Laboratory changes and prognostic indicators of the adverse course of chronic heart failure with preserved left ventricular ejection fraction, excess weight and concomitant atrial fibrillation

Abstract

Aim. To investigate the peculiarities of clinical and laboratory changes and to identify prognostic indicators of the adverse course of chronic heart failure with preserved left ventricular ejection fraction (CHFprEF), excess weight and concomitant atrial fibrillation (AF). Materials and methods. The open, prospective, cohort study in parallel groups included 248 patients with CHFprEF, overweight and abdominal obesity, average age 65.0 ± 11.0 years; 146 (58.9 %) women and 102 (41.1 %) men. The first group included 181 patients with CHFprEF and excess weight without concomitant AF, and the second group – 67 CHFprEF patients with excess weight and AF. The complex clinical examination was performed according to the standards, including complaints, medical and family history, clinical, laboratory and instrumental examinations. Results. It has been established that patients with CHFprEF and overweight or abdominal obesity concomitant AF have a predisposition to anemia, which was manifested by significant lower indicators of hemoglobin and erythrocytes in parallel with lower values of lymphocytes, more pronounced signs of systemic inflammation, dysfunction of the kidneys and liver with manifestations of cholestasis, which indicated deeper functional and structural disorders of organs and systems. ROC-analysis of the patients with CHFprEF, excess weight and concomitant AF demonstrated increase in the clinical endpoints rate for patients with BMI ˃32 kg/m2, the waist circumference / hips circumference ratio ˃1.1 U, leucocytes level ˃6 × 109 l, serum creatinine ˃96 mcmol/l, urea ˃7.3 mmol/l, glomerular filtration rate ≤65 ml/min/1.73 m2, LDL / HDL cholesterol ratio ˃2.05 U. The 5-years death predictors were found in patients with CHFprEF, excess weight and concomitant AF: functional class of CHF ˃ІІ, HDL cholesterol ≤0.9 mmol/l, LDL cholesterol ≤0.66 mmol/l and triglycerides ≤1.45 mmol/l; additionally, there were defined the predictors of recurrent admission to hospital with the CHFprEF decompensation: leucocytes level ˃6 × 109 l, LDL cholesterol ˃2.49 mmol/l, the LDL / HDL cholesterol ratio ˃2.05 U and the atherogenic ratio ˃2.91 U. Conclusions. In patients with CHFprEF and excess weight, concomitant AF was associated with more severe laboratory changes, which reflected deeper functional and structural disorders of organs and systems. Laboratory predictors of the adverse course of CHFprEF in this category of patients have been established.