The thesis is devoted to improving the practical recommendations for treatment of patients with chronic heart failure (CHF) regard to the state of their cognitive function by finding out factors, the prognostic importance and new possibilities for the treatment of cognitive impairment (CI) in this syndrome. In the prospective study, 124 patients (pts) with stable CHF and reduced left ventricular ejection fraction (LVEF) (<40 %) aged 25 to 75 years (Me = 63.0 (54; 68; 3)) were included. The etiological factors of CHF were coronary heart disease (CHD) (94 people) or dilated cardiomyopathy (19 people). History of hypertension had 92 people, type II diabetes mellitus (DM) - 35, renal dysfunction (GFR =<60 ml / min) - 53 people. Nearly half of pts had a permanent or persistent form of atrial fibrillation (AF). The control group consisted of 30 pts with hypertension and/or CHD without CHF with normal LVEF. CI was defined as MMSE?26 points, it was observed in most of pts - 85 (68,6 %). Pts with CHF have significantly lower cognitive performance (p = 0.019 for MMSE and p = 0.001 for Schulte test) and a higher the HADS depression level (p <0.001) compared with pts without CHF. The presence of CI in CHF is associated with age, severity of CHF and the presence of hypertension, CHD and renal dysfunction. MMSE scale results directly correlates with the distance of 6-minute walking test (r = 0.264, p = 0.003), the level of physical activity (r = 0.275, p = 0.002), the number of red blood cells (r = 0.204, p = 0.023), glomerular filtration rate (r = 0.275, p = 0.002), EMVR (r = 0.207, p = 0.021), superoxiddismutase activity (r = 0.205, p = 0.028) and inverse - with age (r = -0.429, p <0.001) ), the degree of worsening quality of life (r = -0.179, p = 0.049), severity of depression (r = -0.257, p = 0.004), serum ceruloplasmin plasma level (r = -0.308, p = 0.004). The results of Schulte test directly correlates with age (r = 0.572, p <0.001), the degree of worsening quality of life (r = 0.382, p <0.001), the severity of depression (r = 0.280, p = 0.002), interleukin-6 (r = 0,254, p = 0,006), NTproBNP (r = 0,168, p = 0,034) and inverse - with physical activity level (r = -0,338, p <0,001), 6-minute walking test distance (r = -0,35 , p <0.001), level of hemoglobin and erythrocytes (r = -0.292, p = 0.001 and r = -0.250, p = 0.005, respectively), hematocrit (r = -0.262, p = 0.003), blood albumin level (r = 0.271, p = 0.043), GFR (r = -0.351, p <0.001) and EMVR (r = -0.213, p = 0.017). According to univariate regression analysis, high risk of CI has pts NYHA III-IV, with worse quality of life and higher ceruloplasmin level. Higher risk of CI was associated with worse functional status, lower adherence to treatment, and also with worse EMVR. In multivariate analysis the independent predictors of CI in pts with CHF were age, duration of hypertension, low adherence to treatment and high level of ceruloplasmin plasma. The MMSE scale is highly informative regarding the prediction of long-term survival and the onset of a combined critical event even after adjustment to age and NYHA class. Schulte test had low predictive survival informativeness and sufficient informativeness on the onset of a combined critical event, which, however, was reduced after age and NYHA class adjustment. Inclusion in the prognostic algorithm HADS depression ubscale can increase the validity of difference between the comparable groups of pts with CI vs non-CI as for long-term survival and the onset of a combined critical event. More than half of pts with CHF have low and moderate adherence to treatment which is associated with worse performance of cognitive tests. Data on the relationship between adherence to treatment and the results of cognitive tests obtained using the heart failure disease-specific questionnaire are comparable to Moriski-Green questionnaire. However, unlike the Moriski-Green questionnaire, using the heart failure disease-specific questionnaire has a high informativeness for prediction long-term survival and the onset of a combined critical event in pts with CHF. Prescription for four weeks in pts with CHF fixed combination of meldonium with gamma-buthyrobetaine in addition to the standard basic treatment was associated with significant improvement of cognitive tests results, quality of life, and EMVR.
