RESUMO
OBJECTIVE: To assess the significance of melatonin, NT-proBNP and morphological markers of myocardial remodeling for predicting the risk of complications after coronary artery bypass grafting (CABG) in patients with ischemic heart disease and chronic heart failure (CHF). MATERIALS AND METHODS: We included in this study 83 patients who underwent CABG in the period from September 2013 to October 2014. All patients before CABG underwent standard laboratory and instrumental examination. Concentrations of melatonin and NT-proBNP were measured in 2 days before and after surgery. The evaluation of morphological markers of myocardial remodeling (expression of MT2 melatonin receptors [MTR2], caspase-3, bcl-2) was carried out in tissue samples taken at biopsies of the right atrial appendage during CABG. RESULTS: Analysis of groups of patients with favorable and unfavorable hospital outcomes revealed no significant differences in serum levels of NT-proBNP. There was a significant decrease in the level of melatonin in the subgroup of patients with unfavorable outcome of CABG in combination with high comorbid load and high degree of apoptosis of cardiomyocytes at the background of moderate and high MTR2 expression. Comparative assessment of pharmacotherapy prior to CABG revealed favorable effect on myocardial remodeling of a combination of perindopril and amlodipine. CONCLUSION: Preoperative evaluation of the level of melatonin sulfate, apoptosis markers, and comorbid load can serve as prognostic factors of complicated course of the postoperative period after CABG in patients with CHF. The combination of perindopril and amlodipine in patients with heart failure with preserved ejection fraction exerted a significant cardioprotective effect on the myocardium, contributing to a decrease of the apoptotic dominant.