[Erythrone system in aged patients with chronic cardiac insufficiency]

Basic mechanisms underlying the development of chronic cardiac insufficiency (CCI) in aged subjects were investigated in a randomized study of 30 patients with I-IV functional class CCI and preserved left ventricular systolic function. CCI affected the left side of the heart in 23 patients due to concurrent hypertensive disease and the right side in 7 patients with concomitant chronic broncho-pulmonary pathology. Mean age of the patients was 65 years. Control group comprised 8 practically healthy middle-age subjects. Erythrone system condition was evaluated from erythrocyte morphological characteristics and chemical composition studied by scanning electron microscopy on a FEI quanta 2003D apparatus in the Nanotechnologies and Nanomaterials Centre, Belgorod State University. Pathological changes in the erythrone system of CCI patients included changes of erythrocyte shape and chemical composition especially well apparent in cases with chronic pulmonary heart. As CCI progressed, erythrocytes in the form of bi-convex disks turned to spheres with the papillose surface. The sphere to disk ratio in the compensation, sub- and decompensation stages was 1:7, 1:4, and 9:1 respectively compared with 1:60 in controls. Spherocytes contained less nitrogen than normal diskocytes. Protein degradation was more apparent in aged CCI patients. Their erythrocytes contained 4.5-5, 2, 3 and 4 times more calcium, magnesium, aluminium, and silicon respectively than the cells of healthy subjects. It suggests development of calcium paradox, abnormal membrane permeability and gradual cell death (hemolysis). Anemia in aged CCI patients appears be of haemolytic nature. It occurred in 6.7-11.5% of the cases of left ventricular CCI and in 33.3% of the aged patients with chronic pulmonary heart, the lethality rate being 0.93 and 28.6% respectively. It is concluded that changes in the erythrone system in the form of erythrocyte spherulation, accumulation of calcium and other chemical elements suggest a poor prognosis of CCI in elderly patients.