Spivak Y. Optimization of diagnosis and treatment of heart failure in patients with acute myocardial infarction and concomitant type 2 diabetes

The dissertation focuses on the problem of increasing the effectiveness of treatment of heart failure (HF) with a left ventricular ejection fraction (LVEF) > 40% in patients with acute myocardial infarction (AMI) and concomitant type 2 diabetes mellitus (T2DM) by improving the diagnosis of structural and functional disorders of the myocardium, optimization of therapeutic measures using medicinal agents: mineralocorticosteroid receptor antagonist (MCRA) – eplerenone and sodium-dependent glucose cotransporter type 2 (SGLT2) inhibitor – empagliflozin. Despite the rapid development of modern technologies with the expansion of diagnostic and therapeutic capabilities, there is still insufficient data on the features of remodeling of the infarcted myocardium with subsequent progression of heart failure, especially in patients with concomitant T2DM, the formation of cardio-endocrine approaches with optimal individual programs and the differentiation of therapeutic measures depending on comorbid pathology. The analysis of literary sources demonstrates the insufficiency of information, or its fragmentary and superficial nature about the features of the clinical and cardiological course, structural and functional recovery and cardiorehabilitation potential of patients in the acute and recovery periods of myocardial infarction against the background of concomitant T2DM and without it. The results of the study can be used in the doctor's practice in order to deepen the understanding of the problem, optimize the timely verification of this pathology, and apply optimal treatment tactics. This will allow us to achieve maximum efficiency during the clinical course, stabilization and subsequent recovery of patients. Having analyzed the existing approaches to the use of various treatment methods in clinical practice for the course of HF against the background of AMI and T2DM, one can assert that HF remains an unsolved problem, as there are no unified recommendations for diagnosis and treatment period relative to the onset of the disease, and the available results only contain data on the effectiveness of treatment of the symptomatic course of the disease. In addition, the dynamics of recovery of the heart muscle has not yet been determined, the regulatory link of the body in patients with AMI and concomitant T2DM under the influence of medicinal treatment by prescribing cardiac agents MCRA and/or SGLT2 has not been identified, the effectiveness of their separate use has not been compared, the efficacy of their combination against the background of baseline therapy has not been clarified, which determined the direction of this research. The aim of the research was to increase the efficiency of diagnosis and treatment of heart failure against the background of acute myocardial infarction in combination with and without type 2 diabetes mellitus based on the study of the pathogenetic mechanisms of the course of syntropy. The expediency of the early prescription of combined pharmacological therapy (eplerenone and empagliflozin) to increase the efficiency of functional recovery of the heart and further reduce the clinical consequences of a sustained heart attack has been convincingly proven. The obtained data made it possible to optimize the tactics of treatment of HF patients with LVEF >40% in the acute and post-infarction periods against the background of concomitant T2DM by using pharmacological correction methods for 6 months, namely by prescribing a combination of MCRA and SGLT2 in the comprehensive treatment of the pathology.