Keywords
coronary artery disease
type 2 diabetes mellitus
obesity
GAS6
catestatin
nesfatin-1
How to Cite
Abstract
In press
Background. Predicting the course of chronic heart failure (CHF) remains a challenging task, especially in the presence of comorbid metabolic disorders. Traditional prognostic tools, such as the Seattle Heart Failure Model (SHFM) and MAGGIC score, often do not take into account the specific impact of obesity and type 2 diabetes mellitus (T2DM), which can lead to the risk underestimation. This necessitates the search for new biomarkers to create more accurate risk stratification models in patients with polymorbidity.
Aim. To develop and internally validate a prognostic model for the risk of progression of chronic heart failure of ischaemic origin against the background of concomitant metabolic pathology such as type 2 diabetes mellitus and obesity.
Materials and Methods. The study was conducted on a cohort of 75 patients with CHF against the background of coronary artery disease with concomitant T2DM and obesity, examined twice with a frequency of one year. The diagnosis of CHF and concomitant pathology was verified in accordance with international and national standards. Biomarkers (NT-proBNP, GAS6, catestatin) were determined by enzyme-linked immunosorbent assay (ELISA).
Research Ethics. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Bioethics Committee of the Kharkiv National Medical University. All patients provided written informed consent to participate.
Results. The prognosis for CHF Functional Class (FС) deterioration within one year was calculated using binary logistic regression analysis with the method of sequential inclusion of parameters. The prognostic significance of individual indicators (NT-proBNP, GAS6, catestatin, insulin, nesfatin-1, and body mass index (BMI)) was assessed by ROC analysis to determine the optimal cut-off points and convert quantitative variables to binary (0/1). It was found that the most powerful prognostic factors were NT-proBNP at a level above 2347 pg/ml with the highest specificity (96.8%); BMI exceeding 32.47 kg/m2, which is a highly sensitive screening factor (92.8% sensitivity); catestatin at a level below 4.92 ng/ml – as a marker of a deficient cardioprotective mechanism, with high sensitivity (88.7%) and specificity (81.3%). Insulin levels above 32.18 mg/ml and GAS6 levels exceeding 23.48 ng/ml were also found to be significant independent predictors of CHF progression.
Conclusions. The developed integrative model effectively combines neurohumoral, metabolic, and inflammatory factors, allowing for personalised and accurate stratification of the risk of chronic heart failure progression in patients with comorbid obesity and type 2 diabetes mellitus.
Keywords: therapy, coronary artery disease, type 2 diabetes mellitus, obesity, GAS6, catestatin, nesfatin-1.
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