Aim - optimization of the treatment of obesity and chronic heart failure (CHF) patients by identifying key factors for the progression of cardiac decompensation and the principles of using metoprolol succinate, taking into account pharmacogenetic aspects in the complex treatment of this comorbidity. 127 patients with CHF 2nd-3rd stages, 1st-4th functional class by New York Heart Association at the age of 32-87 (61 [57; 65]) years were examined, including 93 men and 34 women. A comparative analysis of certain clinical criteria using the sequential analysis of Wald A.A. The results were statistically plausible with p<0.05. Conducting factor analysis allowed to separate groups of indicators and estimate the specific weight of individual factors in the pathogenesis of combined pathology - obesity and heart failure. The first two factors determine 76.8% of the variability of the indicators, given the indicators that load them, they were given descriptive titles "clinical-hemodynamic factor", "clinical and anthropometric factor". The proposed prognostic protocol provides new possibilities for predicting the efficacy of metoprolol succinate in patients with obesity and chronic heart failure. The developed discriminatory models allow to objectify the criteria for determining the doses of metoprolol succinate in patients with obesity and chronic heart failure - the maximum initial, maximal endpoint, and also to evaluate the expediency of a subsequent stepwise increase in dose. Perspective of further studies - development and clinical approbation of the protocol of the use of metoprolol succinate in patients with CHF in the context of obesity, taking into account the results of the conducted factor analysis and developed prognostic means.
The study was aimed at investigation of the effect of the "low triiodothyronin syndrome" (LT3S) on the course of heart failure (HF) developed on the background of post-infarction cardiosclerosis. The biennial study included 157 patients with HF (with a myocardial infarction on the background of coronary heart disease). During hospitalization, a standardized assessment was carried out, hemodynamic parameters, clinical and biochemical blood tests, levels of thyroid hormones (thyroid stimulating hormone (TSH), free T3f and T4f, reverse T3r) were determined. Statistical analysis has shown that for the diagnosis of LT3S in patients with HF on the background of post-infarction cardiosclerosis, it is advisable to use serum T3f level, ≤2.07 pmol/l. The frequency of LT3S in patients with HF during hospitalization is 17.8%. Patients with LT3S are younger, have larger left ventricular size, lower ejection fraction, a high relative risk of re-hospitalization within 2 years due to decompensation of HF (2.224 [1.363-3.630]). A regression model of the re-hospitalization of patients with HF has been described, which included: weight, thyroxine and triiodothyronine concentrations, non-toxic goiter, growth, total cholesterol levels and LDL cholesterol, blood granulocyte content. It is shown that the risk of re-hospitalization of patients with HF due to decompensation of the disease increases when the equation of this model exceeds ≥1,321 (sensitivity - 93.78% and specificity - 40.45%, p=0.0001).