L.G. Voronkov, M.R. Ilnytska, T.I. Gavrylenko, A.V. Lyashenko, L.V. Yakushko, N.A. Ryzhkovа, G.V. Ponomaryova.Adipose tissue hormones, circulating tumor necrosis factor alpha, lipid metabolism and insulin resistance in patients with chronic heart failure and left ventricular systolic dysfunction.

The aim – to study adipose tissue hormones and humoral systemic inflammatory response (TNF-α), lipid status depending on the presence of insulin resistance (IR) in patients (pts) with chronic systolic heart failure (CHF).
Material and methods. We examined 107 pts with CHF II–IV NYHA class without diabetes with left ventricular systolic dysfunction. Insulin and adipokines were determined an automatic enzyme immunoassay analyzer IEMS LabSystems (Finland) using specific reagent kits: insulin (DRG Diagnostics, Germany), leptin (DRG Diagnostic, Germany), adiponectin (Assaypro, USA). Glucose, lipid and uric acid levels in the blood plasma were determined by automatic biochemical analyzer «A-25» (BioSystems, Spain). For the determination of TNF-α in plasma we used enzyme immunoassay test system «Proteins circuit» (Russia). IR was based on the value of the index HOMA ≥ 2.77. All of these studies were conducted on patients achieving euvolemic state. Statistical analysis was performed using the software package SPSS Statistics.
Results. IR was found in 45 patients (42 %) with chronic heart failure. About a third of pts (33 of 107) had a HOMA index value between 3.0 or more. Accordingly IR-pts had higher levels of fasting glucose (5.39±0.59 vs 4.98±0.62 mmol/l, Р=0.001). Also, the insulin level in blood plasma of IR-pts was significantly higher Me=15.34 [12.97; 24.27] compared to the group of non-IR-pts Me=7.87 [4.87; 10.39] mU/ml (Р<0.001) and control group Ме=9.07 [6.47; 12.39] mkU/ml (Р<0,001). On the basic demographic and clinical hemodynamic parameters significant difference was not found between patients with CHF with and without IR. However, patients with CHF and IR had significantly higher values of leptin (Me=8.30 [3.69; 22.01] ng/ml vs 5.53 [1.36; 16.97] ng/ml (Р=0.044), higher values of TNF-α (Me=3.4 [1.35; 19.25] pg/ml vs. Me=2.8 [1.82; 5.38] pg/ml, P=0.041) and uric acid (549.37±155.23 umol/l vs. 463.55±131.15 umol/l, P=0.003) in blood plasma compared with a group non-IR pts with CHF. Conclusions. Patients with CHF, regardless of the IR phenomenon, have higher levels of leptin and adiponectin. In patients with CHF and IR we observed significantly higher levels of leptin in the blood plasma compared to patients with CHF without IR, with no significant differences in levels of adiponectin and relation leptin/adiponectin. In IR-pts with CHF there are signs of humoral autoimmune response with higher levels of circulating tumor necrosis factor-alpha compared to non-IR pts and control subjects. The level of uric acid in the blood plasma was significantly higher in IR-pts with CHF compared to non-IR pts with CHF.

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