Dynamics of clinical and laboratory parameters in patients with coronary heart disease in combination with type 2 diabetes mellitus and their effect on the structural and functional state of the heart and blood vessels in various cases of chronic heart fa

Abstract

The aim: determination of the characteristics of the dynamics of clinical, laboratory and ultrasound parameters in patients with ischemic heart disease in combination with type 2 diabetes mellitus with various types of heart failureMaterial and methods. After the course of therapy, 100 men with CHF were examined in the hospital against the background of the combined course of IHD and type 2 diabetes with LV EF ≥ 50%, CHF of the II functional class, with glomerular filtration rate ≥ 50 ml / min / 1.73 m2, NT-proBNP ≥ 125 pg / ml.Patients were divided into groups depending on the nature of the course of heart failure: group I (n = 66) - patients with a stable course, group II (n = 34) - patients with an unfavourable course. Patients of group II, in turn, were divided into three subgroups depending on the nature of the adverse course: CHF: IIa (n = 7) - who died during the year of observation, IIb (n = 13) - with a decrease in LV EF, II in ( n = 14) with a violation of the state of diastolic function of the heart at the end of the observation period.An analysis of complaints, cardiological history, objective research was conducted, the level of NT-proBNP, total cholesterol), high-density lipoproteins, low-density lipoproteins and triglycerides were studied, and the atherogenic coefficient was calculated, glycosylated haemoglobin (HbA1c) was examined, serum glucose, insulin level, insulin resistance index (HOMA) were calculated.Transthoracic echocardiography (echocardiography) was performed, and endothelium-dependent brachial artery vasodilation (EDD) was examined.The Mann-Whitney U test was used to determine the differences between independent samples. The frequency of symptoms in groups was compared using the χ2 criterion. One-way analysis of variance was performed using the non-parametric Kruskal-Wallis test.Results. Adverse course of CHF in patients with CHD and type 2 diabetes, which progressed and ended in death, was associated with a significantly older age of men, with a longer history of CHD and type 2 diabetes, decreased tolerance for exercise, high levels of AH which is arguably a potential cause of CHF. I degree of diastolic dysfunction, despite the fact that the size of the left atrium did not go beyond normal, was noted in all patients, but the average size was significantly larger in the dead. Significantly fewer of these patients had LV EDV, indicating greater disruption of LV diastolic filling processes.Patients with a decrease in LV systolic function after 12 months of follow-up were characterized by a significant decrease in LV EF medians (by 21.5%) and test distance with a 6-minute walk (by 4.1%), while there was a tendency to increase endothelial dysfunction in the form of a decrease in the median EDD of the brachial arteries. Significant positive dynamics of the medians of all indicators of carbohydrate metabolism showed good control of the carbohydrate profile. Medians of lipid metabolism parameters did not experience significant dynamics, but tended to positive changes. The median NT-proBNP blood level was significantly reduced by 14%. A decrease in systolic function of the heart was associated with a tendency to increase the diastolic size of the left atrium and a significant increase in LV ESV.Conclusions. Two-thirds of CHD patients with CHF with preserved LV EF of the heart in combination with type 2 diabetes receiving pathogenetic complex therapy have a stable course of CHF observed during the year, which is characterized by improvement of the clinical and laboratory status of patients and parameters of the structural and functional state of the heart and vessels.An unfavourable course of heart failure during the year against the background of pathogenetic complex treatment in patients with CHD in combination with type 2 diabetes is accompanied by a decrease in systolic and / or diastolic LV heart function, exercise tolerance with a simultaneous absence of worsening dyslipidaemia and dysglycemia.In patients with CHD in combination with type 2 diabetes and retained LV EF, fasting glycemia and HbAc1 levels significantly affect the state of LV systolic and diastolic function, which indicates the important role of concomitant type 2 diabetes in heart remodelling in this category of patients