Decompensation Of Chronic Heart Failure Research Articles

Differences in the Biomarker Profile of De Novo Acute Heart Failure versus Decompensation of Chronic Heart Failure.

The perception of acute heart failure (AHF) as a single entity is increasingly outdated, as distinct patient profiles can be discerned. Key heart failure (HF) studies have previously highlighted the difference in both the course and prognosis of de novo AHF and acute decompensated chronic HF (ADHF). Accordingly, distinct AHF profiles with differing underlying pathophysiologies of disease progression can be shown. We compared a range of selected biomarkers in order to better describe the profile of de novo AHF and ADHF, including the inter alia—serum lactate, bilirubin, matrix metallopeptidase 9 (MMP-9), follistatin, intercellular adhesion molecule 1 (ICAM-1), lipocalin and galectin-3. The study comprised 248 AHF patients (de novo = 104), who were followed up for one year. The biomarker data of the de novo AHF and ADHF profiles was then compared in order to link biomarkers to their prognosis. Our study demonstrated that, although there are similarities between each patient profile, key biomarker differences do exist—predominantly in terms of NTproBNP, serum lactate, bilirubin, ICAM-1, follistatin, ferritin and sTfR (soluble transferrin receptor). ADHF tended to have compromised organ function and higher risks of both one-year mortality and composite endpoint (one-year mortality or rehospitalization for heart failure) hazard ratios (HR) (95% CI): 3.4 (1.8–6.3) and 2.8 (1.6–4.6), respectively, both p < 0.0001. Among the biomarkers of interest: sTfR HR (95% CI): 1.4 (1.04–1.8), NGAL(log) (neutrophil gelatinase-associated lipocalin) HR (95% CI): 2.0 (1.3–3.1) and GDF-15(log) (growth/differentiation factor-15) HR (95% CI): 4.0 (1.2–13.0) significantly impacted the one-year survival, all p < 0.05.

Up-dates on Cardio-Circulatory Support

In-hospital mortality rates have approved in the recent past1 6 to 12-month death persists at approximately 50%2. The goal of treatment is to reestablish tissue perfusion while closely monitoring hemodynamics. Provisional automatic cardiovascular support is a mainstay of the management of patients who cannot be stabilized with medical therapy. Apart from the acute setting, automatic cardiovascular support is also used in the mid- and long-term treatment of heart failure patients. This can either be until heart transplant or life-long in patents who are not candidates for heart transplant. Further it is an essential tool of open-heart surgery. In the present review we will give an overview and update of the different devices for mechanical cardiac support. Non-mechanical Cardio-Circulatory Support includes intravenous fluids and pharmacological treatment with vasopressors and inotropic agents. Norepinephrine is mainly a vasopressor, but also has other activities such as inotropy. It serves as first line agent, particularly in the acute setting of a cardiogenic shock. A recent randomized trial comparing Norepinephrine versus Epinephrine in cardiogenic shock after myocardial infarction found that Norepinephrine appeared to be a safer choice than Epinephrine3. Vasopressin causes less pulmonary vasoconstriction than norepinephrine and is therefore might better as a first line vasopressor compared to Norepinephrine4. Dobutamine, a beta agonist is frequently being used for cardiogenic shock, acting as inotropic agent. Levosimendan is a Calcium sensitizer and often used in patients with acute decompensation of chronic heart failure.

Evaluation of the beneficial effect of metformin on clinical indicators of heart failure patients with coronary artery disease and impaired glucose tolerance within a 12-month follow-up

BackgroundTaking into account evident interrelation between chronic heart failure (CHF) and carbohydrate metabolism disorders (CMD), hyperglycemia correction should also mitigate adverse metabolic effects on the course of CHF, improving the quality of life (QOL) and prognosis. To date, there are several clinical observational and experimental studies on the cardioprotective properties of metformin. No randomized clinical trials currently available. PurposeSo, the aim of the study is to evaluate baseline and prospective data of ischemic etiology HF FC III (NYHA) patients with prediabetes. Methodsopen label randomized clinical trial in 76 CHF patients with prediabetes was performed. Inclusion criteria: ischemic CHF FC III (NYHA) without CMD and glucose-lowering drugs intake in anamnesis, not older than 65, receiving CHF and CAD basic therapy 3 months prior to inclusion. Exclusion criteria: acute coronary syndrome, acute CHF decompensation, thyroid dysfunction, CKD with eGFR less than 45 ml/min/1,74m2. Clinical examination with collection of complaints, medical history; systolic and diastolic blood pressure (DBP), heart rate (HR), anthropometric indicators (height, weight, BMI, waist circumference) were evaluated. HF FC was assessed by 6-minute walking test results, QOL – by MLHFQ. Laboratory data: fasting and postprandial glucose, HbA1C, lipid profile, creatinine with eGFR, daily proteinuria, serum lactate. Insulin, aldosterone, Nt-proBNP levels determined by ELISA. IR was assessed using HOMA-IR. LV EF was assessed using transthoracic echocardiography. All patients were on lifestyle modification (LSM) and randomized for 2 groups with (n=39) and without (n=37) metformin. Results. In comparison with baseline indicators in metformin group decreasing of BMI (p=0.000), DBP (p=0.005), HR (p=0.000), postprandial glycemia, HbA1C, insulin (IR), aldosterone and Nt-proBNP levels, as well as improvement of kidney function (serum creatinine, eGFR, daily proteinuria) and neurohormonal profile (aldosterone, Nt-proBNP) were revealed after 12 months (p=0.000 in all cases). Moreover, both indicators of QOL (MLHFQ points (p=0.001) and 6-minute walking test results (p=0.000)) and left ventricular ejection fraction were significantly better (p=0.000). In contrast, LSM was associated with significant increasing of fasting glucose and, what`s important, kidney function deterioration. No increasing of lactate was registered in two groups. ConclusionMetformin benefits in relation to CHF course become apparent and determine importance and necessity of further large, randomized placebo-controlled trials in HF patients. So, modern therapeutic approaches should be complex and span all pathophysiological links of CHF progression already at the prediabetes stage.

Risk factors and outcome variables of cardiorenal syndrome type 1 from the nephrologist’s perspective

Background and aimIn cardiorenal syndrome (CRS) type 1, acute cardiac failure or acute decompensation of chronic heart failure causes acute kidney injury (AKI). Every individual AKI episode increases the risk for chronic kidney disease (CKD) in the long term. In this study, we aimed to evaluate epidemiological characteristics and outcome variables of CRS type 1 individuals from the nephrologist’s perspective.MethodsThe study was performed in a retrospective, observational manner. All AKI patients treated at the Brandenburg Hospital of the Medical School of Brandenburg between January and December 2019 were screened for diagnostic criteria of CRS type 1. Endpoints were in-hospital death, need for dialysis, and renal recovery.ResultsDuring the screening, 198 out of 1189 (16.6%) AKI subjects were assigned to the diagnosis CRS type 1. The overall in-hospital mortality was 19.2%; 9.6% of the patients required dialysis due to AKI. Complete recovery of kidney function was observed in 86 individuals (43.4%); incomplete recovery occurred in 55 patients (27.8%). Mortality-predictive variables were AKIN stage 2, longer ICU treatment, and insulin-dependent diabetes. Regarding dialysis, AKIN stage 3 and higher potassium at the time of diagnosis were predictive. Subjects with longer in-hospital stay recovered more often from CRS type 1.ConclusionsThe incidence of CRS type 1 is high (∼16% of all in-hospital AKI subjects) and the mortality is higher than the average mortality of AKI in general. At the same time, complete recovery of kidney function occurs less frequent. The kidney-related follow-up management of CRS type 1 needs to be significantly optimized to improve the long-term outcome of affected patients.

Empagliflozin in patient with heart failure and type 2 diabetes mellitus: new possibilities for drug therapy

The article demonstrates the practical experience of the effective use of inhibitor of sodium-glucose co-transporter 2 emplagliflozin as a part of optimal drug therapy in patients with decompensation of chronic heart failure with systolic dysfunction of ischemic genesis and type 2 diabetes mellitus. The place of this group of drugs in improving the quality of life and prognosis in patients with severe comorbidity has been indicated according to the data of evidence-based studies.

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.

Features of the distribution of polymorphic variants of candidate genes and clinical presentation of long-term period in patients with myocardial infarction and diabetic nephropathy

Abstract Objective To evaluate rate of distribution of the NOS3, APOE, SLCO1B1 and CYP2C19 genes and features of clinical presentation of the long-term period (12 months) in patients with myocardial infarction (MI) and diabetic nephropathy (DN). Materials and methods Examined 160 patients treated for MI (Males – 58,2%; 41,8% – females, average age 67,1±4,2 years). Patients were divided into 2 groups: the first (I) – 84 patients with MI and DN, the second (II) – 76 persons with MI without DN. The samples were comparable by sex and age. Determination of genotypic accessories genes NOS3 (rs2070744), APOE (rs769452), CYP2C19 (rs4986893 and rs4244285) and SLCO1B1 (rs4149056) were based on the analysis of genomic human DNA by polymerase chain reaction. The long-term follow-up period was 1 year. Results Analysis of the distribution of alleles of the gene NOS3 (T786C), affecting the synthesis of nitric oxide showed that polymorphic allele C 2 times more often detected in the group with MI and DN– 38,7%, compared to the comparison group 17,1%, p&amp;lt;0,05. T- allele was statistically more frequent in II-82,9% than in I-61,3%, p&amp;lt;0,05. Polymorphism (Leu28Pro) of the APOE gene, potentiating hyperlipoproteinemia, the Pro allele was more often detected in group I – 8,9%, than in group II – 1,3%, p&amp;lt;0,05. Analysis of allele expression features of the SLCO1B1 gene polymorphism (Val174Ala), which affects the metabolism of statins, did not revealed a significant difference between the groups, p&amp;gt;0,05. Polymorphic variants (G681A and Trp212Ter) of CYP2C19 gene, determining sensitivity to clopidogrel, had the following characteristics: allele *1 was more frequently detected in the control group – 96,7%, relative to the Ist – 88,7%, p&amp;lt;0,05. Allele *2 was leader in patients with MI and DN – 8,9%, compared to control 2,0%, p&amp;lt;0.05. Distribution of allele *3 between groups did not differ statistically in I – 2,4%, II – 1,3%, p&amp;gt;0,05. Clinical presentation of the long-term period (12 months): hospitalizations of patients due to decompensated chronic heart failure (CHF) in I – 19,1%, in II – 6,6%, p&amp;lt;0,05. Recurrences of acute coronary syndrome (ACS) met 3 times more often in group I – 15,5%, versus 5,3% in the second group, p&amp;lt;0,05. Stent thrombosis: 6 times more frequent in the group with MI and DN, compared to the control group of 1,3%, p&amp;lt;0,05. Long-term mortality: I – 15,5%, II – 4,0%, p&amp;lt;0,05. Conclusions In patients with MI and DN, polymorphic alleles of the NOS3, APOE, and CYP2C19 genes are statistically more common, which probably has an additional aggravating effect on the course of disease in the long-term period (1 year). In the group of patients with MI and DN, for a long-term period (1 year), it is statistically more often complicated by CHF decompensation, recurrent ACS, and stent thrombosis, which finally led to fatal outcomes with mortality rate 14,7%. Funding Acknowledgement Type of funding sources: None. Distribution of genetic variantsPresentation of the long-term period

“Rehospitalization Prognostic Factors In Patients with Heart Failure”

Introduction: The prognosis of chronic heart failure (CHF) is determined by the complex relationship of neurohormonal, mechanical and polyorgan pathological changes emerging in the course and progression of the disease.&#x0D; Objective: To assess the risk and rate of rehospitalisation due to decompensation of chronic heart failure (CHF) in relation to certain biologic, clinical and instrumental characteristics.&#x0D; Material and Methods: This study conducted in the Department of Cardiology, Community Based Medical College &amp; Hospital, Bangladesh. Prospective study on 228 consecutive CHF patients. The follow-up period was 12 to 24 months. The primary endpoint was rehospitalization due to HF decompensation. The risk values were calculated using the Cox regression models. &#x0D; Results: Median survival time was 8 months. The total number of rehospitalizations was 86 (37.7%). Rehospitalization risk values were insignificantly lower in women (HR 0.7, 95% CI 0.4-1.1, р &gt;0.05) and higher in older age groups (HR 1.4 95% CI 0.8-2.2, р&gt;0.05). Univariate regression analysis showed a higher rehospitalization risk in patients with survived myocardial infarction, clinical signs of CHF, high functional class and pulmonary pressure. Multivariate regression analyses revealed the leading role of functional class on rehospitalization risk. &#x0D; Conclusion: rehospitalization rates due to decompensation of CHF are high. Age and gender are insignificant predictors for rehospitalization in our study. Functional class is the prognostic factor with an independent effect on rehospitalization risk over the defined follow-up period among the examined group of patients.

Management of myocarditis in clinical practice.

Myocarditis is an inflammatory heart muscle disease characterized by heterogeneous clinical presentation and outcome. Clinical heterogeneity of myocarditis, ranging from acute onset chest pain with electrocardiographic changes resembling an acute coronary syndrome, to arrhythmic storm and chronic decompensated heart failure, makes diagnosis challenging. However, a correct diagnosis is fundamental to proper patients' management and should always be seeked. Although a definite diagnosis is only provided by endomyocardial biopsy, the European Society of Cardiology task force on myocardial and pericardial diseases provided specific criteria for the diagnosis of clinically suspected myocarditis, which has been facilitated by the advent of noninvasive imaging tests (i.e. cardiovascular magnetic resonance based myocardial tissue characterization). Due to the heterogeneous presentation and disease course of myocarditis, a tailored treatment would be the best strategy, but a standardized management is still not available. However, over the years, new, promising therapies, such as antiviral and immune-suppressive treatment, have come side by side to the standard pharmacological heart treatment, i.e. antiheart failure medications. In this paper we will review the basic principles of myocarditis management in clinical practice, including diagnostic work-up, conventional and disease-specific therapy and patients' follow-up.

Possibilities of cardio- and nephroprotective eff ects of drugs of the SGLT2 inhibitor group

This work is an attempt to analyze the data on the mechanisms of cardio- and nephroprotection of drugs of the SGLT2 inhibitor group (Sodium / glucose cotransporter 2). The data of recent studies are shown to indicate the eff ect of drugs of this group on the indices of central hemodynamics, on the volume of circulating plasma in particular, which can reduce the risk of progression and decompensation of chronic heart failure (CHF). The ability of empaglifl ozin to reduce pulsatility, a marker of increased vascular wall stiff ness, has been demonstrated. Also, SGLT2 inhibitors improve the energy supply of the myocardium and kidney tissue by increasing the concentration of ketone bodies in the blood, which are a more effi cient energy substrate than glucose and fatty acids. A direct pleiotropic eff ect on the myocardium, improvement of diastolic myocardial dysfunction is also not excluded. It is known that SGLT2 inhibitors also reduce cortical hypoxia, decrease intraglomerular hypertension and increase glomerular fi ltration rate, lessen incidence of nephropathy, its severity and rate of progression. Some studies have revealed antioxidant, anti-infl ammatory, antifi brotic eff ect of type 2 sodium glucose cotransporter inhibitors. The use of this group of drugs also leads to a decrease in body weight. This eff ect is more pronounced in combination with other drugs intended for the treatment of obesity. All this makes SGLT2 inhibitors a promising group of drugs that have a large number of pathogenetic points of application in relation to cardiorenal syndrome.

Health Status Predicts Short- and Long-Term Risk of Composite Clinical Outcomes in Acute Heart Failure

ObjectivesThis study aims to examine the association between the Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 score and the 30-day and 1-year rates of composite events of cardiovascular death and heart failure (HF) rehospitalization in patients with acute HF. BackgroundFew studies reported the prognostic effects of KCCQ in acute HF. MethodsThis study prospectively enrolled adult patients hospitalized for HF from 52 hospitals in China and collected the KCCQ-12 score within 48 hour of index admission. The study used multivariable Cox regression to examine the association between KCCQ-12 score and 30-day and 1-year composite events and was further stratified by new-onset HF and acutely decompensated chronic heart failure (ADCHF). Subgroup analyses were performed to explore the potential heterogeneity. The study evaluated the incremental prognostic value of KCCQ-12 score over N-terminal pro−B-type natriuretic peptide (NT-proBNP) levels and established risk scores by C-statistics, net reclassification improvement, and integrated discrimination improvement. ResultsAmong 4,898 patients, 29.4% had new-onset HF. After adjustment, each 10-point decrease in the KCCQ-12 score was associated with a 13% increase in 30-day risk and a 7% increase in 1-year risk. The associations were consistent regardless of new-onset HF or ADCHF, age, sex, left ventricular ejection fraction, New York Heart Association functional class, NT-proBNP level, comorbidities, and renal function. Adding KCCQ-12 score to NT-proBNP and established risk scores significantly improved prognostic capabilities measured by C-statistics, net reclassification improvement, and integrated discrimination improvement. ConclusionsIn acute HF, a poor KCCQ-12 score predicted short- and long-term risks of cardiovascular death and HF rehospitalization. KCCQ-12 could serve as a convenient tool for rapid initial risk stratification and provide additional prognostic value over NT-proBNP and established risk scores.

Posthospital Cardiovascular Complications in Patients after Non-Cardiac Surgery

The objective: to analyze the incidence and spectrum of cardiovascular complications within 12 months after noncardiac surgery, as well as to assess the association of preoperative values of various cardiac risk indices (CRI) and other potential risk factors with the actual development of complications.Subjects and Methods. We analyzed data of medical records and telephone interviews of 141 patients aged 65 [60-71] years who had undergone non-cardiac surgery a year before the interview The operations were low risk in 13.5% of observations, medium risk in 64.5%, and high risk in 22%. A retrospective calculation of the Revised CRI (RCRI), Individual CRI (Khoronenko CRI), and the American College of Surgeons Perioperative Risk for Myocardial Infarction or Cardiac Arrest (MICA) was performed.Results. Cardiac events (myocardial infarction, decompensation of chronic heart failure, new arrhythmias, stroke, and/or the need to prescribe or escalate the dose of cardiovascular drugs and/or hospitalization for cardiac indications, and/or death from cardiovascular diseases) within 12 months after elective noncardiac surgeries were detected in 27.7% of cases, and in 2.1% of patient's death occurred due to cardiac disorders. Predictors of cardiac events were concomitant ischemic heart disease (OR = 2.777; 95% CI 1.286-5.966; p = 0.0093) and chronic heart failure (OR = 2.900; 95% CI 1.224-6.869; p = 0, 0155), RCRI (OR = 1.886; 95% CI 1.2-8-2.944; p = 0.005), Khoronenko CRI (OR = 3254.3; 95% CI 64.33-164,638; p = 0.0001), MICA (OR = 1.628; 95% CI 1.156-2.292; p = 0.005), creatininemia on the first postoperative day (OR = 1.023; 95% CI 1.010-1.061; p = 0.005), and propensity for bradycardia during surgery (OR = 0.945; 95% CI 0.908-0.983; p = 0.005). Combined analysis of Khoronenko's CRI and postoperative creatininemia provided a very good model: area under the ROC-curve - 0.823 (95% CI 0.728-0.641; p = 0.0002).Conclusion. All studied CRIs can be used to predict posthospital cardiac events; however, the most promising is a joint assessment of Khoronenko's CRI and postoperative creatinemia.

Cardiovascular complications in patients with severe pneumonia with influenza A/H1N1 / 09

Aim of the study was to analyze the frequency and nature of cardiovascular complications in influenza A/H1N1/09 in Zabaykalsky Krai from 2018 to 2019. Material and methods. 86 cases of severe influenza A/H1N1/09 were analyzed. Results. The patients were divided into 2 groups, comparable by gender and age. The first group consisted of patients with cardiovascular complications of influenza A/H1N1 / 09 (41 people). The second group consisted of patients without complicated flu (45 people). The average age of patients in the first group was 60 ± 13.7 years. According to the ECG results, sinus tachycardia with a heart rate of 94 ± 14.2 beats/min was dominant, in combination with various rhythm and conduction disorders: supraventricular extrasystole – in 5 (12 %) patients, acute (paroxysmal) atrial fibrillation – in 19 (46 %), ventricular extrasystole – in 7 (17 %), complete right and left bundle branch block – in 7 (17 %) and 7 (17 %), respectively, atrioventricular block of the 1st degree – in 1 (2 %) patients. Long QT syndrome was revealed in 5 patients (12 %). The severe cardiovascular system complications were: myopericarditis in 2 (5 %) people, decompensation of chronic heart failure in 4 (10 %) people, pulmonary embolism in 1 (2 %), acute myocardial infarction in 11 (27 %). The mortality rate in this group was 12 (29 %) cases from hospitalized patients. The average age of patients in the second group was 58 ± 14.1 years. According to the ECG results, sinus tachycardia with a heart rate of 91 ± 9.4 beats/min was detected in 98 % of cases, 3 (7 %) patients had complete left bundle branch block, 1 (2 %) patient had atrial fibrillation. No other rhythm or conduction disturbances were detected. No organic heart pathology was detected in this group of patients. The mortality rate was 5 (11 %) people. Conclusion. The analysis of 86 cases showed that elderly patients with a heavy premorbid background prevailed. The severe cardiovascular system complications were mainly represented by cardiac arrhythmias and the development of acute myocardial infarction. The fatal outcome occurred on the 8th-22nd day from the onset of the disease. The presence of cardiovascular complications doubles the mortality rate.

Evidence and Current Use of Levosimendan in the Treatment of Heart Failure: Filling the Gap

Levosimendan is a distinctive inodilator combing calcium sensitization, phosphodiesterase inhibition and vasodilating properties through the opening of adenosine triphosphate-dependent potassium channels. It was first approved in Sweden in 2000 for the short-term treatment of acutely decompensated severe chronic heart failure when conventional therapy is not sufficient, and in cases where inotropic support is considered appropriate. After more than 20 years, clinical applications have considerably expanded across critical care and emergency medicine, and levosimendan is now under investigation in different cardiac settings (eg, septic shock, pulmonary hypertension) and for non-cardiac applications (eg, amyotrophic lateral sclerosis). This narrative review outlines key milestones in levosimendan history, by addressing regulatory issues, pharmacological peculiarities and clinical aspects (efficacy and safety) of a drug that did not receive great attention in the heart failure guidelines. A brief outlook to the ongoing clinical trials is also offered.

Острая декомпенсация сердечной недостаточности: актуальные вопросы эпидемиологии, диагностики, терапии

The relevance and importance of the problem of acute decompensation of heart failure (ADHF) for the healthcare system worldwide is due to significant increase in the number of hospitalizations with associated increase in material costs and extremely unfavorable prognosis. The article covers the issues of epidemiology, modern approaches to the diagnosis and treatment of ADHF. The article touches upon the still unsolved problem of differentiation between the terms «acute heart failure» (AHF) and «acute decompensation of chronic heart failure». Particular attention is given to the risk factors and causes of ADHF, the clinical phenotypes of patients, the peculiarities of diagnosis in elderly and «fragile» patients are discussed. In approaches to drug therapy, the emphasis is placed on the tactics of using loop diuretics; doses and methods of their administration are analyzed in terms of effectiveness, influence on prognosis, and methods of achieving and controlling euvolemia are discussed. The importance of prescribing basic therapy for CHF after stabilization of the condition is emphasized, factors that worsen the prognosis are highlighted.

Detection of pathological mechano-acoustic signatures using precision accelerometer contact microphones in patients with pulmonary disorders

Monitoring pathological mechano-acoustic signals emanating from the lungs is critical for timely and cost-effective healthcare delivery. Adventitious lung sounds including crackles, wheezes, rhonchi, bronchial breath sounds, stridor or pleural rub and abnormal breathing patterns function as essential clinical biomarkers for the early identification, accurate diagnosis and monitoring of pulmonary disorders. Here, we present a wearable sensor module comprising of a hermetically encapsulated, high precision accelerometer contact microphone (ACM) which enables both episodic and longitudinal assessment of lung sounds, breathing patterns and respiratory rates using a single integrated sensor. This enhanced ACM sensor leverages a nano-gap transduction mechanism to achieve high sensitivity to weak high frequency vibrations occurring on the surface of the skin due to underlying lung pathologies. The performance of the ACM sensor was compared to recordings from a state-of-art digital stethoscope, and the efficacy of the developed system is demonstrated by conducting an exploratory research study aimed at recording pathological mechano-acoustic signals from hospitalized patients with a chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, and acute decompensated heart failure. This unobtrusive wearable system can enable both episodic and longitudinal evaluation of lung sounds that allow for the early detection and/or ongoing monitoring of pulmonary disease.

Prognostic value of atrial fibrillation in group of patients with myocardial infarction. Long-term observation results

Purpose. To assess the effect of preexisting atrial fibrillation (AF) on prognosis in patients with type 1 myocardial infarction (MI).Material and methods. These patients were selected from 1660 patients with MI admitted to cardiology department of the NWSMU named after I.I. Mechnikov in 2013-2018. They formed the main group (100 patients). The control group included 200 patients with type 1 MI without AF with the same gender, age. In order to balance groups by prognostically significant factors propensity score matching was carried out. Тhen effect of AF on endpoints was assessed.Results. Patients with type 1 MI and preexisting AF have higher comorbidity, lower ejection fraction. In this group in-hospital pulmonary embolism (PE) (9 % versus 1 % in patients without AF, p=0,0011), minor bleeding (21 % versus 9,5 %, p=0,0057), combined endpoint (stroke + PE + mortality) (19 % versus 10,5 %, p=0,0415) were more common. In the long-term period patients with AF had a higher rate of hospitalizations due to decompensation of chronic heart failure (CHF) (OR=2,47 (95 % CI =1,20–5,08), p=0,0137) and higher incidence of minor bleeding (OR=10,77 (95 % CI =2,36–49,24), p=0,0022). Preexisting AF in patients with type 1 MI (after adjustment for prognostically significant factors) increased the risk of all-cause (OR=5,0 (95 % CI =1,5-17,1), p=0,0072) and cardiovascular mortality (OR=4,1 (95 % CI =1,1-14,9), p=0,0236), increased the risk of CHF III-IV (OR=4,9 (95 % CI =1,2–20,4), p=0,0147), but had no effect on the frequency of ischemic events.Сonclusion. In patients with type 1 MI and pre-existing AF in-hospital and long-term prognosis is worse than in patients without AF. Preexisting AF in these patients is an independent predictor of severe CHF at discharge, cardiovascular and all-cause mortality over follow-up period.

Role of Scoring Systems Calculation in Predicting Extracorporeal Life Support Patients’ Outcomes: A Single Centre Experience

Purpose To investigate the predictive value of Acute Physiology, Age and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology (SAPS) II and Sequential Organ Failure Assessment (SOFA) scores for patient selection and timing to Extracorporeal Life Support (ECLS) as treatment of refractory cardiogenic shock. Methods Retrospective analysis of a prospectively-maintained operative dataset. Results Our study population included 185 patients receiving ECLS at our department between 2006 and 2018. Patient median age was 50.6 years; 62% were male. The most frequent reason for ECLS need, in our subset of patients, was post-cardiotomy syndrome (52.4%) followed by acute decompensation of chronic heart failure (17.5%), isolated right ventricular dysfunction (16.2%), acute myocardial infarction (10.2%) and myocarditis (3.7%). Median duration of ECLS was 8.9 days. Forty-one patients (22.2%) received heart transplantation. In-hospital mortality was 34.6% on ECLS running and 25.9% after ECLS removal. Multivariate regression analysis showed patient age, ECLS duration and bridge to transplantation (BTT) category as indipendent predictors of death (p Conclusion This study confirms the poor prognosis of critically ill patients receiving ECLS support. The APACHE II and SOFA scores, mainly, proved to be a reproducible evaluation tool with high prognostic abilities. In our population, age >65 years, ECLS duration >10 days and BTT ECLS intention appear to impact negatively.

Clinical Characteristics of De Novo Heart Failure and Acute Decompensated Chronic Heart Failure: Are They Distinctive Phenotypes That Contribute to Different Outcomes?

Heart failure is currently one of the leading causes of morbidity and mortality. Patients with heart failure often present with acute symptoms and may have a poor prognosis. Recent evidence shows differences in clinical characteristics and outcomes between de novo heart failure (DNHF) and acute decompensated chronic heart failure (ADCHF). Based on a better understanding of the distinct pathophysiology of these two conditions, new strategies may be considered to treat heart failure patients and improve outcomes. In this review, the authors elaborate distinctions regarding the clinical characteristics and outcomes of DNHF and ADCHF and their respective pathophysiology. Future clinical trials of therapies should address the potentially different phenotypes between DNHF and ADCHF if meaningful discoveries are to be made.

Застосування левосимендану порівняно з добутаміном за необхідності інотропної підтримки в пацієнтів з гострою декомпенсованою хронічною серцевою недостатністю тяжкого ступеня

The aim – to conduct clinical effectiveness, meta-analysis of 30 and 120-days mortality data, pharmacoeconomic evaluation of levosimendan treatment compared with dobutamine in patients with severe acute decompensated chronic heart failure (ADCHF) who require inotropic support.Materials and methods. The PubMed and Cochrane databases were searched for direct randomized clinical trials of levosimendan treatment compared with dobutamine in patients with ADCHF. The clinical efficacy of levosimendan and dobutamine was analyzed. Pharmacoeconomic analysis was carried out using the cost-effectiveness method with an assessment of the incremental cost-effectiveness ratio. A decision tree model of levosimendan or dobutamine treatments was constructed. The efficacy endpoints and impact on the budget were analyzed in terms of long-term effectiveness of levosimendan and dobutamine use. Discounted was conducted with rate of 3 %. Sensitivity analysis was carried out in terms of price changing of drugs, the cost of drugs in mg, the likelihood of re-hospitalization of the patient in a 3-year horizon and survival in the long term.Results and discussion. Analysis of clinical data and meta-analysis of randomized clinical trials found that mortality rates with levosimendan and dobutamine in the 30-day period were 9.6 % and 13.8 %, RR 0.71 (95 % CI 0.53–0.95) and in the 120-day period – 13.5 % and 25.2 %, RR 0.54 (95 % CI 0.32–0.92), respectively. The total cost of the course of treatment, taking into account the price of the drug, medical devices, staff services, diagnostic procedures and treatment of adverse reactions when using levosimendan, was 34 003.02 UAH per patient and 18 787.28 UAH when treated with dobutamine. The weighted average hospital stay was 6.4 days in case of levosimendan treatment and 7.5 days of dobutamine treatment. Extrapolation of the data from clinical trials to the 3-year survival rate of patients allowed us to determine an additional indicator of efficacy – the number of life years saved with levosimendan – 2.64 and 2.37 with dobutamine treatment. A cost-effectiveness analysis found that levosimendan is more efficient but more expensive technology compare to dobutamine. The incremental cost-effectiveness ratio for the additional life year saved of a patient with severe CHF is 43,473.55 UAH, which is 6 times less than the likely threshold of willingness to pay in Ukraine.Conclusions. The multivariate sensitivity analysis detected the model sustainability to the most crucial parameters of the model – drug price; the cost of drugs associated with their actual use in mg, the possibility of re-hospitalization of the patient in a 3-year horizon, and long-term survival, which is associated with the time horizon of the model. The total cost of a cohort of patients with ADCHF in Ukraine when using scenario 1 (100 % distribution of costs for dobutamine treatment) over 5 years is 268 188 351.94 UAH, when using scenario 2 (100 % distribution for treatment with levosimendan) total budget costs will be in amount of 485 393 073.09 UAH, if scenario 3 is applied (gradual 5 % transition in the treatment of patients with ADCHF with dobutamine for treatment with levosimendan within 5 years), the total budget costs will amount to 289 916 431.92 UAH.