Course Of Chronic Heart Failure Research Articles

In Search of Optimal Criteria for Iron Deficiency in CHF Patients. Post-hoc Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)".

Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 μmol/l. An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 μg/l or ferritin from 100 to 299 μg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed. ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml). Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 μg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

Association of I/D polymorphism of ACE gene with different course of chronic heart failure and myocardial remodeling in patients with coronary heart disease after coronary artery bypass grafting

Association of I/D polymorphism of ACE gene with different course of chronic heart failure and myocardial remodeling in patients with coronary heart disease after coronary artery bypass grafting

The value of percutaneous transcatheter mitral valve regurgitation repair in the combination treatment of chronic heart failure patients: Results from a 6-month observational prospective study

Rationale: Surgical interventions have been recognized as the main method to repair of valvular disorders. Percutaneous transcatheter intervention with a clipping system is being actively introduced into the treatment of chronic heart failure (CHF) patients and mitral valve insufficiency (MVI) for correction of mitral regurgitation (MR), along with drug therapy. Aim: To establish the effect of the mitral valve leaflet clipping in the combination treatment of CHF patients on the clinical course of heart failure and the remodeling process. Methods: This single center prospective comparative study included 80 patients with CHF NYHA class II–IV and secondary MR grade 3–4. The patients were on optimal medical treatment (OMT) for CHF for at least 3 months before inclusion into the study. The main group included 55 patients who underwent transcatheter mitral valve repair with the use of MitraClip system, and the control group consisted of 25 patients in whom the surgery for MR was waived for various reasons (refusal of the surgery by the patient, some valve characteristics), and only OMT for CHF was used. At baseline, main clinical and demographic characteristics of the patients in the both groups were comparable. The duration of the follow-up was 6 months. Echocardiography (echoCG), a 6-minute walk test, and measurements of the brain natriuretic propeptide level were performed in all patients at baseline and at 6 months of the follow-up. Results: At 6 months, there was a significant reduction in CHF NYHA class and an increase in the 6-minute walk test distance and a decrease in diuretic requirements (converted to furosemide, from 58.4 ± 17.2 to 38.1 ± 20.7 mg daily, р = 0.02) in the group with the MitraClip implant, but not in the control group. In the OMT only group, there were no changes over 6 months in the diuretic requirements (48.1 ± 6.68 and 43.8 ± 27.15 mg daily, respectively, р = 0.8). The number of hospital readmissions due to CHF decompensation was 7 (12.7%) in the implanted MitraClip group and 4 (16%) in the OMT group (р = 0.69). EchoCG performed at 6 months after the surgical intervention identified no cases of MR grade 2. In the MitraClip implant group, there was a decrease in the size and volumes of the left atrium (р = 0.02 and р = 0.05, respectively), left ventricle (for end-diastolic diameter p = 0.002, end-diastolic volume p = 0.03), mean pulmonary artery pressure (p = 0.03), as well as an increase in cardiac output (р = 0.04). In the patients receiving OMT only, there were no significant changes in EchoCG parameters over time. Conclusion: Our study has shown benefits of the implantation of the mitral valve leaflet clipping system, compared to OMT only, in CHF. The clipping procedure promotes a significant improvement in clinical course of CHF, reverse myocardial remodeling, and reduction in diuretic requirements.

The influence of physical rehabilitation of patients on the course of chronic heart failure

The influence of physical rehabilitation of patients on the course of chronic heart failure

Features of chronic heart failure on the background of thrombocytopenia in persons infected with the human immunodeficiency virus

The general context of the study is to review the characteristics of the course of chronic heart failure (CHF) in persons infected with the human immunodeficiency virus (HIV) as a part of a single-stage screening clinical trial.Aim: To determine the features of the CHF course in HIV-infected patients, depending on the presence of thrombocytopenia (TP).Material and Methods. In a multidisciplinary hospital, 240 patients with HIV infection were examined for four years, where a cohort of patients with CHF (160 people) was identified, further divided into groups of patients with TP (107 people) and without TP (53 people). Patients underwent the same amount of research, including echocardiography, non-invasive arteriography, and a detailed laboratory examination.Results. TP in patients with CHF and HIV infection is more common in smokers and people with alcohol dependence and is associated with hemodynamic disorders in the form of higher systolic and diastolic blood pressure, left atrium increase. With TP, the values of NT-proBNP in blood plasma are higher, and in the blood serum – tissue inhibitor of metalloproteinases-1, urea, bilirubin, while the concentration of sodium and potassium ions in the blood serum is lower. Anemia and leukopenia were more common in the group of patients with thrombocytopenia. Patients with TP are more adherent to taking protease inhibitors and non-steroidal anti-inflammatory drugs.Conclusion. The frequency of CHF detection in patients with HIV infection against the background of TP is almost 2 times higher and is more often accompanied by dilatation of the left atrium, higher blood pressure, an increase in TIMP-1 and a decrease in the concentration of potassium ions in the blood serum. The concentration of NT-proBNP in blood plasma has a close inverse correlation with the number of platelets in patients with CHF and TP, and the presence of severe TP ≤ 30 × 109 cells/l increases the chances of developing CHF with low left ventricular ejection fraction by 10.8 times. Smoking, possible alcohol dependence and adherence to taking protease inhibitors and NSAIDs are significant factors associated with the development of thrombocytopenia in HIV-infected patients with CHF.

The influence of alcohol dependence on the course of chronic heart failure in patients with HIV infection

Introduction. Alcohol dependence is a condition, the consequences of which are severe in persons with cardiovascular diseases and immunodeficiency. The purpose of the study is to evaluate the influence of alcohol dependence on the course of chronic heart failure (CHF) in persons infected with human immunodeficiency virus (HIV). Materials and methods. A clinical study including 240 HIV-infected patients, 160 of them were diagnosed with CHF, 72 had alcohol dependence. AUDIIT scale was used for diagnostics of alcohol dependence. All patients underwent echocardiography, NT-proBNP concentration was determined in blood plasma, serum - content of SRB, transferrin, ferritin, iron, potassium, sodium, bilirubin, creatinine, urea, uric acid, AST, ALT, GGTP activity. Statistical calculations: Kolmogorov-Smirnov, Mann-Whitney methods, odds ratios and risks. Results. Congestion, lower heart rate prevailed in the group of patients with alcohol dependence. On the background of alcohol dependence in blood serum there was a decrease in the level of total cholesterol, transferrin, potassium, an increase in total bilirubin and GGTP activity, a decrease in the number of platelets. Increase in NT-proBNP concentration was found in blood plasma. Discussion. Alcohol is characterized by cardiotoxic effect, and regular ethanol consumption is associated with the development of non-ischemic dilated cardiomyopathy and CHF. Echocardiographic findings suggest a predominance of right atrial and left ventricular dilatation in the group of patients with alcohol dependence among all patients with CHF infected with HIV due to the formation of cardiomyopathy. Conclusion. Alcohol dependence is a condition aggravating the course of CHF in HIV-infected patients, which is manifested by higher values of blood plasma NT-proBNP, with CHF more often acquiring a congestive character. The course of CHF in HIV-infected patients against the background of alcohol dependence is accompanied by liver dysfunction - 3.5 times increase the chance of cholestasis development, 2.5 times increase the chances of death within 2 months after admission to hospital.

Myostatin and the Heart.

Myostatin (growth differentiation factor 8) is a member of the transforming growth factor-β superfamily. It is secreted mostly by skeletal muscles, although small amounts of myostatin are produced by the myocardium and the adipose tissue as well. Myostatin binds to activin IIB membrane receptors to activate the downstream intracellular canonical Smad2/Smad3 pathway, and additionally acts on non-Smad (non-canonical) pathways. Studies on transgenic animals have shown that overexpression of myostatin reduces the heart mass, whereas removal of myostatin has an opposite effect. In this review, we summarize the potential diagnostic and prognostic value of this protein in heart-related conditions. First, in myostatin-null mice the left ventricular internal diameters along with the diastolic and systolic volumes are larger than the respective values in wild-type mice. Myostatin is potentially secreted as part of a negative feedback loop that reduces the effects of the release of growth-promoting factors and energy reprogramming in response to hypertrophic stimuli. On the other hand, both human and animal data indicate that myostatin is involved in the development of the cardiac cachexia and heart fibrosis in the course of chronic heart failure. The understanding of the role of myostatin in such conditions might initiate a development of targeted therapies based on myostatin signaling inhibition.

Standardization of liver ultrasound elastometry and transthoracic echocardiography techniques for simultaneous use in patients with chronic heart failure

Objective. To develop a standartized approach to the diagnosis of the subclinical course of chronic heart failure using a combination of transthoracic echocardiography, liver elastometry and stress test in cardiac patients.Materials and methods: All patients (n=97) were examined according to a single diagnostic algorithm: physical examination, transthoracic echocardiography and ultrasound elastometry of the liver. In addition to the main studies for patients of group No. 2 with questionable (borderline) results, according to instrumental studies, a stress test was additionally conducted to determine the latent course of heart failure. All 3 groups of patients were also dynamically examined after 3 and 6 months.Results: In patients of groups 1 and 3, the results of instrumental studies did not differ dynamically at 3 study points: 0 months — 3 months — 6 months: in patients with CHF 1 according to elastography, the indicators were within F0-F1, which corresponded to the absence of clinically significant fibrosis, for patients of group 3, the indicator It remained within F3-F4, which indicated a prolonged course of the disease, as well as venous stagnation and/or true fibrosis with subsequent transition to cirrhosis. In group No. 2 (CHF 2A-B, II–IIIFK), where a stress test was performed, the results in dynamics differed statistically significantly depending on the difference in elastometry indicators before and after physical activity: in patients with a difference of less than 15% after six months, the result remained within the same values, in a cohort of patients with a difference of 15–25% in dynamics, there was an increase in the results of liver elastometry, in the group with a difference of >25%, there was a marked increase in liver elastometry and a decrease in the left ventricular ejection fraction according to echocardiography; in addition, 45% of them have passed into the decompensation stage.Conclusion. For dynamic control of the functional state of the liver, as well as the detection of subclinical forms of CHF in cardiac patients, the use of the combined TTE+2D-SWE+test with a load test is an interesting and promising alternative to invasive manipulations, which will provide a differential approach to the diagnosis of CHF in patients at different stages of the disease.

Chronic kidney disease in patients with chronic heart failure infected with human immunodeficiency virus

Chronic kidney disease (CKD) is the most common manifestation of target organ damage in chronic heart failure (CHF). The aim of the study was to determine the risk factors associated with the course of CKD in patients with CHF infected with the human immunodeficiency virus (HIV). According to the results obtained, the prevalence of CKD among HIV-infected patients with CHF is 58.82%, which is 4 times more common than in patients with HIV infection without CHF. The dependence of glomerular filtration rate (GFR) on three main factors that reflect damage to the heart muscle – blood plasma NT-proBNP concentration, left ventricular ejection fraction (LVEF%) and left ventricular myocardial mass index (LVMI) was proved, which together, being included in the regression model, determine 42.2% of the variance of GFR values and are decisive in the development of CKD in patients with CHF on the background of HIV infection. The concentration of NT-proBNP in the blood plasma of patients with CHF equal to or greater than 683.65 pg/ml can be considered as a diagnostic criterion for the development of CKD in HIV-infected people with a sensitivity of the method of 75.0% and a specificity of 75.4%, respectively. In addition, risk factors for the development of CKD in patients with CHF and HIV infection are smoking, alcohol and drug use, a history of chronic and acute forms of coronary artery disease, atrial fibrillation, ventricular arrhythmias, diabetes mellitus, chronic viral hepatitis C, anemia and thrombocytopenia. Patients with CHF and CKD have a more rigid arterial wall – there is a significant excess of the stiffness indices of the aorta and peripheral arteries. Long-term use of antiplatelet agents, NRTIs, NNRTIs, and protease PIs may aggravate the course of CHF in HIV-infected people with CKD manifestations.

ДЕПРЕССИВНЫЕ РАССТРОЙСТВА И ПРОГНОЗ У ПАЦИЕНТОВ С ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ ИШЕМИЧЕСКОЙ ЭТИОЛОГИИ

Abstract. Introduction. Clinical depression occurs in 21.5% of patients with heart failure, aggravating both the clinical course and the prognosis of the disease. The aim is to present the findings of the clinical course of chronic heart failure in patients with depressive disorders and to study their prognoses. Material and Methods. The study included 78 patients with heart failure, functional classes 1-4. The degree of depressive disorders was assessed using the Hospital Anxiety and Depression Scale (HADS). Life quality was assessed using the Minnesota Living with Heart Failure Questionnaire. All patients passed a 6-minute walk test and echocardiography. The patient’s clinical condition was assessed according to the clinical condition assessment scale. Prognoses were assessed after 1 year of study. Results and Discussion. Depression level analysis has shown that the clinically pronounced depression is common in patients with heart failure, which corresponds to 9.0 (6.0;11.0) points. In a closer consideration of the structure of disorders, no depression was found in 37.2 % of cases, subclinical depression was found less frequently in patients with heart failure (26.9 %), while clinical depression was found in 35.9 %. All-cause mortality was observed in 7.7 % of cases, while cardiovascular mortality occurred in 4.6 %. Pronounced depression was registered in patients with chronic heart failure, in case of hospital admission. Conclusions. Average depression level in patients with heart failure is 9.0 (6.0; 11.0) points, which corresponds with clinical depression. Depression occurs in 62.8 % of cases and associated with worse clinical condition. Overt clinical depression occurs more frequently in patients with chronic heart failure, who have come up to the event of hospitalization.

Evaluation of a New Telemedicine System for Early Detection of Cardiac Instability in Patients With Chronic Heart Failure: Real-Life Out-of-Hospital Study.

For a decade, despite results from many studies, telemedicine systems have suffered from a lack of recommendations for chronic heart failure (CHF) care because of variable study results. Another limitation is the hospital-based architecture of most telemedicine systems. Some systems use an algorithm based on daily weight, transcutaneous oxygen measurement, and heart rate to detect and treat acute heart failure (AHF) in patients with CHF as early on as possible. The aim of this study is to determine the efficacy of a telemonitoring system in detecting clinical destabilization in real-life settings (out-of-hospital management) without generating too many false positive alerts. All patients self-monitoring at home using the system after a congestive AHF event treated at a cardiology clinic in France between March 2020 and March 2021 with at least 75% compliance on daily measurements were included retrospectively. New-onset AHF was defined by the presence of at least 1 of the following criteria: transcutaneous oxygen saturation loss, defined as a transcutaneous oxygen measurement under 90%; rise of cardiac frequency above 110 beats per minute; weight gain of at least 2 kg; and symptoms of congestive AHF, described over the phone. An AHF alert was generated when the criteria reached our definition of new-onset acute congestive heart failure (HF). A total of 111 consecutive patients (n=70 men) with a median age of 76.60 (IQR 69.5-83.4) years receiving the telemonitoring system were included. Thirty-nine patients (35.1%) reached the HF warning level, and 28 patients (25%) had confirmed HF destabilization during follow-up. No patient had AHF without being detected by the telemonitoring system. Among incorrect AHF alerts (n=11), 5 patients (45%) had taken inaccurate measurements, 3 patients (27%) had supraventricular arrhythmia, 1 patient (9%) had a pulmonary bacterial infection, and 1 patient (9%) contracted COVID-19. A weight gain of at least 2 kg within 4 days was significantly associated with a correct AHF alert (P=.004), and a heart rate of more than 110 beats per minute was more significantly associated with an incorrect AHF alert (P=.007). This single-center study highlighted the efficacy of the telemedicine system in detecting and quickly treating cardiac instability complicating the course of CHF by detecting new-onset AHF as well as supraventricular arrhythmia, thus helping cardiologists provide better follow-up to ambulatory patients.

КЛИНИЧЕСКИЕ ОСОБЕННОСТИ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ С НИЗКОЙ ФРАКЦИЕЙ ВЫБРОСА В СОЧЕТАНИИ С АНЕМИЕЙ

Introduction. In patients with chronic heart failure (CHF), anemia is more common than in the general population, and its prevalence, according to various authors, ranges from 15 to 61%. Decreased hemoglobin levels are an independent factor contributing to mortality in this cohort. According to a retrospective analysis of the Val-HeFT study, patients with CHF with a decrease in hemoglobin during 12 months of follow-up had a higher rate of readmissions, complications and death compared with patients without a decrease in hemoglobin (Hb). The aim of our work was to study the clinical features and laboratory and instrumental manifestations in patients with CHF with low ejection fraction (CHFrEF) and anemia. Material and methods. We conducted a continuous sample and analyzed 105 case histories of patients for 2022, who were admitted with CHFlEF (EF < 40%) to the cardiology department of the City Clinical Hospital No. 3. The functional class (FC) of CHF was established according to the scale for assessing the clinical condition in CHF (SHOKS, modified by Mareeva V.Yu., 2000), stage - according to the Strazhesko-Vasilenko classification. The edematous syndrome was assessed by points (1 - feet, 2 - lower leg, 3 - scrotum / inguinal region, 4 - abdomen, 5 - chest wall). The presence of anemia was determined by the level of Hb: <130 g/l for men, <120 g/l for women. All patients underwent Holter monitoring of the electrocardiogram (HM ECG) and echocardiography (EchoCG). The indicators of patients with CHFrEF with and without anemia were studied and compared. For this purpose, the Mann–Whitney, Wilcoxon, and c2 tests were used for nonparametric data. The Statistica 12.0 software package (Statsoft, USA) was used. Results. The general group of patients with CHFrEF included 72.4% of men (n=76) and 27.6% of women (n=29), mean age 66.9±12.3. Of these, anemia was detected in 25.7% of cases (n=27), the proportion of men was 66.7% (n=18, mean age 69.1±9.4), women - 33.3% (n=9 , mean age 68.9±16.7). The mean age of patients with CHFrEF in the group with and without anemia did not differ significantly (69.0±12.0 and 66.1±12.3, respectively, р˃0.05). In patients with CHFrEF and anemia, hemoglobin values were significantly lower (106.9±12.7 and 151.6±15.8 g/l, respectively, p<0.001), mean hemoglobin content in erythrocytes (29.1±13, 2 and 31.2±7.7 pg, respectively, p<0.001), the number of erythrocytes (4.2±1.0 and 5.0±0.6 1012/l, respectively, p<0.001), serum iron ( 9.9±9.6 and 10.4±4.1 µmol/l, respectively, p<0.001), erythrocyte sedimentation rate (ESR) (20.9±13.7 and 8.8±8.8 mm/ hour, respectively, p<0.001). Patients with anemia had lower FC (10.3±2.2 and 8.9±2.7 points, respectively, p=0.022) and CHF stage (IIa - 19%, IIB - III - 81% versus IIa - 57 %, IIB - III - 43%, respectively, p=0.02), more pronounced edematous syndrome (2.3±1.0 and 1.8±1.1 points, respectively, p=0.039). According to HM ECG data, patients with anemia had a greater number of ventricular extrasystoles (3445.4±4439 versus 1727.4±3059.0, respectively, p=0.05). EchoCG parameters did not differ in both groups. Conclusion. Every fourth patient with CHFrEF has anemia, while there are no significant differences in age and gender. The combination of CHFrEF with anemia significantly aggravates the course of CHF (according to SHOKS, stage of CHF, severity of edematous syndrome).

Клинические особенности течения хронической сердечной недостаточности при новой коронавирусной инфекции

According to statistics, the number of patients with chronic heart failure (CHF) is growing in Russia. The cause of CHF can be various comorbid conditions that will aggravate the course of CHF. Objective. To determine the clinical features of the course of CHF in the context of COVID-19. Materials and methods. The retrospective study included 210 patients with a confirmed diagnosis of CHF and COVID-19 hospitalized in the pulmonology department. To assess the course of CHF, we used data on the severity of CHF symptoms (severity of shortness of breath on the mMRC scale, chest pain, presence of edema, level of physical activity) and objective examination data (blood pressure level, pulse dynamics). Results and conclusions. The risk group for severe COVID-19 included patients over 60 years of age with concomitant diseases. The clinical picture is noteworthy: severe shortness of breath, significant limitation of physical activity, and swelling in some patients. Patients with CHF during the treatment of COVID-19 require mandatory correction of both the underlying and concomitant diseases to prevent decompensation of CHF and death from all causes.

The results of orthotopic heart transplantation using the bicaval technique

Circulatory failure, which develops in the final stages of the course of the most heart diseases, is a link in the progressive process. This process is accompanied by a significant decrease in the quality of life, as well as high disability and mortality.
 Heart transplantation increases the survival of patients with chronic heart failure, increases tolerance to physical exertion, improves the quality of life of patients and allows most of them to return to vigorous activity.
 Aim. The work is devoted to the analysis of the results of orthotopic heart transplantation in patients with a progressive course of chronic heart failure that cannot be treated conservatively.
 Materials and methods. We analyzed the clinical course of heart transplants in 55 patients. There were 46 (83.6 %) men and 9 (16.4 %) women among the recipients. The average age was 46.0 ± 10.0 years.
 Results. The result of the conducted retrospective study revealed that in-hospital (early) and one-year (longterm) survival among patients in our study was 92.7 % and 81.8 %, respectively.
 Conclusions. Heart transplantation is the most effective method of treatment for terminal heart failure. The quality of life of heart transplant patients improves significantly after surgery and is the main factor in the development of heart transplantation nowadays.
 The main causes of death were acute graft dysfunction, rejection reactions, and coronary heart disease of the transplanted heart. Problems related to cardiac graft dysfunction and rejection in the early and long-term period still need to be definitively resolved.

The course of chronic heart failure in patients after COVID-19 against the background of active cytomegalovirus infection

Background. A new coronavirus infection may be complicated in the post-COVID period by the development of adverse cardiovascular events associated with chronic heart failure.
 Aim. To study the features of the course of chronic heart failure in patients after COVID-19 infection against the background of active cytomegalovirus infection.
 Material and methods. The study included 102 patients with chronic heart failure with reduced and intermediate left ventricular ejection fractions, who underwent COVID-19 in mild and moderate forms. The control group consisted of 61 patients with chronic heart failure and no COVID-19. Within 6 months after the infection with COVID-19, the features of the course of chronic heart failure were assessed. Quantitative determination of deoxyribonucleic acid (DNA) of cytomegalovirus in blood plasma was carried out by polymerase chain reaction. To assess the risk of adverse events, the odds ratio (OR) with a 95% confidence interval (95% CI) was calculated. Quantitative data were presented as median and interquartile range (25th and 75th percentiles).
 Results. After coronavirus infection, the risk of an unfavorable course of chronic heart failure (OR=6.237; 95% CI=2.91113.362; p=0.001), hospitalization due to decompensation of chronic heart failure (OR=5.9; 95% CI=1.31326.504; p=0.033), an increase in the functional class of heart failure by 1 class or more (OR=4.19; 95% CI=1.63610.736; p=0.009), development of atrial fibrillation paroxysms (OR=3.832; 95% CI=1.38510.599, p=0.014), significantly increased. The number of copies of cytomegalovirus DNA in patients who underwent COVID-19 was significantly higher in the group of patients with an unfavorable course of chronic heart failure compared to the same group, in which patients did not tolerate COVID-19 2238.5 (1888.5; 2647.5) and 1411.5 (1112.5; 1684.5) copies/ml, respectively (p 0.001).
 Conclusion. Patients with chronic heart failure after 6 months of COVID-19 infection are at high risk of developing adverse cardiovascular events against the background of active cytomegalovirus infection.

Characteristics of patients with chronic heart failure in different age groups

There are indications that the severity of clinical manifestations of chronic heart failure (CHF) is related to the age of patients, with older age groups characterized by a more severe course of CHF and more significant pathological changes in instrumental and laboratory parameters. In view of the above, the aim of the present study was to compare NT-proBNP level, other basic parameters of left ventricular myocardial contractility and the results of 6-min walk test, in CHF patients of different age. We investigated these parameters by dividing the total number of subjects into subgroups of young (18-44 years), middle-aged (45-59 years) and elderly (60-74 years) age according to WHO guidelines. There were 111 patients with CHF (82 men and 29 women) aged 20 to 74 years (mean age 60.4±1.25 years). The patients were divided into three subgroups: 1st - young age (21 patients), 2nd - middle age (37 patients) and 3rd - old age (53 patients). Echocardiographic examination, 6-minute walking test, determination of NT-proBNP level in blood plasma were used during the examination. The number of patients with decreased EF (<35%) was significantly lower among young patients, while those with preserved EF was significantly higher among elderly patients. There were more patients with signs of pulmonary hypertension (high systolic pulmonary artery pressure (SPAP)) among elderly patients. The average distance walked during a 6-minute walk was relatively shorter in elderly patients, as well as a greater number of patients with higher (III-IV functional classes (FC)). The number of patients with elevated blood NT-proBNP levels as well as mean NT-proBNP levels were also relatively higher in the older age groups. Thus, the clinical course of CHF is characterized by a more severe course in elderly patients, despite the prevalence of patients with preserved EF, which is confirmed by more frequent occurrence of FC III-IV, clinical-instrumental and laboratory parameters, and is associated, at least partly, with more frequent occurrence of comorbid pathology.

Catheter ablation of atrial fibrillation versus antiarrhythmic therapy in patients with left ventricular systolic dysfunction

Aim. To evaluate the efficacy of catheter ablation (CA) of atrial fibrillation (AF) in patients with left ventricular systolic dysfunction and the effect of the procedure on the course of chronic heart failure (CHF) compared with the use of antiarrhythmic therapy (AAT). Materials and methods. The study included patients (n=80) with left ventricular ejection fraction (LVEF) less than 50% and AF, who were divided into 2 groups: the first group (n=40) underwent CA, the second group included patients on AAT. At baseline and after 6 months of follow-up, transthoracic echocardiography, determination of NT-proBNP concentration, 6-minute walk test and The Minnesota Living With Heart Failure Questionnaire were performed. Results. After 6 months of follow-up, the absence of documented AF paroxysms was observed in 80% in the CA group versus 45% in the AAT group (p=0,001). A significant increase in LV EF was revealed in both groups, however, in CA group it was more significant (57% [50,5; 60] in the CA group versus 46% [40; 50] in the AAT group (p=0,0001)). There was a decrease in the left ventricle ESD and the left atrial size and volume in the CA group, while in the AAT group the dynamics of these parameters did not change within six months (p=0.0001). An improvement in the clinical course of CHF was observed in both groups: the level of NT-proBNP was 196,6 [116,5; 327,1] pg/ml and 540.5 [382,8; 861,2] pg/ml (0,0001), the 6-minute walk distance increased to 470 m [400; 500] and 368 [330; 400] m (p=0,0001), respectively, the improvement of the functional class (1,15±0,67 and 2,05±0,55 (p=0,0001)) and the quality of life (p=0,0001) were observed. Conclusion . CA is an effective method for patients with AF and CHF. The use of CA in patients with CHF promotes reverse remodeling, a decrease in the level of NT-proBNP, as well as an improvement in the quality of life and an increase in exercise tolerance.

Delaminating Intramyocardial Hematoma in Patients with Heart Failure with Reduced Ejection Fraction: а Series of Clinical Cases

Delaminating intramyocardial hematoma (DIMH) is a rare and potentially life-threatening complication of acute myocardial infarction. Currently, only isolated reports of cases of myocardial dissection have been published, and until recently, the diagnosis of DIMH was carried out during autopsy or surgery. The article describes echocardiographic criteria and discusses some aspects of the therapy of this pathology. The description of clinical cases of noninvasive diagnosis of DIMH in men aged 60 and 62 years hospitalized with the clinic of decompensation of chronic heart failure is given. This complication in the presented patients was diagnosed using transthoracic echocardiography, thanks to which it was possible to identify the dissection of the myocardium, as well as to trace the dynamics of the organization of an intramyocardial hematoma into a parietal thrombus. Various approaches to patient management are demonstrated: conservative tactics allowed to successfully stabilize the course of chronic heart failure in the first patient, while the condition of the other required the transplantation of a donor heart a few months after discharge from the hospital.

Chronic Heart Failure and Pulmonary Hypertension: Difficulties in Assessment of Prognosis and Potential Solutions

Pulmonary hypertension and right heart dysfunction often complicate the course of chronic heart failure. At the same time, the addition of these pathological conditions significantly increases the frequency of hospitalizations and worsens survival prognosis. That is why the assessment of the unfavorable outcome’s risk in the group of such patients is extremely important. This problem draws an interest for a more detailed study, considering the fact that the most convenient, accessible and minimally invasive prognosis marker has still being searched for nowadays. In this review article, which is based on the analysis of literature over the past 20 years dedicated to the problem of pulmonary hypertension and chronic heart failure, right ventricular-arterial coupling, has been considered as a relatively new parameter and as an example of one of these prognostic markers. This parameter can be assessed by echocardiography examination and our article describes several options of calculating it, including one of the most popular and valuable ratio of tricuspidal anular plane systolic excursion to the systolic pulmonary artery pressure (TAPSE/sPAP).

Laboratory changes and prognostic indicators of the adverse course of chronic heart failure with preserved left ventricular ejection fraction, excess weight and concomitant atrial fibrillation

Aim. To investigate the peculiarities of clinical and laboratory changes and to identify prognostic indicators of the adverse course of chronic heart failure with preserved left ventricular ejection fraction (CHFprEF), excess weight and concomitant atrial fibrillation (AF). Materials and methods. The open, prospective, cohort study in parallel groups included 248 patients with CHFprEF, overweight and abdominal obesity, average age 65.0 ± 11.0 years; 146 (58.9 %) women and 102 (41.1 %) men. The first group included 181 patients with CHFprEF and excess weight without concomitant AF, and the second group – 67 CHFprEF patients with excess weight and AF. The complex clinical examination was performed according to the standards, including complaints, medical and family history, clinical, laboratory and instrumental examinations. Results. It has been established that patients with CHFprEF and overweight or abdominal obesity concomitant AF have a predisposition to anemia, which was manifested by significant lower indicators of hemoglobin and erythrocytes in parallel with lower values of lymphocytes, more pronounced signs of systemic inflammation, dysfunction of the kidneys and liver with manifestations of cholestasis, which indicated deeper functional and structural disorders of organs and systems. ROC-analysis of the patients with CHFprEF, excess weight and concomitant AF demonstrated increase in the clinical endpoints rate for patients with BMI ˃32 kg/m2, the waist circumference / hips circumference ratio ˃1.1 U, leucocytes level ˃6 × 109 l, serum creatinine ˃96 mcmol/l, urea ˃7.3 mmol/l, glomerular filtration rate ≤65 ml/min/1.73 m2, LDL / HDL cholesterol ratio ˃2.05 U. The 5-years death predictors were found in patients with CHFprEF, excess weight and concomitant AF: functional class of CHF ˃ІІ, HDL cholesterol ≤0.9 mmol/l, LDL cholesterol ≤0.66 mmol/l and triglycerides ≤1.45 mmol/l; additionally, there were defined the predictors of recurrent admission to hospital with the CHFprEF decompensation: leucocytes level ˃6 × 109 l, LDL cholesterol ˃2.49 mmol/l, the LDL / HDL cholesterol ratio ˃2.05 U and the atherogenic ratio ˃2.91 U. Conclusions. In patients with CHFprEF and excess weight, concomitant AF was associated with more severe laboratory changes, which reflected deeper functional and structural disorders of organs and systems. Laboratory predictors of the adverse course of CHFprEF in this category of patients have been established.