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.

Aim. Evaluation of markers of systemic inflammation in patients with chronic heart failure in comorbidity with chronic kidney disease.Methods. The study included 188 patients with heart failure and kidney disease including control group (76 patients) with heart failure with preserved renal function aged 38 to 83 years (mean age 66.8±10.1 years), with the duration of heart failure of about 8 years. Quantitative measurement of C-reactive protein and proteins of blood serum and daily excretion of protein with urine were performed.Results. Glomerular filtration rate in patients without renal pathology was 71.1±11.7 ml/min/1.73 m2, and in the group with heart failure associated with kidney dysfunction it was 51.5±19.1 ml/min/1.73 m2. C-reactive protein, γ-globulin, albumin and total serum protein in patients with chronic kidney disease differed from those in patients with heart failure without kidney damage.Conclusion. C-reactive protein and γ-globulin in the serum significantly increase in patients with heart failure and chronic kidney disease and can be used as markers of cardiac as well as renal events.

Literature review on the use of angiotensin II receptors blockers in patients with combined pathology of the cardiovascular and renal systems: chronic heart failure and chronic kidney disease is presented. The angiotensin II receptors blockers positive effect is determined by the selective and complete type 1 receptors blockade and simultaneous stimulation of the type 2 receptors. On the one hand angiotensin II blockers are well-studied and widely used class of drugs in patients with cardiac pathology. On the other hand, the efficacy and safety of this drugs group in patients with renal impairment due to cardiac pathology or coexisting urinary system diseases are not well studied. Clinical studies have confirmed the angiotensin II receptor blockers pharmacotherapeutic activity and safety in reducing the cardiovascular events rate, including cardiovascular mortality, myocardial infarction, stroke, number of hospitalizations due to decompensated heart failure. There is data regarding the heart failure poor prognosis in decreased kidney function, but most of these studies were conducted in patients with end-stage renal failure. Data on angiotensin II receptor blockers effect on the course and prognosis of patients with heart failure in association with kidney damage is not enough. The effect of angiotensin II on the heart failure clinical presentation and outcomes according to the left ventricular ejection fraction preservation or reduction, and on the severity of kidney damage is not studied.

The discussion continues about the role of systemic inflammation in the pathogenesis of cardiovascular diseases of ischemic etiology. This article reviews the information on the role of C-reactive protein in patients with atherosclerosis and heart failure in risk stratification for adverse cardiovascular events, including assessment of factors affecting the basal level of highly sensitive C-reactive protein. Research data (MRFIT, MONICA) have demonstrated a relationship between an increased level of C-reactive protein and the development of coronary heart disease. An increase in the serum level of highly sensitive C-reactive protein is observed in arterial hypertension, dyslipidemia, type 2 diabetes mellitus and insulin resistance, which indicates the involvement of systemic inflammation in these disorders. Currently, the assessment of highly sensitive C-reactive protein is used to determine the risk of developing myocardial infarction and stroke. It has been proven that heart failure patients have a high level of highly sensitive C-reactive protein compared with patients without heart failure. The level of C-reactive protein is referred to as modifiable risk factors for cardiovascular diseases of ischemic origin, since lifestyle changes or taking drugs such as statins, non-steroidal anti-inflammatory drugs, glucocorticoids, etc. reduce the level of highly sensitive C-reactive protein. In patients with heart failure with different left ventricular ejection fraction values, it was found that the regression of the inflammatory response is accompanied by an improvement in prognosis, which confirms the hypothesis of inflammation as a response to stress, which has negative consequences for the cardiovascular system.