Course Of Chronic Heart Failure Research Articles

Highly effective lipid-lowering therapy on local vascular stiffness and symptoms of chronic heart failure in patients with postinfarction cardiosclerosis

Objective. To study the effect of achieving the target level of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL–C) on the parameters of local vascular stiffness and the development of chronic heart failure (CHF) in patients with ST-elevation myocardial infarction (STEMI).Design and methods. The study included 80 patients with myocardial infarction with ST segment elevation (STEMI) aged 35 to 65 years. On the 7–9th day of STEMI, at the 24th and 48th weeks of treatment with atorvastatin 40–80 mg clinical symptoms of heart failure were analyzed, the lipid profile and brain natriuretic peptide (BNP) were determined. Ultrasound of the common carotid arteries using high-frequency RF signal technology was performed. Depending on the effectiveness of treatment with atorvastatin, patients were retrospectively divided into 2 groups: 40 people who reached the target level of LDL–C (highly effective therapy, HET) and 37 patients who did not reach the target level of LDL–C (relatively effective therapy, RET).Results. In patients who reached the target LDL–С level, the initial BNP values were 115,2 pg/ml, with the regression by 34,5 % at follow-up (p = 0,03). There was no significant change in the RET group. In the HET group, a decrease in IMT, an improvement in distensibility parameters, a decrease in local PWV and stiffness index of common carotid arteries, were found. Based on the 6-minute walk test, only patients in HET group showed an increase in exercise tolerance after 24th week (p = 0,04). Also, individuals who did not reach the target LDL–С level, showed a decrease in the quality of life 27,4 % (p = 0,03). Patients in the HET group showed no negative dynamics.Conclusion. We showed that at the long-term follow-up after STEMI, the achievement of the target LDL cholesterol values was accompanied by a significant improvement in the parameters of local rigidity of the main arteries, and a decrease in BNP level, as well as by more favorable course of CHF.

The Prognostic Role of Biomarkers in Patients With Chronic Heart Failure

Objective Investigate the role of biomarkers in the prognosis of the clinical course of the disease in patients with chronic heart failure (CHF) of different NYHA functional classes (FC).Material and Methods The study included 132 patients with CHF: Group 1 was composed of 70 patients with NYHA FC II CHF, and Group 2 included 62 patients with FC III-IV CHF. The patients underwent clinical, instrumental, functional, and laboratory measurements, which included serum concentrations of NT-proBNP, ST-2, galectin-3, and C-reactive protein. Patients were examined at baseline and at 3, 6, and 12 mos of follow-up. The following cardiac complications were used as endpoints: urgent hospitalization due to decompensated CHF, heart transplantation, cardiovascular death. Endpoints were registered during the 12-mo follow-up period.Results Endpoints were recorded for 58 patients (44%) of the total sample of patients with CHF: 38 patients were urgently hospitalized, 10 patients underwent heart transplantation, 10 patients died. Cardiac complications were recorded at a higher rate in patients with FC III-IV CHF (63% vs. 27% of patients with FC II; p<0.001). In FC II CHF patients, the incidence of cardiac complications was significantly correlated with NT-proBNP blood concentrations (Rpb=0.53; p=0.023), left ventricular end-diastolic volume (LVEDV) (Rpb=0.50; p=0.044), and mitral regurgitation (Rpb=0.53; p=0.038). Cardiac complications in patients with FC III-IV CHF were associated with ST-2 (Rpb=0.52; p=0.004) and galectin-3 (Rpb=0.46; p=0.009) blood concentrations, and with systolic pulmonary artery pressure (PAP) (Rpb=0.41; p=0.014). Unlike other laboratory measurements, galectin-3 concentrations were significantly correlated with type 2 diabetes mellitus (DM2) (Rpb=0.40; p=0.003). In this study, correlation analysis and evidence of significant differences in the concentrations of biomarkers provided a rationale for identifying potential predictors of severe cardiac complications during medium- and long-term follow-up periods in patients with CHF of different severity: NT-proBNP concentrations in FC II patients; ST-2 and galectin-3 serum concentrations in FC III-IV patients; galectin-3 concentrations in patients with CHF and DM2.Conclusion NT-proBNP blood concentrations are associated with CHF severity and serious cardiac complications in patients with FC II CHF within the following 12 mos. The poor prognosis of FC III-IV CHF is associated with the concentration of the ST-2 biomarker. The blood concentration of galectin-3 is a significant predictor of poor prognosis in patients with CHF and DM2. Predictors of the adverse course of CHF of varying severity were differentiated. For FC II CHF, NT-proBNP > 1723 pg/ml or, if NT-proBNP < 1723 pg/mL, then EDV > 311 ml. For FC III-IV CHF, ST-2 > 67 ng/mL or, if ST-2 < 67 ng/mL, then PAP > 61 mm Hg. Galectin-3 has a prognostic value for the clinical course of the disease at different follow-up periods in patients with CHF and DM2: galectin-3 concentrations > 16 ng/mL and 13-16 ng/mL are risk factors for mid- and long-term cardiac complications, respectively.

Polymorbidity and its association with the unfavorable course of chronic heart failure in outpatients aged 60 years and older

This study was carried out to evaluate polymorbidity taking into account geriatric syndromes and their relationship with the course of chronic heart failure (CHF) in outpatients aged 60 years and older.Methods. We conducted an open, prospective, non-randomized study. The main group included 80 patients with CHF, the comparison group - 40 patients without CHF. Conducted clinical examination, ECG, echocardiography, two-photon X-ray absorptiometry. The scale of assessment of clinical status in CHF,Charlson comorbidity index were used. The criteria for frailty were the presence of at least 3 signs due FRAIL scale. Mean follow-up was 24.1±13.0 months.Results. All patients with CHF (100%) and 92.5% of the comparison group had a concomitant pathology. A combination of 3 or more of any diseases was more common in CHF compared to control group (p=0.008), CKD (66%) and obesity (35%) were the most common pathology. Combinations of osteoporosis and CKD (28%), obesity and CKD (23%) were the most frequent in the CHF patients, a combination of obesity and CKD (28%), obesity and diabetes (18%) - without CHF patients. The same incidence of osteoporosis (p=0.768), falls (p=0.980), fractures (p=0.549) and frailty (p=0.828) was observed in CHF patients and different EFLV, but prevalence of frailty was observed at the age of 75 years and older. During the observation period, 24% CHF patients and 5% patients without CHF (p=0.022) died. The worst survival of patients with ischemic genesis of CHF and osteoporosis was noted. The factors associated with an increased risk of death in CHF patients were the ischemic etiology of CHF (OR 8.33; 95% CI 1.11-62.4; p=0.039), male gender (OR 7.91; 95% CI 2.3-27.2; p=0.001), LV EF <45% (OR 2.52; 95% CI 1.01-6,27; p=0.047), low bone mineral density in femoral neck region (р=0.016, ОR 4.3, 95% CI 1.3-17.2), comorbidity score (OR 1.19; 95% CI 1.04-1.37; p=0.012), a total score on the scale of assessment of clinical status in CHF (OR 1.13; 95% CI 1.03-1.24; p=0.008).Conclusion. All СHF patients had concomitant diseases, CKD and obesity were the most common pathologies. The ischemic etiology of CHF, along with the male gender, LV EF less than 45%, severe clinical statusand high score on the Charlson comorbidity index turned out to be risk factors for death in outpatients aged 60 years and older with CHF.

Clinical course of chronic heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation

Introducrion. Recent randomized controlled trials suggest that catheter ablation of atrial fibrillation (AF) in heart failure (HF) patients leads to improvements in left ventricular function, exercise capacity, and quality of life, but focused on HF with reduced left ventricle ejection fraction (LVEF). Aim. To study the clinical course of chronic heart failure with preserved ejection fraction after radiofrequency catheter ablation for atrial fibrillation. Materials and methods. 194 patients with AF and chronic HF with preserved ejection fraction were included in the study: 136 patients – underwent catheter ablation (CA) for AF; 58 − control group, who continued pharmacological therapy (PT) for rhythm control strategy. All the patients had New York Heart Association (NYHA) class I, II or III HF, LVEF > 40 %. Baseline characteristics comprised demographic and clinical data, medical history echocardiography and ECG results of the included patients. Results. Patients on PT were significantly more symptomatic for HF in comparison to CA patients (the average value of NYHA class HF 2,2 ± 07 versus (vs.) 1,8 ± 0,6; p = 0,019), but AF for itself were more symptomatic in CA group (the average value of EHRA 3,1 ± 0,5 vs. 2,9 ± 0,6; p = 0,001). Among patients with HF with preserved LVEF who underwent CA and were followed-up 24 months 52,9 % of patients remained free of AF recurrence; while in the control group only 7 %. At the 24 months follow-up NYHA class significantly improved in ablation group, as well as EHRA score. Conclusions. Radiofrequency catheter ablation was associated with improved the clinical course of chronic heart failure with preserved left ventricle ejection fraction and AF – related symptoms itself.

Варианты течения хронической сердечной недостаточности у больных с сердечно-сосудистой патологией. Фокус на паци-ентов с сохраненной фракцией выброса левого желудочка

Aim: to assess the application of leading scientific communities’ recommendations for the patient management with chronic heart failure (CHF) in practical medicine.Patients and Methods: a retrospective analysis of 274 case records of patients (both sexes, over 18 years of age) with cardiovascular pathology, arterial hypertension and/or CHD, hospitalized in a Moscow hospital in 2019, was performed. 89 cases were selected for the study. The incidence and patterns of CHF course were analyzed; the scope of methods usage for diagnosing CHF and the treatment compliance of CHF with the principles reflected in the current recommendations for CHF was evaluated.Results: the study included 89 patients, 28 men and 61 women, with an average age of 59±16 and 70±10 years, respectively. CHF was diagnosed in 62 (70%) patients. At the same time, CHF in combination with a low left ventricular ejection fraction (LVEF) was observed in 7 (11%), with intermediate LVEF indicators — in 3 (5%), and with preserved LVEF — in 52 (84%). The main method for confirming CHF was two-dimensional echocardiography with Doppler ultrasound. Comorbidity was observed in 89% of patients with CHF. It was not possible to conduct the complete analysis of treatment compliance, prescribed in accordance with approved national clinical guidelines due to the small number of patients with CHF.Conclusion: at present, it is necessary to expand the scope of diagnostic measures reflected in current national guidelines, as well as to further study the disease and determine treatment tactics for patients with CHF to verify both systolic and diastolic CHF. KEYWORDS: chronic heart failure, arterial hypertension, coronary heart disease, ejection fraction, comorbidity, recommendations.FOR CITATION: Eremina Yu.N., Fedulayev Yu.N., Lomaichikov V.V. et al. Variants of chronic heart failure course in patients with cardiovascular pathology. Focus on patients with preserved left ventricular ejection fraction. Russian Medical Inquiry. 2020;4(7):406–411. DOI: 10.32364/2587-6821-2020-4-7-406-411.

The course of chronic heart failure in patients with early rheumatoid arthritis on the anti-rheumatic therapy

Objective: To evaluate the effect of the “treat to target” anti-rheumatic therapy on the course of chronic heart failure (CHF) in patients with early rheumatoid arthritis (RA). Materials and methods: The study included 22 patients (17, or 77% female) with CHF with valid diagnosis of RA (ACR/EULAR criteria, 2010), median (Me) age of 60 years, and median disease duration of 7 months. Ten patients (45%) were seropositive for IgM rheumatoid factor and 22 (100%) had antibodies to cyclic citrulline peptide. Their median (1st; 3rd quartiles) DAS28 was 5.6 [4.8; 6.5]. The diagnosis of CHF was confirmed in accordance with the guidelines on the diagnosis and treatment of CHF by the Russian Society of Specialists in Heart Failure (2013). NT-proBNP levels were measured by electrochemiluminescence (Elecsys proBNP II, Roche Diagnostics, Switzerland). All patients were started on subcutaneous methotrexate (MT) with rapid dose titration to 30 mg weekly. If the MT was insufficiently effective, a biological disease-modifying antirheumatic drug (bDMARD) was added to the therapy after 3 months, mainly a TNF-alpha inhibitor. After 18 months, 10 (45%) patients were in remission and had low disease activity, 6 (60%) patients underwent MT therapy in combination with bDMARDs. Results: At baseline, 21 (95%) patients were diagnosed with CHF with preserved ejection fraction and one patient had CHF with reduced ejection fraction. After 18 months there was an improvement of clinical symptoms, echocardiographic parameters (reduction of the left atrium diameter and the left atrium end-systolic volume index, IVRT, E'LV), and diastolic function of the left ventricle (LV). No episodes of acute CHF deterioration were registered. LV diastolic function normalized in 7 (32%) patients who reached the target level of blood pressure, remission (n=5) and low disease activity (n=2), mainly under the treatment with MT and bDMARDs. In patients with RA and CHF, the NT-proBNP levels decreased from 192.2 [151.4; 266.4] to 114.0 [90.4; 163.4] pg/ml (p<0.001) and became normal in 16 of 22 (73%) patients (p<0.001) with remission or low RA activity. In 5 (22%) patients, clinical CHF manifestations resolved, LV diastolic function and NT-proBNP levels were normalized. Conclusion: In the patients with early RA and CHF anti-rheumatic therapy improves the clinical course of CHF, LV diastolic function and reduces NT-proBNP levels.

Longitudinally Measured Fibrinolysis Factors are Strong Predictors of Clinical Outcome in Patients with Chronic Heart Failure: The Bio-SHiFT Study.

This article investigates whether longitudinally measured fibrinolysis factors are associated with cardiac events in patients with chronic heart failure (CHF). A median of 9 (interquartile range [IQR] 5-10) serial, tri-monthly blood samples per patient were prospectively collected in 263 CHF patients during a median follow-up of 2.2 (IQR 1.4-2.5) years. Seventy patients (cases) reached the composite endpoint of cardiac death, heart failure hospitalization, left ventricular assist device, or heart transplantation. From all longitudinal samples, we selected baseline samples in all patients and the last two samples before the event in cases or the last sample available in event-free patients. Herein, we measured plasminogen activator inhibitor 1 (PAI-1), tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), and soluble urokinase plasminogen activator surface receptor (suPAR). Associations between temporal biomarker patterns during follow-up and the cardiac event were investigated using a joint model. Cases were on average older and showed higher New York Heart Association class than those who remained event-free. They also had lower blood pressures, and were more likely to have diabetes, renal failure, and atrial fibrillation. Longitudinally measured PAI-1, uPA, and suPAR were independently associated with adverse cardiac events after correction for clinical characteristics (hazard ratio [95% confidence interval]) per standard deviation increase of 2.09 (1.28-3.45) for PAI-1, 1.91 (1.18-3.24) for uPA, and 3.96 (2.48-6.63) for suPAR. Serial measurements of tPA were not significantly associated with the event after correction for multiple testing. Longitudinally measured PAI-1, uPA, and suPAR are strongly associated with adverse cardiac events during the course of CHF. If future research confirms our results, these fibrinolytic factors may carry potential for improved, and personalized, heart failure surveillance and treatment monitoring.

Community-acquired pneumonia in patients with chronic heart failure: clinical manifestation and a diagnostic role of biomarkers

The aims of this study were to evaluate clinical course of community-acquired pneumonia (CAP) in patients with chronic heart failure (CHF) and to assess the time course of serum biomarkers, such as C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), and brain natriuretic peptide (BNP), at baseline and after treatment in patients with CAP and CHF. Methods. This was a prospective observational study. Adult patients with CHF admitted to a hospital due to suspected CAP were recruited in the study. The diagnosis of CAP was confirmed by chest computed tomography (CT). Subsequently, patients were assigned to the group 1 (with confirmed CAP) or the group 2 (with respiratory infections other than CAP). Echocardiography was performed in all patients at baseline and in follow-up visits. In addition to the routine clinical examination and laboratory tests, serum biomarkers were measured in all patients at admission (Visit 1), at days 10 to 14 (Visit 2), and at days 28 to 42 (Visit 3). Standard statistical methods were used for data analysis. Results. Seventy patients who met the inclusion criteria were enrolled in this study; of them, 35 patients had confirmed CAP and 35 patients had respiratory infections other than CAP. Both groups were similar for demographic and clinical characteristics, as well as for laboratory, echocardiographic and radiological findings. CAP did not affect the clinical course of CHF and echocardiographic parameters did not differ significantly between the groups. Clinical signs of both diseases improved after the treatment in majority of patients. Echocardiographic parameters also improved in both groups that indicates the improvement in cardiac dysfunction under the treatment. During the follow-up, the most prominent changes were seen in CRP level which was significantly higher at baseline in CAP patients compared to patients with other respiratory infections. CRP level decreased at Visit 2 in both groups and in Visit 3 in CAP group. CRP levels differed significantly between the groups both at Visits 1 and 2. Other biomarkers, such as PCT, IL-6, and BNP, were significantly higher at Visit 1 compares to Visit 2. TNF-α level did not change significantly neither in any group during the study nor between the groups at any study time. Conclusion. CAP did not affect the clinical course of CHF. Inflammatory biomarkers, such as CRP, PCT, and IL-6, could be used additionally to the routine diagnostic procedures to differentiate between CAP and other respiratory infections in patients with CHF. CRP is the most promising biomarker. Serum levels of the biomarkers decreased significantly under the standard hospital treatment of CAP and CHF; this could be considered to evaluate treatment success and prognosis.

P1619Polymorphic variants rs6684209 and rs7521023 of the calsequestrin 2 gene as risk factors for adverse course of heart failure

Abstract Calsequestrin 2 protein binds most of Ca2+ ions inside the sarcoplasmic reticulum and is involved in the regulation of Ca2+ release through the ryanodine receptors of the cardiomyocytes. Due to mutations in the CASQ2 gene, there is an enhanced release of ions from the sarcoplasmic reticulum, which leads to disruption of Ca2+ homeostasis. In turn, this is a risk factor for the development and progression of chronic heart failure (CHF) and heart rhythm disturbances. Purpose Investigate the association between polymorphic variants rs6684209, rs7521023 of the CASQ2 gene and heart failure in patients with coronary artery disease (CAD). Methods The sample included 174 patients with CAD complicated by CHF. Of these, 115 (66.1%) are men and 59 (33.9%) are women aged 64 (59; 70) years. The functional class (FC) of CHF was defined according to the classification of the New York Heart Association (NYHA). The distribution of CHF FC I, FC II, FC III was 25 (14.4%), 97 (55.7%), 52 (29.9%). The left ventricular ejection fraction in the patient sample was 62% (52; 66). The polymorphic variants rs6684209 (115707991C>T in the intron) and rs7521023 (115700759G>A in 3-UTR) of the CASQ2 gene were determined by real-time polymerase chain reaction. For the analysis of the qualitative data, Pearson's χ2 test or the Fisher two-sided exact test was used. Results In the total sample of patients, there was no assotiation between the rs6684209 variant of the CASQ2 gene and the clinical picture of CHF. However, among men, but not women, differences in the frequency of FC I, II, III CHF (p=0.029) between CC, CT and TT genotypes were found. In addition, among carriers of the CT genotype, diastolic myocardial dysfunction occurred in 80% of patients, while among CC homozygotes, its frequency was 63.1% and was not observed in TT homozygotes (p=0.034). At the same time, there were more patients with heart rhythm disorders among CC homozygotes than among carriers of the T allele (60.8% vs. 45.2% for CT and 0% for TT, p=0.046). The association of the polymorphic variant rs7521023 with the course of CHF was assessed. A significant (p=0.044) increase in the frequency of left atrial enlargement in GG homozygotes (69.2%) compared with carriers of the AA (45.1%) and AG (41.9%) genotypes was found in the total sample of patients. Gender features were absent in the association of variant rs7521023 with risk factors for the development and progression of CHF. Conclusion The polymorphic variants rs6684209 and rs7521023 of the CASQ2 gene are associated with the severity of CHF and the risk of developing heart rhythm disturbances. With the CT genotype of the rs6684209 variant, diastolic myocardial dysfunction was more common, but the T allele appeared to be protective against the development of heart rhythm disturbances. Carrier genotype GG (rs7521023) is a risk factor for dilatation of the left atrium, which in turn can serve as a substrate for the development of arrhythmias. Acknowledgement/Funding This work was supported in part by the Russian Foundation for Basic Research, No. 17-04-01450 A.

Safety and effectiveness of physical training in inotrop-dependent patients with compensation for chronic heart failure at the level of the III-IV functional class

Aim. To assess the safety and effectiveness of physical training in inotrop-dependent patients with stabilization of the course of chronic heart failure (CHF) at the level of the III-IV functional class (FC). Materials and methods. The prospective randomized study included men of 18-65 years old who were committed to Almazov National medical research center "due to decompensated CHF III-IV FC, left ventricular ejection fraction of 30% or less due to coronary heart disease or dilated cardiomyopathy receiving dopamine or dobutamine for 2 weeks or more, stabilizing heart failure at level III-IV FC and arterial pressure 90/60 mm Hg and above against the background of ongoing inotropic therapy. Patients were randomized into 2 groups: 1st - those participating in the physical rehabilitation program (PRP), 2nd - receiving standard CHF therapy. Results. There was no increase in the number of fatal cases and the number of patients with episodes of decompensation of CHF in the 1st group compared with the 2nd group. The number of episodes of CHF decompensation before FC IV was higher in the 2nd group compared to the 1st: 13 (50%) in the 1st group and 20 (80%) in the 2nd (p=0.04). Episodes of CHF decompensation, requiring transfer to the anesthesiology and resuscitation departments, were 2 times less frequent in patients of the 1st group compared to the 2nd: 8 (31%) and 16 (64%), respectively (p=0.03). In patients with the 1st group, malignant ventricular arrhythmias were not registered during physical training and for 3 hours after their completion. There was a tendency (without achieving a statistically significant difference) to a decrease in pulmonary thromboembolism episodes in patients of the 1st group compared with the 2nd (p=0.05). In the 1st group, after 6 months, there was a decrease in the number of lower respiratory tract infections - bronchitis + pneumonia compared with the 2nd group (p=0.0006). Conclusion. Participation of inotropic-dependent patients in individually designed RPF does not increase their mortality and does not increase their number of life-threatening cardiac rhythm disturbances. In the group of inotropic-dependent patients participating in RPF, there was a significant decrease in the number of lower respiratory tract infections and a tendency to a decrease in the number of pulmonary embolism compared with patients not participating in RPF.

Clinical use of the new biomarker ST2 in patients with chronic heart failure of ischemic genesis: an exercise test

Aim . To study the role of soluble stimulating growth factor expressed by gene 2 (sST2), at rest and after exercise at the end of six-minute walk distance (6MWD) in predicting the development of adverse cardiovascular events (CVA) in patients with coronary artery disease with chronic heart failure (CHF) for 12 months of prospective observation. Material and methods . We included 35 patients with CHF of ischemic genesis (32 men) with 44 left ventricular ejection fraction [35; 52]% (average age 62 [57; 67] years). The concentration of sST2 in serum was determined by enzyme immunoassay prior to and immediately after completion of 6MWD. Results . After 12 months of prospective observation, patients were divided into 2 groups depending on the CHF genesis. Group 1 (n=15) included patients with an unfavorable CHF course, group 2 (n=20) included patients without adverse CVA. In patients of group 1, the level of sST2 reached 39,68 [32,28; 52,32] ng/ml, which is 26,2% higher than (p=0,007) the similar parameter in patients of group 2 — 29,29 [26,34; 33,78] ng/ml. According to the ROC-analysis, the level of sST2 >33,14 ng/ml can be considered as a marker of the development of adverse CVA for 12 months of observations (sensitivity — 73,3%, specificity — 75,0%, area under the ROC curve — 0,77, p=0,002). After 6MWD patients with unfavorable CHF had a tendency (p=0,211) for an increase in sST2 level by 9,3% from 39,68 [32,28; 33,78] ng/ml to 43,75 [36,85; 54,80] ng/ml. In patients with a favorable course of CHF, the level of sST2 did not change, reaching 29,29 [26,34; 33,78] ng/ml and 29,43 [23,79; 34,79] ng/ml after 6MWD. According to the ROC-analysis, it was found that in patients with coronary artery disease and CHF, determining of sST2 concentration in the blood after 6MWD allowed to achieve higher levels of specificity and sensitivity of stratification risk method of adverse CVA — 86,7% and 85,0%, respectively (the area under the ROC curve is 0,86, p<0,0001). Conclusion . Thus, the level of sST2 can be considered as a noninvasive marker for predicting of unfavorable cardiovascular diseases in patients with CHF and intermediate/reduced left ventricular ejection fraction. Concentrations of sST2, determined after exercise, have a higher prognostic value for the stratification of the risk of an adverse course of CHF in this cohort of patients.

Stability of chronic heart failure from the position of a doctor and a patient: in search of contact points

To assess how ofen the subjective assessment of a doctor regarding the stability of a patient with CHF coincides with the subjective opinion of the patient with CHF regarding the stability of his condition; and to identify those parametrs that have a leading influence on the assessment of the stability of the state from the point of view of the physician and the patient. Data collection was carried out in the form of interviews among general practitioners and cardiologists in outpatient clinics (OC) of Nizhny Novgorod, which were randomly selected by the method of blind envelopes. In parallel, a survey was conducted of patients with CHF who applied for outpatient medical care about this syndrome to this OC, which the doctors were not informed about, because patient interviews were conducted after the end of outpatient admission in a separate room. Answers of doctors about a patient with CHF were compared with the answers of the corresponding patient; for this, a single code was assigned to both questionnaires. The study included 211 patients with CHF of any etiology older than 18 years. The study involved 25 doctors. The study was conducted from 11/01/17 to 11/30/17. Analysis of the data suggests that the doctor is more likely to consider the patient more stable in cases when the patient notes a decrease in the severity of shortness of breath, weakness and does not detect edema, while the fact of therapy with loop diuretics (LD) or an increase in them did not affect assessment of stability from the point of view of the doctor. From the point of view of the patient, the absence of the first three signs also testifies to the stability of the condition, however, unlike doctors, patients more often (p &lt;0.001) considered themselves unstable in those cases when they needed LD therapy or an increase in LD dose. A logit regression analysis and ROC analysis based on selected signs and symptoms of CHF confirmed that a model that combines questions about persistent weakness and edema is best suited to predict the patient's subjective assessment of patient's stability from a doctor's point of view (61.8% of the results can be correctly predicted), and at the cutoff threshold of 0.5, it has the highest sensitivity of 64.9%. To predict the subjective assessment of stability in relation to the patient, the optimal model turned out to be the one that includes answers to the questions of "shortness of breath", "weakness" and "intake of loop diuretics", which allows to predict 66.7% of the results correctly at the cut‑off threshold 0, 5 has a better balance of sensitivity and specificity (54.9 and 78.6, respectively). Reducing the severity of dyspnea, weakness and lack of edema of the lower extremities are important signs of the stability of the condition, both in the opinion of the doctor and in the opinion of the patient. Unlike the doctor, the patient is more likely to be classified as unstable in those cases when he is forced to receive therapy with loop diuretics at the outpatient stage or to increase their dose. The model for assessing the stability of a patient with CHF from the point of view of a physician more often allows one to confirm the patient's stable condition, while the model used by patients more often allows to identify patient instability and worsening of the course of CHF.

Inflammation associated with chronic heart failure leads to enhanced susceptibility to depression.

Epidemiological and clinicopathological studies indicate that there is a high risk for chronic heart failure (CHF) in patients suffering from neuropsychiatric disorders, such as depression. However, it is unclear whether CHF causes depression, and the underlying mechanisms of this association remain largely unknown. In this study, mice with myocardial infarction and CHF were used to investigate behavioral alterations as well as changes in the brain-heart axis. During the first 6months, abnormalities in neuropsychiatric behaviors were detected in mice with CHF. Using the sucrose preference test, a 9months course of CHF resulted in two subgroups: mice with a significant decrease in sucrose preference, defined herein as "susceptible" (Sus), and mice with a normal sucrose preference, defined herein as "resilient." Compared to the resilient and sham-operated animals, the Sus mice displayed imbalances in glutamate transmission and hypothalamic-pituitary-adrenal axis activation, abnormal synaptic plasticity, and increased inflammatory responses. Furthermore, abnormal kynurenine metabolism was detected in Sus mice. Our results suggest that long-term CHF increases inflammatory responses in the central nervous system and leads to depression in Sus mice.

Cough: the evolution of views and modern approaches to an objective assessment.

The article is a review of literature, that provides information on ways to assess cough, how those ways have improved over recent years, the latest data in the field of an objective assessment of cough and the possibility of its use in scientific and clinical practice. Search for articles was carried out in such databases as Pubmed, CyberLeninka, RSCI in English and Russian.

Features of chronic heart failure depending on the left ventricular ejection fraction

Aim.To assess clinical and demographic data, structural and functional features of the myocardium in patients with chronic heart failure (CHF) with a preserved ejection fraction in comparison with patients with CHF with an intermediate (CHF-inEF) and a reduced ejection fraction (CHF-rEF).Material and methods. The study included 186 patients with CHF I-IIB stages, I-III functional classes. One hundred and three patients had a preserved ejection fraction (EF) (≥50%), 43 — intermediate (40-49%) and 40 — reduced (&lt;40%). All patients underwent a comprehensive clinical examination, as well as standard echocardiography.Results.Among patients with CHF-rEF, remodeling of the left ventricular myocardium by the type of concentric hypertrophy was more often observed (69,9%), and among CHF-inEF and CHF-nEF patients — by the type of eccentric hypertrophy (88,4 and 875%, respectively). Restrictive diastolic dysfunction was observed in 2,0% of patients with CHF-rEF and in 21,7% of patients with EF less than 50%.Conclusion.The severity of the clinical course of CHF does not depend on the left ventricular EF. Epidemiology and etiology of CHF-rEF has fundamental differences from CHF-inEF and CHF-nEF: CHF-rEF is more common among women over 60 years old with arterial hypertension and obesity. For patients with CHF-inFV, myocardial remodeling by the type of concentric hypertrophy and the prevalence of non-restrictive types of diastolic dysfunction are characteristic.

Current Trends and Possibilities of Providing Medical Palliative Care in Chronic Heart Failure

Chronic heart failure (CHF) is an important healthcare problem because of high prevalence, morbidity and mortality rates. Treatment resistant symptoms, need for communication and support, unite patients with CHF and oncological diseases but despite that CHF patients rarely receive specialized palliative care (SPC). This review is devoted to the need and possible ways of providing SPC to patients with CHF and their families. We discuss here variants of CHF course in terminal phase, the term end of life appropriate care, various specialists' concepts of SPC delivering to CHF patients in accordance with their preferences.

Клинические варианты течения хронической сердечной недостаточности в сочетании с хронической обструктивной болезнью легких

Клинические варианты течения хронической сердечной недостаточности в сочетании с хронической обструктивной болезнью легких

Prediction role of a novel biomarker ST2 in risk assessment of adverse cardiovascular events in chronic heart failure with preserved and intermediate ejection fraction after myocardial revascularization

Aim. To evaluate prediction role of the biomarkers soluble ST2 (sST2) and natriuretic hormone N-terminal propeptide (NT-proBNP) in risk assessment of adverse cardiovascular events (ACVE) in coronary heart disease patients (CHD) with chronic heart failure (CHF) after myocardial revascularization.Material and methods. Totally, 87 patients included (72 males) with CHD and CHF I-III functional class by NYHA with ejection fraction of the left ventricle (LVEF) 63 [55; 65]%, mean age 63 [57; 69] y.o. Levels of sST2 and NT-proBNP in plasma were measured by immune enzyme assay before myocardial revascularization.Results. In 12 months of prospective follow-up, patients were selected to 2 groups according to clinical course of CHF. To the group I the patients included (n=35) with ACVE, group II (b=52) — with none. It was found that in the group I the level of sST2 was higher by 41,5% (p&lt;0,001) and reached 46,78 [37,88; 64,96] ng/mL, and in the group II — 27,39 [23,02; 35,4] ng/mL. Concentration of NT-proBNP in the group with ACVE was 2,5 times (p=0,004) higher comparing with group II and reached 189,21 [74,46; 580,79] and 73,58 [26,64; 155,77] pg/mL, respectively. In ROC-analysis it was found that the level of sST2 ≥34,18 ng/mL (sensitivity — 90,6%, specificity — 75,0%, AUC — 0,88, р&lt;0,0001) and level of NT-proBNP ≥276,96 pg/mL (sensitivity — 88,4%, specificity — 43,7%, AUC — 0,64, р&lt;0,004) can be regarded as markers of ACVE during 12 months in CHD and CHF patients after revascularization. Also, together these two markers increase predictive significance of the analysis (sensitivity — 92,6%, specificity — 77,1%, AUC — 0,90, р&lt;0,0001).Conclusion. Therefore, the preprocedural level of sST2 can be regarded as non-invasive marker for prediction of ACVE. Combination of sST2 and NT-proBNP shows higher diagnostic sensitvity and specificity for prediction of adverse CHF course.

Hypothyroidism and heart failure.

The article is a review of the literature, which presents the results of experimental and clinical studies, meta-analysis data on the effects of hypothyroidism on the clinical course of heart failure, the association between hypothyroidism and clinical outcomes in patients with heart failure. Thyroid gland dysfunction is a risk factor for development of cardiovascular diseases. From all types of thyroid gland dysfunction hypothyroidism is the most common. Increasing of thyroid-stimulating hormone level (which happens in patients with hypothyroidism) can influence the clinical course of chronic heart failure because of its extrathyroid effects - namely - influence on lipide metabolism, endothelial function of vessels and blood pressure. Apart from adverse effects of hormonal deficiency of thyroid gland on the start and progression of a chronic heart failure, the heart failure itself can make negative impact on a thyroid gland functioning, therefore pathophysiological "vicious circle" is formed. Manifest hypothyroidism is associated with an increased risk of general and cardiovascular mortality and frequency of hospitalizations of patients with a heart failure. Association between subclinical hypothyroidism (SCH) and heart failure is less studied. Figuring out the mechanisms of influence of thyroid gland hypofunction on systolic and diastolic function of myocardium may be important for effective treatment of heart failure and improvement of clinical outcomes.

Effects of milrinone on serum IL-6, TNF-α, Cys-C and cardiac functions of patients with chronic heart failure.

Effects of milrinone on serum interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), cystatin C (Cys-C) and cardiac functions of patients with chronic heart failure were analyzed to investigate the value of milrinone in chronic heart failure. A total of 70 patients diagnosed with chronic heart failure were selected and randomly divided into treatment group (n=35) and control group (n=35). All patients were treated with conventional anti-heart failure therapy, and patients in the treatment group received milrinone on the basis of conventional therapy. The general data of patients, such as age, sex and course of chronic heart failure, were collected; the levels of serum IL-6, TNF-α and Cys-C before and after treatment were compared between the groups, and the cardiac function indexes were also compared, including cardiac output (CO), stroke volume (SV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd), left ventricular end-systolic diameter (LVSd) and brain natriuretic peptide (BNP) level. Besides, the curative effects and adverse reactions in the two groups were recorded. The results revealed that serum IL-6, TNF-α and Cys-C levels had no significant difference between the two groups before treatment; however, the curative effect in the treatment group was significantly superior to that in control group (p<0.05); after treatment, CO, SV and LVEF in both groups were obviously increased, but LVDd, LVSd and BNP levels were obviously decreased; the curative effect in the treatment group was significantly superior to that in control group (p<0.05); heart rate in both groups was obviously decreased after treatment (p<0.05); the total effective rate in the treatment group was significantly higher than that in control group after treatment (p<0.05). In conclusion, based on the conventional anti-heart failure therapy, the application of milrinone can reduce the serum IL-6, TNF-α and Cys-C levels and improve the cardiac functions of patients effectively.