CArdio-Reno- Hepato -MEtabolic Disease iN Chronic Heart Failure (CARMEN-CHF)

Inclusion Criteria: 1. Age ≥18 years; 2. A diagnosis that satisfies one of the following criteria: * At least one of the following: LVEF \<50%, LV longitudinal systolic strain (GLS) \<18%, NT-proBNP \>125 pg/mL in sinus rhythm or 365 in AF/AT, E/é \>9 at rest by tissue Doppler, Indexed left ventricular volume (ILV) \>34 mL/m2 in sinus rhythm or 40 mL/m2 in AF/AT, Tricuspid regurgitation (TR) velocity \>2.8 m/s or pulmonary artery systolic pressure (PASP) \>35 mmHg. at rest, Left ventricular myocardial mass index (LVMI) \>115/95 g/m2 in men/women and relative wall thickness (RWT) \>0.42, in the absence of symptoms and/or signs of current or past CHF, which corresponds to "pre-CHF" in accordance with the 2024 clinical guidelines. or * LVEF \<50% and the presence of symptoms and/or signs of current or past CHF or * LVEF ≥50% and the presence of symptoms and/or signs of current or past CHF, as well as at least one of the following (A, B, C) criteria: A. Presence of one of the signs of structural and/or functional heart disorders consistent with the presence of diastolic dysfunction / elevated left ventricular filling pressure: 1. . NT-proBNP level \>200 pg/mL in sinus rhythm or \>600 pg/mL in AF/AT, 2. . E/é \>13 at rest by tissue Doppler, 3. . 13 ≥E/é \>9 + left atrial dilation (LAD) \>34 ml/m2 in sinus rhythm or \>40 ml/m2 in AF/AT, 4. . 13 ≥E/é \>9 + TR velocity \>2.8 m/s or PASP \>35 mmHg at rest, 5. . 13 ≥E/é \>9 + presence of left ventricular hypertrophy, defined as LVMI \>115 g/m2 in men and \>95 g/m2 in women, WCT \>0.42, OR B. Presence of 7-9 points on the H2FPEF scale; OR C. Positive diastolic stress test result confirming increased LV filling pressure (E/e'≥15, TR velocity \>3.4 m/s) 3. No intravenous therapy with diuretics, nitrates, vasopressors, or inotropes within 24 hours prior to inclusion; 4. Availability of results of all of the following tests, performed no earlier than in the previous 6 months prior to inclusion in the study: \[1\] Complete blood count with hemoglobin and platelet levels, \[2\] Blood chemistry with total bilirubin, ALT, and AST levels, \[3\] Serum uric acid and creatinine levels, with glomerular filtration rate (eGFR) calculation using the 2021 CKD-EPI formula, \[4\] Fasting glucose and HbA1c, and, if the diagnosis is uncertain, an oral glucose tolerance test, \[5\] Ultrasound of the carotid and/or femoral arteries (only in patients with no prior history of atherosclerotic cardiovascular disease), \[6\] Urine test for CKD markers - at least one of the following: daily albuminuria (mg/day) and/or albumin/creatinine ratio in a single urine portion (mg/g or mg/mmol) and/or daily proteinuria (g/day) and/or protein/creatinine ratio in a single urine portion (mg/g or mg/mmol). - Exclusion Criteria: * 1\. Current participation in a randomized clinical trial; 2. Confirmed or suspected diagnosis of an alternative or comorbid condition that, in the opinion of the investigator, may explain the patient's symptoms and signs of CHF; 3. History of heart transplantation, combined congenital heart disease, or the presence of a mechanical circulatory support device; 4. Cardiac tamponade; 5. Pregnancy and lactation, planning a pregnancy in the next 24 months; 6. Acute cerebrovascular accident, transient ischemic attack, acute coronary syndrome, or coronary revascularization within less than 30 days prior to or on the day of study inclusion; 7. Acute dysfunction or failure of one or more internal organs within 3 months prior to or on the day of inclusion; 8. Any cardiac surgery performed within 3 months prior to enrollment or planned within the next 6 months, including implantation of intracardiac devices, ablation for cardiac arrhythmias, or correction of valvular pathology; 9. Severe cognitive impairment or other conditions that, in the opinion of the investigator, prevent the patient from understanding the program, providing informed consent, or interfere with participation in the study; 10. Active cancer; 11. Verified cardiac amyloidosis or other infiltrative cardiomyopathy (hemochromatosis, Fabry disease, Gaucher disease); 12. Verified hereditary cardiomyopathy; 13. Heart disease due to reversible causes (e.g., Takotsubo syndrome).