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 VOLUME Vol.05 Issue01 2025 

PAGE NO. 28-31 

DOI 10.37547/ajbspi/Volume05Issue01-07 

 
 
 
 

Dynamics of immuno-inflammatory markers in patients 

with chronic heart failure after myocardial infarction 

during treatment with rosuvastatin 
 

M.M. Abdurakhmanov 

Bukhara State Medical Institute, Karakul College of Public Health named Abu Ali ibn Sino, Bukhara, Uzbekistan 

 

A.N. Khamraev 

Bukhara State Medical Institute, Karakul College of Public Health named Abu Ali ibn Sino, Bukhara, Uzbekistan 

 

M.S. Radjabova 

Bukhara State Medical Institute, Karakul College of Public Health named Abu Ali ibn Sino, Bukhara, Uzbekistan 

 

 

 

Received: 26 October 2024; Accepted: 29 December 2024; Published: 30 January 2025 

 

Abstract: In the occurrence and progression of chronic heart failure (CHF), the role of pro- inflammatory cytokines 
has been established: tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), which induce the synthesis of C-
reactive protein (CRP), an increasing the level of these markers leads to the progression of CHF. It was determined 
that with the development of the maladaptive phase of left ventricular remodeling, there is a sharp rise in the 
level of pro- inflammatory cytokines and serum CRP, which are closely interrelated with the structural and 
functional changes of the left ventricle in CHF. Against the background of taking rosuvastatin at a daily dose of 20 
mg, there is a decrease in the levels of pro-inflammatory cytokines and serum CRP and a positive dynamics of 
heart remodeling indicators. 

 

Keywords: Systemic inflammation, left ventricular remodeling, rosuvastatin, chronic heart failure. 

 

Introduction: In addition to the cardiac, hemodynamic 
and neurohumoral concepts of progressive chronic 
heart failure (CHF) has been developed the theory of 
immune activation, according to that, endothelial 
dysfunction is recognized as one of the main links in the 
pathogenesis of CHF, induced by oxidative stress and 
pro- inflammatory cytokines that suppress the 
production of nitric oxide (NO) [1,3,7]. In the 
occurrence and progression of CHF, the role of pro-
inflammatory cytokines has been established: tumor 
necrosis factor-α (TNF-α) and interleukin-6 (IL-6) [4,9]. 

The biological effects of these cytokines 

are largely similar: they induce the synthesis of C-
reactive protein (CRP), an increasing the level of those, 
in turn, leads to the progression of CHF [6]. Many 

authors suggest that pro- inflammatory cytokines play 
an important role in the progression of CHF, mediating 
the nature and intensity of myocardial and vascular 
remodeling processes by regulating the level of 
apoptosis of cardiomyocytes, which is currently 
considered as a fundamental mechanism capable of 
causing irreversible impairment of myocardial 
contractile activity in CHF [5]. 

The aim of the study was to study the clinical and 
laboratory significance of immuno- inflammatory 
markers (CRP, IL-6 and TNF-α) in patients with CHF 
during the treatment with rosuvastatin. 

METHODS 

96 patients with CHF stages I–IIB and functional class I–
IV were examined in the cardiology department of the 

 

https://doi.org/10.37547/ajbspi/Volume05Issue01-07
https://doi.org/10.37547/ajbspi/Volume05Issue01-07
https://doi.org/10.37547/ajbspi/Volume05Issue01-07
https://doi.org/10.37547/ajbspi/Volume05Issue01-07


American Journal of Applied Science and Technology 29 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

Bukhara Regional Center of the Republican Scientific 
Center for Medical Emergencies in Bukhara. There 
were: 85 men and 11 women, aged 40 to 

80 years (mean age 60.73 ± 9.86 years). Previously, all 
patients had suffered a myocardial infarction (MI) of 
various statutes of limitations - from 1 to 21 years 
(average 10.61 

± 7.26 years). Criteria for inclusion in the study: the 
presence in patients of CHF of ischemic etiology. To 
objectify FC CHF, a test with a 6- minute walk in a 35-
meter long corridor marked every 5 meters was carried 
out and the clinical condition of patients was assessed 
according to the modified V.Yu. Mareev in 2000 on the 
clinical assessment scale (SHOKS) in CHF. Drug 
treatment included angiotensin- converting enzyme 
inhibitors, β-blockers, diuretics, if necessary, nitrates, 
cardiac glycosides. At the time of inclusion in the study, 
patients did not take lipid-lowering drugs or stopped 
taking them for various reasons at least 6 weeks before 
the study. All patients were prescribed rosuvastatin 
(Mertenil, Gedeon Richter company) at a daily dose of 
20 mg once. The duration of therapy was 12 weeks, 
after that all patients were re-examined. All of them 
underwent a general clinical examination, which 
included the collection of anamnesis and assessment of 
objective data; complex ultrasound examination of the 
heart. 

The following indicators were determined: 

final systolic and diastolic dimensions (FDD, FSD, cm) 
and volumes (FDV, FSV, ml) of the left ventricle (LV); 
ejection fraction (EF, %); the thickness of the 
interventricular septum in systole and diastole (IVSd, 
IVSs, mm); thickness of the posterior wall in systole and 
diastole (ThPWs, ThPWd, mm); the myocardial mass of 
LV (MM, g); stroke volume (SV, ml); minute volume 
(MV, ml/min). The relative thickness of wall (RTW) of 
the LV was calculated using the formula: RTW = (IVSd + 
ThPWd)/FDD. Systolic myocardial stress (MS in 
dynes/cm2) was calculated using the formula: MS = BPs 
× FSD/4 × ThPWs × ( 1 + ThPW/FSD), where BPs is 

systolic blood pressure. To assess myocardial 
contractile activity, the EF/MS index proposed by K. 
Taniguchi and co-authors was used. (2000) , which 
reflects the degree of adequacy of the global systolic 
function of the heart to the test load with a given LV 
geometry [10].Diastolic properties of LV were studied 
using the study of transmitral diastolic flow (TMDF) by 
determining the maximum TMDF velocity during early 
LV filling (Ve, m/s), the maximum TMDF velocity during 
late LV filling (Vа, m/s), the ratio of maximum velocities 
flows in the period of early and late filling (E/A), time of 
isovolumic relaxation of the left ventricle (TIR, ms). The 
content of CRP (Vector-Best, Russia) and pro-

inflammatory cytokines: TNF- α and IL-6 (Protein 
contour, St. Petersburg) were determined in the blood 
serum of patients by enzyme immunoassay using 
appropriate test systems. When examining a group of 
healthy people, the average levels of IL-6 (7.27 

± 0.42 pg/ml) and TNF-α (4.62 ± 0.19 pg/ml) were 
determined. Data analysis was carried out using 
parametric and nonparametric statistical methods. 
After a preliminary analysis of the distribution of the 
studied features for normality, the mean value (M) and 
standard error (m) were calculated. The significance of 
the differences between the compared parameters 
was calculated using the method of variation statistics 
according to Student's t-test. The difference between 
the compared indicators was taken as reliability p < 
0.05. To identify correlations between the 

differences and the parameters, a calculation was 
carried out using the Pearson squares method. The 
correlation between the estimated parameters was 
considered reliability at p < 0.05. 

RESULTS AND DISCUSSION 

All patients were divided into 2 groups depending on 
the severity of left ventricular remodeling according to 
echocardiography, according to OSSN criteria (2010). 
Group 1 included 67 (69%) patients with adaptive LV 
remodeling (stages I–IIA), group 2 included 29 (31%) 
patients with incompatible LV remodeling (stage IIB). 
During the observation period, 6 (6.25%) adverse 
cardiovascular events occurred. 2 patients of group 1 
and 4 patients of group 2 died. The cause of death of 
one patient from group 1 was complex arrhythmias, the 
other - complications of myocardial infarction. In group 
2, the cause of death was progressive heart failure. 
From the presented data, it can be seen that patients 
with maladaptive remodeling had significantly more 
severe manifestations of CHF: a higher FC of circulatory 
failure and a more significant decrease in exercise 
tolerance. It was also noted that the development of 
CHF is accompanied by a change primarily in the 
geometry of the LV and an increase in the mass of the 
LV myocardium. As CHF progressed, an increase in the 
linear dimensions of the LV cavity was observed. In 
patients with the development of maladaptive 
remodeling, there was a decrease in the relative LV wall 
thickness index, which indicates the development of 
eccentric hypertrophy of LV and the progression of 
maladaptive remodeling LV , the severity of which 
increases with the increase in CHF FC. In patients with 
adaptive LV remodeling, concentric hypertrophy of LV 
prevailed (77%), and in 23% of cases in this group of 
patients, the development of eccentric hypertrophy of 
LV was noted. In the study of diastolic function, it was 
found that the 1st type of diastolic dysfunction 



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American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

prevailed in patients with adaptive LV remodeling, and 
the 2nd type prevailed in patients with maladaptive LV 
remodeling. Changes in the levels of the studied 
cytokines in the blood serum and the concentration of 
CRP in patients with CHF were characterized by their 
significant increase with the progression of CHF (Table 
1). 

The maximum level of cytokines (TNF-α 

and IL-6) was found in patients with maladaptive left 

ventricular remodeling. In patients with adaptive LV 
remodeling, there was also an increase in the level of 
TNF-α in blood serum, but it was insignificant 
compared to the group of healthy individuals. There 
was no significant difference in the level of IL-6 with the 
group of healthy subjects. The level of CRP in the blood 
serum before treatment was increased both in group 1 
and in group 2, and amounted to 25.99 ± 16.3 and 43.41 
± 11.19 mg/l, respectively, which is significantly higher 
than normal values. 

Table 1. 
Dynamics of inflammation markers and laboratory parameters before and after treatment with rosuvastatin 

 

Note LDL - low density lipoproteins; TAG, triacyglycerides; 

Significant difference (p < 0.05) from pre- treatment 
scores; ** Significant difference (p < 0.05) from the 
same indicator in group 1. 

We have established a relationship bet- ween the levels 
of pro-inflammatory cytokines in the blood serum and 
the morpho-functional parameters of the left ventricle. 
In the group of patients with maladaptive remodeling, 
a correlation between TNF-α and myocardial mass was 
noted (r = 0.65; p < 0.05); MS (r = 0.63; p < 0.05); with 
the state of diastolic function: peak E and E/A (r = 0.72; 
p < 0.05, r = 0.58; p < 0.05). 

There was no connection with EF, but there was a 
correlation with the EF/MS index, which characterizes 
the specific contractility of the myocardium (r = 0.46; p 
< 0.05). In patients with adaptive LV remodeling, IL-6 
correlated with MS (r = 0.39; p < 0.05) and LV wall 
thickness (r = 0.75; p < 0.05), while TNF-α correlated 
with LDL (r = 0.41; p < 0.05) and TAG (r = 0.38; p < 0.05). 
Thereafter, the results of this study demonstrated that 
the levels of pro- inflammatory cytokines in the serum 
of patients with CHF are associated with the 
development and severity of clinical manifestations of 
CHF. A previously undescribed abrupt increase in 
serum pro- inflammatory cytokines was found in 
patients with maladaptive LV remodeling. 

Against the background of taking rosuvastatin at a daily 
dose of 20 mg, a positive trend in the clinical 
manifestations of CHF was noted, which was 

characterized by a significant decrease in the FC of CHF 
and an increase in exercise tolerance according to the 
test with a 6-minute walk in both group 1 and group 2. 
There was a significant decrease in myocardial mass, 
and a decrease in FDV and FSV. An improvement in 
myocardial contractility was noted, and the EF/MS 
index increased by 14.2 and 36.0% in patients with 
adaptive and maladaptive remodeling, respectively. A 
positive change in the structural and functional state of 
the left ventricle was accompanied by an improvement 
in the diastolic function of the left ventricle in the form 
of a positive change in the structure of diastolic filling 
(E/A) in both groups. 

After 12 weeks of the study, in patients with both 
adaptive and maladaptive LV remodeling, against the 
background of clinical improvement, a significant 
decrease in the concentration of CRP and pro-
inflammatory cytokines (IL-6, TNF-α) in the blood 
serum was noted. All patients at the time of inclusion 
in the study according to the SCORE scale for assessing 
the risk of death from cardiovascular diseases were in 
the high and very high-risk group. In 62% of patients, 
after 3 months from the start of treatment with 
rosuvastatin at a daily dose of 20 mg, the target LDL 
level (< 2.5 mmol / l) was achieved. 

Our data are largely consistent with the literature data 
on the adverse effect of pro- inflammatory cytokines on 
the initiation, becoming and progression of LV ischemic 
dysfunction [8]. They also indicate a close relationship 



American Journal of Applied Science and Technology 31 https://theusajournals.com/index.php/ajast 

American Journal of Applied Science and Technology (ISSN: 2771-2745) 
 

 

between the processes of LV remodeling in CHF and the 
mechanisms of the immune response, which is 
activated in this disease. The detected significant 
abrupt increase in the levels of pro-inflammatory 
cytokines and CRP during the development of the 
maladaptive phase of heart remodeling can serve as a 
criterion for the severity of CHF and become the 
starting point in the clinician's reasoning about the 
intensity (aggressiveness) of the therapeutic effect. The 
results of our study showed that rosuvastatin therapy 
is not only accompanied by a hypolipidemic effect, but 
also leads to a significant decrease in the concentration 
of pro-inflammatory cytokines in the blood serum and 
CRP in patients with CHF of ischemic etiology. In our 
study, the level of CRP significantly decreased during 
treatment with rosuvastatin in both groups, which 
indicates a decrease in inflammation and is associated 
with a decrease in cardiac decompensation and, 
accordingly, the risk of an unfavorable course. 

This is consistent with the results of a number of 
studies, which also noted a correlation between the 
level of pro- inflammatory cytokines and the severity of 
clinical manifestations of CHF, a decrease in life 
expectancy, and a decrease in their concentration 
during treatment is associated with clinical 
improvement [2]. 

Thus, after 12 weeks, most patients reach- ed the 
target level of blood lipids, but even more important to 
us is the pronounced effect of this treatment on the 
level of pro-inflammatory cytokines and CRP, which 
may contribute to the inhibition of the development of 
the disease. 

CONCLUSION 

1. The development of the maladaptive phase of 
LV remodeling is accompanied by a sharp rising the 
level of pro-inflammatory cytokines and CRP in the 
blood serum. 

2. There is a significant correlation of pro- 
inflammatory cytokines with structural and functional 
changes in the heart in CHF. 

3. Treatment with rosuvastatin (Mertenil drug) at 
a dose of 20 mg in patients with CHF of ischemic 
etiology is accompanied by a decrease in the level of 
pro-inflammatory cytokines (TNF-α, IL-6), serum CRP 
and an improvement in the structural and functional 
state of the LV in patients with CHF of ischemic 
etiology. 

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