Ilnytska M. Insulin sensitivity in chronic heart failure: factors and clinical and prognostic significance

The dissertation is devoted to optimization of recommendations of treatment of pts with CHF and LVSD with consideration of presence of IR. Among 107 examined patients with CHF IR was found in 45 pts. Рts with CHF and IR are characterized by lower FMD (p=0.033), higher values of leptin (p=0.044), TNF-alfa (p=0.041), UA (p=0.003). Predictors of RI were the serum TNF-alfa>16.48 pg/ml, UA>584 umol/L, leptin>2.265 ng/ml, ratio L/A>0.16, MPAP>40 mmHg, FMD<6.27 %. On the standard treatment is observed a decrease in HOMA index (p=0.024) and increase in proportion of pts with its normal values (p=0.008). No difference was found in HOMA index values depending on the nature of beta-blocker therapy (bisoprolol or carvedilol). According to the results of a Cox regression analysis (12 months) there is expected credibly worse prognosis of survival in pts (the end-point was combined and defined as the time of the first re-hospitalization for cardiovascular reasons or cardiovascular death) with HOMA index value >=2.77 (p=0.003).