ИСХОДЫ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА: ПРОСПЕКТИВНОЕ 5-ЛЕТНЕЕ ИССЛЕДОВАНИЕ

Abstract

Introduction. Epidemiology and trends in survival of patients with chronic heart failure have changed over the past decades. As an important reason for prognostic deviations is recognized, among other things, the steady worldwide increase in the prevalence of obesity and concomitant conditions associated with it, such as diabetes mellitus, arterial hypertension, and atrial fibrillation, especially in young patients with chronic heart failure, which creates the so- called survival paradox. The aim of the study is to assess the structure of 5-year outcomes in patients with ischemic heart failure and identify some new long-term prognosis markers (mortality and cardiovascular events). Materials and Methods. 313 patients with ischemic heart failure of functional class I-IV were examined. A clinical study was conducted, and 5-year prognosis endpoints were assessed (all-cause mortality, cardiovascular mortality, and non-fatal cardiovascular events). The composite endpoint included cardiovascular mortality and nonfatal cardiovascular events. Results. All-cause 5-year mortality was 28.1%, including the cardiovascular mortality of 24.6%. In patients of functional class III-IV chronic heart failure, the 5-year risk of death from any cause and cardiovascular death was higher than in class I-II patients. All-cause death, cardiovascular mortality, and the composite endpoint risks were higher in patients with reduced ejection fraction than in those with moderately reduced or reduced left ventricular ejection fraction. The risk of death within 5 years from all causes and cardiovascular death was higher in women with a body mass index of <25 kg/m² and >30 kg/m² than in those who were moderately overweight. Mortality from all causes was lower in functional class III-IV patients with some overweight than in those with a body mass index of <25 kg/m² (p=0.03). With moderately reduced and reduced left ventricular ejection fraction, all-cause mortality and cardiovascular mortality were lower in overweight patients than in those with a body mass index of <25 kg/m² (p=0.009 and p=0.022). In patients with heart failure with reduced left ventricular ejection fraction, their overweight was a protective factor for all-cause mortality (OR=0.07, CI: 0.001-0.76) as compared to those with a body mass index of <25 kg/m²