Bolotskykh G. Role fibrotic, inflammatory and genetic factors of heart failure course variants in diabetes mellitus type 2 patients.

The clinical course, the nature of the heart structural and functional changes, parameters of carbohydrate metabolism and fibro-inflammatory factors in patients with concomitant HFpEF and T2DM were evaluated. There is a high incidence of IR, which is 70.4%, in non-diabetic HFpEF patients was revealed. Increased levels of galectin-3, TNF-?, serum insulin dependent on the state of insulin sensitivity and associated with T2DM. A significant association of IR, TNF-alpha, galectin-3 levels and echocardiographic parameters in HFpEF patients without concomitant T2DM. The association between serum galectin-3 level and the severity of diastolic dysfunction and systolic blood pressure were established. Modest correlation serum galectin-3 and TNF-a levels was found in the presence of impaired glucose tolerance in HF-patients. This dependence increases with the progression of IR. Galectin-3 level has prognostic informative regarding high risk of unfovarible clinical events development at levels more than 3.68 ng / ml in HFpEF diabetic and non-diabetic patients. In the general HFpEF patients population no significant difference in the prevalence this gene polymorphism incidence at HFpEF diabetic and non diabetic not patients has been found. The analysis showed that A allele carrying was significantly associated with moderate stage of LVDD (?2 = 14,065 , р = 0,0001, Mantel-Haenszel OR = 2.47, 95% CI 1.10-5.52; P <0.0001), LA volume (OR = 3,34, 95% CI 1,04 - 10,73; p-value = 0.042), a history of myocardial infarction (p-value = 0.010), body mass index (OR = 0.85, 95% CI 0.73-0.99; p-value = 0.044) and diastolic blood pressure (OR = 0.95, 95% CI 0.90-0.99; p-value = 0.039). High predictive value of A-allele caring allows to include it into the LVDD progression forecast model for clinical use. The study presents the results of improvement in prediction of HFpEF course in combination with T2DM. The main comorbidity worst course prognostic factors were determined and the methods of high risk of unfovarible clinical events development for such group of patients were calculated.