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Провоспалительные цитокины при хронической сердечной недостаточности: состояние проблемы - Журнал Терапевтический архив №11 Инфекционные болезни 2021
Провоспалительные цитокины при хронической сердечной недостаточности: состояние проблемы
Коротаева А.А., Самойлова Е.В., Миндзаев Д.Р., Насонова С.Н., Жиров И.В., Терещенко С.Н. Провоспалительные цитокины при хронической сердечной недостаточности: состояние проблемы. Терапевтический архив. 2021;93(11):1389–1394. DOI: 10.26442/00403660.2021.11.201170
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Аннотация
Системное воспаление характеризуется индукцией провоспалительных цитокинов, повышенный уровень которых в крови больных с хронической сердечной недостаточностью (ХСН) коррелирует с неблагоприятными клиническими исходами. Однако неясно, являются провоспалительные цитокины причиной или следствием прогрессирования заболевания. ХСН с сохраненной фракцией выброса и ХСН с низкой фракцией выброса имеют различные воспалительные особенности, что предполагает различную степень активации воспалительных путей. В обзоре рассматривается участие провоспалительных цитокинов в патофизиологических процессах развития ХСН, подчеркивается значение активации интерлейкина-6, влияние сопутствующих заболеваний на течение системного воспаления. В настоящее время продолжается активный поиск новых подходов к профилактике и лечению ХСН. В обзоре приводятся результаты клинических исследований таргетной антицитокиновой терапии, выявившие трудности в противодействии воспалению в хронических условиях сердечной недостаточности. Выявление специфических провоспалительных путей в патогенезе ХСН позволит управлять воспалительными каскадами и обеспечит перспективную терапевтическую стратегию.
Ключевые слова: сердечная недостаточность, воспаление, цитокины, интерлейкин-6, антицитокиновая терапия
Keywords: heart failure, inflammation, cytokines, interleukin-6, anticytokine therapy
Ключевые слова: сердечная недостаточность, воспаление, цитокины, интерлейкин-6, антицитокиновая терапия
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Keywords: heart failure, inflammation, cytokines, interleukin-6, anticytokine therapy
Полный текст
Список литературы
1. Терещенко С.Н., Галявич А.С., Ускач Т.М., и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Российский кардиологический журнал. 2020;25(11):311‑74 [Tereshchenko SN, Galyavich AS, Uskach TM, et al. Clinical practice guidelines for Chronic heart failure 2020. Russian Journal of Cardiology. 2020;25(11):311-74 (in Russian)].
DOI:10.15829/1560-4071-2020-4083
2. Ponikowski P, Voors AA, Anker DS, et al. Рекомендации ESC по диагностике и лечению острой и хронической сердечной недостаточности 2016. Российский кардиологический журнал. 2017;1(141):7‑81 [Ponikowski P, Voors AA, Anker DS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2017;1(141):7-81 (in Russian)]. DOI:10.15829/1560-4071-2017-1-7-81
3. Li Z, Zhao H, Wang J. Metabolism and chronic inflammation: the links between chronic heart failure and comorbidities. Front Cardiovasc Med. 2021;8:650278. DOI:10.3389/fcvm.2021.650278
4. Mann DL. Stress-activated cytokines and the heart: from adaptation to maladaptation. Annu Rev Physiol. 2003;65:81-101.
DOI:10.1146/annurev.physiol.65.092101.142249
5. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116:1254-68.
DOI:10.1161/CIRCRESAHA.116.302317
6. Hanna A, Frangogiannis NG. inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020;34(6):849-63.
DOI:10.1007/s10557-020-07071-0
7. Kalogeropoulos A, Georgiopoulou V, Psaty BM, et al. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010;55(19):2129-37. DOI:10.1016/j.jacc.2009.12.045
8. van Wijk SS, van Empel V, Davarzani N, et al. Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction. Eur J Heart Fail. 2015;17:1006-14. DOI:10.1002/ejhf.414
9. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71.
DOI:10.1016/j.jacc.2013.02.092
10. Cleland JGF, Bunting KV, Flather MD, et al. Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. Eur Heart J. 2018;39(1):26-35. DOI:10.1093/eurheartj/ehx564
11. Van Linthout S, Tschope СC. inflammation – cause or consequence of heart failure or both? Curr Heart Fail Rep. 2017;14(4):251-65. DOI:10.1007/s11897-017-0337-9
12. Gullestad L, Ueland T, Fjeld JG, et al. Effect ofthalidomide oncardiac remodelinginchronic heart failure: results of a double-blind, placebo-controlled study. Circulation. 2005;112(22):3408-14.
DOI:10.1161/CIRCULATIONAHA.105.564971
13. Skudicky D, Bergemann A, Sliwa K, et al. Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation. 2001;103(8):1083-8. DOI:10.1161/01.cir.103.8.1083
14. Gullestad L, Aass H, Fjeld JG, et al. Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure. Circulation. 2001;103(2):220-5. DOI:10.1161/01.cir.103.2.220
15. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107(25):3133-40. DOI:10.1161/01.CIR.0000077913.60364.D2
16. Mann DL, McMurray J, Packer M, et al. Targeted аnticytokine therapy in patients with chronic yeart failure. Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109(13):1594-602. DOI:10.1161/01.CIR.0000124490.27666.B2
17. Torre-Amione G, Anker SD, Bourge RC, et al. Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial. Lancet. 2008;371(9608):228-36. DOI:10.1016/S0140-6736(08)60134-8
18. Ridker PM, Everett BM, Thuren T, et al.; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119-31. DOI:10.1056/NEJMoa1707914
19. Van Tassell BW, Trankle CR, Canada JM, et al. IL-1 blockade in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2018;11(8):e005036.
DOI:10.1161/CIRCHEARTFAILURE.118.005036
20. Abbate A, Trankle CR, Buckley LF, et al. Interleukin-1 Blockade Inhibits the Acute Inflammatory response in patients with st-segment-elevation myocardial infarction. Am J Cardiol. 2020;9(5):e014941. DOI:10.1161/JAHA.119.014941
21. Morton AC, Rothman AM, Greenwood JP, et al. The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes: the MRC-ILA Heart Study. Eur Heart J. 2015;36:377-84. DOI:10.1093/eurheartj/ehu272
22. Yan AT, Yan RT, Cushman M, et al. Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2010;31(7):875‑82. DOI:10.1093/eurheartj/ehp454
23. Harhay MO, Tracy RP, Bagiella E, et al. Relationship of CRP, IL‑6, and fibrinogen with right ventricular structure and function: The MESA-Right Ventricle Study. Int J Cardiol. 2013;168(4):3818-24. DOI:10.1016/j.ijcard.2013.06.028
24. Fontes JA, Rose NR, Cihakova D. The varying faces of IL-6: from cardiac protection to cardiac failure. Cytokine. 2015;74(1):62-8. DOI:10.1016/j.cyto.2014.12.024
25. Wu JW, Hu H, Li D, Ma LK. Hypoxia-inducible factor 2-alpha-dependent induction of IL-6 protects the heart from ischemia/reperfusion injury. Aging (Albany NY). 2021;13(3):3443-58. DOI:10.18632/aging.202276
26. Smart N, Mojet MH, Latchman DS, et al. IL-6 induces PI 3-kinase and nitric oxide-dependent protection and preserves mitochondrial function in cardiomyocytes. Cardiovasc Res. 2006;69:164-77.
DOI:10.1016/j.cardiores.2005.08.017
27. Dawn B, Xuan YT, Guo Y, et al. IL-6 plays an obligatory role in late preconditioning via JAK-STAT signaling and upregulation of iNOS and COX-2. Cardiovasc Res. 2004;64:61-71.
DOI:10.1016/j.cardiores.2004.05.011
28. Hilfiker-Kleiner D, Shukla P, Klein G, et al. Continuous glycoprotein-130-mediated signal transducer and activator of transcription-3 activation promotes inflammation, left ventricular rupture, and adverse outcome in subacute myocardial infarction. Circulation. 2010;122:145‑55. DOI:10.1161/CIRCULATIONAHA.109.933127
29. Danesh J, Kaptoge S, Mann AG, et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS medicine. 2008;5:e78. DOI:10.1371/journal.pmed.0050078
30. Kishimoto T, Akira S, Narazaki M, Taga T. Interleukin-6 family of cytokines and gp130. Blood. 1995;86(4):1243-54.
DOI:10.1182/blood.V86.4.1243.bloodjournal8641243
31. Yamamoto K, Rose-John S. Therapeutic Blockade of Interleukin-6 in Chronic Inflammatory Disease. Clin Pharmacol Ther. 2012;91(4):574‑6. DOI:10.1038/cplt.2012.11
32. Rose-John S, Scheller J, Elson G, Jones SA. Interleukin-6 biology is coordinated by membrane-bound and soluble receptors: role in inflammation and cancer. J Leukoc Biol. 2006;80(2):227-36. DOI:10.1189/jlb/1105674
33. Askevold ET, Gullestad L, Dahl CP, et al. Interleukin-6 signaling, soluble glycoprotein 130, and inflammation in heart failure. Curr Heart Fail Rep. 2014;11(2):146-55. DOI:10.1007/s11897-014-0185-9
34. Jostock T, Mullberg J, Ozbek S, et al. Soluble gp130 is the natural inhibitor of soluble interleukin-6 receptor transsignaling responses. Eur J Biochem. 2001;268(1):160-7. DOI:10.1046/j.1432-1327.2001.01867.x
35. Чепурнова Д.А., Самойлова Е.В., Анисимов А.А., и др. Компоненты рецепторного комплекса интерлейкина-6 при остром повреждении легких. Бюллетень экспериментальной биологии и медицины. 2018;164(5):609-11 [Chepurnova DA, Samoilova EV, Anisimov AA, et al. Compounds of IL-6 receptor complex during acute lung injury. Bull Exp Biol Med. 2018;164(5):609-11 (in Russian)]. DOI:10.1007/s10517-018-4042-9
36. Korotaeva AA, Samoilova EV, Chepurnova DA, et al. Soluble glycoprotein 130 is inversely related to severity of coronary atherosclerosis. Biomarkers. 2018;23(2):1-18. DOI:10.1080/1354750X.2018.1458151
37. Zhou M, Dai W, Cui Y, et al. Associations between the IL-6-neutralizing sIL-6R-sgp130 buffer system and coronary artery disease in postmenopausal women. Ann Transl Med. 2020;8(6):379-90. DOI:10.21037/atm.2020.02.27
38. Самойлова Е.В., Миндзаев Д.Р., Чепурнова Д.А., и др. Циркулирующий гликопротеин 130 у пациентов с различной степенью выраженности симптомов хронической сердечной недостаточности. Кардиологический вестник. 2019;3:57-61 [Samoilova EV, Mindzaev DR, Chepurnova DA, et al. Circulating glycoprotein 130 in patients with chronic heart failure of varying symptom degrees. Kardiologicheskii vestnik. 2019;3:57-61 (in Russian)].
DOI:10.36396/MS.2019.14.03.009
39. Hirota H, Izumi M, Hamaguchi T, et al. Circulating interleukin-6 family cytokines and their receptors in patients with congestive heart failure. Heart Vessels. 2004;19(5):237-41. DOI:10.1007/s00380-004-0770-z
40. Askevold ET, Nymo S, Ueland T, et al. Soluble glycoprotein 130 predicts fatal outcomes in chronic heart failure: analysis from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Circ Heart Fail. 2013;6(1):91-8.
DOI:10.1161/CIRCHEARTFAILURE.112.972653
41. McElvaney OJ, Curley GF, Rose-John S, McElvaney NG. Interleukin-6: obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med. 2021:9(6):643-54. DOI:10.1016/S2213-2600(21)00103-X
42. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest. 2011;121(9):3375-83. DOI:10.1172/JCI57158
43. Rabe B, Chalaris A, May U. Transgenic blockade of interleukin 6 transsignaling abrogates inflammation. Blood. 2008;111:1021-8. DOI:10.1182/blood-2007-07-102137
DOI:10.15829/1560-4071-2020-4083
2. Ponikowski P, Voors AA, Anker DS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2017;1(141):7-81 (in Russian). DOI:10.15829/1560-4071-2017-1-7-81
3. Li Z, Zhao H, Wang J. Metabolism and chronic inflammation: the links between chronic heart failure and comorbidities. Front Cardiovasc Med. 2021;8:650278. DOI:10.3389/fcvm.2021.650278
4. Mann DL. Stress-activated cytokines and the heart: from adaptation to maladaptation. Annu Rev Physiol. 2003;65:81-101.
DOI:10.1146/annurev.physiol.65.092101.142249
5. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116:1254-68.
DOI:10.1161/CIRCRESAHA.116.302317
6. Hanna A, Frangogiannis NG. inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020;34(6):849-63.
DOI:10.1007/s10557-020-07071-0
7. Kalogeropoulos A, Georgiopoulou V, Psaty BM, et al. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010;55(19):2129-37. DOI:10.1016/j.jacc.2009.12.045
8. van Wijk SS, van Empel V, Davarzani N, et al. Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction. Eur J Heart Fail. 2015;17:1006-14. DOI:10.1002/ejhf.414
9. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71.
DOI:10.1016/j.jacc.2013.02.092
10. Cleland JGF, Bunting KV, Flather MD, et al. Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. Eur Heart J. 2018;39(1):26-35. DOI:10.1093/eurheartj/ehx564
11. Van Linthout S, Tschope СC. inflammation – cause or consequence of heart failure or both? Curr Heart Fail Rep. 2017;14(4):251-65. DOI:10.1007/s11897-017-0337-9
12. Gullestad L, Ueland T, Fjeld JG, et al. Effect ofthalidomide oncardiac remodelinginchronic heart failure: results of a double-blind, placebo-controlled study. Circulation. 2005;112(22):3408-14.
DOI:10.1161/CIRCULATIONAHA.105.564971
13. Skudicky D, Bergemann A, Sliwa K, et al. Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation. 2001;103(8):1083-8. DOI:10.1161/01.cir.103.8.1083
14. Gullestad L, Aass H, Fjeld JG, et al. Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure. Circulation. 2001;103(2):220-5. DOI:10.1161/01.cir.103.2.220
15. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107(25):3133-40. DOI:10.1161/01.CIR.0000077913.60364.D2
16. Mann DL, McMurray J, Packer M, et al. Targeted аnticytokine therapy in patients with chronic yeart failure. Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109(13):1594-602. DOI:10.1161/01.CIR.0000124490.27666.B2
17. Torre-Amione G, Anker SD, Bourge RC, et al. Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial. Lancet. 2008;371(9608):228-36. DOI:10.1016/S0140-6736(08)60134-8
18. Ridker PM, Everett BM, Thuren T, et al.; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119-31. DOI:10.1056/NEJMoa1707914
19. Van Tassell BW, Trankle CR, Canada JM, et al. IL-1 blockade in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2018;11(8):e005036.
DOI:10.1161/CIRCHEARTFAILURE.118.005036
20. Abbate A, Trankle CR, Buckley LF, et al. Interleukin-1 Blockade Inhibits the Acute Inflammatory response in patients with st-segment-elevation myocardial infarction. Am J Cardiol. 2020;9(5):e014941. DOI:10.1161/JAHA.119.014941
21. Morton AC, Rothman AM, Greenwood JP, et al. The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes: the MRC-ILA Heart Study. Eur Heart J. 2015;36:377-84. DOI:10.1093/eurheartj/ehu272
22. Yan AT, Yan RT, Cushman M, et al. Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2010;31(7):875‑82. DOI:10.1093/eurheartj/ehp454
23. Harhay MO, Tracy RP, Bagiella E, et al. Relationship of CRP, IL‑6, and fibrinogen with right ventricular structure and function: The MESA-Right Ventricle Study. Int J Cardiol. 2013;168(4):3818-24. DOI:10.1016/j.ijcard.2013.06.028
24. Fontes JA, Rose NR, Cihakova D. The varying faces of IL-6: from cardiac protection to cardiac failure. Cytokine. 2015;74(1):62-8. DOI:10.1016/j.cyto.2014.12.024
25. Wu JW, Hu H, Li D, Ma LK. Hypoxia-inducible factor 2-alpha-dependent induction of IL-6 protects the heart from ischemia/reperfusion injury. Aging (Albany NY). 2021;13(3):3443-58. DOI:10.18632/aging.202276
26. Smart N, Mojet MH, Latchman DS, et al. IL-6 induces PI 3-kinase and nitric oxide-dependent protection and preserves mitochondrial function in cardiomyocytes. Cardiovasc Res. 2006;69:164-77.
DOI:10.1016/j.cardiores.2005.08.017
27. Dawn B, Xuan YT, Guo Y, et al. IL-6 plays an obligatory role in late preconditioning via JAK-STAT signaling and upregulation of iNOS and COX-2. Cardiovasc Res. 2004;64:61-71.
DOI:10.1016/j.cardiores.2004.05.011
28. Hilfiker-Kleiner D, Shukla P, Klein G, et al. Continuous glycoprotein-130-mediated signal transducer and activator of transcription-3 activation promotes inflammation, left ventricular rupture, and adverse outcome in subacute myocardial infarction. Circulation. 2010;122:145‑55. DOI:10.1161/CIRCULATIONAHA.109.933127
29. Danesh J, Kaptoge S, Mann AG, et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS medicine. 2008;5:e78. DOI:10.1371/journal.pmed.0050078
30. Kishimoto T, Akira S, Narazaki M, Taga T. Interleukin-6 family of cytokines and gp130. Blood. 1995;86(4):1243-54.
DOI:10.1182/blood.V86.4.1243.bloodjournal8641243
31. Yamamoto K, Rose-John S. Therapeutic Blockade of Interleukin-6 in Chronic Inflammatory Disease. Clin Pharmacol Ther. 2012;91(4):574‑6. DOI:10.1038/cplt.2012.11
32. Rose-John S, Scheller J, Elson G, Jones SA. Interleukin-6 biology is coordinated by membrane-bound and soluble receptors: role in inflammation and cancer. J Leukoc Biol. 2006;80(2):227-36. DOI:10.1189/jlb/1105674
33. Askevold ET, Gullestad L, Dahl CP, et al. Interleukin-6 signaling, soluble glycoprotein 130, and inflammation in heart failure. Curr Heart Fail Rep. 2014;11(2):146-55. DOI:10.1007/s11897-014-0185-9
34. Jostock T, Mullberg J, Ozbek S, et al. Soluble gp130 is the natural inhibitor of soluble interleukin-6 receptor transsignaling responses. Eur J Biochem. 2001;268(1):160-7. DOI:10.1046/j.1432-1327.2001.01867.x
35. Chepurnova DA, Samoilova EV, Anisimov AA, et al. Compounds of IL-6 receptor complex during acute lung injury. Bull Exp Biol Med. 2018;164(5):609-11 (in Russian). DOI:10.1007/s10517-018-4042-9
36. Korotaeva AA, Samoilova EV, Chepurnova DA, et al. Soluble glycoprotein 130 is inversely related to severity of coronary atherosclerosis. Biomarkers. 2018;23(2):1-18. DOI:10.1080/1354750X.2018.1458151
37. Zhou M, Dai W, Cui Y, et al. Associations between the IL-6-neutralizing sIL-6R-sgp130 buffer system and coronary artery disease in postmenopausal women. Ann Transl Med. 2020;8(6):379-90. DOI:10.21037/atm.2020.02.27
38. Samoilova EV, Mindzaev DR, Chepurnova DA, et al. Circulating glycoprotein 130 in patients with chronic heart failure of varying symptom degrees. Kardiologicheskii vestnik. 2019;3:57-61 (in Russian).
DOI:10.36396/MS.2019.14.03.009
39. Hirota H, Izumi M, Hamaguchi T, et al. Circulating interleukin-6 family cytokines and their receptors in patients with congestive heart failure. Heart Vessels. 2004;19(5):237-41. DOI:10.1007/s00380-004-0770-z
40. Askevold ET, Nymo S, Ueland T, et al. Soluble glycoprotein 130 predicts fatal outcomes in chronic heart failure: analysis from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Circ Heart Fail. 2013;6(1):91-8.
DOI:10.1161/CIRCHEARTFAILURE.112.972653
41. McElvaney OJ, Curley GF, Rose-John S, McElvaney NG. Interleukin-6: obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med. 2021:9(6):643-54. DOI:10.1016/S2213-2600(21)00103-X
42. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest. 2011;121(9):3375-83. DOI:10.1172/JCI57158
43. Rabe B, Chalaris A, May U. Transgenic blockade of interleukin 6 transsignaling abrogates inflammation. Blood. 2008;111:1021-8. DOI:10.1182/blood-2007-07-102137
DOI:10.15829/1560-4071-2020-4083
2. Ponikowski P, Voors AA, Anker DS, et al. Рекомендации ESC по диагностике и лечению острой и хронической сердечной недостаточности 2016. Российский кардиологический журнал. 2017;1(141):7‑81 [Ponikowski P, Voors AA, Anker DS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2017;1(141):7-81 (in Russian)]. DOI:10.15829/1560-4071-2017-1-7-81
3. Li Z, Zhao H, Wang J. Metabolism and chronic inflammation: the links between chronic heart failure and comorbidities. Front Cardiovasc Med. 2021;8:650278. DOI:10.3389/fcvm.2021.650278
4. Mann DL. Stress-activated cytokines and the heart: from adaptation to maladaptation. Annu Rev Physiol. 2003;65:81-101.
DOI:10.1146/annurev.physiol.65.092101.142249
5. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116:1254-68.
DOI:10.1161/CIRCRESAHA.116.302317
6. Hanna A, Frangogiannis NG. inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020;34(6):849-63.
DOI:10.1007/s10557-020-07071-0
7. Kalogeropoulos A, Georgiopoulou V, Psaty BM, et al. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010;55(19):2129-37. DOI:10.1016/j.jacc.2009.12.045
8. van Wijk SS, van Empel V, Davarzani N, et al. Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction. Eur J Heart Fail. 2015;17:1006-14. DOI:10.1002/ejhf.414
9. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71.
DOI:10.1016/j.jacc.2013.02.092
10. Cleland JGF, Bunting KV, Flather MD, et al. Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. Eur Heart J. 2018;39(1):26-35. DOI:10.1093/eurheartj/ehx564
11. Van Linthout S, Tschope СC. inflammation – cause or consequence of heart failure or both? Curr Heart Fail Rep. 2017;14(4):251-65. DOI:10.1007/s11897-017-0337-9
12. Gullestad L, Ueland T, Fjeld JG, et al. Effect ofthalidomide oncardiac remodelinginchronic heart failure: results of a double-blind, placebo-controlled study. Circulation. 2005;112(22):3408-14.
DOI:10.1161/CIRCULATIONAHA.105.564971
13. Skudicky D, Bergemann A, Sliwa K, et al. Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation. 2001;103(8):1083-8. DOI:10.1161/01.cir.103.8.1083
14. Gullestad L, Aass H, Fjeld JG, et al. Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure. Circulation. 2001;103(2):220-5. DOI:10.1161/01.cir.103.2.220
15. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107(25):3133-40. DOI:10.1161/01.CIR.0000077913.60364.D2
16. Mann DL, McMurray J, Packer M, et al. Targeted аnticytokine therapy in patients with chronic yeart failure. Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109(13):1594-602. DOI:10.1161/01.CIR.0000124490.27666.B2
17. Torre-Amione G, Anker SD, Bourge RC, et al. Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial. Lancet. 2008;371(9608):228-36. DOI:10.1016/S0140-6736(08)60134-8
18. Ridker PM, Everett BM, Thuren T, et al.; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119-31. DOI:10.1056/NEJMoa1707914
19. Van Tassell BW, Trankle CR, Canada JM, et al. IL-1 blockade in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2018;11(8):e005036.
DOI:10.1161/CIRCHEARTFAILURE.118.005036
20. Abbate A, Trankle CR, Buckley LF, et al. Interleukin-1 Blockade Inhibits the Acute Inflammatory response in patients with st-segment-elevation myocardial infarction. Am J Cardiol. 2020;9(5):e014941. DOI:10.1161/JAHA.119.014941
21. Morton AC, Rothman AM, Greenwood JP, et al. The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes: the MRC-ILA Heart Study. Eur Heart J. 2015;36:377-84. DOI:10.1093/eurheartj/ehu272
22. Yan AT, Yan RT, Cushman M, et al. Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2010;31(7):875‑82. DOI:10.1093/eurheartj/ehp454
23. Harhay MO, Tracy RP, Bagiella E, et al. Relationship of CRP, IL‑6, and fibrinogen with right ventricular structure and function: The MESA-Right Ventricle Study. Int J Cardiol. 2013;168(4):3818-24. DOI:10.1016/j.ijcard.2013.06.028
24. Fontes JA, Rose NR, Cihakova D. The varying faces of IL-6: from cardiac protection to cardiac failure. Cytokine. 2015;74(1):62-8. DOI:10.1016/j.cyto.2014.12.024
25. Wu JW, Hu H, Li D, Ma LK. Hypoxia-inducible factor 2-alpha-dependent induction of IL-6 protects the heart from ischemia/reperfusion injury. Aging (Albany NY). 2021;13(3):3443-58. DOI:10.18632/aging.202276
26. Smart N, Mojet MH, Latchman DS, et al. IL-6 induces PI 3-kinase and nitric oxide-dependent protection and preserves mitochondrial function in cardiomyocytes. Cardiovasc Res. 2006;69:164-77.
DOI:10.1016/j.cardiores.2005.08.017
27. Dawn B, Xuan YT, Guo Y, et al. IL-6 plays an obligatory role in late preconditioning via JAK-STAT signaling and upregulation of iNOS and COX-2. Cardiovasc Res. 2004;64:61-71.
DOI:10.1016/j.cardiores.2004.05.011
28. Hilfiker-Kleiner D, Shukla P, Klein G, et al. Continuous glycoprotein-130-mediated signal transducer and activator of transcription-3 activation promotes inflammation, left ventricular rupture, and adverse outcome in subacute myocardial infarction. Circulation. 2010;122:145‑55. DOI:10.1161/CIRCULATIONAHA.109.933127
29. Danesh J, Kaptoge S, Mann AG, et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS medicine. 2008;5:e78. DOI:10.1371/journal.pmed.0050078
30. Kishimoto T, Akira S, Narazaki M, Taga T. Interleukin-6 family of cytokines and gp130. Blood. 1995;86(4):1243-54.
DOI:10.1182/blood.V86.4.1243.bloodjournal8641243
31. Yamamoto K, Rose-John S. Therapeutic Blockade of Interleukin-6 in Chronic Inflammatory Disease. Clin Pharmacol Ther. 2012;91(4):574‑6. DOI:10.1038/cplt.2012.11
32. Rose-John S, Scheller J, Elson G, Jones SA. Interleukin-6 biology is coordinated by membrane-bound and soluble receptors: role in inflammation and cancer. J Leukoc Biol. 2006;80(2):227-36. DOI:10.1189/jlb/1105674
33. Askevold ET, Gullestad L, Dahl CP, et al. Interleukin-6 signaling, soluble glycoprotein 130, and inflammation in heart failure. Curr Heart Fail Rep. 2014;11(2):146-55. DOI:10.1007/s11897-014-0185-9
34. Jostock T, Mullberg J, Ozbek S, et al. Soluble gp130 is the natural inhibitor of soluble interleukin-6 receptor transsignaling responses. Eur J Biochem. 2001;268(1):160-7. DOI:10.1046/j.1432-1327.2001.01867.x
35. Чепурнова Д.А., Самойлова Е.В., Анисимов А.А., и др. Компоненты рецепторного комплекса интерлейкина-6 при остром повреждении легких. Бюллетень экспериментальной биологии и медицины. 2018;164(5):609-11 [Chepurnova DA, Samoilova EV, Anisimov AA, et al. Compounds of IL-6 receptor complex during acute lung injury. Bull Exp Biol Med. 2018;164(5):609-11 (in Russian)]. DOI:10.1007/s10517-018-4042-9
36. Korotaeva AA, Samoilova EV, Chepurnova DA, et al. Soluble glycoprotein 130 is inversely related to severity of coronary atherosclerosis. Biomarkers. 2018;23(2):1-18. DOI:10.1080/1354750X.2018.1458151
37. Zhou M, Dai W, Cui Y, et al. Associations between the IL-6-neutralizing sIL-6R-sgp130 buffer system and coronary artery disease in postmenopausal women. Ann Transl Med. 2020;8(6):379-90. DOI:10.21037/atm.2020.02.27
38. Самойлова Е.В., Миндзаев Д.Р., Чепурнова Д.А., и др. Циркулирующий гликопротеин 130 у пациентов с различной степенью выраженности симптомов хронической сердечной недостаточности. Кардиологический вестник. 2019;3:57-61 [Samoilova EV, Mindzaev DR, Chepurnova DA, et al. Circulating glycoprotein 130 in patients with chronic heart failure of varying symptom degrees. Kardiologicheskii vestnik. 2019;3:57-61 (in Russian)].
DOI:10.36396/MS.2019.14.03.009
39. Hirota H, Izumi M, Hamaguchi T, et al. Circulating interleukin-6 family cytokines and their receptors in patients with congestive heart failure. Heart Vessels. 2004;19(5):237-41. DOI:10.1007/s00380-004-0770-z
40. Askevold ET, Nymo S, Ueland T, et al. Soluble glycoprotein 130 predicts fatal outcomes in chronic heart failure: analysis from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Circ Heart Fail. 2013;6(1):91-8.
DOI:10.1161/CIRCHEARTFAILURE.112.972653
41. McElvaney OJ, Curley GF, Rose-John S, McElvaney NG. Interleukin-6: obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med. 2021:9(6):643-54. DOI:10.1016/S2213-2600(21)00103-X
42. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest. 2011;121(9):3375-83. DOI:10.1172/JCI57158
43. Rabe B, Chalaris A, May U. Transgenic blockade of interleukin 6 transsignaling abrogates inflammation. Blood. 2008;111:1021-8. DOI:10.1182/blood-2007-07-102137
________________________________________________
DOI:10.15829/1560-4071-2020-4083
2. Ponikowski P, Voors AA, Anker DS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Russian Journal of Cardiology. 2017;1(141):7-81 (in Russian). DOI:10.15829/1560-4071-2017-1-7-81
3. Li Z, Zhao H, Wang J. Metabolism and chronic inflammation: the links between chronic heart failure and comorbidities. Front Cardiovasc Med. 2021;8:650278. DOI:10.3389/fcvm.2021.650278
4. Mann DL. Stress-activated cytokines and the heart: from adaptation to maladaptation. Annu Rev Physiol. 2003;65:81-101.
DOI:10.1146/annurev.physiol.65.092101.142249
5. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116:1254-68.
DOI:10.1161/CIRCRESAHA.116.302317
6. Hanna A, Frangogiannis NG. inflammatory cytokines and chemokines as therapeutic targets in heart failure. Cardiovasc Drugs Ther. 2020;34(6):849-63.
DOI:10.1007/s10557-020-07071-0
7. Kalogeropoulos A, Georgiopoulou V, Psaty BM, et al. Inflammatory markers and incident heart failure risk in older adults: the Health ABC (Health, Aging, and Body Composition) study. J Am Coll Cardiol. 2010;55(19):2129-37. DOI:10.1016/j.jacc.2009.12.045
8. van Wijk SS, van Empel V, Davarzani N, et al. Circulating biomarkers of distinct pathophysiological pathways in heart failure with preserved vs. reduced left ventricular ejection fraction. Eur J Heart Fail. 2015;17:1006-14. DOI:10.1002/ejhf.414
9. Paulus WJ, Tschope C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263-71.
DOI:10.1016/j.jacc.2013.02.092
10. Cleland JGF, Bunting KV, Flather MD, et al. Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. Eur Heart J. 2018;39(1):26-35. DOI:10.1093/eurheartj/ehx564
11. Van Linthout S, Tschope СC. inflammation – cause or consequence of heart failure or both? Curr Heart Fail Rep. 2017;14(4):251-65. DOI:10.1007/s11897-017-0337-9
12. Gullestad L, Ueland T, Fjeld JG, et al. Effect ofthalidomide oncardiac remodelinginchronic heart failure: results of a double-blind, placebo-controlled study. Circulation. 2005;112(22):3408-14.
DOI:10.1161/CIRCULATIONAHA.105.564971
13. Skudicky D, Bergemann A, Sliwa K, et al. Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation. 2001;103(8):1083-8. DOI:10.1161/01.cir.103.8.1083
14. Gullestad L, Aass H, Fjeld JG, et al. Immunomodulating therapy with intravenous immunoglobulin in patients with chronic heart failure. Circulation. 2001;103(2):220-5. DOI:10.1161/01.cir.103.2.220
15. Chung ES, Packer M, Lo KH, et al. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-alpha, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107(25):3133-40. DOI:10.1161/01.CIR.0000077913.60364.D2
16. Mann DL, McMurray J, Packer M, et al. Targeted аnticytokine therapy in patients with chronic yeart failure. Results of the Randomized Etanercept Worldwide Evaluation (RENEWAL). Circulation. 2004;109(13):1594-602. DOI:10.1161/01.CIR.0000124490.27666.B2
17. Torre-Amione G, Anker SD, Bourge RC, et al. Results of a non-specific immunomodulation therapy in chronic heart failure (ACCLAIM trial): a placebo-controlled randomised trial. Lancet. 2008;371(9608):228-36. DOI:10.1016/S0140-6736(08)60134-8
18. Ridker PM, Everett BM, Thuren T, et al.; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med. 2017;377(12):1119-31. DOI:10.1056/NEJMoa1707914
19. Van Tassell BW, Trankle CR, Canada JM, et al. IL-1 blockade in patients with heart failure with preserved ejection fraction. Circ Heart Fail. 2018;11(8):e005036.
DOI:10.1161/CIRCHEARTFAILURE.118.005036
20. Abbate A, Trankle CR, Buckley LF, et al. Interleukin-1 Blockade Inhibits the Acute Inflammatory response in patients with st-segment-elevation myocardial infarction. Am J Cardiol. 2020;9(5):e014941. DOI:10.1161/JAHA.119.014941
21. Morton AC, Rothman AM, Greenwood JP, et al. The effect of interleukin-1 receptor antagonist therapy on markers of inflammation in non-ST elevation acute coronary syndromes: the MRC-ILA Heart Study. Eur Heart J. 2015;36:377-84. DOI:10.1093/eurheartj/ehu272
22. Yan AT, Yan RT, Cushman M, et al. Relationship of interleukin-6 with regional and global left-ventricular function in asymptomatic individuals without clinical cardiovascular disease: insights from the Multi-Ethnic Study of Atherosclerosis. Eur Heart J. 2010;31(7):875‑82. DOI:10.1093/eurheartj/ehp454
23. Harhay MO, Tracy RP, Bagiella E, et al. Relationship of CRP, IL‑6, and fibrinogen with right ventricular structure and function: The MESA-Right Ventricle Study. Int J Cardiol. 2013;168(4):3818-24. DOI:10.1016/j.ijcard.2013.06.028
24. Fontes JA, Rose NR, Cihakova D. The varying faces of IL-6: from cardiac protection to cardiac failure. Cytokine. 2015;74(1):62-8. DOI:10.1016/j.cyto.2014.12.024
25. Wu JW, Hu H, Li D, Ma LK. Hypoxia-inducible factor 2-alpha-dependent induction of IL-6 protects the heart from ischemia/reperfusion injury. Aging (Albany NY). 2021;13(3):3443-58. DOI:10.18632/aging.202276
26. Smart N, Mojet MH, Latchman DS, et al. IL-6 induces PI 3-kinase and nitric oxide-dependent protection and preserves mitochondrial function in cardiomyocytes. Cardiovasc Res. 2006;69:164-77.
DOI:10.1016/j.cardiores.2005.08.017
27. Dawn B, Xuan YT, Guo Y, et al. IL-6 plays an obligatory role in late preconditioning via JAK-STAT signaling and upregulation of iNOS and COX-2. Cardiovasc Res. 2004;64:61-71.
DOI:10.1016/j.cardiores.2004.05.011
28. Hilfiker-Kleiner D, Shukla P, Klein G, et al. Continuous glycoprotein-130-mediated signal transducer and activator of transcription-3 activation promotes inflammation, left ventricular rupture, and adverse outcome in subacute myocardial infarction. Circulation. 2010;122:145‑55. DOI:10.1161/CIRCULATIONAHA.109.933127
29. Danesh J, Kaptoge S, Mann AG, et al. Long-term interleukin-6 levels and subsequent risk of coronary heart disease: two new prospective studies and a systematic review. PLoS medicine. 2008;5:e78. DOI:10.1371/journal.pmed.0050078
30. Kishimoto T, Akira S, Narazaki M, Taga T. Interleukin-6 family of cytokines and gp130. Blood. 1995;86(4):1243-54.
DOI:10.1182/blood.V86.4.1243.bloodjournal8641243
31. Yamamoto K, Rose-John S. Therapeutic Blockade of Interleukin-6 in Chronic Inflammatory Disease. Clin Pharmacol Ther. 2012;91(4):574‑6. DOI:10.1038/cplt.2012.11
32. Rose-John S, Scheller J, Elson G, Jones SA. Interleukin-6 biology is coordinated by membrane-bound and soluble receptors: role in inflammation and cancer. J Leukoc Biol. 2006;80(2):227-36. DOI:10.1189/jlb/1105674
33. Askevold ET, Gullestad L, Dahl CP, et al. Interleukin-6 signaling, soluble glycoprotein 130, and inflammation in heart failure. Curr Heart Fail Rep. 2014;11(2):146-55. DOI:10.1007/s11897-014-0185-9
34. Jostock T, Mullberg J, Ozbek S, et al. Soluble gp130 is the natural inhibitor of soluble interleukin-6 receptor transsignaling responses. Eur J Biochem. 2001;268(1):160-7. DOI:10.1046/j.1432-1327.2001.01867.x
35. Chepurnova DA, Samoilova EV, Anisimov AA, et al. Compounds of IL-6 receptor complex during acute lung injury. Bull Exp Biol Med. 2018;164(5):609-11 (in Russian). DOI:10.1007/s10517-018-4042-9
36. Korotaeva AA, Samoilova EV, Chepurnova DA, et al. Soluble glycoprotein 130 is inversely related to severity of coronary atherosclerosis. Biomarkers. 2018;23(2):1-18. DOI:10.1080/1354750X.2018.1458151
37. Zhou M, Dai W, Cui Y, et al. Associations between the IL-6-neutralizing sIL-6R-sgp130 buffer system and coronary artery disease in postmenopausal women. Ann Transl Med. 2020;8(6):379-90. DOI:10.21037/atm.2020.02.27
38. Samoilova EV, Mindzaev DR, Chepurnova DA, et al. Circulating glycoprotein 130 in patients with chronic heart failure of varying symptom degrees. Kardiologicheskii vestnik. 2019;3:57-61 (in Russian).
DOI:10.36396/MS.2019.14.03.009
39. Hirota H, Izumi M, Hamaguchi T, et al. Circulating interleukin-6 family cytokines and their receptors in patients with congestive heart failure. Heart Vessels. 2004;19(5):237-41. DOI:10.1007/s00380-004-0770-z
40. Askevold ET, Nymo S, Ueland T, et al. Soluble glycoprotein 130 predicts fatal outcomes in chronic heart failure: analysis from the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Circ Heart Fail. 2013;6(1):91-8.
DOI:10.1161/CIRCHEARTFAILURE.112.972653
41. McElvaney OJ, Curley GF, Rose-John S, McElvaney NG. Interleukin-6: obstacles to targeting a complex cytokine in critical illness. Lancet Respir Med. 2021:9(6):643-54. DOI:10.1016/S2213-2600(21)00103-X
42. Jones SA, Scheller J, Rose-John S. Therapeutic strategies for the clinical blockade of IL-6/gp130 signaling. J Clin Invest. 2011;121(9):3375-83. DOI:10.1172/JCI57158
43. Rabe B, Chalaris A, May U. Transgenic blockade of interleukin 6 transsignaling abrogates inflammation. Blood. 2008;111:1021-8. DOI:10.1182/blood-2007-07-102137
Авторы
А.А. Коротаева1, Е.В. Самойлова*1, Д.Р. Миндзаев1, С.Н. Насонова1, И.В. Жиров1,2, С.Н. Терещенко1,2
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*erihter@mail.ru
1 National Medical Research Center for Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuing Professional Education, Moscow, Russia
образования» Минздрава России, Москва, Россия
*erihter@mail.ru
1 ФГБУ «Национальный медицинский исследовательский центр кардиологии» Минздрава России, Москва, Россия;
2 ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*erihter@mail.ru
________________________________________________
1 National Medical Research Center for Cardiology, Moscow, Russia;
2 Russian Medical Academy of Continuing Professional Education, Moscow, Russia
образования» Минздрава России, Москва, Россия
*erihter@mail.ru
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