EFFECT OF STANDARD THERAPY ON CLINICAL PARAMETERS, QUALITY OF LIFE AND MORPHO-FUNCTIONAL STATE OF THE LEFT VENTRICULAR MYOCARDIUM IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN AND CONCOMITANT TYPE 2 DIABETES MELLITUS AND OBESITY

Introduction. Modern medicine is increasingly challenged by a growing number of patients with complex comorbidities, including chronic heart failure, ischemic heart disease, obesity, and type 2 diabetes mellitus. These conditions exacerbate one another, significantly impair patients’ quality of life, and increase the risk of hospitalization and mortality. Achieving meaningful improvements in clinical outcomes within this group is a considerable challenge, requiring a comprehensive, individualized, and multidisciplinary approach. Ischemic heart disease, as a primary cause of chronic heart failure, is frequently associated with chronic low-grade inflammation, endothelial dysfunction, and myocardial remodeling. Concomitant obesity further amplifies systemic inflammation, induces adverse metabolic alterations, increases cardiac workload, and accelerates the progression of heart failure. In turn, type 2 diabetes mellitus contributes to the development of diabetic cardiomyopathy and both microvascular and macrovascular complications, thereby further worsening the management of chronic heart failure and coronary artery disease. Objective. To assess the effect of standard therapy on clinical parameters, quality of life and morphofunctional state of the left ventricular myocardium in patients with chronic heart failure of ischemic origin and concomitant type 2 diabetes mellitus and obesity. Materials and methods. The study included 154 patients divided into 4 groups according to the presence of metabolic disorders: Group 1 included individuals having chronic heart failure with coronary artery disease and type 2 diabetes mellitus and abdominal obesity (n = 42); Group 2 included inwividuals having chronic heart failure with coronary artery disease and concomitant type 2 diabetes mellitus (n = 46); Group 3 involved individuals having chronic heart failure with coronary artery disease and concomitant abdominal obesity (n = 36); Group 4 comprised individuals having chronic heart failure of ischemic origin without metabolic disorders (n = 30). The control group consisted of 30 practically healthy individuals matched for age and sex. To assess the functional status, the 6-minute walk test was performed. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Results. Positive dynamics were found in patients with chronic heart failure and metabolic disorders during the treatment. There was a significant decrease in the percentage of patients with dyspnea on exertion (from 100% to 20%) and a decrease in the severity of palpitations (from 81.3% to 9.3%). The medication helped to reduce fatigue and general weakness (fatigue: from 86.7% to 16%, weakness: from 100% to 20%). There was also a decrease in the manifestations of depressed mood (from 61.3% to 10.7%) and an improvement in attention concentration. An increase in exercise tolerance was noted based on the 6minute walk test findings. Conclusion. Standard therapy has a positive effect on clinical parameters, quality of life, and morphofunctional state of the left ventricular myocardium in patients with chronic heart failure of ischemic origin and concomitant metabolic disorders. The results obtained indicate the importance of an integrated approach to the treatment of this category of patients.