Characteristics of the phenotypes of cardiovascular-renal-hepatic-metabolic syndrome in patients with chronic heart failure

Introduction

Type 2 diabetes mellitus, obesity, chronic kidney disease (CKD), atherosclerotic cardiovascular diseases (ASCVD), non-alcoholic fatty liver disease (NAFLD) are often found in patients in various combinations, they are components of cardiovascular-renal-hepatic-metabolic syndrome (CRHMS) and synergistically increase cardiovascular risk. However, the prevalence of different phenotypes in patients with chronic heart failure (CHF) has not been sufficiently studied.

Aim

To determine the prevalence of various phenotypes of CRHMS in patients with CHF.

Materials and methods

The study included 418 patients (Me [IQR] 72 [65;81] years) admitted to a multidisciplinary hospital for CHF decompensation (from 2021 to 2023), 56.46% (n=236) were men. All patients underwent standard laboratory tests, as well as echocardiography, ultrasound and liver fibroelastometry. The prevalence of the components of cardiovascular-renal-hepatic-metabolic syndrome (type 2 diabetes mellitus, CKD, obesity, NAFLD, ASCVD), as well as their combinations, was analyzed. Death from all causes within 1 year was estimated as the primary endpoint.

Results

Preserved left ventricular ejection fraction (LVEF) was observed in 41.6% (n=174), moderately reduced LVEF – in 20.6% (n=86), low LVEF – in 37.8%.

In the included cohort of patients, the prevalence of ASCVD was 63.2% (n=264), obesity – 48.8% (n=204), type 2 diabetes – 32.8% (n=137), NAFLD – 28.2% (n=118), CKD – 17.5% (n=73). The most common phenotype of a combination of 2 diseases was 31.1% (n=130), 27.0% (n=113) had only 1 component of CRHMS, 22.0% (n=92) had 3 components, 11.5% (n=48) had none of the diseases, 6.7% (n=28) – 4 components and in 1.7% (n=5) – all 5 components.

According to laboratory data, significant differences in LDL levels were obtained in patients with and without ASCVD (2.1 [1.6; 2.8] vs. 2.4 [1.9; 3.3], p<0.05), apparently, these differences are associated with a high frequency of statin therapy in the group of patients with ASCVD; albumin in obese and non-obese patients (37.6 [34.9; 40.0] vs. 35.9 [33.0; 39.3], p<0.05); AST (21.9 [17.8; 30.6] vs. 24.8 [19.8; 34.8], p<0.05), glucose (7.1 [5.8; 9.7] vs. 5.7 [4.9; 6.6], p<0.05) and HbA1c (6.5 [5.4; 7.7] vs. 5.4 [5.1; 5.8], p<0.05) in patients with and without diabetes mellitus.

The death rate during the year of follow-up was 21.3% (n=89). There were no significant differences in mortality from all causes over the 1-year follow–up period: in the presence of ≥1 component of CRHMS, mortality was 21.9%, ≥2 components of CRHMS – 21.4%, ≥3 components of CRGMS - 21.6%, ≥4 components of CRHMS – 20.0%, p>0.05.

Conclusion

CRHMS is widespread in hospitalized patients with CHF decompensation, the presence of at least 1 component reaches 88.5% (n=370), and a combination of 2 diseases is most common – 31.1% (n=130). Every fifth patient with CHF in the presence of CRHMS had an unfavorable outcome during 1 year of follow-up.