The thesis is devoted to the improvement in a follow-up management of patients with CHF and reduced LV EF by studying their clinical and instrumental characteristics, in regard of an iron deficiency presence, iron metabolism indices levels, establishing iron deficiency state predictors, ID and its separate parameters prognostic value during long-term observation, studying ID types and ID without anaemia. The study included 134 CHF patients II-IV NYHA class with LV EF =< 40% with the background of iscemic heart disease (77%) or dilated cardiomyopathy (23%), median age was 59.5 (54;68) years, 113 (83%) were men and 21 (15%) - women. Iron deficiency was detected in 62 % patients. The observation period lasted until 27.5 months. Patients with ID compared to non-ID patients were characterized by a greater proportion of ІІІ-ІV NYHA class patients and patients with renal dysfunction, lower BMI and lower hemoglobin levels, lower physical activity index, less 6 minutes walking test distance, less thigh quadriceps durability, worse quality of life, along with a significantly higher level of circulating biomarkers such as NTproBNP, interleukin 6 and citrulline. Among patients with CHF and rLV EF absolute ID was detected in 39% of cases, functional - in 21%. Compared to patients with absolute ID, patients with functional ID were characterized by higher, but within the reference values, hemoglobin, MCV and MCH levels, higher circulating interleukin 6 and citrulline concentrations, in the absence of significant differences in mortality and combined critical events (death or hospitalization for cardiovascular reasons). Among examined patients with CHF and rLV EF, anemia was absent in 71% of cases. In turn, among patients without anemia, ID was observed at 54%. Its presence, in comparison with non-anemia and non-ID patients, was associated with a higher proportion of patients in NYHA III-IV, lower physical capacity (6-minute test, index of physical activity, muscular endurance), poorer quality of life, higher interleukin 6, NTproBNP, and citrulline levels and the worst long-term clinical outcomes (mortality, combined critical event) during 12-27.5 months of follow-up. For the first time, a direct link between low-intensity inflammation / oxidant stress biomarkers, NTproBNP and the presence / severity of ID was established. For the first time, quantitative criteria for long-term clinical risk stratification in patients with CHF and rLV EF, based on iron state metabolism separate indicators (transferrin saturation, iron), were determined. For the first time, it has been established that more than half of CHF patients without anemia have ID and are characterized by worse clinical and functional parameters, higher low intensity systemic inflammation and oxidative stress values, and worse long-term prognosis. Thus, it is advised to conduct all patients with CHF and reduced LV EF, regardless of hemoglobin level, a standardized four-headed hip muscle endurance and with the number of lower limb extensions less than 30 times to perform ID laboratory tests; to use TSAT or serum iron levels as more accessible in patients with CHF and reduced LV EF with a view to stratify clinical risk; to define prognostic criteria for the mortality risk in patients with CHF and reduced LV EF with their long-term follow-up, based on the assessment of TSAT and serum iron levels.
