The main pathogenetic mechanisms of chronic heart failure in patients with coronary heart disease and type 2 diabetes mellitus are considered, in particular, morphological, hemodynamic, metabolic and neurohumoral factors that contribute to the development and progression of chronic heart failure in patients with these comorbid conditions. The purpose of the study was to review the scientific literature and summarize the results of research to study the role of hemodynamic and metabolic factors in the development and progression of chronic heart failure in patients with coronary heart disease and type 2 diabetes. The study emphasizes the leading role of disorders of carbohydrate metabolism (insulin resistance and hyperglycemia) in the occurrence of type 2 diabetes mellitus specific myocardial injury called diabetic cardiomyopathy which leads to disorders of the left ventricular function and the development of chronic heart failure. It is the mechanisms associated with insulin resistance, hyperglycemia and atherogenic dyslipidemia that are responsible for the formation and development of chronic macro- and microvascular complications of type 2 diabetes mellitus, which also include chronic heart failure. The study showed that the increase in myocardial stiffness with the development of its diastolic dysfunction was the earliest sign of myocardial damage in type 2 diabetes mellitus. Hyperfunction and hypertrophy of the left ventricle in terms of mobilization of energy and structural reserves of its myocardium lead to increased dysfunction and clinical manifestations of chronic heart failure. Ultrastructural and morphological changes in the myocardium in diabetic diabetic cardiomyopathy, which are the basis of disorders of cardiomyocyte metabolism, their subsequent hibernation and apoptosis, which ultimately contributes to fibrosis in the myocardium and the development of its systolic and diastolic dysfunction. Conclusion. The peculiarities of cardiovascular remodeling in coronary heart disease, concomitant type 2 diabetes mellitus and the role of these processes in the development of cardiovascular complications, primarily chronic heart failure, are also highlighted. An in-depth understanding of the pathogenetic mechanisms of chronic heart failure development in patients with type 2 diabetes mellitus and coronary heart disease opens new perspectives for the development of more effective pharmacological agents, optimization of drug treatment regimens for chronic heart failure in order to improve the quality and life expectancy of patients.
Keywords: type 2 diabetes mellitus, ischaemic heart disease, chronic heart failure, metabolic, neurohumoral mechanisms
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