A PREDICTION MODEL FOR CHRONIC HEART FAILURE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction. One of the common adverse complications that may occur in patients with type 2 diabetes mellitus (T2DM) after acute myocardial infarction (AMI) is the development and progression of chronic heart failure (CHF). Currently, it remains relevant to study biomarkers of energy homeostasis that are involved in the pathogenesis of CHF in T2DM patients. Aim. To predict the development of CHF in patients with T2DM using a generalized linear mixed model (GLMM). Materials and methods. A total of 74 patients with T2DM were examined after ST-segment elevation AMI (STEMI). Serum concentrations of adropin, fatty acid binding protein 4 (FABP4) and C1q/TNF-related protein 3 (CTRP3) were measured using enzyme-linked immunosorbent assays. Fasting blood glucose levels were determined by the glucose oxidase method. Serum high-density lipoprotein (HDL) levels were analyzed by the peroxidase enzymatic method. Low-density lipoprotein (LDL) levels were estimated by the Friedewald formula. The GLMM was applied to construct a predictive model of CHF in patients with T2DM. Results. The study has revealed decreased serum adropin and CTRP3 levels and increased FABP4 levels in T2DM patients after STEMI. A predictive model of CHF development in patients with T2DM has been developed. The fixed effects of the model were represented by two univariate (adropin and CTRP3 on day 1) and two bivariate indicators (adropin and FABP4 on day 10, glucose on day 1 and 10), as well as the random effects were represented by five univariate indicators (acute heart failure, diastolic blood pressure on day 1, heart rate on day 10, LDL on day 1 and HDL on day 1). The accuracy of predicting the occurrence of NYHA functional class II within a year in patients with T2DM was 61.5%, while that of NYHA functional class III was 89.6%. The overall accuracy of the model was 79.7%. Conclusions. Thus, the level of adropin on day 1 has been found to be a strong negative prognostic factor, while the combined effect of the adropin and FABP4 levels on day 10 – a positive prognostic factor. The combined effect of blood glucose levels on day 1 and 10, as well as a negative effect of CTRP3 concentration on day 1 has been shown. The option of using energy metabolism biomarkers in the model has indicated the importance of studying these parameters in T2DM patients.