RU2550664C1 - Method for individual assessment of patients to establish fact of chronic cardiac insufficiency suffered - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: patients are assessed individually to establish the fact of chronic cardiac insufficiency (CCI) suffered by detecting: age, height, weight, Quetelet index, Brock constant, systolic blood pressure, diastolic blood pressure, triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, low-density lipoprotein cholesterol to total cholesterol ratio, very low-density lipoprotein cholesterol, high-density lipoprotein cholesterol to low-density lipoprotein cholesterol ratio, sum of the very low-density lipoprotein cholesterol and high-density lipoprotein cholesterol to low-density lipoprotein cholesterol ratio, atherogenic index, alanine aminotransferase, aspartate aminotransferase, aspartate aminotransferase to alanine aminotransferase ratio, lactate dehydrogenase, glucose, α-amylase, total protein, albumin, uric acid, carbamide, creatinine, creatinine kinase, alkaline phosphatase, total bilirubin, conjugated bilirubin, ADP-induced thrombocyte aggregation, thrombocyte count, mean thrombocyte volume, erythrocyte count, mean erythrocyte volume, erythrocyte volume distribution, haematocrit, haemoglobin, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration, leukocyte count, segmented neutrophil percentage, eosinophil percentage, basophile percentage, lymphocyte percentage, monocyte percentage and displacement constant. The derived discriminator functions are used to establish the fact of the absence of CCI, the first stage of CCI, or the second stage of CCI.

EFFECT: method enables assessing the patients to establish the fact of CCI by determining the significant parameters.

3 dwg, 2 tbl, 1 ex

Description

The invention relates to medicine, namely to therapy, cardiology, pathophysiology, biochemistry, pharmacology, and is intended for the diagnosis of the first stage of development of chronic heart failure (CHF), including without clinical manifestations of the disease.

A known method of individual quantitative risk assessment of the development of clinical manifestations of atherosclerosis (Pat. 2385668, Russian Federation, IPC A61B. Method of individual quantitative risk assessment of the development of clinical manifestations of atherosclerosis [Text] / Bovtyushko V.G., Bovtyushko P.V., Poddubsky G.A., Yusubov A.N .: patent holder Vasily Grigoryevich Bovtyushko (RU). - No. 2007131472; filed August 13, 2007; published April 10, 2010; Bull. 10. - 7 pp.), Which consists in the fact that at the preliminary stage mass examination of patients at various known stages of development atology, with the determination of the values of biochemical, immunological, physiological and clinical indicators, then conduct a discriminant analysis and obtain the coefficients and the bias constant, determine the integral health indicator for each patient, determine its dependence on the incidence rate and, using the data on the coefficients, constant and nature of the aforementioned dependencies, assess the risk of developing atherosclerosis for any patient, including those without clinical manifestations of the disease.

The disadvantage of this method is the lack of information about the parameters by which the diagnosis was made in people studied at the preliminary stage of the development of the method, as well as about the sensitivity of the method, and the identification of the first stage of development of heart failure during a population survey.

The objective of the invention is to obtain a reliable, ready-to-use, sensitive method for individual diagnosis of the first stage of development of heart failure.

The problem is solved due to the fact that they use a method developed on the basis of discriminant analysis with a classification sensitivity of 91.3%, which allows assessing the development of the first stage of heart failure among the population with a diagnostic quality of 94.3%, for which the values of discriminant functions are calculated by applying a certain set of indicators, coefficients, and functions, by applying a specific set of indicators, coefficients, and bias constants, using the parameters with the corresponding by their weighting coefficients for discriminant functions 1 and 2, respectively: age (0.014, 0.023), height (-0.801, -2.219), weight (-0.007, 0.037), Quetelet index (0.390, 0.058), Brock's constant (-0.079, -0.024), triglycerides (THL) (-0.027, 1.990), total cholesterol (OXC) (1.652, 2.031), high density lipoprotein cholesterol (HDL-C) (0.732, -0.537), low density lipoprotein cholesterol (HDL-C) ) (-2.252, -2.473), (cholesterol-LDL / OXS) · 100 (0.098, 0.154), very low density lipoprotein cholesterol (cholesterol-VLDL) (-0.970, -3.490), (cholesterol-HDL / cholesterol-LDL (6.082, 2.120), (XL-VLDL + XL-HDL / XL-LDL) (-10.709, -0.675), atherogenic coefficient (KA) (-0.094, -0, 092), HELL syst. (-0.006, -0.015), HELL diast. (0.008, 0.021), alanine aminotransferase (ALT) (-0.656, 1.245), aspartate aminotransferase (ACT) (-0.080, 0.696), AST / ALT (-0.018, 0.005), lactate dehydrogenase (LDH) (0.160, -0.643), glucose (0.022, 0.009), α-amylase (-0.001, -0.080), total protein (OB) (0.004, -0.050), albumin (0.010, -0.018), uric acid (0.001, -0.002), urea (-0.081 , 0.087), creatinine (0.025, 0.008), creatine kinase (-0.078, -0.015), alkaline phosphatase (ALP) (0.669, 0.005), total bilirubin (0.021, 0.010), direct bilirubin (-0.019, 0.045), ADP- induced platelet aggregation (ADP-IAT) (-0.020, 0.024), collagen-induced platelet aggregation KIAT (0.012, -0.043), platelet count (-0.005, 0.004), the average platelet volume (-0.026, -0.005), the number of red blood cells (0.288, 0.124), hematocrit (0.603, 0.925), hemoglobin (-12.345, -19.162), the average volume of red blood cells (0.005, -0.017), the distribution coefficient of red blood cells by volume (0.149, -0.102), average erythrocyte hemoglobin content (MCH) (-0.415, 1.096), average erythrocyte hemoglobin concentration (MCHC) (4.598, 6.686), white blood cell count (-0.058, 0.073), percentage of segmented neutrophils (0.182 , 0.069), the percentage of eosinophils (0.02, -0.053), the percentage of basophils (-0.017, 0.206), the percentage of lymphocytes (0.200, 0.062), the percentage of monocytes (0.103, 0.214) and the displacement constants (-52.772, -44,497); then discriminant functions d1 and d2 are calculated, and an individual assessment of membership in a group without heart failure is determined by the formula: OP = 1 / (1 + EXP (d1) · 100%, where RR is the risk assessment, d1 is the value of the first discriminant function; membership in the first stage of heart failure is determined by the formula: OP = 1 / (1 + EXP (d2) · 100%, where RR is the risk assessment, d2 is the value of the second discriminant function; membership in the second stage of heart failure is determined by subtracting from 100% the sum of the values obtained from OR without CHF and OR in the first stage of CHF The invention will be clear from the following description and attached to his drawings.

In fig. 1 shows a graph of the distribution of patients without heart failure, determined by the first and second discriminant functions relative to the centroid of this group.

In fig. 2 shows a graph of the distribution of patients with the first stage of heart failure, determined by the first and second discriminant functions relative to the centroid of this group.

In fig. 3 shows a graph of the distribution of patients with a second stage of heart failure, determined by the first and second discriminant functions relative to the centroid of this group.

The method is as follows: they examine any patient with the following parameters: age, height, weight, Quetelet index, Brock's constant, TGL, OXS, HDL-C, HDL-C, HDL-C, HDL-C, HDL-C / Cholesterol-LDL, cholesterol-VLDL + cholesterol-HDL / cholesterol-LDL, CA, AD syst, AD diast, ALT, ACT, AST / ALT, LDH, glucose, α-amylase, OB, albumin, uric acid, urea, creatinine, creatine kinase, alkaline phosphatase, total bilirubin, direct bilirubin, ADP-IAT, KIAT, platelet count, average platelet volume, red blood cell count, hematocrit, hemoglobin, average red blood cell Coefficient distribution by volume of erythrocytes, MCH, MCHC, white cell count, percentage of segmented neutrophils, eosinophils percentage, the percentage of basophils, percent lymphocytes, percent monocytes. Based on these clinical and biochemical parameters, using the weight coefficients and bias constants obtained during the development of the method, the values of discriminant functions for each patient are individually calculated, which determine the absence of heart failure, the presence of the first stage of heart failure, the presence of the second stage of heart failure.

At the stage of developing a method for individual quantitative assessment of the development of the first stage of CHF, a mass examination of 234 patients was carried out, with a diagnosis of CHF and without this pathology. Diagnosis of heart failure was carried out on the basis of clinical data and echocardiography. Cases of latent forms of insufficiency were detected using functional loads - bicycle ergometry. In order to predict the development of the first stage of heart failure, other indicators were used than in the diagnosis of heart failure. At the preliminary stage, clinical and biochemical parameters were determined. We studied indicators recommended by the All-Russian Society of Cardiology for the study of cardiovascular diseases, as well as indicators that directly or indirectly reflect pathophysiological changes in the development of the disease. Determined: age, height, weight, calculated Quetelet index, calculated Brock's constant, determined TGL, OXS, HDL-C, HDL-C, calculated the ratio of LDL-C / OH, determined the LDL-VLP, calculated the ratio of HDL-HDL / C- LDL, cholesterol-HDL / cholesterol-LDL + cholesterol-VLDLP, counted KA, determined blood pressure system, blood pressure diast, ALT, ACT, calculated the ratio of AST / ALT, determined LDH, glucose, α-amylase, total protein (OB), albumin , uric acid, urea, creatinine, creatine kinase, alkaline phosphatase, total bilirubin, direct bilirubin, ADP-IAT, KIAT, platelet count, average platelet volume erythrocyte count, hematocrit, hemoglobin, average erythrocyte volume, MCH, MCHC, erythrocyte distribution coefficient by volume, white blood cell count, percentage of segmented neutrophils, percentage of eosinophils, percentage of basophils, percentage of lymphocytes, percentage of monocytes, shortness of breath, heart failure, heart failure angina attacks, edema of the extremities. We conducted a discriminant analysis of the obtained values, obtained weight coefficients for each indicator and bias constants for two discriminant functions. The values of the discriminant functions were determined for each subject as a weighted sum of the values of all the obtained indicators, multiplied by the corresponding weight coefficient and the displacement constant added to them. The values of discriminant functions were used to determine the membership in groups without heart failure and with early stages of heart failure.

A discriminant analysis of the indices of 234 patients and healthy showed that the canonical correlation coefficient for the first discriminate function (d1) was 0.876 and was reliable according to the Wilkes criterion (p <0.001). According to the second discriminant function (d2), the canonical correlation coefficient was 0.583 with reliable separation ability by the Wilks criterion λ (p <0.001). The values of the calculated discriminant functions for which the patients were divided into groups are shown in table 1.

Table 1. The values of discriminant functions in the diagnosis of the first stage of chronic heart failure.

From table 1 it is seen that patients who do not have heart failure will have values of discriminant functions close to the centroid, with coordinates along the x axis -1,211 (d1) along the y axis 0,026 (d2). Patients with the first stage of heart failure will have values of discriminant functions close to the centroid, with coordinates along the x axis 2.544 (d1), along the y axis -l, 015 (d2).

Patients with the second stage of heart failure will have values of discriminant functions close to the centroid, with coordinates along the x axis 2.907 (d1), along the y axis 1.638 (d2). Thus, in the presence of the first stage of CHF, the area of discriminant values in comparison with patients without CHF shifts to the right to the positive range of x (d1) and down to the negative range of y-axis (d2), and the values themselves will be close to 2.544 (d1) and k -1.015 (d2). (Table 1, Fig. 1, 2). In the presence of the second stage of heart failure, the range of values shifts even more to the region of positive values along the x (d1) axis, and along the y axis, the shift to the positive region, but much higher than in the absence of heart failure (Figs. 1, 3), and the values themselves will be are close to 2.907 (d1) and 1.638 (d2, Table 1). The closer the values of the 2 discriminant functions to the values of the discriminant functions of the centroids, the higher the likelihood that the subjects belong to these groups.

The effectiveness of the classification of stages of CHF is shown in Table 2 below. The table shows that out of 159 patients who do not have CHF, 151 patients are correctly classified, which makes up 95% of the correct diagnosis within this group. Of the 46 patients with the first stage of heart failure, 39 were correctly diagnosed, which is 84.8% of the correct classification within this group. Of 26 patients of the second stage, 21 were correctly evaluated, which is 80.8% of the correct classification within this group. On average, 93.1% of the 234 initial, selected, grouped and calculated statistics observations programs are correctly classified, which suggests the high efficiency of the found values (d1), (d2) and bias constants in assessing the development of the first stage of heart failure.

The accuracy of the clinical diagnosis of the first stage of CHF still leaves much to be desired, especially in the subgroup of women, elderly patients and those who are obese. The complexity of early diagnosis is associated not only with multiple organ pathologies in the elderly, but also with extracardial problems, as well as the fact that arterial hypertension and coronary artery disease

progress against a background of age-related organic changes. A significant number of such patients do not receive the necessary adequate therapy in connection with the late diagnosis of systolic heart failure [Atroshchenko ES Ways to optimize the treatment of heart failure / E.S. Atroshchenko // Heart failure. - 2002. - T.3, No. 4. - S. 27-30. Gurevich M.A. Some features of the clinic and treatment of chronic heart failure in the elderly / M.A. Gurevich // Ros. cardiol. journal - 2002. - T. 33, No. 1. - S. 81-84]. Unfortunately, diagnoses of the first stage of heart failure are rare, which indicates an underestimation by the practical doctors of the prognosis of this condition. According to the IMPROVEMENT HF study, among patients with heart failure observed by local physicians, only about 9% diagnosed the first stage of the disease, which is much lower than in reality. On the other hand, CHF is a progressive syndrome, and those patients who today have only the latent or first stage of CHF, within 1-5 years, can go to the group of the most severe patients (stages 3 and 4 of CHF) that are difficult to treat [Moiseev V.S. Heart failure and advances in genetics / V.S. Moiseev // Heart failure. -2000. - T. 1, No. 4. - S. 121-130. National recommendations of GFCF and OSSN for the diagnosis and treatment of heart failure (third revision) / Text preparation committee: V.Yu. Mareev, F.T. Ageev, G.P. Arutyunov [et al.] // Heart failure. - 2009. - T. 10, No. 2. - S. 64-103]. Therefore, the identification of the first stage of heart failure is most important when screening for hidden heart failure. The quality of population diagnostics was calculated based on the prevalence of the disease among the adult population of the Russian Federation, which depends on age, reaching a maximum in older age groups, along with the prevalence of arterial hypertension (AH) and coronary heart disease (CHD), as the main causes of heart failure. So, in the European population, the prevalence of heart failure is 2.1%, in the USA it varies from 1 to 1.5% and reaches 10% among people over 60 years old (Gurevich M.A. Some features of the clinic and treatment of chronic heart failure in the elderly / M .A. Gurevich // Russian Cardiological Journal - 2002. - V. 33, No. 1. - P. 81-84. 19 Provotorov V.M. Diagnosis of chronic heart failure in the early stages of the elderly / V. M. Provotorov, E.S. Burlova // Clin. Gerontology. - 2007.- T. 13, No. 6. - P. 57-62). If we take 1% and 10% the prevalence of heart failure as the most extreme values, then on average it will turn out 10 + 1/2 / = 5.5%. With rounding, an average of 6% is obtained. Diagnostic quality indicator is the percentage of correctly diagnosed cases per 1000 patients examined. Thus, based on a 6% incidence, it can be said that of the 1000 patients examined, 60 patients have CHF, and 940 do not have CHF. Based on the data in Table 2, 60 patients with CHF of the first and second stages will be classified correctly (60 * 0.828 = 50 patients), where the coefficient 0.828 reflects the average classification efficiency of the early stages of CHF (84.8% + 80.8%) / 2 /one hundred. 10 patients with CHF will not be detected (60 patients - 50 patients = 10 patients). Out of 940 patients without heart failure, its absence will be diagnosed correctly in 893 patients (940 * 0.950 = 893) and 47 patients will be identified as having heart failure (940 patients, -893 patients = 47 patients). The quality of detection of CHF in those who have been diagnosed by the method developed by us when examining the population is 893 + 50/1000 = 0.943 or 94.3%, which shows the high efficiency of the method for detecting the first stage of CHF.

An individual quantitative assessment of the development of heart failure is calculated according to the known risk dependence on the values of the discriminant functions (d1) and (d2), the values of which are defined as the sum of the measured indicators multiplied by the weight coefficients obtained for (d1) and (d2) with the addition of displacement constants for each functions obtained by us at the preliminary stage, that is, by the formula common to (d1) and (d2):

d = b ₁ x ₁ + b ₂ x ₂ + ... + b _n x _n + a,

where x ₁ and x _n are the values of the variables corresponding to the cases under consideration, the coefficients b ₁ -b _n and a is the constant of the canonical discriminant function. The dependence of the values of discriminant functions on the belonging of the subjects to the absence groups, the first and second stages of heart failure makes it possible to prognostically assess the membership of the person being examined in one of these groups, which makes it possible to identify heart failure in the early stages.

Thus, conducting a discriminant analysis using our proposed set of clinical, pathophysiological and biochemical parameters allows us to determine the significance of each parameter studied in the development of the disease, to select the most important indicators, in the study of which heart failure can be diagnosed. That is, a method for the early diagnosis of heart failure with high classification characteristics of 91.3% was created, which allows for early detection of patients with the first stage of heart failure with a high diagnostic quality of 94.3% among the population.

Example Patient No. 169. Used indicators:

1. Gender - Male

2. Age - 44 years

3. Height - 1.76 m

4. Weight 80 kg

5. HELL syst = 125 mm Hg

6. HELL diast = 85 mm Hg

7. TGL = 2.07 mM / L

8. OXS = 5.73 mM / L

9. HDL-C = 1.37 mM / L

10. LDL-C = 3.42 mM / L

11. CS-VLDL = 0.94 mM / L

12. ALT = 0.348 μM / hp

13. AST = 0.308 μM / hp

14. LDH = 5.5 μm / hp

15. Glucose = 4.92 mM / L

16. α-amylase 1.66 μM / hp

17. ALP = 2.25 μM / hp

18. OB = 77.0 g / l

19. Albumin = 6.56 mM / L

20. Uric acid = 484 μM / L

21. Urea = 9.30 mmol / l

22. Creatinine = 115 μM / L

23. Creatine kinase = 1.28 μM / hp

24. Direct bilirubin 2.7 μm / l

25. Bilirubin total 8.3 μm / l

26. ADP agr = 51.0%

27. KIAT = 47.0%

28. Number of platelets = 227 billion / l

29. The average platelet volume = 9.5 units.

30. Number of red blood cells = 4.31

31. White blood cells 4.0 / L

32. Hematocrit = 35.7%

33. Hemoglobin = 1.88 mM / L

34. Average red blood cell volume = 82.8

35. The distribution coefficient of red blood cells by volume = 12.9

36. SIT = 0.436 * 10v 15 soda hemoglobin in a red blood cell

37. MCHC = 5.26 mM / L hemoglobin concentration in the red blood cell.

38. Segmented neutrophils = 61%

39. Eosinophils = 5.0%

40. Lymphocytes = 28%

41. Monocytes = 6.0%

calculated:

42. BMI = 26

43. C. Brock = 105

44. (CS-LDL / OXS) * 100 = 60%

45. CS-HDL / CS-LDL = 0.40

46. HS-HDL / HS-LDL + HC-VLDL = 0.31

47. KA = 2.5

48. AST / ALT = 0.89

(d1 is the first discriminant function) = (44 * 0.014 + 1.76 * -0.801 + 80 * -0.007 + 26 * 0.390 + 105 * -0.079 + 2.07 * -0.027 + 5.73 * 1.652 + 1.37 * 0.732 + 3.42 * -2.252 + 60 * 0.098 + 0.94 * -0.97 + 0.40 * 6.082 + 0.31 * -10.709 + 2.50 * -0.094 + 125 * -0.006 + 85 * 0.008 + 0.348 * -0.656 + 0.308 * -0.080 + 0.89 * -0.018 + 5.50 * 0.160 + 4.92 * 0.022 + 1.66 * -0.001 + 77.0 * 0.004 + 6.56 * 0.010 + 484 * 0.001 + 9.30 * -0.081 + 115 * 0.025 + 1.28 * -0.078 + 2.52 * 0.669 + 8.30 * 0.021 + 2.7 * -0.019 + 51 * -0.020 + 47.00 * 0.012 + 227 * -0.005 + 9.5 * -0.026 + 4.31 * 0.288 + 35.7 * 0.603 + 1.88 * -12.345 + 82.8 * 0.005 + 5.26 * 4.598 + 0.436 * -0.415 + 12.9 * 0.149 + 4.0 * -0.058 + 61.0 * 0.182 + 5.0 * 0.02 + 28 * 0.200 + 6.0 * 0.103 + (- 52.772) = 1.767912

(d2 is the second discriminant function) = (44 * 0.023 + 1.76 * -2.219 + 80 * 0.037 + 26 * 0.058 + 105 * -0.024 + 2.07 * 1.99 + 5.73 * 2.031 + 1.37 * -0.537 + 3.42 * -2.473 + 60 * 0.154 + 0.94 * -3.490 + 0.40 * 2.120 + 0.31 * -0.675 + 2.50 * -0.092 + 125 * -0.015 + 85 * 0.021 + 0.348 * 1.245 + 0.308 * 0.696 + 0.89 * 0.005 + 5.50 * -0.643 + 4.92 * 0.009 + 1.66 * -0.080 + 77.0 * -0.050 + 6.56 * -0.018 + 484 * -0.002 + 9.30 * 0.087 + 115 * 0.008 + 1.28 * -0.015 + 2.52 * 0.005 + 8.30 * 0.010 + 2.7 * 0.045 + 51 * 0.024 + 47.00 * -0.043 + 227 * 0.004 + 9.5 * -0.005 + 4.31 * 0.124 + 35.7 * 0.925 + 1.88 * -19.162 + 82.8 * -0.017 + 5.26 * 6.686 + 0.436 * 1.096 + 12.9 * 0.149 + 4.0 * 0.073 + b1.0 * 0.069 + 5.0 * -0.053 + 28 * 0.062 + 6.0 * 0.214 + (- 44.497) = - 0.808036

The obtained quantitative data (d1), equal to 1,767912, and (d2), equal to -0.808036, in patient 169 indicate the presence of the first stage of heart failure in a patient, since values (d1) and (d2) are closest to 1 and 2 discriminant functions of the centroids of the group with the first stage of heart failure (Table 1) and (Fig. 1-3).

A quantitative assessment of the degree of belonging to a group without heart failure, determined by the formula: OR = 1 / (1 + EXP (1.767912) * 100 = 14.5%. Thus, membership in a group without heart failure is 14.5% and not The degree of belonging of the same patient to the initial or first stage of CHF, determined by the formula: OR = 1 / (1 + EXP (-0.808036) * 100, was 69.2%. Thus, the patient has the first stage of CHF with 69.2% probability, while the probability of absence of heart failure is 14.5%, and the probability of the second stage of heart failure is also low and is (100% -69.2% -14.5% = 16.3%) 16.3%.

The technical result of the invention is the creation of a method for the early diagnosis of heart failure with high classification characteristics of 91.3%, which allows for the early identification of patients with the first stage of heart failure with a high diagnostic quality of 94.3%.

Claims (1)

The method of individual assessment of patients belonging to chronic heart failure (CHF), which consists in determining the value of the integral indicator of the state of health for each examined person as a weighted sum of the values of all the indicators multiplied by their respective weight coefficient and the displacement constant added to it, which differs the fact that they use the values of the following indicators that are of the greatest importance for identifying the first and second stages of chronic heart disease river failure with appropriate weights; for the first discriminant function: age (0.014), height (-0.801), weight (-0.007), Quetelet index (0.390), Brock's constant (-0.079), systolic blood pressure (BP syst.) (-0.006), blood pressure diastolic (AD diast.) (0.008), triglycerides (THL) (-0.027), total cholesterol (OXC) (1.652), high density lipoprotein cholesterol (HDL-C) (0.732), low density lipoprotein cholesterol (HDL-C) (-2,252), the ratio of low-density lipoprotein cholesterol to total cholesterol (cholesterol-LDL / OXS) · 100 (0,098), very low-density lipoprotein cholesterol (cholesterol-VLDL) (-0,970), about the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol (cholesterol-HDL / cholesterol-LDL) (6,082), the sum of very low density cholesterol and the ratio of high density lipoprotein cholesterol to low density lipoprotein cholesterol (cholesterol-VLDL + cholesterol-HDL / -LDPE) (-10.709), atherogenic coefficient (CA) (-0.094), alanine aminotransferase (ALT) (-0.656), aspartate aminotransferase (ACT) (-0.080), ratio of aspartate aminotransferase to alaminaminotransferase (ACT / ALT), (0.018) lactate dehydrogenase (LDH) (0.160), glucose (0.022), α-amylase (-0.001), total protein (OB) (0.004), albumin (0.010), uric acid (0.001), urea (-0.081), creatinine (0.025), creatinine kinase (-0.078), alkaline phosphatase (ALP) (0.669) total bilirubin (0.021), direct bilirubin (-0.019), ADP-induced platelet aggregation (ADP-IAT) (-0.020), collagen-induced platelet aggregation (KIAT) (0.012), platelet count (-0.005), average platelet count (-0.026), the number of red blood cells (0.288), the average volume of red blood cells (0.005), the distribution coefficient of red blood cells (RED) (0.149), hematocrit (0.603), hemoglobin (-12.345), the average hemoglobin content in erythrocyte (MCH) (-0.415), the average concentration of hemoglobin in erythrocyte (MCHC) (4.598), the number of leukocytes (-0.058), the percentage of segmented neutrophils (0.182), the percentage of eosinophils (0.201), the percentage of basophils (-0.017), percentage of lymphocytes (0.200), percentage of monocytes (0.103) and displacement constant (-52.772); for the second discriminant function: age (0.023), height (-2.219), weight (0.037), Quetelet index (0.058), Brock's constant (-0.024), systolic blood pressure (BP syst.) (-0.015), diastolic blood pressure (AD diast.) (0.021), triglycerides (THL) (1,990), total cholesterol (OXS) (2,031), high density lipoprotein cholesterol (HDL-C) (-0,537), low density lipoprotein cholesterol (LDL-C) ( -2.473), the ratio of low-density lipoprotein cholesterol to total cholesterol (cholesterol-LDL / OXS) · 100 (0.154), very low-density lipoprotein cholesterol (cholesterol-VLDL) (-3,490), about wearing high-density lipoprotein cholesterol to low-density lipoprotein cholesterol (cholesterol-HDL / cholesterol-LDL) (2,120), the sum of very low-density cholesterol and the ratio of high-density lipoprotein cholesterol to low-density lipoprotein cholesterol (cholesterol-VLDL + cholesterol-HDL / -LDPE) (-0.675), atherogenicity coefficient (CA) (-0.092), alanine aminotransferase (ALT) (1.245), aspartate aminotransferase (ACT) (0.696), the ratio of aspartate aminotransferase (AST / ALT) (0.005), Lactate ) (-0.643), glucose (0.009), α-amylase (-0.080), total protein (OB) (0.050), albumin (-0.018), uric acid (-0.002), urea (0.087), creatinine (0.008), creatinine kinase (-0.015), alkaline phosphatase (alkaline phosphatase) (0.005) ), total bilirubin (0.010), direct bilirubin (0.045), ADP-induced platelet aggregation (ADP-IAT) (0.024), collagen-induced platelet aggregation (KIAT) (-0.043), platelet count (0.004), average volume of thrombus (-0.005), the number of red blood cells (0.124), the average volume of red blood cells (-0.017), the distribution coefficient of red blood cells by volume (RED) (-0.102), hematocrit (0.925), hemoglobin (-19.162), the average hemoglobin content in erythrocyte (MCH) (1,096), the average concentration of hemoglobin in erythrocyte (MCHC) (6,698), the number of leukocytes (0,073), the percentage of segmented neutrophils (0,069), the percentage of eosinophils (-0,053), the percentage of basophils (0,206), the percentage of lymphocytes (0,062), the percentage of monocytes (0,214) and the displacement constant (-44,497), and an individual assessment of membership in a group without heart failure is determined by the formula: OP = 1 / (1 + EXP (d1) · 100%, where RR is the risk assessment, d1 is the value of the first discriminant function; belonging to the first stage of heart failure is determined by the formula: OP = 1 / (1 + EXP (d2) · 100%, where RR is the risk assessment, d2 is the value of the second discriminant function; belonging to the second stage of heart failure is determined by subtracting the sum of the values from 100% obtained from PR without CHF and PR in the first stage of CHF.

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