FEATURES OF THE MORPHO-FUNCTIONAL MYOCARDIUM STATE AND RELATIONSHIP WITH GALECTIN-3 IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN ON THE BACKGROUND OF METABOLIC PATHOLOGY

Abstract

The aim. To evaluate the presence and nature of changes in the morpho-functional state of the myocardium in patients with coronary heart disease (CHD) with concomitant type 2 diabetes mellitus (T2DM) and obesity, depending on the functional class (FC) of chronic heart failure (CHF) and the relationship with the concentration of galectin-3 in blood serum. Materials and methods. The study involved 75 patients with CHD with concomitant metabolic diseases such as T2DM and obesity, who were treated in the cardiology department of the State Clinical Hospital No. 27. Patients were divided into groups according to the FC of CHF. Group 1 included 30 patients with CHF FC II, group 2 – 24 patients with CHF FC III, group 3 – 21 patients with CHF FC IV. Results. In patients with СHD and metabolic disorders with CHF FC III, the levels of end-systolic dimension (ESD) and end-diastolic dimension (EDD) were higher by 16.3 % and 17.9 %, respectively, compared with FC II, end-systolic volume (ESV) and end-diastolic volume (EDV) also increased significantly in patients of this cohort with FC III compared with CHF FC II by 35.8 % and 16.5 %, respectively. Significantly increased ESV, EDV by 42.9 % and 37.8 %, respectively, as well as the size of the left atrium by 14.3 % in patients of the study group who had CHF FC IV compared with FC III. The ejection fraction (EF) index decreased in patients of this cohort with CHF FC IV by 14.4 % compared with FC III. The size of the right ventricle was larger by 10.8 % in CHF FC IV than in FC III in patients with CHD on the background of comorbid metabolic pathology. Indicators of the thickness of the LV posterior wall, LV relative wall thickness and intraventricular septum were lower in patients with FC IV compared with FC II, left ventricle mass (LVM) and left ventricle mass index (LVMI) increased by 32 % and 33 %, respectively. Сomparing the levels of Ea/Es in patients with CHF FC II and IV in СHD with concomitant T2DM and obesity, a significant increase in this indicator was found in FC IV (p<0.05). The level of galectin-3 in patients with CHF FC III and IV of ischemic origin against the background of concomitant metabolic disorders was higher than in patients with FC II. Сomparing the concentration of galectin-3 in patients with CHF FC III and IV in patients with CHD with comorbid metabolic pathology, significantly higher levels were found in FC IV (p<0.05). The study of the relationship between the fibrosis factor galectin-3 and cardiohemodynamic parameters revealed probable links, namely direct links between galectinemia and ESV (r=0.52; p<0.05), EDV (r=0.58; p<0.05), Еа/Es (r=0.51; p<0.05). Conclusions. The growth of the functional class of chronic heart failure is accompanied by dilatation of the left cavities of the heart, a decrease in the inotropic function of the left ventricle, an increase in myocardial-arterial stiffness, and an increase in the levels of the galectin-3 fibrosis factor in the studied patients.