) Killip ≥II is associated with a poor prognosis. AIM: To identify predictors of the development of AHF and the prognostic value of AHF in patients with STEMI after PCI. MATERIALS AND METHODS: In a prospective study, which lasted 6 months, included 233 patients (average age of 62.1±10.89 years, 73.4% of men) admitted to the hospital due to the development of STEMI who underwent PCI. The endpoint was defined as the death from cardiovascular causes. Statistical processing of the results was carried out using the statistical packages of the programs "SPSS Statistics 17.0". RESULT: During the follow-up observation from 1 day to 6 months (median follow-up of 5.2 months), 25 patients (10.7%) reported the onset of the endpoint, including 20 cases during the index hospitalization. AHF Killip ≥II during indexed hospitalization developed in 25 patients (10.7%). Independent predictors of Killip ≥II were: GFR.

[Duration and Timing of Initiation of Therapy With Platelet P2Y12 Inhibitors in the Treatment of Patients With Acute Coronary Syndrome].

In recent years, the issues of choice of an agent for dual antiplatelet therapy (DAPT) as well as timing of initiation and duration of DAPT in patients with acute coronary syndrome (ACS) have been actively discussed. In this article we present data of major randomized trials of clopidogrel and novel P2Y12 inhibitors - prasugrel, ticagrelor, cangrelor - assessing strategy of administration of antiaggregants in patients with ACS before coronary angiography / percutaneous coronary intervention. The article also contains analysis of differences between recommendations of the European Society of Cardiology and American College of Cardiology/American Heart Association on therapy with oral P2Y12 inhibitors in the management of patients with ACS.

Cardiorenal syndrome in the early stages of coronary bypass surgery.

AIM: Evaluate the frequency and risk factors of postoperative atrial fibrillation (pAF) in patients with chronic coronary artery disease (CHD) with acute kidney injury (AKI) developed in connection with coronary artery bypass grafting (CABG). MATERIALS AND METHODS: The study involved 90 patients (pts) undergoing CABG at age 58±7 years, duration of CHD - 6±6 years. 80% of pts had previous myocardial infarction. Chronic heart failure, functional class II was detected in 53.3% pts, functional class III - in 46.7% pts. Multi-vessel coronary lesions had 75.6% pts. CABG with cardiopulmonary bypass was performed in 88.9% pts, operation on a beating heart was fulfilled in 11.1% pts. Creatinine was determined by Jaffe method, the glomerular filtration rate (GFR) was calculated with the СКD-EPI formula. AKI was diagnosed according to KDIGO criteria, 2012. RESULTS: The frequency of transient AKI after CABG was 33.3%, pAF - 17.8 %, pAF among those with AKI was 20%. The development of AKI was associated with higher levels of troponin T after CABG (Me [25; 75 percentiles] - 0.36 [0.24; 0.99] versus 0.28 [0.11; 0.50] ng/ml; p=0.037), with more frequent use of inotropic drugs (60% and 25%; p=0.002), longer duration of inotropic therapy (2.0 [1.0; 2.5] versus 1.0 [0; 1.0] days; p=0.001). The proportion of patients who had pAF among those with AKI and without it were not significantly different (20% and 16.7%; p=0.7). Decrease in GFR less than 39 [29.8; 45.7] ml/min/1.73 m2 after CABG was the most important risk factor of pAF in pts with CHD and AKI.

[Rate of in-hospital cardiovascular complications in patients with postoperative renal dysfunction after surgical myocardial revascularization]. / Chastota gospital'nykh serdechno-sosudistykh oslozhnenii u bol'nykh s posleoperatsionnoi disfunktsiei pochek posle khirurgicheskoi revaskulyarizatsii miokarda.

The study was aimed at revealing the factors associated with renal dysfunction having developed after coronary artery bypass grafting (CABG) and assessing the in-hospital cardiovascular complications rate amongst patients with postoperative renal dysfunction. The study included a total of 99 patients presenting with stable angina pectoris and having indications for CABG. The mean age of the patients amounted to 57±7 years, with the average duration of coronary artery disease (CAD) of 6±5.7 years. A multi-vessel lesion of coronary arteries was revealed in 69.7% of patients, ≥ 50% stenosis of the trunk of the left coronary artery was diagnosed in a further 15.1%. CABG was performed in conditions of assisted circulation (AC) in 88.9% of patients and on the functioning heart in 11.1%. We implanted from 1 to 4 grafts to each patient. At admission, and then on the first and second postoperative days after CABG we determined blood serum creatinine and calculated the creatinine clearance (CrCl) according to the Cockcroft-Gault equation. A decrease in the CrCl < 60 ml/min was regarded as renal dysfunction. Assessing the cardiovascular complications rate we took into consideration cases of cardiac death, perioperative myocardial infarctions (POMI), severe acute cardiac insufficiency having required placement of a counterpulsator, and as well as the proportion of patients with paroxysmal atrial fibrillation. We also evaluated the frequency of repeat sternotomy. The incidence rate of transitory renal dysfunction following CABG amounted to 18.2%. The factors associated with a decrease in the CrCl < 60 ml/min after CABG were found to be as follows: age above - Me 62.5 (range 59-68) years, increased duration of AC above - Me 103 (range 88-133) min and prolonged time of aortic occlusion (AO) above - Me 53 (range 44-60) min, severe postoperative acute cardiac insufficiency, and re-sternotomy. The cumulative rate of in-hospital cardiovascular complications turned out to be significantly higher (55.6 versus 18.5%, p=0.001) amongst patients with postoperative renal dysfunction. We also revealed a substantially higher incidence rate of re-sternotomies in the cohort of patients with a CrCl < 60 ml/min after CABG (11.1 vs.1.2%, p=0.027). Hence, moderate transitory renal dysfunction appears to develop nearly in every fifth patient in the early period after CABG. The risk factors for the development of postoperative renal dysfunction include: age, increased duration of the period of artificial circulation (AC) and time of aortic occlusion (AO), severe acute postoperative cardiac insufficiency, and re-sternotomy. Even moderately pronounced transitory renal dysfunction after CABG is associated with an unfavourable prognosis of in-hospital cardiovascular complications.

[Prognostic value of pathogenetic therapy-induced changes in NT-proBNP in patients with chronic heart failure].

AIM: To study the prognostic value of therapy-induced changes in plasma NT-proBNP levels in patients with left ventricular (LV) systolic dysfunction. SUBJECTS AND METHODS: The study covered 84 patients aged 23 to 70 years (mean 54 +/- 8.1 years) with LV systolic dysfunction (an ejection fraction of < 40%). Plasma NT-proBNP levels were determined in all the patients at baseline and 3 months later to evaluate the efficiency of therapy for heart failure (HF). The median follow-up was 18 months. The follow-up recorded the following outcomes (end points): death from decompensated HF and unplanned hospital admissions for progressive HF symptoms. RESULTS: The baseline and therapy high plasma levels of NT-proBNP (more than 3000 pg/ml) were associated with worsening prognosis. The therapy-induced decrease in NT-proBNP levels was associated with more favorable prognosis. CONCLUSION: Repeat dynamic determination of plasma NT-proBNP levels allows identification of patients at increased risk of poor outcomes for a more intensive observation and more aggressive pathogenetic therapy.

[Prognostic power of various models in determination of level of coronary risk in patients with non ST-elevation acute coronary syndrome].

The GRACE prognostic scale appeared ineffective for prognostication of deaths and sum of deaths and myocardial infarctions (MI) during hospitalization and demonstrated moderate level of prognostic value during 6 months of observation. TIMI model gave similar result relative to prediction of death/MI/refractory ischemia during 14 days and 12 months of observation. PURSUIT risk model showed very good level of prognostic significance during 30 days and 12 months of observation. Comparison of GRACE and PURSUIT models relative to all cause death and composite of death and MI showed that PURSUITd scale had better accuracy of predictions.

[Prognostic value of creatine kinase MB-fraction and TroponinT increase in patients after coronary bypass grafting (data of 3-year prospective observation)].

The aim of this work was to investigate prognostic value of creatine kinase MB-fraction and troponin T increase in patients after coronary bypass grafting (during 3-year prospective observation). Parameters were studied in 6, 12, 48 and 72 hours after surgical myocardial revascularization. It was revealed that increase of myocardial necrosis markers is associated with significant more frequent development of cardiovascular complications during 3-year prospective observation.

[Early invasive and non-invasive approach to treatment of acute non-ST-segment elevation coronary syndrome].

AIM: The aim of the study is to assess the efficiency of early invasive treatment versus conservative treatment for patients with non-ST acute coronary syndrome (ACS), and to study immediate results of percutaneous coronary intervention (PCI) in terms of the risk of adverse events. MATERIAL AND METHODS: The investigation includes 112 patients with non-ST ACS having risk of adverse outcome determined by the GRACE system. More than half of the patients (77/68.8%) underwent diagnostic coronary angiography within 72 hours of admission, and the decision was made on a subsequent treatment strategy (early invasive or conservative approach). In-hospital outcomes (cardiac deaths, nonfatal MI, reMI), cumulative frequency of these events have been studied according to the risk assessment scale GRACE and treatment strategy. RESULTS: Low risk was determined in 33.9% of patients, intermediate--in 32.1%, and high--in 33.9%. On the whole, frequency of myocardial revascularization was assessed as 56.3%. Fifty-one (45.5%) patients received early invasive treatment, 12 (10.7%)--coronary artery bypass grafting (CABG). A conservative approach was used in 49 cases (43.8%). An early invasive treatment was given to 20 patients (52.6%) from each of the low- and high-risk groups, 11 (30.6%)--from the intermediate risk group. In-hospital cardiac deaths were observed only in the high-risk group, and this number was higher in case of conservative treatment versus early invasive treatment: 3 (30%) versus 1 (50%). Non-fatal MIs in the form of re(MI) were also diagnosed only in the high-risk group following conservative treatment: 2 (20.0%). Nevertheless, no reliable difference in the frequency of each complication was found (p = 0.095; p = 0.1). Significant differences in the high-risk group were proven while comparing the impact of early invasive and conservative approaches on the cumulative frequency of in-hospital death and (re)MI cases (50.0% versus 5.0%; p = 0.009). No benefits of an early invasive approach were identified for low-risk and intermediate risk groups. CONCLUSION: Early invasive approach compared with a conservative approach in high risk patients with non-ST acute coronary syndrome can improve clinical outcomes with a decrease in the total frequency of in-hospital death, reMI.

[Acute coronary syndrome in patients with carbohydrate metabolic disturbances (a review)].

The review gives the results of large clinical studies of the prognostic value of hyperglycemia in patients with acute coronary syndrome and discusses the basic mechanisms determining the increased cardiovascular risk. The advantages of invasive treatment policy are also described in diabetic patients with an exacerbation of coronary heart disease.

[Prognostic value of plasma levels of N-terminal pro-brain natriuretic peptide and proinflammatory cytokines in patients with heart failure of ischemic etiology].

We included 63 patients with chronic heart failure of ischemic origin (32 with left ventricular ejection fraction less than 40%) into prospective study with average duration of follow-up 27+/-10 months. Relative risk of lethal outcome was significantly increased in patients with initial endsystolic left ventricular dimension >6.0 m, enddiastolic left ventricular dimension >7.0 m, left atrial dimension >5.0 cm, left ventricular ejection fraction <35%, hemoglobin level <120 g/L, with disturbances of rhythm and conduction, and elevation of plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) >1000 mol/ml and interleukin-6 >20 g/ml. Relative risk of combined endpoint significantly increased at same values of echocardiographical parameters, plasma levels of NT-proBNP >500 mol/ml and interleukin-6 >10 g/ml.

[N-terminal fragment of the brain natriuretic peptide and proinflammatory cytokines in patients with ischemic heart disease].

AIM: To determine plasmic concentrations of NT-proBNP, TNFalpha and IL-6 in patients with coronary heart disease (CHD) complicated with chronic cardiac failure (CCF); to compare these parameters with hemodynamic and functional ones. MATERIAL AND METHODS: A total of 157 CHD patients (84.1% males, mean age 54.3 +/- 6.8 years) were divided into 3 groups matched by sex and age according to the presence of CCF and left ventricular (LV) or systolic dysfunction. RESULTS: CCF patients with LV dysfunction or intact LV function had much higher plasmic concentrations of neurohumoral mediators than CHD patients without CCF. A plasmic NT-proBNP level over 1000 fmol/ml was associated with a 5.5-fold increase in the relative risk of LV diastolic dysfunction for CCF patients (rR 5.6; 95% CI 1.4-30.0; p = 0.0065) while an IL-6 level over 6.1 pg/ml was associated with a 9-fold increase in this risk (rR 8.9; 95% CI 2.3-35.4; p = 0.00001). Plasmic NT-proBNP and IL-6 levels went up in correlation with a CCF functional class. A plasmic level of TNFalpha correlated with anginal functional class. CONCLUSION: Changes in plasmic levels of the above neuromediators are associated with changes in some LV function and functional parameters of CCF patients.