Background: The presence of even subclinical forms of heart failure in type 2 DM is associated with a negative prognosis of the disease, leading to a significant increase in the frequency of hospitalizations and mortality. Aims: Identification of left ventricle subclinical dysfunction in terms of its diastolic function, deformation parameters and rotational properties of the myocardium in patients with type 2 diabetes. Materials and methods: A prospective case-control single-center study, performed simultaneously in groups of patients with type 2 diabetes and hypertension. To identify left ventricular dysfunction (LV), an echocardiographic study was performed, including tissue dopplerography and Speckle Tracking Echocardiography. Results: We examined three groups of patients comparable in age and sex distribution, with no obvious clinical signs of heart failure. Group I comprised 56 patients with type 2 diabetes and moderate hypertension. Group II included 52 patients with type 2 diabetes without an increase of blood pressure. Group III (54 people) consisted of patients with hypertension without diabetes. The use of tissue dopplerography and Speckle Tracking Echocardiography allows more often (p˂0.05) to detect signs of LV dysfunction in patients with type 2 diabetes compared with routine echocardiography methods. In patients with a combination of type 2 diabetes and hypertension, an unfavorable restrictive variant of diastolic dysfunction is more common (p˂0.05) in contrast to patients with diabetes without hypertension or those with hypertension without diabetes. The combination of type 2 diabetes and hypertension to a greater extent leads to an increase in the longitudinal global deformation of the left ventricle compared with patients who had only one of these diseases (p˂0.05). A decrease in the Global area strain was expressed (p˂0.05) in patients with type 2 diabetes, regardless of the presence of concomitant hypertension. Conclusions: This study shows the importance of using tissue dopplerography and Speckle Tracking Echocardiography in the diagnosis of subclinical heart failure. The results indicate a high prevalence of subclinical systolic-diastolic LV dysfunction in type 2 diabetes, which is aggravated in the presence of concomitant hypertension in patients without obvious clinical signs of heart failure and other cardiovascular diseases.

Objective: of article was to study the level of cerebral natriuretic peptide in patients with type 2 diabetes mellitus with diastolic dysfunction and with various types of left ventricular remodeling. Materials and methods: 256 patients with type 2 diabetes mellitus (DM) who had moderate arterial hypertension (AH) and no clinical signs of chronic heart failure were examined. The control group consisted of 30 practically healthy persons, comparable in age and sex with the examined patients. All patients were determined the concentration of brain natriuretic peptide (BNP) in blood plasma. The structural and functional parameters of the heart were determined by echocardiography in B- and M-modes according to the standard technique. Results: in patients with type 2 diabetes and diastolic dysfunction, the BNP concentration was 156 (84; 228) pg / ml, in patients without diastolic filling disorders — 24 (12; 38) pg / ml. The highest BNP values were found in the subgroup of patients with a restrictive type of transmitral flow. Also, BNP values were higher in the group of patients with concentric and eccentric left ventricular (LV) hypertrophy. Conclusion: in all patients with type 2 diabetes and concomitant moderate hypertension, even in the absence of clinical signs of CHF, there is an increase in the BNP level compared to the control group. The highest BNP values were observed in patients with severe diastolic dysfunction and unfavorable variants of LV remodeling.

Patients with type 2 diabetes mellitus (DM) have a high risk of secondary cardiorenal syndrome, which increases the death rate in these patients. Diabetes-associated heart and kidney damage is an important and largely underestimated cause of global morbidity and mortality. The research for new combinations of cardionephroprotective drugs is currently an urgent task. The aim of this study was to evaluate the effectiveness of the combination of valsartan and amlodipine versus the combination of sacubitril/valsartan and amlodipine in relation to cardiac and nephroprotection in patients with type 2 diabetes mellitus. The study involved 96 patients with type 2 diabetes with secondary cardiorenal syndrome. There were 54 (56.25%) men and 42 (43.75%) women. The average age was 60.27±7.53 years. During the study, patients were randomized into two groups. Group 1 (n=48) consisted of patients with type 2 diabetes with age 59.38±7.74 years who received a combination of valsartan and amlodipine for 6 months. Group 2 (n=48) consisted of patients with type 2 diabetes with age 61.17±7.29 years who received therapy which consisted of sacubitrile/valsartan and amlodipine for the same time. The control group consisted of 40 practically healthy volunteers whose average age was 60.3 ± 7.0 years. It was revealed that cardiac markers NT-proBNP, cystatin C, aldosterone are integral indicators of the risk of developing cardiovascular and renal dysfunctions, and increases in patients with type 2 diabetes indicates a high probability of progression of secondary cardiorenal syndrome. A six-month therapy with a combination of antihypertensive drugs valsartan with amlodipine and sacubitrile/valsartan with amlodipine in patients with type 2 diabetes equally effectively reduces blood pressure, while NT-proBNP and cystatin C significantly decrease against the background of an increase in glomerular filtration rate. In patients with secondary cardiorenal syndrome who received a combination of sacubitril/valsartan and amlodipine there was a more pronounced dynamics of a decrease in albuminuria and aldosterone levels.

The monograph is devoted to the actual problem of modern clinical medicine – proteinuria. The appearance of protein in the urine, often a symptom of kidney damage, is important diagnostic and prognostic value. The wide spread of proteinuria among patients with various diseases makes this problem urgent and studied. This monograph is designed for a large number of readers: from medical University students to doctors of various specialties.

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