Role of caspase-6 in the formation of severe chronic heart failure in patients infected with the human immunodeficiency virus

Abstract

Caspases are a group of cysteine proteases that play a leading role in the processes of apoptosis. There is evidence that apoptosis of cardiomyocytes is the morphological basis for the formation of chronic heart failure (CHF). The aim of the study was to study the role of caspase-6 in the blood serum of patients with severe CHF infected with the human immunodeficiency virus (HIV). In 2019–2022, on the basis of a large hospital, a one-stage screening clinical study was performed with the inclusion of 240 patients infected with HIV, 160 of them (66.6 %) were diagnosed with CHF. Inclusion criteria for the study were the presence of confirmed CHF, the presence of HIV infection, stabilization of the condition due to the disease that required hospitalization, and the patient's consent to participate in the study. The criteria for exclusion from the study were social deprivation and refusal to sign informed voluntary consent, acute decompensation of CHF, acute heart failure, and oncology. The criterion for severe CHF was an increase in the level of NT-proBNP in blood plasma ≥ 1500 pg/ml. According to the results of the study, a direct close relationship was revealed between the formation of severe CHF and the content of caspase-6 in the blood serum, which may indicate an intensification of the processes of cardiomyocyte apoptosis. When the content of caspase-6 is equal to 148.35 pg/ml and above, there is a high risk of developing severe CHF with NT-pro BNP ≥ 1500 pg/ml, the chances of developing the following complications increase – CHF with low left ventricular ejection fraction (LVEF) < 40 % – 11.77 times, left ventricular hypertrophy (LVH) – 1.31 times, cachexia with a body mass index (BMI) < 18 – 18.91 times, valvular heart disease – 2.32 times, arterial hypotension - 5.96 times. In patients with CHF and HIV infection, the patterns obtained allow us to state the role of the effector enzyme apoptosis-caspase-6 as a prognostic factor for the development of such complications as LVEF < 40 %, cachexia, arterial hypotension, valvular heart disease and LVH.