The aim – to study diagnostic and prognostic possibilities of cardiotropic autoantibodies in the elderly patients with ischemic heart disease and different myocardial contractile function.
Material and methods. 130 patients with ischemic heart disease and stable angina pectoris II–III functional classes, at the age range 60–74 years (average age 69.5±0.9 years) were included. Among them, 70 patients with chronic heart failure IIA stage, II–III functional classes NYHA, with decreased left ventricular contractile fiunction (left ventricular ejection fraction (LVEF) < 45 %) and 60 patients with preserved LVEF (> 45 %). 10 normal subjects aged 60–75 years were examined as controls. The follow-up period was 3 years. At an initial stage, a comprehensive medical history was collected for all patients, as well as data of current clinical, instrumental and laboratory tests (ECG, echocardiography, blood, urine samples), HRV. Cardiotropic autoantibodies levels were assessed using imunoenzyme method.
Results. Patients with LV dysfunction had significant differences regarding incidence of increased titer of cardiotropic autoantibodies, characterizing status of different myocardial structures: β1-adrenergic receptors (β1-AR), membranes of cardiomyocytes (Com-02), cytoplasm of cardiomyocytes (Cos-05), cardiomyosin (L-myosin). It has been noted that in patients with left ventricular systolic dysfunction an increased autoantibodies titer was observed 2–3 times more frequently than in patients with unchanged LVEF. The results of a correlation analysis revealed the presence of a probable inverse correlation between the level of autoantibodies to β1-AR (r=0.81; P<0.05), Com-02 (r=0.62; P<0.05), Cos-05 (r=0.58; P<0.05) and LVEF. The titer of autoantibodies to β1-AR was found to have the best predictive value for stratifying patients in the group with chronic heart failure. At higher levels of autoantibodies, the risk of having this type of systolic dysfunction was increased by 6.42 times. An increased titer of other autoantibodies had rather a low diagnostic value for L-myosin (OR 3.49; 95 % CI 1.49–8.29); Com-02 (OR 3.38; 95 % CI 1.34–8.68). In the presence of an elevated titer of autoantibodies to β1-AR, Cos-05 and L-myosin OR distribution of patients into groups by criteria of presence of systolic dysfunction was 12.0 (95 % CI 7.5–25.4). In case of combination of β1-AR, Com-02 and L-myosin, this indicator was 6.1 (95 % CI 1.21–10.4). In case of a simultaneous increase in the titer of autoantibodies to β1-AR and L-myosin OR was 5.27 (95 % CI 1.17–12.2). These data suggest the diagnostic value of an increased titer of cardiotropic autoantibodies to β1-AR to assess the presence of chronic heart failure in elderly patients with IHD. Conclusions. An increased titer of autoantibodies to β1-AR, Cos-05 and L-myosin has a predictive value for the development of chronic heart failure.