Online ISSN: 2515-8260

Keywords : chronic heart failure


FEATURES OF VIOLATIONS OF THE DIASTOLIC FUNCTION OF THE LEFT VENTRICLE IN PATIENTS WITH CHRONIC HEART FAILURE, DEPENDING ON THE CLINICAL COURSE OF THE DISEASE

Kamilova Umida Kabirovna; Nuritdinov Nuriddin Anvarkhodjaevich; Zakirova Gulnoza Alisherovna; Khamraev Abror Asrarovich

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1169-1179

The aim of our study was to study the features of impaired left ventricular diastolic function in patients with chronic heart failure, depending on the clinical course of the disease. A total of 131 patients with CHF of ischemic origin with I, II and III FC CHF (men aged 38-60 years, mean age 54.51 ± 6.89 years) were examined. Patients with FC I were 31 (23.7%) patients, with FC II - 51 (38.9%) and FC III - 49 (37.4%) patients. The structural
and functional state of the myocardium and the process of LV remodeling were assessed by echocardiography with Doppler ultrasonography. EchoCG was performed on the device "MEDISON ACCUVIX V20" (South Korea), using a 3.25 MHz transducer in standard echocardiographic positions, transthoracic method in accordance with the recommendations of the American Society of Echocardiography (ASE). In patients with CHF, diastolic function disorders were identified in 74.8% of cases: grade I (impaired relaxation) was recorded in 38.9% (51 patients), grade II - (pseudonormal) in 21.4% (28), type III (reversible restrictive) - in 14.5% (19) patients. An analysis of the grades of diastolic dysfunction showed the predominance of relaxation disorders in 52% of patients and an increase in the number of patients with restrictive type of diastolic dysfunction with an increase in CHF FC. Thus, in 74.8% of CHF patients, impaired LV diastolic function was observed, characterized by its deterioration with the progression of the disease. At the same time, impaired LV diastolic function was characterized to a greater extent by impaired relaxation, and with the progression of the disease, a restrictive type of LVDD impairment.

PREDICTION OF THE DEVELOPMENT OF RENAL DYSFUNCTION IN PATIENTS WITH CHRONIC HEART FAILURE

Kamilova Umida; Nuritdinov Nuriddin; Zakirova Gulnoza

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1368-1374

Purpose. To identify prognostic factors for the development of renal dysfunction (RD) and to develop a method for
assessing and predicting RD in patients with chronic heart failure (CHF).
Methods. A total of 101 patients with functional class I-III (FC) CHF (according to the classification of the New
York Heart Association) were examined. Also, the patients were divided, depending on the glomerular filtration
rate, determined by the calculation method according to the CKD-EPI formula (eGFR), into two groups: patients
with eGFR≥90 ml / min (n = 20), with eGFR <90 ml / min (n = 81). All patients were determined: creatinine (Cr),
eGFR according to the CKD-EPI formula, albumin / creatinine (Al / Cr) level (mg / mmol) in morning urine,
specific gravity in morning urine portion (SG); studied renal blood flow according to Doppler sonography at the
level of the common left and right renal arteries. To assess the significance of signs for determining and predicting
RD in CHF, we used a method based on Wald's sequential statistical analysis with the development of differential
diagnostic tables, determination of diagnostic coefficients (DC) and information content (J) of each sign in groups of
patients with CHF, depending on the level eGFR, determination of diagnostic thresholds (amount of DC).
Results. As a result of the developed differential diagnostic tables, the most informative signs were identified that
determine the unfavorable prognosis of RD in patients with CHF: creatinine above 80 μmol / l, eGFR less than 90
ml / min, Al / Cr ratio in morning urine more than 3.4 mg / mmol, urine specific gravity SG less than 1015,
resistance index (RI) at the level of the right and left renal arteries more than 0.7. The sum of DCs of these signs,
depending on the severity of symptoms, determines the risk of developing RD: a very high risk in the range from
+15 to +32, high risk - from +8 to +14, moderate risk - from +7 to +3, favorable course of CHF - from 0 to +2
points.
Conclusion. Signs of an unfavorable prognosis for the development of RD in patients with CHF were determined:
creatinine above 80 μmol / l, eGFR less than 90 ml / min, Al / Cr ratio in morning urine more than 3.4 mg / mmol, urine SG less than 1015, RI at the renal level arteries more than 0.7.