FEATURES OF THE PSYCHO-EMOTIONAL STATUS IN PATIENTS WITH COMORBID CORONARY HEART DISEASE, TYPE 2 DIABETES MELLITUS, AND OBESITY, ACCORDING TO THE FUNCTIONAL CLASS OF CHRONIC HEART FAILURE
Authors: Borovyk K.M. 
Published: December 2024

The purpose of this study is to assess the presence and nature of changes in the components of emotional status in patients with comorbidity of coronary heart disease and type 2 diabetes mellitus or its combination with obesity, according to the functional class of chronic heart failure.
Subjects and methods. This study involved 225 patients with chronic heart failure secondary to coronary heart disease, divided into groups based on the presence of metabolic disorders. Group 1 included patients with chronic heart failure, coronary heart disease, type 2 diabetes mellitus, and obesity (n = 75). Group 2 consisted of patients with chronic heart failure and coronary heart disease, along with type 2 diabetes mellitus (n = 50). Group 3 included patients with chronic heart failure and coronary heart disease, with concomitant obesity (n = 50). The comparison group, Group 4, consisted of patients with ischemic chronic heart failure without metabolic disorders (n = 50). All groups were comparable in age and sex. The Beck Depression Inventory scale was used to assess the presence and nature of depressive disorders.
Results. In patients with chronic heart failure II functional class and a combination of type 2 diabetes mellitus and obesity, the cognitive-affective subscale scores were lower than in patients with chronic heart failure III functional class by 23.4% (p<0.01) and chronic heart failure IV functional class by 83.8% (p<0.01). Similar differences were noted for the somatic subscale scores in patients with chronic heart failure in coronary heart disease in combination with type 2 diabetes mellitus and obesity. The somatic subscale scores in patients with chronic heart failure II functional class were significantly reduced when compared with chronic heart failure III functional class by 40.7% (p<0.01) and chronic heart failure IV functional class by 105.7% (p<0.01). Analyzing the components of emotional status in patients with ischemic chronic heart failure and concomitant type 2 diabetes mellitus, an increase in cognitive-affective subscale scores in patients with chronic heart failure III functional class by 21% (p<0.01) was found, compared with chronic heart failure II functional class. In patients with chronic heart failure IV functional class, cognitive-affective subscale scores were higher than in patients with III functional class by 72.3% (p<0.01). Somatic subscale scores in patients with IV functional class of chronic heart failure significantly exceeded those in patients with III functional class by 63.8% (p<0.01). When comparing somatic subscale scores in patients with II and III functional class of chronic heart failure of ischemic origin against the background of concomitant type 2 diabetes mellitus, no significant differences were found (p>0.05).
Conclusions. The deterioration of emotional status in patients with ischemic chronic heart failure and type 2 diabetes mellitus occurs in proportion to the worsening of symptoms, particularly on the cognitive-affective subscale. At the stage of pronounced cardiac decompensation, progressive somatic depressive manifestations emerge. In patients with coronary heart disease and combined metabolic pathology, changes in both the cognitive-affective and somatic subscales are observed, correlating with an increase in the functional class of heart failure.