Clinical Course Of Chronic Heart Failure Research Articles

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.

Study of the rs1800795 polymorphism of the <i>IL6</i> gene to verify the clinical portrait of a patient with chronic heart failure: gender aspects

Background. Genetic studies in cardiology allow to identify predisposition and predict the course of multifactorial cardiovascular diseases by identifying the association of polymorphic loci of candidate genes with the clinical phenotype. One of these diseases associated with poor prognosis is chronic heart failure (CHF). Activation of pro-inflammatory cytokines is one of the key aspects of the development and progression of CHF.
 Aim. To identify the features of the clinical course of CHF of ischemic etiology in patients, taking into account the gender and genotype of the rs1800795 polymorphism of the IL6 gene.
 Materials and methods. Four hundred fourteen patients of both sexes with stable CHF of ischemic origin, aged 66.410.4 years, were included. Clinical characteristics of men and women of each genotype of the rs1800795 polymorphism of the IL6 gene were compared. Genotyping of the rs1800795 polymorphism of the IL6 gene was performed by real-time polymerase chain reaction.
 Results. In male patients with CHF, the frequency of allele C was higher than in the control group (p=0.04). Homozygous carriers of the C allele showed a greater risk of developing atrial fibrillation (p=0.021). In terms of biochemical parameters, in patients with a heterozygous genotype, compared with homozygotes for the G allele of the rs1800795 polymorphism of the IL6 gene, the levels of cholesterol, triglycerides (TG), cholesterol not associated with high-density lipoproteins (non-HDL-cholesterol) were higher (p=0.044, p=0.019, p=0.016). Patients with the CC genotype of the rs1800795 polymorphism of the IL6 gene females compared with men were more likely to have IIIIV functional class of CHF (p=0.001) and had a high heart rate (p=0.021). Male patients of the CG genotype were more likely to undergo coronary interventions (p=0.001). In women of the CG genotype, CHF was more often combined with DM (p=0.015), the level of non-HDL-cholesterol (p=0.04) was higher, and glomerular filtration rate was lower than in men (p=0.001). Comparison of the GG genotype revealed a higher incidence of chronic kidney disease in women (p=0.022). Women had significantly lower glomerular filtration rate (p=0.001), systolic blood pressure (p=0.004). The level of such biochemical parameters as cholesterol (p=0.001), TG (p=0.019), low-density lipoprotein cholesterol (p=0.002) was reduced, except for high non-HDL-cholesterol (p=0.001). There were more men with left ventricular ejection fraction 40% (p=0.009), women with left ventricular ejection fraction 50% (p=0.002).
 Conclusion. The identified phenotypic and gender differences create prerequisites for determining patient-oriented genetic risk, opening up new opportunities for preventing the progression and complications of CHF.

Chronic heart failure: Clinical trends and modern approaches

Chronic heart failure (CHF) is one of the most pressing problems in modern cardiology, and the prevalence and diagnosis of this disease is increasing due to improvements in medical diagnosis and treatment, increased patient life expectancy, and advances in cardiology. This article discusses the specifics of the clinical course of CHF, modern trends in the course of the disease, early detection, analysis of causes and the criteria for the final classification in a broad sense, taking into account the latest data. At the same time, the latest achievements and modern views in the field are briefly described.

Euvolemia as a criterion of diuretic therapy efficacy in chronic heart failure: Literature review

Chronic heart failure (CHF) is a typical outcome for all pathological processes affecting the cardiovascular system and is diagnosed in 1–2% of the population in developed countries. The strategy for managing patients with CHF involves the prescription of diuretics for the relief of volume retention syndrome in addition to pathogenetic pharmacotherapy. Considering the confl icting data concerning the effects of diuretics on the long-term prognosis and clinical course of CHF, a strict approach to the analysis of risk/benefit ratio is necessary while choosing a specific diuretic and determining its optimal dose and duration of use. The article reviews state-of-theart literature on the assessment of hydration status in patients with CHF. The euvolemia state, in which the optimal volume of fl uid is achieved in the body of a patient with CHF is viewed from the perspective of evaluating the efficacy and relevance of diuretic therapy.

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.

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.

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 (<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.

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<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<0,0001) and level of NT-proBNP ≥276,96 pg/mL (sensitivity — 88,4%, specificity — 43,7%, AUC — 0,64, р<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<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.

Features of cardiac hemodynamics at chronic heart failure with overweight and obesity depending on the functional state of the kidneys

Several researches had demonstrated connection between the kidney dysfunction and worse prognosis in patients with both acute and chronic heart failure (CHF). The aim of research was to study the special features of cardiac hemodynamics at CHF with overweight and obesity depending on functional state of kidneys.Methods. There were examined 347 patients with CHF 0f 1-111 functional class on the background of overweight and abdominal obesity of 1-111 degree and different functional state of kidneys. There was calculated the speed of glomerular filtration (on MDRD formula) and carried out Doppler echocardiography for all examined persons. There was used an unpaired Student t-criterion or Mann-Whitney U-criterion depending on the size of sample and distribution of indicators.Results. Concomitant kidney functional state disorder complicates the clinical course of CHF on the background of overweight and obesity. It is demonstrated as an increase of functional class of disease at moderate and heavy kidney dysfunction. It is based on an increase of the degree of dilatation of the left and right atrium, left ventricle (LV) and the more degree of myocardium hypertrophy. The more significant calcination of mitral and aortic valves, the growth of degree of mitral regurgitation takes place. Simultaneously with structural changes in heart there take place functional disorders namely the worsening of contractility of LV and spread of systolic and diastolic myocardium function of 1 type, development of kidney hypertension. The remodeling of myocardium in this category of patients is mainly presented as concentric hypertrophy although at progression of kidney dysfunction the tendency to gradual elevation of excentric hypertrophy of LV takes place.Conclusions: It was established that CHF on the background of overweight and obesity associated with kidney dysfunction is characterized with heavier clinical course, elder age and more representation of women, dilatation of heart chambers, progression of hypertrophy of LV, calcination of valves and complication of mitral regurgitation. There took place a decrease of contractility of LV and spread of systolic and diastolic function by the type of relaxation disorder, kidney hypertension was forming. Among the types of myocardium remodeling the most widespread is concentric hypertrophy of LV that tends to decrease in favor of ecxentric hypertrophy at intensification of kidney dysfunction

Age-related clinical features of chronic heart failure and structural-functional changes in the heart on the background of overweight and obesity

The results of epidemiologic researches in European countries and USA demonstrated that the prevalence of chronic heart failure (CHF) varies within 0,4-2,5 %. The aim of research –an assessment of clinical features of CHF and structural-functional changes in the heart on the background of overweight and obesity in patients of the different age groups. Methods . It was examined 300 patients of the different age groups with CHF of 1-111 functional class (FC) on the background of overweight and abdominal obesity of 1-111 degree. Depending on division of indicators there was used an unpaired Student t-criterion or Mann-Whitney U-criterion. Results . In examined patients with overweight and obesity CHF progress with age that declares itself by FC increase and of body mass index (BMI) decrease. The clinical course of CHF in elder age is characterized by the spread of the permanent form of atrial fibrillation. With age CHF of combined etiology is more often. The structural changes in the heart at CHF in elder patients are characterized by the more significant dilatation of the left atrial and hypertrophy of the left ventricle of concentric type. The clinical course of CHF in elder age is characterized by an increase of frequency of systolic dysfunction of the left ventricle and formation of the lung hypertension. Conclusions : It was established that in examined patients with CHF on the background of an overweight and obesity with age took place an increase of FC of disease, the prevalence of CHF of combined etiology and decrease of BMI. In elder patients with CHF it were observed the more apparent spread of the permanent form of atrial fibrillation and the dilatation of the left atrial and hypertrophy of myocardium of concentric type. Functional changes in the heart in examined patients of an elder age group are characterized by the more frequent systolic dysfunctio ns of the left ventricle and formation of the lung hypertension.

Treatment motivation in patients with chronic cardiorenal syndrome

To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2. The clinical course of CHF, personality profile, and motivation for non-drug and drug treatments were assessed in patients with chronic CRS. CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.

ESPEN Guidelines on Parenteral Nutrition: On Cardiology and Pneumology

Nutritional support is becoming a mainstay of the comprehensive therapeutic approach to patients with chronic diseases. Chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD) are frequently associated with the progressive development of malnutrition, due to reduced energy intake, increased energy expenditure and impaired anabolism. Malnutrition and eventually cachexia have been shown to have a negative influence on the clinical course of CHF and COPD, and to impinge on patients' quality of life. Nutritional support in these patients should be therefore considered, particularly to prevent progressive weight loss, since restoration of lean and fat body mass may not be achievable. In CHF and COPD patients, the gastrointestinal tract is normally accessible and functioning. Although recent reports suggest that heart failure is associated with modifications of intestinal morphology, permeability and absorption, the clinical relevance of these are still not clear. Oral supplementation and enteral nutrition should represent the first choices when cardiopulmonary patients need nutritional support, particularly given the potential complications and economic burden of parenteral nutrition. This appropriately preferential enteral approach partly explains the lack of robust clinical trials of the role of parenteral nutrition in CHF and COPD patients. Based on the available evidence collected via PubMed, Medline, and SCOPUS searches, it is recommended that parenteral nutrition is reserved for those patients in whom malabsorption has been documented and in those in whom enteral nutrition has failed.