The clinical and pedagogical school of Semyon Semyonovich Zimnitsky is described in close connection with the evolution of his academic status, changes in clinical bases and the social structure of society at the beginning of the 20th century. S. S. Zimnitsky took part in the creation of the Clinical Institute, opened the department of infectious diseases, founded the department of propaedeutics of internal diseases at Kazan State University. The outstanding talent of the lecturer and deep knowledge of clinical material won the love of affection and junior doctors. S. S. Zimnitsky creates methods for teaching therapy at the patient bedside in practical classes and in a lecture course, has an active professional position and is fighting with unreconstructed university professors.

Aim. To analyze clinical and echocardiographic characteristics and prognosis in patients with heart failure mid-range ejection fraction. Methods. The study included 76 patients with stable heart failure IIV functional class, with a mean age of 66.110.4 years. All patients were divided into 3 subgroups based on the left ventricular ejection fraction: the first group heart failure patients with reduced ejection fraction (below 40%), 21.1%; the second group patients with mid-range ejection fraction (from 40 to 49%), 23.7%; the third group patients with preserved ejection fraction (50%), 55.3%. The clinical characteristics of all groups were compared. The quality of life was assessed by the Minnesota Satisfaction Questionnaire (MSQ), the clinical condition was determined by using the clinical condition assessment scale (Russian Shocks). The prognosis was studied according to the onset of cardiovascular events one year after enrollment in the study. The endpoints were cardiovascular mortality, myocardial infarction (MI), stroke, hospitalization for acutely decompensated heart failure, thrombotic complications. Statistical analysis was performed by using IBM SPSS Statistics 20 software. Normal distribution of the data was determined by the ShapiroWilk test, nominal indicators were compared between groups by using chi-square tests, normally distributed quantitative indicators by ANOVA. The KruskalWallis test was performed to comparing data with non-normal distribution. Results. Analysis showed that the most of clinical characteristics (etiological structure, age, gender, quality of life, results on the clinical condition assessment scale for patients with chronic heart failure and a 6-minute walk test, distribution by functional classes of heart failure) in patients with mid-range ejection fraction (HFmrEF) were similar to those in patients with reduced ejection fraction (HFrEF). At the same time, they significantly differed from the characteristics of patients with preserved ejection fraction (HFpEF). Echocardiographic data from patients with mid-range ejection fraction ranks in the middle compared to patients with reduced and preserved ejection fraction. In heart failure patients with mid-range ejection fraction, the incidence of adverse outcomes during the 1st year also was intermediate between heart failure patients with preserved ejection fraction and patients with reduced ejection fraction: for all cardiovascular events in the absence of significant differences (17.6; 10.8 and 18.8%, respectively), myocardial infarction (5,9; 0 and 6.2%), thrombotic complications (5.9; 5.4 and 6.2%). Heart failure patients with mid-range ejection fraction in comparison to patients with preserved ejection fraction and reduced ejection fraction had significantly lower cardiovascular mortality (0; 2.7 and 12.5%, p 0.05) and the number of hospitalization for acutely decompensated heart failure (0; 2,7 and 6.2%). Conclusion. Clinical characteristics of heart failure patients with mid-range and heart failure patients with reduced ejection fraction are similar but significantly different from those in the group of patients with preserved ejection fraction; echocardiographic data in heart failure patients with mid-range ejection fraction is intermediate between those in patients with reduced ejection fraction and patients with preserved ejection fraction; the prognosis for all cardiovascular events did not differ significantly in the groups depending on the left ventricular ejection fraction.

The article reviews studies of gene polymorphisms effects on the phenotype and the prognostic value of the genotype determination in patients with congestive heart failure. The results of studies analyzing the impact of angiotensinogen, angiotensin-converting enzyme, β2-adrenoreceptor genes polymorphism on the development of hypertension, myocardial and carotid arteries damage, and congestive heart failure prognosis are surveyed. However, despite the large number of studies addressing the association of polymorphic markers of candidate genes and phenotype, no consensus on the impact of candidate genes on the major systems involved in the pathogenesis of congestive heart failure has been achieved so far. Due to gene distribution variability in different populations, the studies of ethnic and geographical association of candidate genes with congestive heart failure development, as well as studies of phenotypic markers of the disease, are still relevant.

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