Obesity and heart failure with preserved ejection fraction.

OBJECTIVE: Aim: To perform an overall assessment of heart failure with preserved ejection fraction (HFpEF) adults with central obesity. PATIENTS AND METHODS: Materials and Methods: We enrolled HFpEF patients with central obesity (n =73, mean age 52.4 ± 6.3 years) and without obesity (n =70, mean age 51.9 ± 7.1 years) and compared with an age-matched healthy subjects who had not suffered from HF (n = 69, mean age 52.3 ± 7.5 years). Physical examination, routine laboratory tests such as fasting blood glucose, fasting insulin, insulin resistance (HOMA) index, serum lipids, haemoglobin, creatinine, ALT, AST, uric acide, hs CRP, TSH, N-terminal proB-type natriuretic peptide (NT-proBNP) and standard transthoracic echocardiogram (2D and Doppler) examinations were performed and assessed. RESULTS: Results: The average values of diastolic blood pressure (DBP), glucose and lipid profiles, uric acide, hs CRP were found to be significantly higher among obese patients with HFpEF than non-obese. Despite more severe symptoms and signs of HF, obese patients with HFpEF had lower NT-proBNP values than non-obese patients with HFpEF (129±36.8 pg/ml, 134±32.5 pg/ml vs 131±30.4 pg/ml, 139±33.8 pg/ml respectively; p < 0.05). However, it was found that patients with high central (visceral) adiposity have more pronounced obesity-related LV diastolic dysfunction, lower E/e' ratio, lower mitral annular lateral e' velocity, an increased LV diastolic dimension and LV mass index. Compared with non-obese HFpEF and control subjects, obese patients displayed greater right ventricular dilatation (base, 35±3.13 mm, 36±4.7 mm vs 33±2.8 mm, 34±3.2 mm and 29±5.3 mm, 30±3.9 mm; length, 74±5 mm, 76±8 mm vs 67±4 mm, 69±6 mm and 60±3 mm, 61±5 mm respectively; p < 0.05), more right ventricular dysfunction (TAPSE 16±2 mm, 15±3 mm vs 17±2 mm, 17±1 mm and 19±2 mm, 20±3 mm respectively; p < 0.05). CONCLUSION: Conclusions: Obese patients with HFpEF have higher diastolic BP, atherogenic dyslipidemia, insulin resistance index values and greater systemic inflammatory biomarkers, despite lower NT-proBNP values, which increase the risk of cardiovascular events in future. Echocardiography examination revealed not only significant LV diastolic dysfunction, but also displayed greater RV dilatation and dysfunction.

IS FECAL CALPROTECTIN DETERMINATION USEFUL FOR PATIENTS WITH METABOLIC ASSOCIATED FATTY LIVER DISEASE?

OBJECTIVE: Aim: To investigate the possible relationship between fecal calprotectin (FC) level and ultrasound indicators of steatosis and fibrosis wich defined by attenuation coefficient (AC) and liver stiffness (LS) from two-dimensional (2D) shear-wave elastography (SWE) in patients with metabolically associated fatty liver disease (MAFLD). PATIENTS AND METHODS: Materials and Methods: The study included 110 persons with MAFLD; mean age 51.3±4.8 years, 65 (59.1%) men. There were used laboratory, sonography and statistical methods. RESULTS: Results: Stage S1 of steatosis was diagnosed in 42 (38.2%), S2 - in 56 (50.9%), S3 - only in 12 (10.9%) MAFLD patients. The carbohydrate metabolism disorders were found in 62 (56.4%); 38 (34.5%) patients among them suffered from type 2 diabetes. The lipid metabolism disorders were diagnosed in the vast majority of patients included in this study. The minimal excess of fecal calprotectin (FC) was detected in 72 MAFLD patients (65.5%), the moderate increase of FC was found in 12 persons, the FC more than 10-fold excess of the norm was observed in only 8 MAFLD patients. FC levels were significantly elevated in MAFLD patients with a S2-S3 compared to those with a S1 (75.8 [42.9-112.1] vs. 46.3 [28.2-65.4], p<0.01). CONCLUSION: Conclusions: Fecal calprotectin levels are significantly elevated in patients with MAFLD. Future studies are warranted to establish the definitive role and clinical utility of FC as a potential biomarker of probably liver steatosis as well as other diseases associated with methabolic syndrome and its complications.

THE CLINICAL PRESENTATION OF SUBCLINICAL HYPOTHYROIDISM IN PATIENTS WITH TYPE 2 DIABETES MELLITUS ASSOCIATED WITH OBESITY, ITS IMPACT ON CARDIOVASCULAR RISK, AND WAYS OF ITS CORRECTION.

OBJECTIVE: The aim: Calculate CVR in patients with T2DM, obesity and SH and analyze it. PATIENTS AND METHODS: Materials and methods: The selection of patients was carried out based on the Uzhhorod District Clinical Hospital, in the period from November 2016 to July 2021. All examined patients were divided into 3 groups: 1 (n=108) with T2DM and concomitant obesity and SH, 2 (n=91) with T2DM and SH, 3 (n=46) with obesity and SH. The observation and treatment period lasted 1 year. Using American College of Cardiology (ACC) / American Heart Association Guideline on the Assessment of Cardiovascular Risk (AHAGACR) (2013) (ASCVD Risk) and Framingham Risk Score (FRS), CVR was determined in all patients before and at the end of the study. RESULTS: Results: According to the data obtained, patients in each group had a 10-year risk of CVE, however, worse CVR was observed in patients in group 1. In a more detailed analysis and comparison of the obtained data of patients with 10-year risk of CVE, worse CVR values were observed in patients with concomitant SH than without it (p<0.05). CONCLUSION: Conclusions: The presence of SH in consumers may be an additional risk factor for unwanted CVE over a 10-year period.

INFLUENCE OF COMPLEX TREATMENT ON BIOCHEMICAL BLOOD PARAMETERS OF PATIENTS WITH NON-ALCOHOLIC FATTY LIVER DISEASE AND CONCOMITANT PRE-DIABETES.

OBJECTIVE: The aim: Of this research is to evaluate laboratory changes in the liver blood tests, carbohydrate and lipid metabolism in NAFLD patients with concomitant pre-diabetes, and to study the feasibility of their complex treatment with the inclusion of omega-3 polyunsaturated fatty acids and essential phospholipids. PATIENTS AND METHODS: Materials and methods: We have examined 55 patients with non-alcoholic fatty liver disease on the background of pre-diabetes aged 40 to 75 years. Modification of lifestyle was recommended to all patients as a basic treatment. In addition, the patients were prescribed essential phospholipids in 2 capsules 3 times a day and omega-3 polyunsaturated fatty acids 1000 mg per day for 28 patients (group 1) or rosuvastatin 10 mg per day for 27 persons (group 2). The effectiveness of the treatment was evaluated in 3 months, and the long-term outcomes were evaluated in 12 months. RESULTS: Results: Under the influence of the prescribed treatment, a hypolipidemic effect was observed in both groups, but a significant decline in the activity of alanine aminotransferase and aspartate aminotransferase occurred only under the influence of a combination of essential phospholipids and omega-3 polyunsaturated fatty acids. CONCLUSION: Conclusions: Thus, the described results allow to recommend this combination of medicines to patients with non-alcoholic fatty liver disease and concomitant pre-diabetes.

Comparison of the effect of dapagliflozin on contrast to standard therapy of the patients with type 2 diabetes mellitus and concomitant obesity, their effect on laboratory and anthropometric parameters.

OBJECTIVE: The aim: Evaluate clinical and laboratory parameters of the patients with type 2 diabetes mellitus and concomitant obesity after a course of dapagliflozin treatment and compare with a standard treatment regimen. PATIENTS AND METHODS: Materials and methods: Conducted a comprehensive clinical laboratory examination and measurement of the anthropometric parameters of the patients with type 2 diabetes mellitus and concomitant obesity, with subsequent statistical calculations. RESULTS: Results: The data obtained at different stages of the study revealed a statistically significant effect of glucose treatment and glycosylated hemoglobin (HbA1c). Since the 6th month of dapagliflozin treatment, we have shown a tendency to lose weight compared to baseline in this group of patients and controls. CONCLUSION: Conclusions: Type 2 diabetes mellitus and obesity significantly increase the risk of developing a number of complications. Complex control and effects on clinical laboratory and anthropometric parameters can statistically significantly influence the development of the complications, and in this context, dapaglifloflozin showed statistically better results than standard metformin monotherapy.

Comorbidity severity index as a new tool for assessment of co-existing diseases in patients with non-alcoholic fatty liver disease at the carbohydrate metabolism disorder background and concomitant subclinical hypothyroidism.

OBJECTIVE: Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common disease which is characterized by comorbidity. However, no comorbidity index for its assessment has been described yet. The aim of this study was to develop a new index for evaluation of comorbidity in patients with NAFLD. PATIENTS AND METHODS: Materials and methods: 226 patients with NAFLD and associated carbohydrate metabolism disorders were examined. Besides, 60 persons with subclinical hypothyroidism, 30 patients with type 2 diabetes mellitus (T2-DM) and 30 NAFLD patients were examined. 30 healthy persons formed the control group. Clinical diagnoses were based on the laboratory tests and liver sonography. A new index of comorbidity has been used. Calculation of comorbidity severity index (ComSI) includes the possible presence of NAFLD, thyroid disorders, abdominal obesity, dyslipidemia, anemia, chronic complications of T2-DM, aggravated anamnesis. RESULTS: Results: The contradiction in the calculation of the well-known comorbidity indices values (CIRS - Cumulative illness rating scale, CCI - Charlson's comorbidity index, Kaplan-Feinstein index) was shown. So, their limited suitability for using in patients with carbohydrate metabolism disorders who have NAFLD was detected. According to our results an increasing of patients' age is associated with the increasing of concomitant diseases number and with deteriorating of the patients' general condition, which is reflected in an increasing of the ComSI value. The increasing of concomitant diseases number is associated not only with the higher ComSI, but also with the number of persons with a severe comorbidity according the ComSI value. Instead, the persons without comorbidity (groups 6, 7, 8) were marked as the patients with mild or moderate disease according the ComSI. CONCLUSION: Conclusions:The new ComSI index can be used to evaluate the severity of comorbidity in patients with NAFLD.