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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">ssmu</journal-id><journal-title-group><journal-title xml:lang="ru">Бюллетень сибирской медицины</journal-title><trans-title-group xml:lang="en"><trans-title>Bulletin of Siberian Medicine</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1682-0363</issn><issn pub-type="epub">1819-3684</issn><publisher><publisher-name>Siberian State Medical University, the Ministry of Healthcare of the Russian Federation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.20538/1682-0363-2018-3-140-150</article-id><article-id custom-type="elpub" pub-id-type="custom">ssmu-1293</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>ORIGINAL PAPERS</subject></subj-group></article-categories><title-group><article-title>Прогноз сердечно-сосудистых событий после имплантации  кардиовертера-дефибриллятора пациентам с хронической сердечной  недостаточностью: значение повышения концентрации эндотелина-1  и растворимой формы белка ST2 в плазме крови</article-title><trans-title-group xml:lang="en"><trans-title>Prognosis of cardiovascular events after implantation of a cardioverterdefibrillator in patients with chronic heart failure: the value of increasing concentration of endothelin-1 and soluble forms of ST2 protein in blood plasma</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0721-0038</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тепляков</surname><given-names>А. Т.</given-names></name><name name-style="western" xml:lang="en"><surname>Teplyakov</surname><given-names>A. T.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тепляков Александр Трофимович - докторр медицинских наук, профессор, руководитель отделения сердечной недостаточности НИИ кардиологии.</p><p>634012, Томск, ул. Киевская, 111</p></bio><bio xml:lang="en"><p>Teplyakov Alexander T. - DM, Professor, Head of the Department of Heart Failure, Cardiology Research Institute.</p><p>111A, Kievskaya Str., Tomsk, 634012</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4287-4366</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Тарасов</surname><given-names>Н. И.</given-names></name><name name-style="western" xml:lang="en"><surname>Tarasov</surname><given-names>N. I.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Тарасов Николай Иванович - докторр медицинских наук, профессор, зав. кафедрой подготовки врачей первичного звена здравоохранения.</p></bio><bio xml:lang="en"><p>Tarasov Nikolay I. - DM, Professor, Head of the Department of Training of Primary Health Care Physicians.</p><p>22а Voroshilov Str., Kemerovo, 650056</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-0487-3880</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Исаков</surname><given-names>Л. К.</given-names></name><name name-style="western" xml:lang="en"><surname>Isakov</surname><given-names>L. K.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Исаков Леонид Константинович - кандидат медицинских наук, ассистент, кафедра подготовки врачей первичного звена здравоохранения.</p><p>650056, Кемерово, ул. Ворошилова, 22а</p></bio><bio xml:lang="en"><p>Isakov Leonid K. - Assistant, Department of Training of Primary Health Care Physicians.</p><p>22а Voroshilov Str., Kemerovo, 650056</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4019-3735</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гракова</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Grakova</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гракова Елена Викторовна - докторр медицинских наук, старший научный сотрудник, отделение сердечной недостаточности, НИИ кардиологии.</p></bio><bio xml:lang="en"><p>Grakova Elena V. - DM, Senior Researcher, Department of Heart Failure, Cardiology Research Institute.</p><p>111A, Kievskaya Str., Tomsk, 634012</p></bio><email xlink:type="simple">gev@cardio-tomsk.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7604-5481</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Синькова</surname><given-names>М. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Sinkova</surname><given-names>M. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Синькова Маргарита Николаевна - кандидат медицинских наук, ассистент, кафедра подготовки врачей первичного звена здравоохранения.</p><p>650056, Кемерово, ул. Ворошилова, 22а</p></bio><bio xml:lang="en"><p>Sinkova Margarita N. - Assistant, Department of Training of Primary Health Care Physicians.</p><p>22а Voroshilov Str., Kemerovo, 650056</p></bio><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-2285-6438</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Копьева</surname><given-names>К. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kopieva</surname><given-names>K. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Копьева Кристина Васильевна - аспирант, отделение сердечной недостаточности, НИИ кардиологии.</p><p>634012, Томск, ул. Киевская, 111</p></bio><bio xml:lang="en"><p>Kopeva Kristina V. - Postgraduate Student, Department of Heart Failure, Cardiology Research Institute.</p><p>111A, Kievskaya Str., Tomsk, 634012</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1257-3055</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Гармаева</surname><given-names>О. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Garmaeva</surname><given-names>О. B.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Гармаева Оюна Валерьевна врач-кардиолог, отделение сердечной недостаточности, НИИ кардиологии.</p><p>634012, Томск, ул. Киевская, 111</p></bio><bio xml:lang="en"><p>Garmaeva Oyuna V. - Cardiologist, Department of Heart Failure, Cardiology Research Institute.</p><p>111A, Kievskaya Str., Tomsk, 634012</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-8397-0296</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Огуркова</surname><given-names>О. Н.</given-names></name><name name-style="western" xml:lang="en"><surname>Ogurkova</surname><given-names>O. N.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Огуркова Оксана Николаевна - кандидат медицинских наук, научный сотрудник, клинико-диагностическая лаборатория,  НИИ кардиологии.</p><p>634012, Томск, ул. Киевская, 111</p></bio><bio xml:lang="en"><p>Ogurkova Oksana N. - Researcher, clinical diagnostic laboratory, Cardiology Research Institute.</p><p>111A, Kievskaya Str., Tomsk, 634012</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-9640-2028</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжин</surname><given-names>В. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhin</surname><given-names>V. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Калюжин Вадим Витальевич - докторр медицинских наук, профессор, и.о. зав. кафедрой госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины.</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>Kalyuzhin Vadim V. - DM, Professor, Head of the Department of Hospital Therapy.</p><p>2, Moskow Trakt, 634055, Tomsk</p></bio><xref ref-type="aff" rid="aff-3"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7978-5327</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Калюжина</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kalyuzhina</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Калюжина Елена Викторовна - докторр медицинских наук, профессор, кафедра госпитальной терапии с курсом реабилитации, физиотерапии и спортивной медицины.</p><p>634050, Томск, Московский тракт, 2</p></bio><bio xml:lang="en"><p>Kalyuzhina Elena V. - DM, Professor of the Department of Hospital Therapy.</p><p>2, Moskow Trakt, 634055, Tomsk</p></bio><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>Научно-исследовательский институт (НИИ) кардиологии, Томский национальный исследовательский медицинскийй центр (ТНИМЦ) Российской академии наук (РАН)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Cardiology Research Institute, Tomsk National Research Medical Center (TNRMC), Russian Academy of Science (RAS)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>Кемеровский государственный медицинский университет (КемГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Kemerovo State Medical University (KSMU)</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>Сибирский государственный медицинский университет (СибГМУ)</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Siberian State Medical University (SSMU)</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2018</year></pub-date><pub-date pub-type="epub"><day>29</day><month>09</month><year>2018</year></pub-date><volume>17</volume><issue>3</issue><fpage>140</fpage><lpage>150</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Тепляков А.Т., Тарасов Н.И., Исаков Л.К., Гракова Е.В., Синькова М.Н., Копьева К.В., Гармаева О.В., Огуркова О.Н., Калюжин В.В., Калюжина Е.В., 2018</copyright-statement><copyright-year>2018</copyright-year><copyright-holder xml:lang="ru">Тепляков А.Т., Тарасов Н.И., Исаков Л.К., Гракова Е.В., Синькова М.Н., Копьева К.В., Гармаева О.В., Огуркова О.Н., Калюжин В.В., Калюжина Е.В.</copyright-holder><copyright-holder xml:lang="en">Teplyakov A.T., Tarasov N.I., Isakov L.K., Grakova E.V., Sinkova M.N., Kopieva K.V., Garmaeva О.B., Ogurkova O.N., Kalyuzhin V.V., Kalyuzhina E.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://bulletin.ssmu.ru/jour/article/view/1293">https://bulletin.ssmu.ru/jour/article/view/1293</self-uri><abstract><sec><title>Цель исследования</title><p>Цель исследования. Изучение связи повышения концентрации эндотелина-1 и растворимой формы белка ST2 в плазме крови больных с хронической сердечной недостаточностью (ХСН), перенесших имплантацию кардиовертера-дефибриллятора, с развитием сердечно-сосудистых событий (смерть от сердечно-сосудистого заболевания, декомпенсация ХСН, острый коронарный синдром или острое нарушение мозгового кровообращения) для определения возможности применения этих биомаркеров в качестве предикторов неблагоприятного течения заболевания.</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В 6-месячное когортное обсервационное исследование вошли 40 пациентов с ХСН, которым за 4–12 нед до включения в исследование имплантировали кардиовертер-дефибриллятор. В начале исследования наряду с традиционными методами диагностики, принятыми в специализированной кардиологической клинике, анализировали концентрацию эндотелина-1 и растворимой формы белка ST2 в плазме крови иммуноферментным методом.</p></sec><sec><title>Результаты</title><p>Результаты. Фенотип с благоприятным течением заболевания установлен у 21 больного (1-я группа), с неблагоприятным течением – у 19 (2-я группа). Концентрация эндотелина-1 и растворимой формы белка ST2 в плазме крови больных 2-й группы была выше, чем у пациентов 1-й группы. Установлена связь сердечно-сосудистых событий с  высоким уровнем  растворимой формы белка ST2 и эндотелина-1 в плазме крови.  Варьирование порога решающего правила на характеристической кривой позволило принять за точку разделения значение концентрации растворимой формы белка ST2, составляющее 34,93 нг/мл. Точность бинарной классификации (определение апостериорной вероятности сердечно-сосудистых событий) при принятии такой точки разделения характеризовалась чувствительностью 93% и специфичностью 72% (площадь под ROC-кривой – 0,87). При значении плазменной концентрации растворимой формы белка ST2 более 34,93 нг/мл относительный риск сердечно-сосудистых событий составил  4,4 (95% ДИ 1,7–11,1). Информативность профицита эндотелина-1 в плазме крови (точка отсечения 0,34 фмоль/мл) при прогнозировании сердечно-сосудистых событий была ниже: чувствительность 88% и специфичность 68% (площадь под ROC-кривой – 0,74). При повышении концентрации эндотелина-1 в плазме крови более 0,34 фмоль/мл  относительный риск  сердечно-сосудистых событий составил  2,7 (95% ДИ  1,2–6,3).</p></sec><sec><title>Заключение</title><p>Заключение. Повышение концентрации растворимой формы белка ST2 и  эндотелина-1 в плазме крови можно рассматривать в качестве предиктора сердечно-сосудистых событий у пациентов с ХСН, перенесших имплантацию кардиовертера-дефибриллятора.</p></sec></abstract><trans-abstract xml:lang="en"><sec><title>Aim</title><p>Aim. The purpose of this study was to examine the association of increasing concentrations of endothelin-1 and soluble forms of ST2 protein (sST2)  in the blood plasma of patients with chronic heart failure (CHF) who underwent implantation of a cardioverter-defibrillator, with the development of cardiovascular events (death from cardiovascular diseases, decompensated CHF, acute coronary syndrome or acute ischemic stroke) to determine whether these biomarkers can be used as predictors of an unfavorable course of the disease.</p></sec><sec><title>Material and methods</title><p>Material and methods. A 6-month cohort study included 40 patients with CHF who received an ICD 4-12 weeks before their inclusion in the study. At the beginning of the study the concentrations of endothelin-1 and sST2 in plasma by ELISA were analyzed, along with conventional diagnostic techniques typical of a specialized cardiology clinic.</p></sec><sec><title>Results</title><p>Results. Phenotype with a favorable course of the disease was identified in 21 patients (group 1), and with a unfavorable course was seen in 19 (group 2). The concentration of endothelin-1 and sST2 in the blood plasma of the 2nd group patients was higher than in patients of the 1st group. The link of cardiovascular events with high levels of soluble ST2 protein and endothelin-1 in blood plasma has been identified. Variation of the decision rule threshold on the ROC-curve has allowed sST2 concentration of 34.93 ng/ml to be determined as a cutoff  point.  Accuracy of two-class classification (determination of  the posterior probability of cardiovascular events) after identifying such cut-off  point was characterized by 93%  sensitivity and 72% specificity (area under ROC-curve – 0.87).  If the value of the plasma concentrations of sST2 more 34.93 ng/ml the relative risk of cardiovascular events was 4.4 (95% CI 1.7–11.1). The use of endothelin-1 surplus in plasma (cut-off point – 0.34 fmol/ml) in predicting cardiovascular events was lower: the sensitivity – 88%, specificity – 68% (area under ROC-curve – 0.74). When the concentration of endothelin-1 in blood plasma was more than 0.34 fmol/ml the relative risk of cardiovascular events was 2.7 (95% CI 1.2–6.3).</p></sec><sec><title>Conclusion</title><p>Conclusion. The increase in the sST2 and endothelin-1 concentration in blood plasma may be considered as a predictor of cardiovascular events in CHF patients after implantation of cardioverter-defibrillator.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>хроническая сердечная недостаточность</kwd><kwd>имплантируемый кардиовертер-дефибриллятор</kwd><kwd>сердечно-сосудистые события</kwd><kwd>прогноз</kwd><kwd>биомаркеры</kwd><kwd>эндотелин-1</kwd><kwd>растворимая форма белка ST2</kwd></kwd-group><kwd-group xml:lang="en"><kwd>chronic heart failure</kwd><kwd>implantable cardioverter-defibrillator</kwd><kwd>cardiovascular events</kwd><kwd>prognosis</kwd><kwd>biomarkers</kwd><kwd>endothelin-1</kwd><kwd>soluble forms of ST2 protein</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Januzzi J.L., Mebazaa A., Somma S.D. 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