Chronic Heart Failure Functional Class Research Articles

Are there any benefits from prescribing a cardiac cytoprotector to enhance the quality of life in patients with coronary heart disease and chronic heart failure?

Introduction. Type 2 diabetes (T2D) increases the risk of developing cardiovascular diseases, which leads to a high mortality in this category of patients. Issues regarding the prevention of the onset and progression of coronary heart disease (CHD) and chronic heart failure (CHF) in patients with T2D and/or metabolic syndrome (MS) are still not fully understood. The use of metabolic drugs with cardioprotective effects, in particular Mildronate®, is one of the possibilities to improve the effectiveness of combination treatment of CHD and CHF.Aim. To study the effect of Mildronate® on the quality of life (QoL) of patients with CHD and CHF, suffering from T2D and/or MS.Materials and methods. A total of 2.084 patients with co-occurring two (or more) disorders: obesity, type 2 diabetes, angina pectoris, CHT, and CHF were included in the INDICOR observational study conducted in real-life clinical practice settings. Group 1 received therapy with disease-modifying agents prescribed due to CHD and T2D; Group 2 received Mildronate® at a dose of 1000 mg per day in addition to the same therapy. The studied lab test results were assessed at baseline and 42 days of therapy.Results. A 42-day course of therapy in patients receiving Mildronate® at a dose of 1000 mg per day in addition to disease-modifying therapy (DMT) contributed to a percentage increase in the number of patients with CHD, FC (functional class) I angina pectoris (Δ,% + 63%, p < 0.001 ) as compared to the control group with no significant changes (Δ,% + 7%, p > 0.5). A significant increase in the number of patients with FC I CHF was recorded in Group 2 (from 23.5 to 42.1%, Δ,% + 79%) as compared to Group 1, where no significant changes were detected (22.7 to 23.7%, Δ,% + 4%). The QoL in patients with CHF based on data collected using the Minnesota Questionnaire and QoL in patients with CHD based on data collected using the Seattle Questionnaire significantly improved in the groups that received Mildronate® in addition to DMT, as compared with the group of patients who were only on DMT.Conclusion. Results from the Seattle and Minnesota questionnaires showed that the use of Mildronate® as part of combination therapy in patients with CHD and CHF, suffering from T2D and/or MS, contributed to a significant reduction in the frequency of angina attacks and lowering angina FC, CHF FC, and also enhanced the quality of life in this category of patients.

Analysis of the significance of echocardiographic signs of right ventricular dysfunction for predicting the outcome of heart failure with reduced left ventricular ejection fraction

Objective: to determine the ultrasound signs of right heart dysfunction, which increase the prognostic value of the recommended parameters of left ventricular (LV) dysfunction in patients with heart failure with reduced ejection fraction (HFrEF).Materials and methods. The prospective study included 79 patients with HFrEF LV with clinical manifestations of chronic heart failure functional class III according to the New York Heart Association (HF NYHA Class III) in 52 patients (65.8%) and HF NYHA Class IV in 27 (34.1%). The primary end point was death during a follow-up period of up to 3 years while waiting for heart transplantation.Results. Overall mortality was 33 patients (41.7%), 17 (21.5%) during the 1st year of follow-up. Regression analysis revealed the following independent ultrasound predictors of poor prognosis: LV ejection fraction on 3D-echocardiography (3DE LVEF), p = 0.014; global longitudinal strain of the LV (GLS LV), p = 0.010, and of the interventricular septum basal segment (IVSLS BS), p = 0.012; mean longitudinal strain of the basal segment of the right ventricle free wall (FWLS BS RV), p = 0.003. Changes in the configuration and dilatation of the LV cavity, an increase in LV end-diastolic pressure, impaired contractility, and strain of the LV myocardium can affect the function of the right ventricle (RV) through the common interventricular septum (IVS). Dilatation of the RV due to an increase in the end diastolic area (RV EDA) of more than 30 cm2 (p = 0.012) and end systolic area (RV ESA) of more than 25 cm2 (p = 0.001), an increase in the volume of the right atrium (3DE AKI) of more than 100 ml (p = 0.036), and a decrease in the % inspiratory collapse of the inferior vena cava (% IVC) less than 30% (p = 0.005) demonstrated a prognostic significance in the observed patients. A decrease in the deformation properties of the pancreas due to the longitudinal component and impaired strain of the basal segment makes a greater contribution to RV dysfunction (FWLS BS, % < -15% (p < 0.001)).Conclusions. RV dysfunction in patients with HFrEF is an unfavorable prognostic factor, independently associated with existing LV dysfunction. The most significant ultrasound sign for surveillance prediction of patients with LV HFrEF and RV dysfunction are indicators of ventricular myocardial deformation. Remodeling of the right chambers and dysfunction of the RV is a trigger for the separation of the RV and pulmonary artery, which ultimately leads to adverse outcomes.

Whether to implant a defibrillator or not? The Possibility of Using the MADIT-ICD Benefit Score Calculator in Real Practice

To study the predictive capabilities of the MADIT-ICD Benefit Score calculator in assessing the benefit of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death (SCD). This study included 388 patients with NYHA II-IV functional class chronic heart failure (CHF) with a left ventricular ejection fraction (LVEF) ≤35 % who underwent ICD placement for the primary prevention of SCD. Patients were followed up for two years to record the endpoints of first-time paroxysmal sustained ventricular tachyarrhythmia (VT) or non-arrhythmic death. According to the results of calculation with the MADIT-ICD Benefit Score calculator, 276 (71 %) patients had a high risk of VT (score ≥7) and 150 (39 %) had a high risk of non-arrhythmic death (score ≥3). 336 (94%) patients would benefit from an ICD: 148 (38 %) with a high level of probability and 218 (56 %) with a medium level of probability. According to the incidence of endpoints, VT episodes predominated in the low-ICD benefit group (36%), while the high-ICD benefit group had a relatively high incidence of non-arrhythmic death (12%). The results obtained for a cohort of Russian patients with CHF and reduced LVEF indicated that the use of the MADIT-ICD Benefit Score in routine clinical practice does not improve the stratification of SCD risk compared to the traditional approach to selecting patients with CHF for ICD based on the LVEF value.

FEATURES OF THE MORPHO-FUNCTIONAL MYOCARDIUM STATE AND RELATIONSHIP WITH GALECTIN-3 IN PATIENTS WITH CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN ON THE BACKGROUND OF METABOLIC PATHOLOGY

The aim. To evaluate the presence and nature of changes in the morpho-functional state of the myocardium in patients with coronary heart disease (CHD) with concomitant type 2 diabetes mellitus (T2DM) and obesity, depending on the functional class (FC) of chronic heart failure (CHF) and the relationship with the concentration of galectin-3 in blood serum.
 Materials and methods. The study involved 75 patients with CHD with concomitant metabolic diseases such as T2DM and obesity, who were treated in the cardiology department of the State Clinical Hospital No. 27. Patients were divided into groups according to the FC of CHF. Group 1 included 30 patients with CHF FC II, group 2 – 24 patients with CHF FC III, group 3 – 21 patients with CHF FC IV.
 Results. In patients with СHD and metabolic disorders with CHF FC III, the levels of end-systolic dimension (ESD) and end-diastolic dimension (EDD) were higher by 16.3 % and 17.9 %, respectively, compared with FC II, end-systolic volume (ESV) and end-diastolic volume (EDV) also increased significantly in patients of this cohort with FC III compared with CHF FC II by 35.8 % and 16.5 %, respectively. Significantly increased ESV, EDV by 42.9 % and 37.8 %, respectively, as well as the size of the left atrium by 14.3 % in patients of the study group who had CHF FC IV compared with FC III. The ejection fraction (EF) index decreased in patients of this cohort with CHF FC IV by 14.4 % compared with FC III. The size of the right ventricle was larger by 10.8 % in CHF FC IV than in FC III in patients with CHD on the background of comorbid metabolic pathology. Indicators of the thickness of the LV posterior wall, LV relative wall thickness and intraventricular septum were lower in patients with FC IV compared with FC II, left ventricle mass (LVM) and left ventricle mass index (LVMI) increased by 32 % and 33 %, respectively. Сomparing the levels of Ea/Es in patients with CHF FC II and IV in СHD with concomitant T2DM and obesity, a significant increase in this indicator was found in FC IV (p<0.05). The level of galectin-3 in patients with CHF FC III and IV of ischemic origin against the background of concomitant metabolic disorders was higher than in patients with FC II. Сomparing the concentration of galectin-3 in patients with CHF FC III and IV in patients with CHD with comorbid metabolic pathology, significantly higher levels were found in FC IV (p<0.05). The study of the relationship between the fibrosis factor galectin-3 and cardiohemodynamic parameters revealed probable links, namely direct links between galectinemia and ESV (r=0.52; p<0.05), EDV (r=0.58; p<0.05), Еа/Es (r=0.51; p<0.05).
 Conclusions. The growth of the functional class of chronic heart failure is accompanied by dilatation of the left cavities of the heart, a decrease in the inotropic function of the left ventricle, an increase in myocardial-arterial stiffness, and an increase in the levels of the galectin-3 fibrosis factor in the studied patients.

Clinical and echocardiographic findings in patients with COVID-19 across different severity levels.

Cardiovascular pathology can complicate the course of COVID-19. The study aimed to identify echocardiographic abnormalities and key prognostic factors influencing severe and fatal COVID-19 outcomes. This retrospective cohort study included clinical and echocardiogram data from 194 medical records of hospitalized patients with COVID-19: 100 moderate cases, 34 severe cases with favorable outcomes, and 60 severe cases with fatal outcomes. Severe patients with favorable outcomes had greater reductions in left ventricular systolic fraction of left ventricle compared to moderate cases (23.5% vs. 7.0%, respectively, p=0.008) and ejection fraction of left ventricle (14.7% vs. 3.0%, respectively, p=0.013), grade I diastolic dysfunction of the left ventricle (20.6% vs. 8.0%, respectively, p=0.044), and pulmonary hypertension (29.41% vs. 10.0%, respectively, p=0.006). Patients with fatal outcomes had a mean age of 67.1±1.51 years, chronic heart failure functional class II (58.3%), hypertension (50.0%), type 2 diabetes (43.3%), and obesity (33.3%). Compared to severe cases but with favorable outcomes, fatal cases had a greater decrease in left ventricular ejection fraction (36.7% vs. 14.7%, respectively, p=0.024), various types of myocardial dysfunction (51.7% vs. 29.4%, respectively, p=0.037) and a trend towards increased pulmonary hypertension (48.3% vs. 29.4%, respectively, p=0.074). Consequently, chronic heart failure class II, reduced left ventricular ejection fraction, various myocardial dysfunctions, and pulmonary hypertension emerged as key cardiac risk factors for severe disease progression and mortality in patients with COVID-19.

The Role of Metabolic Syndrome in The Nature of Postinfarction Remodeling of The Heart in Patients with Chronic Heart Failure

The aim is to study of heart’s structure and hemodynamic indicators according to composition of metabolic syndrome components in the patient with chronic heart failure (CHF)functional class (FC) IIIII. 62 men-patient with cardiosclerosis after heart attack were examined by the way of echocardiography on CHF FC II-III (NYHA). According to metabolic syndrome components they are devided into 3 groups: 1 st group (n=20), patients without signs of metabolic syndrome; 2nd group (n=21) patients with combination of dyslipidemia (DLP), abdominal obesity (AO), arterial hypertenion (AG) and hypertriglyceridemia; 3rd group (n=21) with different combination of dyslipoproteinemia, diabetes and obesity also AG and hypertriglyceridemia. in CHF passed with metabolic syndrome is seen a clear sign of heart’s systolic and diastolic.the presence of metabolic syndrome in CHF also its progressing is the subject to be hypertrophy of left ventricle, breaking the transmitral blood flow, also thickening of barier between ventricles and left ventricle back thickness

Modern possibilities of correction of broncho-obstructive syndrome in chronic heart failure of ischemic origin in combination with chronic obstructive pulmonary disease: simple randomized parallel group study

AIM: To evaluate the efficacy and safety of complex basic therapy for chronic heart failure (CHF) of ischemic origin in combination with chronic obstructive pulmonary disease (COPD) with the inclusion of prolonged bronchodilators.
 MATERIALS AND METHODS: The study included 67 patients (50 men and 17 women) with CHF IIIII functional class (FC) with left ventricular ejection fraction (LVEF) of 45% in combination with moderate-to-severe COPD (GOLD). The patients were divided into three groups: group 1 (n=30) received formoterol as part of therapy, group 2 (n=19) received aclidinium, and group 3 (n=18) received a fixed combination of aclidinum and formoterol. The basic therapy for CHF included nebivolol, losartan, eplerenone, diuretics, low-dose glucocorticosteroids, nitrates, and cardiac glycosides (if necessary). The clinical condition of patients, intracardiac hemodynamics, was indicated using echocardiography, a 6-min walking test (6MWT), bifunctional 24-h monitoring of blood pressure and heart rate, and spirometry. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, St. Georges Respiratory Questionnaire, and Modified Medical Research Council dyspnea scale.
 RESULTS: After 6 months of therapy, the clinical and instrumental parameters and quality of life improved in all groups. At the end of the observation period, the average FC of CHF and dyspnea severity decreased by 17.5, 18.2, 20.1 20.5, 24.2, and 28.1%, respectively. The increase in exercise tolerance was 22.1, 22.6, and 29.2%. An improvement in intracardiac hemodynamics was noted. The LVEF increased by 17.1, 20.5, and 24.6%, and the myocardial mass index decreased by 8.7, 14.2, and 17.4%. The total peripheral vascular resistance, degree of pulmonary hypertension, and duration and frequency of painless myocardial ischemia significantly decreased. The best results were obtained in group 3 using nebivolol, reninangiotensinaldosterone system antagonists, and a combination of long-acting bronchodilators. Therapy was well tolerated by all study groups, with no serious adverse side effects.
 CONCLUSION: The inclusion of nebivolol and losartan in basic therapy, while taking long-acting bronchodilators, improves the clinical and functional states of patients and quality of life, and slows down disease progression. When used in a fixed combination, the use of aclidinium and formoterol improves spirometry to a greater extent.

Цитомегаловирусная инфекция как фактор риска неблагоприятных сердечно-сосудистых событий у больных с хронической сердечной недостаточностью

The purpose — to study the effect of cytomegalovirus (CMV) infection on the production of pro-inflammatory cytokines (tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β) and its relationship with functional status in patients with chronic heart failure (CHF) of ischemic genesis. Material and methods. We examined 187 patients with CHF of ischemic etiology, hospitalized in the cardiology department for decompensated heart failure (functional class (FC) CHF II-IV). Subsequently, patients were prospectively monitored for 24 months. The end point was a combined one and was defined as an increase by 1 or more in the FC of CHF (according to NYHA), hospitalization for decompensation of CHF, progressive deterioration of the structural and functional parameters of the left ventricle during the study period, the occurrence of adverse clinical events (cardiovascular death, non-fatal myocardial infarction or acute cerebrovascular accident, pulmonary embolism) during 24 months of prospective observation. After stabilization of patients upon inclusion in the study, plasma concentrations of TNF-α and IL-1β were determined by enzyme-linked immunosorbent assay. Qualitative determination of cytomegalovirus DNA in blood was carried out using the polymerase chain reaction method. Results. Based on the results of quantitative determination of CMV DNA, patients were divided into two groups: group 1 — seropositive (CMV+) (n = 128) and group 2 — seronegative (CMV-) (n = 59). In seropositive patients, functional class IV of CHF was significantly more often recorded (p < 0.035), as well as higher levels of TNF-α (p < 0.001) and IL-1β (p < 0.001) regardless of the FC of CHF. In the group of patients with positive CMV serostatus, adverse cardiovascular events were recorded significantly more often during 24 months of observation compared to seronegative patients: there was a significantly higher number of hospitalizations due to decompensation of CHF (p = 0.023), development of acute coronary syndrome (p = 0.031) and pulmonary embolism (p = 0.042), and lethal cases (p = 0.018). Conclusion. High levels of proinflammatory cytokines in patients with CHF correlate with carriage of CMV infection. Seropositive patients have an increased risk of adverse cardiovascular events compared to seronegative patients with CHF.

Гендерные и возрастные особенности больных с хронической сердечной недостаточностью в реальной клинической практике

Aim: to assess and describe gender- and age-specific characteristics of patients with chronic heart failure (CHF). Patients and Methods: in this retrospective study with a prospective component the authors analyzed medical records of 197 patients with CHF, including: CHF stage and functional class, co-morbidities, and echocardiography (Echo) findings. Twenty four (21, 28) months after discharging patients from the hospital, telephone follow-up calls were made to the patients and/or their relatives, and medical documentation of the medical information system was reviewed to assess the vital status of patients or the causes of lethal outcomes. For evaluating the obtained results, patients were divided into groups by gender and age. The middle-aged group comprised of males (45 to 59 years) and females (45 to 54 years) — 18 (9.1%) patients. The group of elderly persons included males (60 to 74 years) and females (55 to 74 years) — 69 (35.1%) patients. The senile group consisted of persons aged 75 years and over — 110 (55.8%) patients. Results: the median and interquartile range of patient age were 74.7 (68, 82) years. In the groups of middle-aged and elderly persons there were more men than women (р=0.001), while women prevailed in the senile group (р<0.001). The diagnosis of HF with reduced ejection fraction (HFrEF) was established more frequently in males than in females, and the difference was statistically significant (p=0.006). There were no statistically significant differences between male and female patients as regards the prevalence of HF with moderately reduced LVEF (HFmrEF). HF with preserved LVEF (HFpEF) was diagnosed more frequently in females than in males, and the difference was statistically significant (p=0.007). Using pair-wise comparison of LVEF in women of different age groups, it was shown that HFmrEF was more prevalent in middle-aged than in elderly (р=0.024) or senile (р=0.011) patients. The prevalence of HFpEF was higher in senile than in middle-aged women (р=0.012). No statistically significant differences in LVEF were found between the male patients of different age groups. There were no significant differences between males and females of middle-aged and elderly groups as regards the prevalence of co-morbidities. However, among senile persons co- morbidities were found more frequently in women than in men, and the difference was statistically significant (p<0.001). Conclusion: more than half of the patients with CHF were senile persons. Most patients with CHF in the elderly group were males, and in the senile group — females. It is necessary to consider gender and age-specific characteristics in the management of CHF patients, risk stratification and in the selection of adequate therapy. KEYWORDS: chronic heart failure, comorbidity, concomitant diseases, age ranges, gender characteristics. FOR CITATION: Reznik E.V., Ushakova N.A., Ershov N.S. et al. Gender- and age-specific characteristics of patients with chronic heart failure in real clinical practice. Russian Medical Inquiry. 2023;7(1):13–21 (in Russ.). DOI: 10.32364/2587-6821-2023-7-1-13-21.

Structural and functional features of the heart and the dynamics of biomarkers in the progression of chronic heart failure with a moderately reduced ejection fraction of the left ventricle in patients with diabetes mellitus

Aim. To study the relationship between serum levels of aldosterone, tissue inhibitor of matrix metalloproteinases-1 (TIMP-1), tumor necrosis factor-alpha (TNF-) and structural and functional changes in the heart during the progression of chronic heart failure (CHF) with a moderately reduced ejection fraction (CHFunEF) in patients with type 2 diabetes mellitus (DM).
 Material and methods. 58 patients were examined 30 (51.7%) men and 28 (48.3%) women diagnosed with DM and CHFunEF (EF=4149%), with functional class (FC) I, II and III of CHF according to New York Heart Association (NYHA). The control group consisted of 16 people. Patients underwent echocardiography, determination of serum levels of aldosterone, TIMP-1 and TNF- by ELISA. The patients were divided into 2 groups: 1st group patients with DM and CHFunEF who had a myocardial infarction (MI) 27 people (46.6%), 2nd group patients with DM and CHFunEF 31 people (53.4%). Statistica v. 10.0 software (USA) was used for statistical analysis. Differences were considered statistically significant at р0.05.
 Results. Serum levels of aldosterone, TIMP-1 and TNF- were significantly higher than those of the control group and increased with an increase in CHF FC. In patients of the 1st group, the volume and index values of the left parts of the heart and serum levels of biomarkers significantly exceeded those of the 2nd group.
 Conclusion. Activation of the aldosterone system, increased profibrotic and immuno-inflammatory processes with the progression of CHFunEF in patients with DM lead to an increase in serum levels of aldosterone, TIMP-1 and TNF- with an increase in CHF FC. Patients with DM and CHFunEF who have undergone MI have more pronounced structural and functional changes in the heart and greater values of volumetric and index parameters of the left heart than patients with DM and CHFunEF. Serum levels of aldosterone, TIMP-1 and TNF- in patients with DM and CHFunEF who have undergone MI exceed those in patients with DM and CHFunEF, these biomarkers can be used to diagnose the progression of CHFunEF in patients with DM.

The effectiveness of cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: results of the 12-month follow-up

To evaluate the efficacy, safety and effect on the prognosis of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and atrial fibrillation compared with the group of only optimal drug therapy (ODT) of the 12-month follow-up. Patients (n=200) were sequentially included in two groups: group 1 patients with CHF who are on ODT in combination with implanted CCM devices (n=100), group 2 comparison patients with CHF who receive only ODT (n=100). Initially and after 12 months, 12-channel electrocardiography (ECG), transthoracic echocardiography, daily ECG-monitoring, determination of the level of NT-proBNP, a six-minute walk test and an assessment of the quality of life according to the Minnesota Questionnaire were performed. In the CCM therapy group, a significant clinical improvement was revealed, which was expressed in the form of a decrease in functional class CHF by NYHA (New York Heart Association), an increase in the distance of a six-minute walk test and an improvement in the quality of life according to Minnesota Questionnaire, as well as an improvement in left ventricle contractile function compared to the ODT group. The absence of a proarrhythmogenic effect of the CCM was shown. There was a significant decrease in the frequency of the readmission due to CHF and the probability of achieving the combined endpoint in the CCM therapy group compared with only ODT. The use of CCM in patients with CHF and atrial fibrillation is an effective and safe method of therapy that leads to the development of reverse remodeling of the myocardium, improves the clinical status of patients and reduces the frequency of readmission due to decompensation of CHF.

Prognostic value of matrix metalloproteinases in patients with anthracycline-induced heart failure

Highlights. Elevated levels of matrix metalloproteinases 2 and 9 are associated with the initiation and severity of CHF developed after breast cancer therapy with anthracyclines, which may contribute to cardiac remodeling and the progression of systolic dysfunction. Concentrations of matrix metalloproteinases-2 and -9 in blood serum serve as predictors of the unfavorable course of anthracycline-induced heart failure.Aim. To assess the role of matrix metalloproteinases-2 (MMP-2) and 9 (MMP-9) in the development and course of anthracycline-induced chronic heart failure (CHF) during 24 months of observation.Methods. The study included 114 women 12 months after completion of chemotherapy (CT) for breast cancer and developed CHF. The control group (n = 70) consisted of women (mean age 45.0 [42.0; 50.0] years old) who received doxorubicin as part of chemotherapy, but they did not develop CHF 12 months after completion of chemotherapy. The levels of biomarkers (MMP-2, MMP-9, NT-proBNP) in blood serum were determined using a sandwich immunoassay.Results. Patients with CHF had signs of cardiac remodeling and higher values of NT-proBNP, MMP-2 and MMP-9 (p<0.001) than women from the control group. After 24 months of observation, all patients with CHF were divided into 2 groups: group 1 – women with an unfavorable course of CHF (n = 54), group 2 – women with favorable course of pathology (n = 60). Criteria for the unfavorable course of CHF: the emergence of new or worsening of existing symptoms/signs of heart failure; and/or hospitalization due to HF decompensation; decrease in left ventricular ejection fraction by more than 10%; or an increase in the functional class of CHF by 1 or more. Baseline echocardiographic parameters and NT-proBNP values did not differ in groups 1 and 2. Levels of MMP-2 were higher by 8% (p = 0.017) and MMP-9 by 18.4% (p<0.001) in group 1. In 1 group the level of MMP-2 decreased after 24 months of observation. In group 2 the level of MMP-2 increased by the end of the observation period. MMP-2 levels ≥388.2 pg/ml (sensitivity 46%, specificity 80%; AUC = 0.64; p = 0.013) and MMP-9 ≥21.3 pg/ml (sensitivity 86%, specificity 84.4%; AUC = 0.9; p<0.001) were determined as predictors of an unfavorable course of CHF.Conclusion. Remodeling of the extracellular matrix may play an important role in the pathogenesis of CHF initiated by drugs of the anthracycline class. Elevated levels of MMP-2 and MMP-9 in the blood serum are associated with an unfavorable course of anthracycline-induced CHF and can be recommended when assessing the risk of an unfavorable course of pathology.

Association of the quality of life parameters with the indicators of chronic heart failure severity in patients with rheumatoid arthritis

Background: The quality of life of patients is one of determining factors in assessing the effectiveness of treatment and prognosis. A search for possible associations of the quality of life parameters with basic clinical indicators provides a possibility of a more detailed and comprehensive assessment of the patients condition, correction of therapy and an improvement in the prognosis. Aim: To carry out a comparative analysis of the quality of life parameters in patients with chronic heart failure (CHF) with preserved and moderately reduced left ventricular ejection fraction against the background of rheumatoid arthritis (RA) and without RA, as well as to identify possible associations of the quality of life indicators with the parameters of the CHF course. Methods: 134 CHF patients with an RA diagnosis were examined, as well as 122 CHF patients without RA. The functional class of CHF in patients participated in the study was I -II by NYHA. The diagnosis of RA was made on the basis of radiological and serological studies. The radiological stage of RA in patients included in the study was I -III, according to Steinbrocker. Methotrexate was the basic anti-inflammatory drug for the RA treatment. A comparative analysis of the CHF symptoms, morphofunctional parameters and their possible association with the quality of life indicators in patients with and without RA was performed. The processing was carried out using the Statistica 10.0 program. Results: In the group of patients with CHF and RA, in addition to the statistically significant differences in the standard clinical laboratory parameters, statistically significant differences were also revealed in the severity of pain syndrome, deterioration of role, physical and emotional functioning as compared to the CHF patients without RA. Besides, in the CHF/RA group, statistically significant associations were revealed between the severity of pain syndrome and the level of the left ventricular ejection fraction and left ventricular mass index. Conclusion: The severity of pain syndrome caused by RA in patients with CHF can negatively affect some morphological and functional parameters of the myocardium, which must be taken into account when managing this group of patients.

The regulatory adaptive status in hypertensive patients with congestive heart failure with preserved left ventricular ejection fraction: the effects of fosinopril versus zofenopril

Objective. To evaluate the impact of fosinopril versus zofenopril on the regulatory adaptive status (RAS) in hypertensive patients with chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction (EF). Design and methods. The study inclded 67 hospitalized patients with hypertension (HTN) and CHF I–II NYHA functional classes with LV EF ≥ 50 %, who were randomized into two groups for treatment with fosinopril (13,8 ± 4,1 mg/day, n = 32) or zofenopril (17,9 ± 5,9 mg/day, n = 35). All patients additionally received nebivolol (7,1 ± 1,9 and 6,9 ± 1,8 mg/day), and if needed, atorvastatin and acetylsalicylic acid were prescribed. At baseline and after 24 weeks, we performed quantitative assessment of RAS-regulatory-adaptive capabilities (by cardio-respiratory coupling test), echocardiography, treadmill test, six-minute walking test, assessment of the N-terminal brain natriuretic pro-peptide level in blood plasma, subjective evaluation of quality of life (QL). Results. Fosinopril versus zofenopril led to a greater improvement of RAS (by 69,0%, p < 0,01 versus 41,1%, p < 0,01) and to a higher increase in tolerance to physical activity: longer distance in a six-minute walk test (by 28,1 %, p < 0,05 versus 25,9 %, p < 0,05), improvement in functional class of CHF (from II to I in 56 % of patients, in 25 % CHF was not registered versus change from II to I in 42 % of patients, and no CHF in 14 %). In both groups, cardiac diastolic function improved (decreased VE/Ve by 39,5%, p < 0,01 and 37,8%, p < 0,01), neurohumoral hyperactivity reduced (NT-proBNP decreased by 40,6 %, p < 0,01 and 39,4 %, p < 0,01), and subjective QL increased (decrease in the amount of negative points by 69,3%, p < 0,01, and 64,9 %, p < 0,01). Conclusions . In HTN patients with CHF with preserved LV EF, fosinopril versus zofenopril may be preferable due to a greater impact on regulatory and adaptive capabilities.

Predictors of atrial fibrillation in patients with ischemic stroke of undetermined etiology.

Aim To identify a complex of predictors and to create a mathematical model for prognosis of atrial fibrillation (AF) in patients with ischemic stroke of undetermined etiology.Material and methods The study included 981 patients with ischemic stroke. Effects of the following factors were evaluated: gender, a history of stroke, a history of thromboembolism, presence of diabetes mellitus, grade of arterial hypertension, functional class (FC) of chronic heart failure (CHF), age, data of blood biochemistry, and data of coagulogram. The prognostic model was constructed using the binary logistic regression. The value of area under the ROC curve for the proposed prognostic model was calculated.Results The main predictors of AF in patients with ischemic stroke of undetermined etiology were CHF FC, a history of stroke, age, gender, values of cholesterol and prothrombin index, which were included into the final prognostic model. The sensitivity of the developed model was 83.5 % and the specificity was 85.5 %. The area under the ROC curve corresponding to the interrelation between the prognosis of AF and the regression function value was 0.921±0.012 with 95 % confidence interval: 0.898-0.944.Conclusion According to the results of the study, the probability of AF in patients with ischemic stroke increased with CHF progression, recurrent stroke, older age, female gender, and reduced prothrombin index and cholesterol level.

Оценка ассоциации параметров диастолической дисфункции с суточными дозировками L-тироксина у пациентов с коронарной патологией сердца и первичным манифестным гипотиреозом

The purpose — to identify possible associations of daily dosages of L-thyroxine with morphofunctional parameters of the myocardium in patients with chronic heart failure (CHF) of ischemic etiology and primary manifest hypothyroidism (PMH). Material and methods. A single-stage cross-sectional study was conducted with the participation of 90 patients with CHF of functional class I–II with ischemic etiology and PMH and 150 patients with CHF of ischemic etiology without hypothyroidism. The assessment of basic clinical parameters, morphofunctional parameters of the myocardium and their possible associations with daily dosages of L-thyroxine was carried out. Results. Statistically significant differences were found in the values of the ratio of the rate of early diastolic filling of the left ventricle and the average rate of elevation of the base of the left ventricle to the early diastole (E/e`), the left ventricular ejection fraction (LVEF) and the cerebral natriuretic peptide (BNP). Significant moderate correlations of the dosage of L-thyroxine (100 mcg/day) with the values of the ratio of the rates of filling of the left ventricle in the early diastole and in the atrial systole (E/A), E/e` and LVEF. Conclusion. L-thyroxine in high daily dosages can contribute to improving the values of morphofunctional parameters of the myocardium.

Фенотипы хронической сердечной недостаточности у пациентов с ревматоидным артритом в зависимости от вариантов базисной противовспалительной терапии

The aim of the research. Determination of the features in the course of chronic heart failure (CHF) against the background of rheumatoid arthritis (RA) through comparative analysis of laboratory-instrumental and clinical indicators of the course of CHF in patients with and without RA, as well as the search for possible associations between basic anti-infl ammatory therapy and the studied parameters. Material and methods. A total of 256 patients participated in the study (all study participants were female): the study group included 134 CHF patients with RA. The comparison group included 122 CHF patients without RA. Th e functional class of CHF in the study groups according to NYHA was I-II. The diagnosis of CHF was established on the basis of modern ESC and RСS criteria. The diagnosis of RA was confirmed using laboratory and instrumental criteria. A comparative assessment of clinical and laboratory parameters in the examined groups was carried out. The analysis of possible associations between basic anti-infl ammatory therapy of RA and the RA course indicators was carried out. Th e paper presents statistically reliable results. Data processing was carried out using the Statistica 10.0 program. The level of significance when testing statistical hypotheses was set at p<0.05. Results. The study revealed statistically signifi cant predominance of the E/e› value in the group of CHF patients with RA in comparison to the patients without RA. The level of NT-proBNP in the group of CHF patients with RA had signifi cantly lower values in comparison to patients without RA. In CHF patients with RA taking lefl unomide, the level of NT-proBNP had no statistically signifi cant diff erences in comparison to CHF patients without RA. In the group of CHF patients with RA, a statistically signifi cant inverse association between methotrexate dosage with the E/e’ and NT-proBNP parameters was found. Conclusion. The intake of 15 mg / day methotrexate may have a positive eff ect on such parameters as E / e› and NT-proBNP in CHF patients with RA. However, prospective studies are required to confirm this hypothesis.

Кардиометаболические особенности постковидного синдрома у лиц пожилого и старческого возраста с коморбидной патологией

Aim: to describe post-COVID-19 cardiometabolic disorders in elderly patients and senile with comorbidities. Patients and Methods: this cross-sectional comparative non-interventional study included 154 patients aged 60–89 years with arterial hypertension (AH), ischemic heart disease (IHD), atrial fibrillation (AF) and type 2 diabetes mellitus (DM2). The patients had similar frequency and nosology of comorbidities. These patients were split into 2 groups: the first group consisting of 79 patients (66 [63; 73] years old) who did not have the novel coronavirus infection in the medical history and the second group consisting of 75 patients (65 [63; 72] years old) who survived mild or moderate SARS-CoV-2 infection. The examination was carried out within 20–24 weeks after the onset of COVID-19. Clinical, laboratory and instrumental parameters were analyzed in the present study. Results: аs compared with group 1, patients from group 2 had a more pronounced atherogenic pattern (total cholesterol 5.44 [4.78; 6.9] mmol/l vs 5.02 [4.05; 5.76] mmol/l (p=0.008), low-density lipoprotein (LDL) — cholesterol 3.11 [2.57; 4.58] mmol/l vs 2.57 [1.95; 3.11] mmol/l (p<0.001), triglycerides 2.5 [1.53; 4] mmol/l vs 1.5 [1.09; 2.47] mmol/l (p<0.001). Also, in group 2 fasting blood glucose levels were higher — 8 [6.65; 11.4] mmol/l vs 6.3 [5.75; 8.1] mmol/l (p<0.001) and glomerular filtration rate was lower 63.8 [57.45; 78.34] ml/min/1.73 m2 vs 70.7 [62; 77.18] ml/min/1.73 m2 (p=0.003). Lower diastolic blood pressure (68 [60; 74] mmHg vs 76 [69; 82] mmHg (p<0.001)) and higher systolic blood pressure (154 [141; 165] mmHg 150 [143; 165] mmHg (p=0.009) was found in patients who had SARS-CoV-2 infection in their medical history. Also, group 2 patients had a higher heart rate — 77 [73; 80] vs 75 [67; 77] beats per min (p=0.002). In addition, a larger diameter of ascending aorta was revealed in patients with the previous COVID-19 infection: 3.5 [3.35; 3.8] cm vs 3.4 [3.2; 3.7] cm (p=0.003). Patients who survived COVID-19 had a higher functional class (FC) of chronic heart failure (CHF) (NYHA) with the predominance of III FC (45.3% vs 22.8% (p=0.004). Group 2 patients compared with group 1 patients had a significantly higher level of NT-proBNP: 128.05 [85.12; 245.21] pg/ml vs 88.4 [38.85; 131.85] pg/ml (p<0.001). Conclusion: adverse cardiometabolic sequela, such as proatherogenic changes in lipid metabolism, hyperglycemia, renal dysfunction, high pulse pressure and a higher heart rate, were found in patients aged 60–89 years with AH, IHD, AF and DM2 who had SARS-CoV-2 infection in their medical history. Despite the prevalence of patients with III FC CHF and higher mean values of NT-proBNP in group 2, the structural markers of myocardial remodeling between the two groups did not differ, except for a larger diameter of ascending aorta in patients who survived the novel coronavirus infection. These differences can be considered as a part of the post-COVID-19 syndrome. KEYWORDS: COVID-19, SARS-CoV-2, novel coronavirus infection, post-COVID-19 syndrome, post-COVID-19 condition, cardiometabolic factors, elderly and senile age, comorbidities. FOR CITATION: Starichkova A.A., Tsygankova O.V., Khidirova L.D. et al. Cardiometabolic characteristics of post-COVID-19 syndrome in elderly and senile patients with comorbidities. Russian Medical Inquiry. 2022;6(9):501–508 (in Russ.). DOI: 10.32364/2587-6821- 2022-6-9-501-508.

Efficiency of endovascular revascularization in patients with chronic heart failure with reduced left ventricular ejection fraction and diabetes mellitus according to a five-year observation

Abstract Purpose The purpose of the study was to evaluate the effect of endovascular coronary revascularization in patients with coronary heart disease (CHD) complicated by chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) and comorbid with type 2 diabetes mellitus (DM) according to a five-year prospective follow-up. Material and methods The study included a total of 83 patients with coronary artery disease with CHF functional class (FC) II-III according to NYHA and LVEF less than 40% aged 48 to 58 years. Group 1 (n=38) included patients with CHD without DM; group 2 comprised 45 patients with CHD associated with DM. The endpoint was one of the adverse cardiovascular events (CVE) (death, nonfatal myocardial infarction, acute coronary syndrome, stroke, stent restenosis, CHF progression by 1 FC or more, repeated coronary revascularization (surgical, endovascular), development of ventricular arrhythmia, atrial fibrillation, and implantation of a pacemaker) occurring within five years of observation. Results One year after endovascular intervention, LVEF increased by 10.3% (p=0.05) in group 1 and by 13.4% (p=0.05) in group 2. The LVEF values in DM patients decreased by 9.5% after three years of observation. Manifestation of CHF occurred by 4.6 and 3.7 times less frequently in patients of group 1 after one and three years, respectively, compared with that in DM patients. After five years, 15.4% of patients in group 2 and none in group 1 (p=0.006) required hospitalizations for CHF progression. After three years, repeated interventions were required twice more often in group 2 (p=0.041). After five years, no repeated interventions were performed in group 1 whereas 30.8% of patients in group 2 received repeated interventions (p=0.011). One year after coronary artery stenting, the Kaplan-Meier survival rates were 91.3% in group 1 and 93.3% in group 2. The study showed that the survival curves significantly (p=0.020) diverged after three years of observation and by the end of the fifth year (p=0.011). The study showed that smoking (odds ratio (OR) 3.861, p=0.01) and the level of postprandial glycemia (OR 2.622; p=0.01) were predictors for the development of unfavorable factors. Evaluation of DM course showed that patients with episodes of hypoglycemia were significantly more frequently diagnosed with onset of new unfavorable CVE including progression of atherosclerosis in the native coronary arteries (p=0.05) and, later, CHF decompensation (p=0.004–0.04). Findings The annual results were comparable between study groups. Assessment of results from three-year follow-up showed that patients with DM and CHF who underwent endovascular revascularization had a significantly lower survival rate and a higher need for repeated revascularization. The five-year survival rate was significantly lower in group of DM patients (p=0.011). Funding Acknowledgement Type of funding sources: None.

Effect of 24-hour blood pressure and heart rate on the prognosis of patients with reduced and midrange LVEF.

Aim Optimal combination therapy for chronic heart failure (CHF) currently implies the mandatory use of at least four classes of drugs: renin-angiotensin-aldosterone (RAAS) system inhibitors or angiotensin receptor blocker neprilysin inhibitors (ARNI); beta-adrenoblockers (BAB); mineralocorticoid receptor antagonists; and sodium-glucose cotransporter 2 inhibitors. Furthermore, many of these drugs are able to decrease blood pressure even to hypotension and alleviate tachycardia. This study focused on the relationship of 24-h blood pressure (BP) and heart rate (HR) with the prognosis for CHF patients with sinus rhythm and left ventricular ejection fraction (LV EF) <50 % as well as on suggesting possible variants of safe therapy for CHF depending on the combination of studied factors.Material and methods Effects of clinical data, echocardiographic parameters, 24-h BP, and heart rhythm (data from 24-h BP and ECG monitors) on the prognosis of 155 patients with clinically pronounced CHF, LV EF <50 %, and sinus rhythm who were followed up for 5 years after discharge from the hospital.Results The one-factor analysis showed that the prognosis of CHF patients was statistically significantly influenced by the more severe functional class (FC) III CHF compared to FC II, reduced LV EF (<35 %), a lower 24-h systolic BP (SBP) (<103 mm Hg), the absence of hypotensive episodes in daytime, a low variability of nighttime BP (<7.5 mm Hg), a higher 24-h HR (>71 bpm vs. <60 bpm), the absence of therapy with RAAS inhibitors + BAB, and a lower body weight index. The multi-factor analysis showed that more severe CHF FC, lower LV EF, and the absence of RAAS inhibitors + BAB therapy retained the influence on the prognosis. After eliminating the influencing factor of drug therapy, also a low SBP variability significantly influenced the prognosis. An additional analysis determined the following four groups of CHF patients with reduced heart systolic function according to mean 24-h HR and SBP: the largest group (38.1 % of all patients) with controlled HR (≤69 bpm), preserved SBP (>103 mm Hg), and the lowest death rate of 15.3 %; the group with increased HR (>69 bpm) but preserved SBP (30.3 % of all patients) where the death rate was 44.7 %, which was significantly higher than in the first group; the group with normal HR (≤69 bpm) but reduced SBP (≤103 mm Hg) (16.1 % of patients) where the death rate was 40 %, which was comparable with the second group and significantly worse than in the first group; and the group with both increased HR (>69 bpm) and reduced SBP (≤103 mm Hg) (15.5 % of patients), which resulted in the maximal risk of death (70.8 % of patients with CHF and LV EF <50 %), which was significantly higher than in the three other groups.Conclusion Low SBP (including 24-h SBP with reduced variability in day- and nighttime) in combination with high HR (including by data of Holter monitoring), low LV EF, more severe clinical course of CHF, and the absence of an adequate treatment with neurohormonal modulators (RAAS inhibitors and BAB) significantly increased the risk of death. Isolating four types of FC II-III CHF with sinus rhythm and EF <50% based on the combination of HR and BP identifies patients with an unfavorable prognosis, which will help developing differentiated therapeutic approaches taking into account clinical features.