Cases Of Chronic Heart Failure Research Articles

Usefulness of Heart Failure Categories Based on Left Ventricular Ejection Fraction.

Heart failure guidelines have recently introduced a narrow category with mildly reduced left ventricular ejection fraction (LVEF) (heart failure with mildly reduced ejection fraction; LVEF 41%-49%) between the previous categories of reduced (heart failure with reduced ejection fraction; LVEF ≤40%) and preserved (heart failure with preserved ejection fraction; LVEF ≥50%) ejection fraction. Grouping of continuous measurements into narrow categories can be questioned if their variability is high. We constructed a cohort of all 9716 new cases of chronic heart failure with an available LVEF in Stockholm, Sweden, from January 1, 2015, until December 31, 2020. All values of LVEF were collected over time, and patients were followed up until death, moving out of Stockholm, or end of study. Mixed models were used to quantify within-person variance in LVEF, and multistate Markov models, with death as an absorbing state, to quantify the stability of LVEF categories. LVEF values followed a normal distribution. The SD of the within-person variance in LVEF over time was 7.4%. The mean time spent in any LVEF category before transition to another category was on average <1 year for heart failure with mildly reduced ejection fraction. Probabilities of transitioning between categories during the first year were substantial; patients with heart failure with mildly reduced ejection fraction had a probability of <25% of remaining in that category 1 year later. LVEF follows a normal distribution and has considerable variability over time, which may impose a risk for underuse of efficient treatment. The heart failure with mildly reduced ejection fraction category is especially inconstant. Assumptions of a patient's current LVEF should take this variability and the normal distribution of LVEF into account.

BMI-Stratified Exploration of the 'Obesity Paradox': Heart Failure Perspectives from a Large German Insurance Database.

Background: The global rise of obesity and its association with cardiovascular risk factors (CVRF) have highlighted its connection to chronic heart failure (CHF). Paradoxically, obese CHF patients often experience better outcomes, a phenomenon known as the 'obesity paradox'. This study evaluated the 'obesity paradox' within a large cohort in Germany and explored how varying degrees of obesity affect HF outcome. Methods: Anonymized health claims data from the largest German insurer (AOK) for the years 2014-2015 were utilized to analyze 88,247 patients hospitalized for myocardial infarction. This analysis encompassed baseline characteristics, comorbidities, interventions, complications, and long-term outcomes, including overall survival, freedom from CHF, and CHF-related rehospitalization. Patients were categorized based on body mass index. Results: Obese patients encompassed 21.3% of our cohort (median age 68.69 years); they exhibited a higher prevalence of CVRF (p < 0.001) and comorbidities than non-obese patients (median age 70.69 years). Short-term outcomes revealed lower complication rates and mortality (p < 0.001) in obese compared to non-obese patients. Kaplan-Meier estimations for long-term analysis illustrated increased incidences of CHF and rehospitalization rates among the obese, yet with lower overall mortality. Multivariable Cox regression analysis indicated that obese individuals faced a higher risk of developing CHF and being rehospitalized due to CHF but demonstrated better overall survival for those classified as having low-level obesity (p < 0.001). Conclusions: This study underscores favorable short-term outcomes among obese individuals. The 'obesity paradox' was confirmed, with more frequent CHF cases and rehospitalizations in the long term, alongside better overall survival for certain degrees of obesity.

Anemia with Red Cell Indices among Patients Suffering from Chronic Cardiac Failure Admitted at Tertiary Care Hospital

Background: Chronic heart failure (CHF), is a progressive condition characterized by the heart's inability to effectively pump blood throughout the body. It is a leading contributor to mortality globally, presenting substantial difficulties in clinical care. Anemia, commonly coexists with chronic cardiac failure and is associated with poorer outcomes and increased mortality rates. Additionally, abnormalities in red blood cell (RBC) indices further complicate the clinical picture, posing challenges in diagnosis and management. Objective: To determine the relationship between the severity of chronic cardiac failure and the severity of anemia, as evidenced by abnormalities in red cell indices. Study Design: Prospective observational study. Settings: Cardiology department of peoples University of Medical and health Sciences, Nawab Shah Pakistan. Duration: Six months from January 2022 to June 2022. Methods: Patients aged 18 years or old, both gender and diagnosed as the cases of chronic heart failure were included. Chronic heart failure was classified to categorize the severity of heart failure based on the level of symptoms and limitations experienced by the patient during physical activities. A 5ml blood sample was obtained from each participant via venipuncture and collected in a tube for complete blood count (CBC) tests. All the information was entered and analyzed using SPSS version 26. Results: A total of 109 patients of chronic heart failure were studied with an overall average age of 61.44+14.28 years. Males were 57.8% and females were 42.2%. Frequency of anemia was 47.7% in chronic heart failure patients, while statistically insignificant according to severity of HF (p-0.202). Average hemoglobin (HB) levels for heart failure (HF) classifications class I - class IV were 14.45 g/dl, 12.41 g/dl, 11.82 g/dl, and 11.30 g/dl, respectively. Furthermore, p-values indicated the statistical insignificance of the observed variations between HF classifications for each parameter (p-&gt;0.05). Conclusion: Anemia among patients of chronic heart failure found to be the highly frequent 47.7%. The average levels of hemoglobin and red blood cell indices showed no significant variation across different severities of chronic heart failure.

Consensus document on palliative care in cardiorenal patients.

There is an unmet need to create consensus documents on the management of cardiorenal patients since, due to the aging of the population and the rise of both pathologies, these patients are becoming more prevalent in daily clinical practice. Chronic kidney disease coexists in up to 40%-50% of patients with chronic heart failure cases. There have yet to be consensus documents on how to approach palliative care in cardiorenal patients. There are guidelines for patients with heart failure and chronic kidney disease separately, but they do not specifically address patients with concomitant heart failure and kidney disease. For this reason, our document includes experts from different specialties, who will not only address the justification of palliative care in cardiorenal patients but also how to identify this patient profile, the shared planning of their care, as well as knowledge of their trajectory and the palliative patient management both in the drugs that will help us control symptoms and in advanced measures. Dialysis and its different types will also be addressed, as palliative measures and when the decision to continue or not perform them could be considered. Finally, the psychosocial approach and adapted pharmacotherapy will be discussed.

Self-management theories, models and frameworks in patients with chronic heart failure: A scoping review.

The aim of this study was to synthesize the self-management theory, model and frameworks of patients with chronic heart failure, focusing on construction process, methods and existing problems. Although the self-management theories have been created and verified for those patients with chronic heart failure, no reviews have been performed to integrate these theories. A scoping review of recent literature (without a date limit) was conducted. A comprehensive literature search was performed. If the study reported the construction of a self-management theory, model or framework about chronic heart failure cases, it would be included in the review. Fourteen studies were included, which could be categorized into situation-specific theory, middle-range theory and other theory models (including conceptual model, hypothetic regression model and identity description model). It also includes the update and validation of theories, the situation-specific theoretical of caregiver contributions extended from situation-specific theories and the nurse-led situation-specific theory in different contexts. Self-management might contribute to start an education programme before patients with chronic heart failure (CHF) begin their chronic disease live as an individual. Our scoping review indicates that a series of self-management theories, models and frameworks for CHF patients have been developed, but more studies are still needed to validate and support these theories according to their cultural contexts.

Usefulness of heart failure categories based on left ventricular ejection fraction

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): This study was sponsored by AstraZeneca. Introduction Heart failure, a common disease with a mortality on par with many cancers, is one of the costliest diseases to society in the western world. Current heart failure guidelines are based on categories of left ventricular ejection fraction (LVEF) and have recently introduced a narrow category with mid-range/mildly reduced ejection fraction (HFmrEF; LVEF 41-49%) between the previous categories with reduced (HFrEF; LVEF ≤40%) and preserved (HFpEF; LVEF ≥50%) ejection fraction. The grouping of continuous variables into narrow categories can be questioned if the variability is high. Purpose To determine the shape of the LVEF distribution and quantify the stability of LVEF categories over time in a large real-world heart failure population, in order to establish the usefulness of LVEF categories for treatment decisions. Methods Population-based observational cohort study of all new cases of chronic heart failure in Region Stockholm, Sweden, from 2016-01-01 until 2020-12-31. All available values of LVEF were collected over time and patients were followed until death or end of study. Mixed models were used to quantify within-person variance in LVEF, and Multistate Markov models, with death as an absorbing state, to quantify the stability of LVEF categories. Results During the study period, 8,455 patients were diagnosed with heart failure. LVEF values followed a perfect normal distribution. The standard deviation of the within-person variance in LVEF was 7.4%. Regardless of initial LVEF category, age or sex, the mean time spent in any LVEF category before transition to another category (mean sojourn time) was on average less than 0.6 years (Figure 1). The one-year probabilities of transitioning between states were substantial (Figure 2). Patients with HFmrEF had a probability of 1/4 of remaining in that category one year later; the probability of patients with HFrEF of remaining in that category one year later was 1/4 for women and 1/3 for men; and patients with HFpEF had a probability of remaining in that category of 2/3 for women and 1/2 for men. Conclusion In patients with heart failure, LVEF has considerable variability over time. Hence, LVEF has limited use for categorisation of the heart failure population into narrow categories.

Raman spectroscopy in chronic heart failure diagnosis based on human skin analysis.

This work aims at studying Raman spectroscopy in combination with chemometrics as an alternative fast noninvasive method to detect chronic heart failure (CHF) cases. Optical analysis is focused on the changes in the spectral features associated with the biochemical composition changes of skin tissues. A portable spectroscopy setup with the 785 nm excitation wavelength was used to record skin Raman features. In this in vivo study, 127 patients and 57 healthy volunteers were involved in measuring skin spectral features by Raman spectroscopy. The spectral data were analyzed with a projection on the latent structures and discriminant analysis. 202 skin spectra of patients with CHF and 90 skin spectra of healthy volunteers were classified with 0.888 ROC AUC for the 10-fold cross validated algorithm. To identify CHF cases, the performance of the proposed classifier was verified by means of a new test set that is equal to 0.917 ROC AUC.

Associations of GPCR autoantibodies with clinical, histological, metabolic and hemodynamic features in non-ischemic heart failure patients

Abstract Background Roughly one third of cases of chronic heart failure (HF) are caused by genetic predisposition, metabolic stress and cardiac inflammation. Animal studies suggest that heart-reactive autoantibodies, most notably those directed against G-protein-coupled receptors (GPCR), could also play a pathogenetic role in the disease. However, so far, a causal link between humoral GPCR-autoimmunity and human non-ischemic heart failure other than Chagas' cardiomyopathy remains unclear. Purpose Here, we investigated possible associations of GPCR autoantibodies with inflammatory, hemodynamic, metabolic and functional parameters in patients with chronic non-ischemic HF unrelated to Chagas' disease. Methods We prospectively included 95 patients with newly diagnosed non-ischemic heart failure of unknown origin. Basic cardiac characterization comprised transthoracic echocardiography, cardiac magnetic resonance imaging, coronary angiography and right heart catheterization with endomyocardial biopsy. Mitochondrial oxidative phosphorylation capacity and coupling was measured using high-resolution respirometry in permeabilized myocardial fibers. A panel of candidate GPCR-autoantibodies was determined by validated and certified immune-assays in peripheral venous blood of the HF-patients and 60 matched healthy individuals. Results were normalized to total IgG. Results Among 10 candidate GPCR-autoantibodies determined, only autoantibodies for α1-adrenergic receptor (α1AR), β1-adrenergic receptor (β1AR), muscarinic receptor M5 (M5AR), angiotensin II receptor type 1 (AT1R) and type 2 (AT2R) exhibited HF-associated alterations: Autoantibodies against β1AR, M5R and AT2R were increased. Autoantibodies against α1AR and AT1R were decreased (Figure). These alterations were significant (p&amp;lt;0.01), but not, or only weakly, correlated with markers of cardiac inflammation, cardiac damage, hemodynamics, endomyocardial histology or left ventricular inflammation judged by T2-mapping. However, in HF-patients, increased AT2R autoantibodies were associated with improved myocardial mitochondrial coupling (r=−0.27, p=0.021), and decreased AT2R autoantibodies were associated with insulin resistance (r=−0.24 p=0.027). Conclusion(s) Some previously postulated alterations of GPCR autoantibodies were confirmed in thoroughly characterized HF-patients. However, association of these alterations with cardiac function was not traceable, which argues against a specific pathogenic role. Our data are compatible with multifaceted interactions of GPCR-autoantibodies with the myocardium and potentially with glucose metabolism, possibly indicating a disease-modifying or compensatory role. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Research comission of the Heinrich-Heine University Duesseldorf

Prevalence of self‑reported heart failure in the adult Polish population: results of the NATPOL 2011 study.

Chronic heart failure (CHF) is a growing medical and economic problem, especially in Central and Eastern Europe. However, only a few studies analyzed the prevalence of CHF in this region. The aim of the study was to assess the prevalence of CHF in a representative sample of adult Poles. The NATPOL 2011 project was a cross‑sectional study of a representative sample of the adult Polish population that included 2413 individuals (1245 women, 1168 men) aged 18 to 79 years (mean [SD] age, 45.8 [16.7] years). All participants completed a detailed questionnaire and underwent laboratory tests. We evaluated the prevalence of CHF based on self‑reported symptoms, Pol-ish National Health Fund database, and the N-terminal pro-B-type natriuretic peptide (NT‑proBNP) level. The proportion of patients that reported the diagnosis of CHF was 4.3% (95% CI, 3.6%-5.2%). Only 0.2% of people aged under 40 years reported CHF, compared with 3.2% of those aged 40 to 59 years and 13.2% of those aged 60 to 79 years. The distribution of NT‑proBNP levels in the patients with CHF was markedly skewed to the right, with the median value of 181 pg/ml (interquartile range, 90.8-531). Among the 104 individuals who declared having CHF, almost 56% had a record of at least 1 outpatient visit or hospitalization related to the ICD‑10 I50 code in the National Health Fund database, which translates to 2.4% of confirmed diagnoses of CHF in all Polish adults. The results of our study indicated that the proportion of inhabitants of Poland aged 18 to 79 years with heart failure was somewhere between 2.4% and 4.3%. This corresponds to 720 000 to 1 200 000 of diagnosed CHF cases in Poland.

Abstract 8956: Association of Serum Irisin Levels with Inflammatory, Biochemical, and Cardiac Imaging Parameters in Patients With Chronic Heart Failure versus Controls

Chronic heart failure (CHF) remains one of the most important causes of morbidity and mortality globally. Metabolic and energetic maladaptation has proven to play a critical in the progression of this condition. In this regard, evidence from preclinical studies has shown that irisin, a recently discovered adipomyokine involved in metabolic control, can induce positive cardioprotective effects by improving cardiac remodeling, cardiomyocyte viability, calcium delivery, and reduction of inflammatory mediators. However, data on the clinical associations between irisin levels and inflammatory and functional imaging parameters are scarce in CHF patients. 32 subjects diagnosed with CHF and 32 healthy controls were evaluated in a cross-sectional study. Serum irisin levels were significantly lower in patients with CHF (4.92, IQR [5.4] ng/ml) than controls (6.45, IQR [3.58] ng/ml). We identified a positive correlation between irisin levels and LVEF (R=0.3), fraction shortening (R=0.4), and body fat percentage (R=0.4). In contrast, a negative correlation between irisin levels and BNP (R=-0.4), insulin levels (R=-0.1), and HOMA index (R=-0.2) was reported. Subjects with CHF showed higher levels of TNF-α (22.05 IQR [12.28] pg/ml) and IL-12p70 (5.58 IQR [4.47] pg/ml) in comparison with controls (9.77 IQR [6.24] and 3.05 [1.90] pg/ml ), while controls showed higher levels of IL-10 (16.27 IQR [10.82] pg/ml) in comparison with CHF cases (7.51 IQR [8.47] pg/ml). However, we did not observe significant correlations between irisin levels and inflammatory cytokines. Irisin levels are possibly reduced in patients with CHF due to the intrinsic energetic and metabolic adaptations that occur as a result of the reduction of cardiac output. Reduced irisin levels play a synergic role with the effects of proinflammatory mediators by hazarding the cardiomyocyte viability, adaptation to ventricular remodeling, and response to fibrosis. This additional damage continues compromising cardiac dynamical parameters creating a vicious cycle.

Chronic kidney disease in patients with recurrent nephrolithiasis and concomitant damage to the cardiovascular system

Introduction. Chronic kidney disease (CKD) is commonly diagnosed in patients with cardiovascular diseases (CVDs) and also manifests itself in most patients with urolithiasis. Numerous studies have shown that renal dysfunction is not only directly related to the high risk of developing various CVDs and chronic heart failure (CHF) as one of the most common complications but also the mortality rate in comorbid patients. CKD and CHF have similar pathogenetic mechanisms and common target organs; co-existing, both pathological conditions accelerate the progression of major diseases and significantly aggravate their course. In patients with recurrent nephrolithiasis combined with CVDs, all the causes leading to the formation of CKD (recurrent obstructive pyelonephritis, nephroangiosclerosis, etc.) are present to some extent.Purpose of the study. To evaluate the incidence and characteristics of CKD in patients suffering from recurrent urolithiasis associated with CVDs.Materials and methods. The prospective study included 406 patients who were treated for recurrent nephrolithiasis and concomitant CVDs from 2007 to 2020 (Urology Division, Burdenko Principal Military Clinical Hospital). From long-term follow-up respondents who lived at least 10 years after inclusion in the study (n = 52), three groups were formed: group I (n = 18) included patients with a combination of essential hypertension (EH) and ischemic heart disease (IHD), complicated by CHF; group II (n = 15) consisted of patients with uncomplicated CVDs (EH – 7 patients, IHD – 8 patients). The control group III (n = 19) included respondents suffering from nephrolithiasis without CVDs. The glomerular filtration rate (GFR) was determined by the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) following the Russian National Guidelines for «Chronic Kidney Disease». The analysis of the obtained data was carried out using Statistica 8.0; the Fisher and Wilcoxon criteria were calculated; the differences were considered significant at p &lt; 0.05.Results. All patients included in the study were repeatedly hospitalized urgently and as planned and underwent at least one non-invasive manipulation or surgery. The average age of the patients was 58.9 ± 2.95 years; men predominated (~ 75 – 78%). A GFR decrease was recorded in 41.1% of patients included in the study, in 40.5% of patients with a combination of nephrolithiasis and uncomplicated CVDs, Also, its decrease was found in 60 (58.8%) of patients with chronic heart failure (CHF) in 41.1% of cases from the general sample and 40.5% of patients without CHF. CKD stage II occurred in 44 (43.1%) cases of CHF; CKD stages III Ca and Cb were detected in 10 (9.8%) and 4 (1%) cases, respectively; CKD stage IV developed in 1 (0.25%) patient with one of the re-hospitalizations. Of the 52 patients included in the second study part, the ratio of men and women was 41/11 (78.8 and 21.2%, respectively). All three groups were also dominated by men. The initial values of GFR in group I patients significantly differed from those in the control group; in group II, statistically significant differences appeared 4 years after the s the study initiation, and in group I – after 2 years. A sharp (1.5-fold) significant decrease in renal filtration function was registered in group I by the 6th research year, in group II (1.3-fold) – by the 8th research year, and in group III (1.28-fold) – only by the 10th research year. The GFR level in group I and group II decreased during the 1st follow-up year by 2.36 and 1.65 times, respectively.Conclusion. CKD in patients suffering from recurrent nephrolithiasis in combination with IHD and EH is generally benign. The progression rate of filtration deficiency is relatively low and is (at least in the early stages) about 4.5 ml/min per year. The addition of CHF increases the rate of decline in renal filtration function by up to 25% (from 4 ml/min per year to 5 ml/min per year). The main negative effect of concomitant CVDs (especially complicated CHF) is not an ultrahigh decrease in GFR but a reduction in kidney functioning stable period up to complete cessation.

Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction

Chronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a further increase in the number of cases of CHF with preserved left ventricular EF.&#x0D; Despite the large number of studies dedicated to analyzing the features of structural and geometric remodeling of the heart, changes in the systolic and diastolic function of the ventricles in patients with CHF, this issue hasn’t been definitively resolved and needs further improvement.&#x0D; The aim of the work – to investigate changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic origin with preserved LV EF.&#x0D; Materials and methods. The study was included 43 patients (men – n = 19; women – n = 24) for CHF of ischemic origin with preserved LV EF, with sinus rhythm, stage II AB, II-IV FC for NYHA (main group), and 90 patients on coronary heart disease without signs of CHF (men – n = 40 (44.5 %); women – n = 50 (55.5 %)), (comparison group). Groups of patients were comparable in age, sex, height, weight, body surface area. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy).&#x0D; Results. In patients with CHF preserved LV EF, the indicators prevailed: the size of the LA by 25 % (P = 0.005), the long axis of the LA by 11 % (P = 0.001), the LV EDV index of the LV by 13 % (P = 0.042), the LV mass index by 16 % (P = 0.013) according to the Penn Convention and (P = 0.004) the ASE. Eccentric left ventricular hypertrophy was diagnosed in 56 % of patients.&#x0D; Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. In 72 % of cases, the type of “relaxation disorder” was established, and in 26 % – “pseudonormal” LV filling profile. In none of the cases was a “restrictive” LV filling profile recorded. The following indicators of left ventricular diastolic function were lower in patients with CHF: e’ of the medial fibrous ring of the mitral valve by 26 % (P = 0.0001) and e’ lateral by 21 % (P = 0.0001), and the A’ the medial fibrous ring of mitral valve by 9 % (P = 0.022), and greater ratios of velocities E/e’ medial by 41 % (P = 0.0001), and E/e’ lateral fibrous ring of the mitral valve by 28 % (P = 0.0001), mean E/e’ by 36 % (P = 0.0001), which indicates a significant increase in end-diastolic pressure in the left ventricle.&#x0D; Conclusions. Structural and geometric remodeling of the heart in patients with CHF with preserved LV EF was characterized by dilatation of the left atrium, a moderate increase in the LV EDV index by 13 % (P = 0.042), a 16 % increase (P = 0.013) in the LV mass index, with the formation eccentric (56 %) and concentric (18 %) LV hypertrophy.&#x0D; Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. Disorders of diastolic filling of the left ventricle (72 % “relaxation disorder” and 26 % “pseudonormal” type) were occurred due to an increase in end-diastolic pressure in the left ventricle (increase by 41 % (P = 0.0001) ratio E/e’ medial fibrous ring MK), in LA (increase of more than 2 times (P = 0.0001) pulmonary capillary wedge pressure), and was accompanied by the development of postcapillary pulmonary hypertension (increase by 34 % (P = 0.0001) systolic pressure in the pulmonary artery).&#x0D; Despite the preserved LV EF, patients with CHF had significantly lower left and right ventricular contractility (10 % MAPSE med (P = 0.031), 18 % S med (P = 0.001) and 19 % (P = 0.007) RV EF).

Risk prediction of chronic heart failure in patients with type 2 diabetes

&lt;b&gt;Introduction.&lt;/b&gt; Diabetes mellitus and chronic heart failure (CHF) occur concomitantly, and each disease independently increases the risk for the other. In this connection, we studied the factors associated with CHF progression and proposed a mathematical model for assessing the prediction of the risk of CHF development, which can be applied in real clinical practice. &lt;br&gt;&lt;b&gt;Patients and methods.&lt;/b&gt; A total of 316 patients with DT2 were examined. The median age was 68 (63; 74) years. The levels of cystatin C, homocysteine, interleukin-6, and albumin/creatinine ratio were assessed in all patients with DT2. To evaluate the efficacy of this model, a retrospective analysis of patients’ medical records was carried out ("test sample"). The discriminant power (ROC) of the model in new cases of CHF was 0.91 (0.87; 1.00). Thus, it indicates a high predictive power of this method. &lt;br&gt;&lt;b&gt;Results.&lt;/b&gt; A model has been built to predict the likelihood of developing CHF in patients with DT2 (sensitivity 76.2%, specificity 73.3%). &lt;br&gt;&lt;b&gt;Conclusions.&lt;/b&gt; This model will allow for accurate prediction of the likelihood of developing CHF in patients with DT2. Further studies are needed to use it for choosing the optimal tactics for managing these patients.

Comparison between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure

Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center.&#x0D; Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV were selected by random sampling, from July 2017 to June 2018. Each patient was randomly allocated into either of the two arms, and was continued receiving treatment with either spironolactone (Arm-I) or eplerenone(Arm-II). Each patient was evaluated clinically, biochemically and echocardiographically at the beginning of treatment (baseline) at 1 month and at the end of 6th month. Echocardiography was performed to find out change in left ventricular systolic function.&#x0D; Result: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P &lt; 0.05). Ejection fraction (EF) changes were 6.2% in eplerenone group and 4.1% in spironolactonearm. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P &lt; 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P&lt;0.05) occurred after 6 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (187.8±37.4 versus 184.5±33.9; P=0.101) and left ventricular diastolic diameter (60.1±4.5 versus 61.0±4.9; P=0.0818) between arms. Assessment of blood pressure six months after treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both arms but difference between two arms were statistically non-significant (p&gt;0.05).&#x0D; Conclusion: In this study, the improvement in systolic function was more in eplerenone arm, which also had fewer adverse side effects when compared to spironolactone arm. So, it can be concluded that eplerenone can be advised in patient with chronic heart failure in addition to other drugs that are used to treat heart failure.&#x0D; University Heart Journal Vol. 16, No. 2, Jul 2020; 65-70

PCV57 THE BURDEN OF HEART FAILURE IN NORTH AMERICA AND WESTERN EUROPE

With population aging and improvements in ischemic heart disease (IHD) survival, the number of heart failure (HF) cases have risen dramatically over the last few decades in developed countries. We present the burden of acute heart failure (AHF) hospitalizations and chronic heart failure (CHF) prevalence in North America and Western Europe in 2019, using a cyclical flow diagram of adult patients from diagnosis/hospitalization until disease stabilization, decompensation, and/or death. We estimated the AHF hospitalization incidence due to de novo and decompensated events and the diagnosed prevalence of CHF in the mature pharmaceutical markets of North America and Western Europe using national hospitalization databases and population-based studies, respectively. We applied the correlation function between the disability adjusted life-years (DALYs) calculated for the major etiological factors of HF, i.e. IHD, rheumatic heart disease, cardiomyopathy, myocarditis, endocarditis, and valvular heart disease, and HF incidence/prevalence in the above countries (R2=0.78 and 0.62 for AHF and CHF, respectively), to estimate the number of AHF events/CHF cases in the countries for which there were no reliable data. The drug-treated percentages for CHF were estimated from primary/secondary research. In 2019, we estimate more than 3.5 million AHF hospitalizations and 7.4 million diagnosed prevalent cases of CHF in North America. In Western Europe, the corresponding numbers were 5.1 million hospitalizations and 8.5 million CHF cases. Of the CHF cases, 86% and 88% were drug-treated, respectively. Approximately 38% of CHF patients were categoried as NYHA Class III/IV in both regions. In 2019, the most widely-prescribed class of drugs for CHF in North America were β-blockers (69%) and in Western Europe, loop diuretics (75%). HF takes a tremendous toll on the healthcare systems in the developed world. The substantially high number of hospitalizations and prevalent cases call for greater implementation public health policies to prevent IHD.

Chronic Heart Failure in Rheumatoid Arthritis Patients (Part III): Effects of Antirheumatic Drugs

Chronic autoimmune inflammation is one of the leading risk factors for the development of chronic heart failure (CHF) in rheumatoid arthritis (RA). The purpose of the review is to analyze the results of investigations on the effects of conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), biological disease-modifying anti-rheumatic drugs (bDMARDs), and targeted csDMARDs on cardiac function and the risk of developing CHF in patients with RA. Methotrexate may reduce the CHF risk and have a positive effect on the course of this condition in patients with RA. Despite the data on the presence of leflunomide effects that impede myocardial remodeling, there is no evidence of the role of the drug in the prevention of CHF in RA patients. Hydroxychloroquine may contribute to the prevention of CHF, but the risk of developing severe cardiotoxicity should be considered when taking the drug for a long time. Most studies have not revealed the negative effect of tumor necrosis factor inhibitors on the prevalence and incidence of new cases of CHF in RA patients, and an improvement in the structure and function of the heart during therapy has been shown. Inhibitors of interleukin (IL) -1, inhibitors of IL-6, inhibitors of T-cell co-stimulation, anti-B-cell therapy, targeted csDMARDs do not increase the risk of CHF and may have cardioprotective effects, including slowing the progression of left ventricle myocardial dysfunction. Due to the high risk of CHF and CHF-associated mortality in RA patients, early diagnosis of cardiac dysfunction, development of a prevention and treatment strategies are needed, including high-quality prospective studies to assess the effect of anti-rheumatic therapy on myocardial function, risk of developing and decompensation of CHF in RA patients. It is possible that some drugs may possess protective effects on cardiomyocytes so they could become the first-line drugs in patients with CHF or the risk of its development.

Comparative Analysis of Cardiovascular Disorders in Patients with Chronic Myeloid Leukemia on Tyrosine Kinase Inhibitor Therapy

Aim. To analyze adverse cardiovascular events in chronic myeloid leukemia (CML) patients who received various tyrosine kinase inhibitors (TKI). Materials &amp; Methods. The trial included 97 CML patients with nilotinib, dasatinib or imatinib indications. By the time of examination the patients had undergone TKI therapy for 1-138 months. The three of them were sequentially treated with 2 drugs over the monitoring period. All CML patients were aged 22-79 years (median 53.5 years): 55 women were aged 22-71 years (median 53.5 years) and 42 men were aged 24-79 years (median 53 years). Results. The comparative analysis demonstrated significantly higher impact of nilotinib on daily maximum QTc duration compared with other TKIs. The patients who received nilotinib (n = 15) throughout 38 months had QTc of 0.47 s (interquartile range [IQR] 0.46-0.47 s), in imatinib group (n = 17) QTc was 0.43 s (IQR 0.43-0.44 s), and in dasatinib group (n = 4) QTc was 0.43 s (IQR 0.42-0.44 s) (p = 0.0008). Among all patients treated with nilotinib there were 62 % (31/50) with QTc &gt; 0.46 s, in imatinib (6/41) and dasatinib (2/18) groups it was detected in 14.6 % and 11.1 % of patients, respectively (p = 0.0008). Five patients had QTc &gt; 0.48 s, which is the criterion for discontinuation of treatment or dose reduction. In two patients the identified changes of QTc duration required TKI temporary suspension. After nilotinib dose reduction or discontinuation QTc duration normalized in all cases within 2 weeks. Decreased ankle-brachial index (ABI) &lt; 0.9 without pronounced clinical symptoms was identified in two patients who received nilotinib. Afterwards they showed peripheral occlusive disease of lower extremities, and nilotinib treatment was discontinued. In patients treated with other TKIs no occlusive vascular lesions were observed. A case of chronic heart failure with reduced left ventricular ejection fraction developing on nilotinib therapy was revealed and described. Conclusion. Despite high specificity for BCR-ABL tyrosine kinase, new TKIs can, although rarely, induce cardiovascular adverse events. Prior to TKI treatment assignment CML patients should be examined with ECG and EchoCG with systolic function evaluation, and the measurement of pulmonary artery pressure as well as ABI. The examination should be repeated in the end of the 1st year TKI treatment if there is no reason for extra examinations. It is recommended to hold 24-hour ECG monitoring with QTc max measurement prior to nilotinib assignment, then once a year within 2 years of nilotinib treatment, and once in 6 months after 3 years of therapy.

Outcome of Albumin Infusion in Heart Failure Patients

Background: Heart Failure (HF) is a major public health burden worldwide. Approximately 5 million Americans, 0.4–2% of the general European population and over 23 million people worldwide are living with heart failure. Like few other chronic disease, low serum albumin is common in patients with heart failure (HF). However, very few studies evaluated the outcome of albumin infusion in different stages of HF. Therefore, the objective of this study is to assess the outcome of albumin infusion in heart failure patients.&#x0D; Methods: It was a cross-sectional study. A total of 50 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV with serum albumin level &lt;2.5g/dl who were admitted in CCUwere selected by purposive sampling, from September 2017 to August 2018. 100ml of 20% albumin was infused and serum albumin was measured after 3 days. Then the patients were divided into two groups, Patients who failed to attain serum albumin of 3g/dl(Group A) or Patients who attained serum albumin of ≥3g/dl (Group B). Analysis and comparison for symptomatic improvement of heart failure by NHYA classification and LVEF was done at 10th day after infusion between group A and B.&#x0D; Result: Among the 50 patients, mean age of patients was 53.64 ± 13.44 years (age range: 26-84 years) with a male-female ratio of 3:2 (60%-male vs 40%- female). Majority patients were previously re-admitted at least two times (40%), 28% were re-admitted once, 16% were re-admitted three times and 4% were re-admitted for four times. Of all, 56% patients presented NYHA class IV and AHA stage D heart failure (56%) and 44% patients presented with NYHA class III and AHA stage C. At day 10 follow up following albumin infusion, overall frequency of following ten days of albumin therapy, in group B, 8 patients (72.7%) among Class III improved to Class I and 3 patients (27.3%) improved to class II. Also, 7 patients (50%), 5 patients (35.7%) and 2 patients (14.3%) among class IV improved to respectively class I, class II and class III. In group A, 3 patients (27.3%) among class III improve to class II and 8 patients (72.7%) remain in class III. Also, 2 patients (14.3%), 5 Patients (35.7%) and 7 patients (50%) among class IV improve to respectively class I, class II and class III. Moreover, statistically significant improvement was noted in ejection fraction of patents irrespective of initial class of heart failure (p&lt;0.001) in group B patients compare to group A (p&lt;0.09).&#x0D; Conclusion: In this study, the improvement of heart failure was more in patients who attained albumin level of ≥3g/dl.Therefore, in can be concluded that albumin infusion improves both subjective and objective improvement of patients with heart failure.&#x0D; University Heart Journal Vol. 15, No. 2, Jul 2019; 47-53

Think-aloud study about the diagnosis of chronic heart failure in Belgian general practice

ObjectivesDiagnosing chronic heart failure (CHF) in general practice is challenging. Our aim was to investigate how general practitioners (GPs) diagnose CHF in real-world patients.DesignThink-aloud study.MethodsFourteen GPs were asked to reason...

Analysis of Exercise-Induced Periodic Breathing Using an Autoregressive Model and the Hilbert-Huang Transform.

Evaluation of exercise-induced periodic breathing (PB) in cardiopulmonary exercise testing (CPET) is one of important diagnostic evidences to judge the prognosis of chronic heart failure cases. In this study, we propose a method for the quantitative analysis of measured ventilation signals from an exercise test. We used an autoregressive (AR) model to filter the breath-by-breath measurements of ventilation from exercise tests. Then, the signals before reaching the most ventilation were decomposed into intrinsic mode functions (IMF) by using the Hilbert-Huang transform (HHT). An IMF represents a simple oscillatory pattern which catches a part of original ventilation signal in different frequency band. For each component of IMF, we computed the number of peaks as the feature of its oscillatory pattern denoted by Δi. In our experiment, 61 chronic heart failure patients with or without PB pattern were studied. The computed peaks of the third and fourth IMF components, Δ3 and Δ4, were statistically significant for the two groups (both p values < 0.02). In summary, our study shows a close link between the HHT analysis and level of intrinsic energy for pulmonary ventilation. The third and fourth IMF components are highly potential to indicate the prognosis of chronic heart failure.