COURSE OF POST COVID-19 DISEASE IN HEART FAILURE PATIENTS WITH MODERATELY REDUCED LEFT VENTRICULAR EJECTION FRACTION.

In this study, we assessed the impact of COVID-19 on the course of HFmrEF by determining the biomarkers furin and NT-proBNP, questionnaires (EQ-5D-5L), and cardiac ultrasound. A comprehensive examination of 72 patients with HFmrEF (main group) and 18 apparently healthy individuals (control group). The main group was divided into two subgroups depending on the history of coronavirus disease. All patients gave their consent to participate in the study. In the group of patients with a history of coronavirus infection compared to the patients without a COVID-19 history were established: significantly higher concentrations of NT-proBNP (1002.79±215.94 pg/ml and 405.37±99.06 pg/ml, respectively, p-value 0.01), uric acid (429.08±27.01 mmol/l vs. 354.44±28.75 mmol/l, p-value 0.04) and a lower furin to NT-proBNP ratio (0.87± 0.26 and 1.38 ± 1.16, p-value 0.045) in blood serum; using the EQ-5D-5L questionnaire, a significant deterioration of quality of life indicators (64.21±3.04 points vs. 72.81±1.82 points by VAS, p-value 0.02); higher indicators of LVMMi (157.39±6.14 g/m2 and 138.68±6.02 g/m2, p-value 0.03), LA dimensions (43.74±0.95 mm and 41.12±0.85 mm, p-value 0.04) and RA dimensions (40.76±1.23 mm and 37.75±0.85 mm, p-value 0.04). Coronavirus infection in patients with HFmrEF leads to disorders of intracardiac hemodynamics and persistent negative structural changes of the heart. The ratio of furin to NT-proBNP serum levels can be used to determine the impact of the HF syndrome itself on the patients' subjective assessment of their quality of life.

[CURRENT ISSUES OF BETA-BLOCKERS USE IN THE MANAGEMENT OF COVID-19 (REVIEW)].

Over the past two decades, the world has witnessed severe acute respiratory syndrome CoV (SARS-CoV), an underlying serious diseases, with a high rate of mortality in patients with comorbidities. Taking into account the clinical features of pulmonary edema, septic shock, deep vein thrombosis and pulmonary embolism, it seems that the severe course of COVID-19 can manifest itself in the body as a sympathetic storm and, possibly, can underlie many of the pathological processes that occur with COVID-19. It is the regulation of the RAAS by the adrenergic system may be crucially important in the course of COVID-19. This article outlines the benefits of beta blockers use in patients with COVID-19 based on the results of recent clinical and epidemiological studies. It has been shown that treatment with beta-blockers in this group of patients can potentially prevent the development of the disease at the earliest stages, reducing morbidity and mortality, preventing or reducing the development of pulmonary embolism, acute respiratory distress syndrome, pulmonary edema and complications of septic shock, fatal rhythm disturbances, etc. Of course, the final conclusions are somewhat premature and further research is needed to assess the positive effects of various beta-blockers use in the treatment of COVID-19.

[POLYMORPHISM OF THE BETA1- AND BETA2-ADRENORECEPTOR GENES AND BISOPROLOL EFFICIENCY IN PATIENTS WITH HEART FAILURE].

The work was aimed at studying the relationship between the efficiency of bisoprolol and the polymorphism of ß1- and ß2-adrenergic receptors (ß-AR) genes in patients with heart failure. The two-year study included 251 patients with heart failure (with myocardial infarction on the background of coronary heart disease). During hospitalization, a standardized examination and prescription of therapy was carried out, including ß-adrenergic blocking agent (ß1-AB) - bisoprolol. Afterward, 61 (24.4%) patients stopped taking ß1-AB (bisoprolol) as a result of intolerance or violation of compliance; 190 patients took bisoprolol for 2 years. The frequency of rehospitalization (RH) due to decompensation of heart failure (HF) (or intravenous injection of loop diuretics), mortality, and the development of a composite endpoint (CE) for 2 years was taken into account. The control group consisted of 55 healthy individuals. Genotyping was performed using 3 polymorphisms (Gly389Arg of the ß1-АR gene, Ser49Gly of the ß1-АR gene, Gln27Glu of the ß2-АR gene) using the polymerase chain reaction. Genetic and epidemiological analysis was carried out using the SNPStats program. The use of bisoprolol with HF reduces the risk of re-hospitalization (odds ratio (OR)=0.519 (0.278-0.967); p=0.037) and CE (OR=0.494 (0.271-0.900); p=0.030) for 2 years of treatment. Treatment of patients with bisoprolol in a dose of >5 mg leads to a decrease in the risk of CE with G/A polymorphism Ser49Gly (c.145A> G) of the ß1-AR gene (OR=0.18 (0.04-0.84), with p=0.014). The use of this drug at this dose also leads to a decrease in the frequency of RH and CE with the homozygous genotype C (C/C) of the Gln27Glu polymorphism (c.79C>G) of the ß2-AR gene (OR=0.09 (0.02-0.46), at p=0.018 and OR=0.14 (0.04-0.58), at p=0.006, respectively).

[THE ROLE OF MARKER FIBROSIS ST2 AND ANGIOTENZINOGEN GENE POLYMORPHISM IN HEART FAILURE PROGRESSING IN PATIENTS WITH TYPE 2 DIABETES MELLITUS].

Despite the progress in the treatment of HF, its prognosis remains disappointing primarily due to the fact that important subgroups of patients with HF are not sufficiently investigated. This also applies to patients with HF and background metabolic disorders, in particular, type 2 diabetes. It is known that the polymorphism of the rs699 marker of the M235T ATG gene is associated with a tendency to arterial hypertension, coronary heart disease and atrial fibrillation. A relationship was found between the polymorphism of M235T and the risk of HF development. One of the promising new biomarkers is the fibrosis marker ST2. The purpose of our study was to evaluate the role of the biomarker ST2 and the genetic polymorphism of the AT2 gene M235T in the progression of CHF and the development of adverse events in patients with concomitant type 2 diabetes. We found that patients with HFpEF and T2DM with ATG TT + MT genotype have a higher level of ST2 and a higher probability of unfavorable cardiovascular events during 24 months of observation compared with MM genotype carriers.

[THE PROGNOSTIC VALUE OF OBESITY AND HYPONATERMIA IN PROGRESSING OF CHRONIC HEART FAILER: CARDIOVASCULAR MORTALITY AND CARDIORENAL SYNDROME].

Aim - to study the predictors of cardiovascular events in patients with chronic heart failure (CHF) with preserved left ventricular ejection fraction role of traditional and non-traditional risk factors, to analyze the prognostic role of hyponatremia. Analysis of the clinical features of CHF was provided by retrospective research of medical cards in 308 patients, with endpoint verification during long-term period from 2010 to 2015. Among the examined patients 81 addmitted to the intensive care unit. The study showed that in obesity patients with body mass index (BMI) more than 30 kg/m2, the incidence of CHF decompensation was higher (p<0,05), but a significant mortality in CHF is only possible with abdominal obesity. It was proved the significant increase of CHF decompensation at patients with diabetes mellitus (p<0,05), the gender specificity of the disease was the higher risk of cardiovascular mortality in males (p<0,05).It was found that the most often in patients with CHF decompensation was reduced systolic pressure with an absolute risk of 82,7%. It was established a significantly higher risk of cardiovascular mortality in CHF with a sodium level less than 135 mmol/l, an increase from 19,0 to 45,0%, the "cut-off point" was established at the Na+ level between 115.0-125.0 mmol/l. After analyzing of the "combined" risk with hyponatremia and obesity, cardiovascular mortality increased to 23,0%.In the group with severe decompensation of CHF, it was set the lower hemoglobin level (p<0,05), lower hematocrit (p<0,05), higher ESR (p<0,05) and total leukocyte count(p<0,05).Absolute risk of cardiovascular mortality with hemoglobin level before 120 g/l was 48,0% vs. 16,0% of patients with normal hemoglobin level. Significant factors, combined with frequent hospitalization were age over 65 years (p<0,05), body mass index more than 30 kg/m2 (p<0,05), III and IV functional classes of CHF (p<0,05),hemoglobin level less than 120 g/l (p<0,05), hyponatremia (p<0,05).It was set the reliable influence of combined hyponatremia and obesity on the frequency of hospitalizations in CHF patients with an increase of absolute risk with 55,0%, reliable RR and OR (p<0,05).