Heart Failure Functional Class Research Articles

The effectiveness of cardiac resynchronization therapy in patients with chronic heart failure of various origin depending on the structural myocardial injury in cardiac magnetic resonance imaging

Aim. To assess the effect of the size and pattern of myocardial structural injury, determined by magnetic resonance imaging (MRI), on response to cardiac resynchronization therapy (CRT) in patients with ischemic and non-ischemic heart failure (HF).Material and methods. Forty seven patients with ischemic and non-ischemic HF (age 62,3±8,9 years (mean±SD), 44,6% females and 55,4% males), left ventricle (LV) ejection fraction <35%, QRS complex >130 ms, and sinus rhythm were included in the study. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) was undertaken to evaluate myocardial scar prior to CRT devices implantation. All CMR analysis was performed on CVI42 software. According to signal intensity, fibrosis zone and “grey zone” were defined for quantitative analysis (proportion and mass) of injury. Scar zone included fibrosis zone and “grey zone”. Scar location was assessed using a 16-segmentLV model. Response was defined as a reduction inLV end systolic volume of >15% at 6 months follow-up and HF functional class amelioration.Results. In nonresponse group there was significantly higher proportion and mass of total scar (median 4% [2,5; 19] vs 24% [7; 44], p=0,012,6 g [3,5; 32,5] vs41 g [8; 86], p=0,013)), fibrosis zone (median 0% [0; 3,5] vs 8% [0; 19], p=0,01,0 g [0; 6] vs14 g [0; 34], p=0,014) and “grey zone” (4% [2,5; 15] vs 15% [7; 23], p=0,018,6 g [3,5; 27,5] vs23 g [8; 39], p=0,25). Response proportion in non-ischemic HF patients was higher than in ischemic HF patients (78,5% vs 28,5%, p<0,01). Response to CRT was less in patients with posterolateral scar, more specifically in segments 4,5,6,11,12,15,16 (p<0,05). CRT response in ischemic HF did not depend on size of myocardial structural injury, but depend on scar localization. Lateral scar was associated with poor response. In non-ischemic HF, proportion and mass of fibrosis zone was less in responder group (median 0% [0; 1] vs 8,5% [0; 11], p<0,05,0 g [0; 1] vs14,5 g [0; 22], p<0,05.Conclusion. Response to CRT is significantly higher in non-ischemic than in ischemic HF patients. Nonresponse to CRT is associated with posterolateral scar, regardless of the HF origin. In patients with non-ischemic HF, size of fibrosis zone is lower in the responder group. In patients with ischemic HF, size ofLV structural injury does not affect the CRT efficiency, but lateral scar is associated with CRT nonresponse.

INDICATORS OF STRUCTURAL AND FUNCTIONAL CHANGES IN THE MYOCARDIUM AS PREDICTORS OF THE ATRIAL FIBRILLATION IN PATIENTS WITH HEART FAILURE AND PRESERVED EJECTION FRACTION


 
 
 A large number of recent trials suggested that atrial fibrillation (AF) and heart failure (HF) should be considered as two epidemic cardiovascular pathologies that are closely interrelated, each contributing to the development of the other. The purpose of our work was to analyze the peculiarities of the structural and functional parameters of the heart and blood vessels in patients with HFpEF, as well as to determine the most informative predictors of AF and their predictive value. A study of the literature indicates that AF has a close relationship with both HFpEF and the diagnostic criteria used to determine it. The relevance of the study of this pathology is that AF has a significant impact on the course and prognosis of HFpEF. The study was conducted on a case-control design. This work is based on the results of ex- amination of 115 hemodynamically stable patients with arterial hypertension (AH), clinical symptoms and signs of heart failure (HF), with left ventricular (LV) ejection fraction (EF) ≥ 50% and signs of diastolic dysfunction (DD) according to echocardiography data. Patients’ age ranged from 40 to 85 years (mean age 66.3 ± 10.8 years). For the first time, criteria for LV DD were analyzed as possible predictors of atrial fibrillation in patients with HFpEF and thresholds for some of them were determined. The study empirically confirms and theo- retically argues that the presence of atrial fibrillation in patients with HFpEF, in contrast to those with sinus rhythm, is associated with a more severe functional class of HF estimated by NYHA classification; higher by 28.1% NTprоBNP level; increased left ventricular filling pres- sure with LAVI thresholds > 40 ml/m2 and E/e ‘> 14.75; with impaired endothelium-depen- dent vasodilation and an initial decrease in glomerular filtration rate. The results of the study may be useful for the screening and detection of AF in patients with established HFpEF, by monitoring of ECG, in case of detection of threshold values of diastolic LV dysfunction.
 
 

Cytoprotective and metabolic therapy for patients with prior Q-QS wave or non-Q wave myocardial infarction complicated by decompensated heart failure on the background of graded exercises

The objective of the research — to determine the efficacy of rehabilitation treatment of the patients with decompensated heart failure (HF) in the early and late post-infarction period using succinic acid and arginine preparations, as well as to assess their effect on exercise tolerance. Material and methods. There were examined 120 patients with Q-QS wave or non-Q wave myocardial infarction (MI), stage II A-B decompensated chronic HF according to the classification by Vasylenko V. Kh. and Strazhesko M. D., the New York Heart Association (NYHA) functional class (FC) III–IV. The patients with Q-QS wave MI (60 individuals) were divided into 4 groups depending on the treatment method. The patients with non-Q wave MI (60 individuals) were divided into 4 analogous groups. All the patients underwent the six-minute walk test (6 MWT) in a quiet 30–50-m long hospital corridor in the morning. Before performing the 6 MWT, heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured and the standard 12-lead electrocardiogram (ECG) was recorded. Criteria for immediate stopping the test included chest pain, severe shortness of breath, limb cramps, dizziness, unsteady gait, sweating, severe pallor, SpO2 < 86%. Results. When assessing the appearance of clinical signs during physical activity in the patients with prior Q wave MI, the signs such as chest pain, heart rhythm disorders and dizziness were found to increase in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and their combination contributed to a significant reduction in clinical signs of graded exercise inadequacy. Thus, chest pain that accompanied physical activity in 60%, 73.3%, 66.7% of the patients at the beginning of treatment, was observed in one-third of the patients — 20%, 26.7%, 13.3%, respectively, 2 months after the beginning of treatment. Similar tendency was observed when assessing a dynamic of dizziness and cyanosis/pallor cases. When analyzing a dynamic of clinical signs during physical activity in the patients with prior non-Q wave MI, an insignificant reduction in the signs such as chest pain, shortness of breath, heart rhythm disorders and dizziness was observed in the patients undergoing standard treatment. At the same time, the use of succinic acid, arginine preparations and especially their combination significantly reduced clinical signs of inadequate response to physical exercises. The patients of group 4, who walked (174.87±1.92) m before treatment, walked a distance of (369.00±4.71) m after two months of treatment (p<0.05). Similar tendency was observed when analyzing the indicators of the metabolic equivalent of task (MET) and O2 consumption. During a course of treatment of the patients with non-Q wave MI complicated by decompensated HF, a gradual increase in exercise tolerance and motor activity was observed in all the groups. According to the 6 MWT, in all the groups, there was observed a significant increase (p<0.05) in distance walked over a span of 6 minutes both one month and two months after the beginning of treatment. In addition, during the first and especially the second month of treatment, the 6 MWT was accompanied by a significantly less reduction in HR before and after the test. At the same time, despite the one-sidedness of probable dynamics of the characteristics indicated by the 6 MWT in case of standard treatment, a favorable dynamic was less significant. Similar tendency in HR response to physical activity was observed during the process of treating the patients of other groups. In general, a gradual reduction in resting HR and a significantly less increase in peak HR were observed. According to the dynamics of both SBP and DBP, the formation of favorable hemodynamic support of physical activity in the patients of all the groups was observed as well. Similar tendency was observed when analyzing the indicators of the MET and O2 consumption. These indicators were found to be significantly higher in the dynamics of treatment in all groups of the patients. Positive dynamics in the MET and O2 consumption indicators in the patients who, in addition to standard therapy, received a preparation of succinic acid and arginine preparations deserved special attention. Conclusions. In the patients with decompensated heart failure secondary to acute myocardial infarction, basic therapy including arginine and succinic acid preparations contributes to the improvement of the 6 minutes walk test indicators, its individual perception. Succinic acid and arginine preparations in combination with standard therapy for the patients with MI and decompensated HF allows improving clinical signs of performing physical activity there by improving functional class of heart failure.

Experience of transcatheter implantation of CoreValve aortic valve bioprostheses in Clinic of Advanced Medical Technologies named after Nikolay I. Pirogov

Background. Every year the number of operations of transcatheter aortic valve implantation increases, and the number of centers performing this intervention increases too. In this article we present the results of the operation of transcatheter aortic valve implantation at the Clinic of Advanced Medical Technologies named after Nikolay I. Pirogov St. Petersburg State University.Material and Methods. From December 2015 to December 2018, the specialists of the Clinic implanted 46 self-expanding transcatheter aortic valves of 2 generations – CoreValve and CoreValve Evolute R. All patients were patients of high and extremely high surgical risk for severe aortic stenosis. The decision on the implementation of TAVI was taken collectively as part of the “Heart Team”.Results. Most operations were performed under general anesthesia with transfemoral access (89%). In 2 cases (4.3%) the conversion of transcatheter surgery into an open cardiac surgery was required due to the development of intraoperative complications. Hospital mortality was 6.5%, non-fatal complications were 21.7%. Now we have mid-term results of CoreValve valves implantation. The functional class of heart failure is estimated to be no higher than II (by NYHA), the observation period is from 6 months to 2.5 years, and the hemodynamic parameters of the valve are satisfactory. Medterm results from the use of CoreValve Evolute R are expected.Conclusion. The TAVI procedure in patients of high and extremely high surgical risk is an alternative to open operation, showing not-worse (non-inferiority) early and medium-term results. Treatment of patients with intraoperative aortic insufficiency of the 2nd degree requires further improvement. Further research is planned with a view to obtaining long-term TAVI results.

Percutaneous Intervention of Left Main Coronary Artery Chronic Total Occlusion

Chronic total occlusion (CTO) of the left main coronary artery (LMCA) is rare on the angiograms; Coronary Artery Bypass Grafting is the standard method of its revascularization. To demonstrate that PCI may in some cases be a safe option for patients with a high-risk surgical category, we report a complex clinical case of revascularization of chronic total occlusion of the LMCA, left anterior descending artery (LAD), and circumflex artery (CX). Methods Recanalization of the occluded LMCA and LAD was performed by utilizing the support-balloon technique, and CTO wires (Miracle 3™ wire, Abbott Vascular; Runthrough® NS Intermediate wire, Terumo); LAD, CX, LMCA, and its bifurcation, were stented with 3 drug-eluting stents (Resolute Integrity DES, Medtronic); the "Culotte Stenting " technique was used for bifurcation stenting, followed by "Kissing Balloon" post-dilatation technique; proximal optimization technique was performed in the LMCA. Results The intervention ended without complications. 2 months after stenting, the ejection fraction increased from 20% to 38%, improved almost all parameters of the heart, Congestive Heart Failure functional class decreased to class I. Conclusions It should be considered that LMCA CTO lesions can be successfully revascularized with PCI in case of the selection of the suitable patient and appropriate revascularization technique.

P4527Cardiac resynchronization therapy in patients with non-ischemic cardiomyopathy and severe heart failure may influence the development of unstable ventricular tachycardia

Abstract Objective The aim of the study was to determine the effect of cardiac resynchronization therapy (CRT) on the development of unstable ventricular tachycardia in patients with non-ischemic cardiomyopathy (CMP) and to analyze the potential of radionuclide methods in predicting life-threatening arrhythmias in the background of CRT. Materials and methods The study included 100 patients with non-ischemic cardiomyopathy aged from 32 to 75 years (55±12 years). Patients had III functional class of heart failure (HF); left ventricular ejection fraction (LV) (EF) 30.1±3.8%; 6 minutes walk at a distance of 290.5±64.3 m; and the final diastolic volume of the left ventricle (EDV) is 220.7±50.9 ml. Before implantation of the device with CRT and after 1 year, all patients underwent a 24-hour ECG monitoring. Patients were divided into two groups depending on the presence or absence of paroxysms of unstable ventricular tachycardia. The 1st group included 55 patients (55%) with registered paroxysms of unstable ventricular tachycardia with adequate doses of antiarrhythmic drugs. Group 2 consisted of 45 patients (45%) without reported episodes. Prior to CRT, myocardial metabolism defect (MMD) was evaluated in all patients using radionuclide methods. Results Control tests were performed 1 year after the onset of CRT and showed positive clinical dynamics: the left ventricular EF increased from 30.1±3.8% to 42.8±4.8% (p≤0.001); functional class decreased from III to II; The 6-minute walking distance increased from 290.5±64.3 m to 377.2±45.3 m (p≤0.001); and LV EDV decreased from 220.7±50.9 ml to 197.9±47.8 ml (p≤0.005). During 1 year of observation in the first group: 48 patients (80%) had no episodes of unstable ventricular tachycardia; In 7 patients (20%), episodes of unstable ventricular tachycardia were recorded. Evaluation of the effect of increasing EF and reducing EDV on the development of VT paroxysms was performed after the distribution of patients with CRT into subgroups based on the presence or absence of VT episodes. The data showed that in patients whose EF increased by 14%, and EDV decreased by 35 ml during 1 year of CRT, there were no VT episodes, even if VT paroxysms were recorded before CRT. Patients who had VT paroxysms showed an increase in EF of only 9% and a decrease in EDV of only 13 ml. Phase 2 of the study was to assess the impact of MMD changes. In the presence of CRT in patients with less than 15% MMD, there were no VT episodes. VT paroxysms were reported in patients whose MMD exceeded 15%. Conclusions (1) Effective CRT in patents with non-ischemic cardiomyopathy significantly reduces the number of VT episodes. (2) Improving fatty acid metabolism (LVD MMD less than 15%) in patients with non-ischemic cardiomyopathy reduces the incidence of VT episodes against the background of CRT.

Dynamic changes of heart structural and functional condition in patients with acute myocarditis

Diagnosis and prognosis of myocarditis course, which is an inflammatory heart muscle disease, has been and remains one of the most urgent, complex and unresolved problem in modern cardiology. The purpose of the study – to investigate the dynamic changes in the structural and functional heart state in patients with acute myocarditis and reduced left ventricular ejection fraction. Materials and methods. In total, 74 patients with clinically suspected acute myocarditis (AM) with reduced left ventricular (LV) ejection fraction (EF) ≤40 % and NYHA heart failure (HF) functional class II or higher were examined three times: in the first month of myocarditis debut, after 6 and 12 months of observation. All the patients underwent echocardiography and speckle-tracking echocardiography, Holter electrocardiogram monitoring and cardiac magnetic resonance imaging (MRI). Results. It was found that the debut of AM was characterized by the presence of active inflammatory process according to the cardiac MRI - edema and hyperemia of the myocardium were detected in 54.0 % and 70.2 % of cases, respectively, followed by LV dilation and systolic dysfunction as well as by a significant decrease in longitudinal and circumferential LV global systolic strain. After 12 months of observation, there was a significant increase in LV EF, decrease in end-diastolic volume index and an improvement in the parameters of longitudinal and circumferntial LV systolic strain by 30.8 % and 36.8 %, respectively, (P < 0.01), the frequency of active inflammatory changes in the myocardium was significantly reduced, herewith in 41.8 % of cases, delayed enhancement was noted, indicating fibrotic changes in the myocardium. The presence of delayed enhancement in cardiac MRI after 12 months since myocarditis onset was correlated with the presence of unstable ventricular tachycardia episodes (r = 0.62; P < 0.02) and with the frequency of ventricular extrasystoles (r = 0.53; P < 0.05). A significant influence of fibrotic changes in the myocardium on the presence of unstable ventricular tachycardia episodes in 12 months after the disease onset was confirmed by determining Fisher's exact test, its value was: P = 0.016 (P < 0.05). Conclusions. It was established that the debut of myocarditis was characterized by a significant violation of the structural and functional heart state: an active inflammatory process in the myocardium causedLV dilatation and contractile dysfunction. After 12 months, a decrease in detection of active inflammatory myocardial changes followed by regression ofLV dilation and its contractile function improvement was observed. It was proved that the presence of fibrotic changes in the myocardium in patients with myocarditis was associated with the persistence of ventricular rhythm disorders.

P6508Percutaneous versus surgical paravalvular leak: a ten-year tertiary centre experience

Abstract Aims Paravalvular leak (PVL) presents an incidence ranging from 2–17%. Open heart surgery is considered the standard treatment and there is no consensus regarding the role of percutaneous closure of non-endocarditis PVL. Methods Single-centre retrospective study including consecutive patients that had their PVL closed percutaneously or by surgery, after heart team agreement, between 2007 and 2018. The primary goal was to assess mortality and rehospitalizations. The secondary goals were: a) the technical success, defined as reduction in regurgitation [≥1 degree] and b) clinic and laboratorial improvement. Results Forty-eight patients were included (mean age of 66±13 years, 56% male), 12 submitted to percutaneous closure and 36 to surgery (74 vs 65 years, p=0,026, respectively), with similar gender distribution. 56% had an aortic PVL, with the remainder having a mitral leak, with no difference between groups. The indications were heart failure in 91% and haemolytic anaemia in 42%. A combination of both indications and NYHA heart failure functional class ≥ III were higher in percutaneous group. The severity of leak was comparable in both groups. Patients treated percutaneously had a significant higher rate of atrial fibrillation (92% vs 42%), COPD (33% vs 3%), peripheral artery disease (58% vs 22%) and higher EuroScore II (13,1% [7,1 - 19,0 CI 95%] vs 4,1 [2,9 - 6,5 CI 95%], p=0,003). There was no significant difference between groups with respect to all- cause mortality at 6 months, and to cardiovascular (CV) mortality and CV rehospitalization at 1-year follow-up. The technical success was lower in percutaneous group, but clinic and laboratorial results did not differ (table). Primary and secondary [(a) tecnical success (b) clinical and laboratorial improvements] endpoints of percutaneous vs surgery paravalvular leak closure Percutaneous PVL closure Surgical PVL Closure p-value Mortality @ 6 M 17% 25% p=1.000 CV Mortality @ 12 M 25% 31% p=1.000 Rehospitalization @ 12 M 18% 21% p=0.694 Technical success (a) 75% 97% p=0.043 NYHA improvement (b) 70% 71% p=0.171 Hb improvement (b) mean Δ: 1.2±1.1 g/dl mean Δ: 1.3±2.5 g/dl p=0.737 LDH reduction (b) mean Δ: −682±828 U/L mean Δ: −473±1215 U/L p=0.577 Conclusions In this high-risk population, clinical and laboratorial improvement was achieved by both methods. The percutaneous technique seems more appropriate for patients with higher risk, despite a lower technical success in the reduction of the severity of the leak.

Cardiac effects of moderate thyrotoxicosis and their changes after surgical treatment of toxic goiter

Introduction. To date, only few studies have been conductedon influence of surgical treatment of patients with toxic goiter on thyrotoxic structural and functional changes in the heart, tolerance to exercise and func­tional class of heart failure. The aim of the study was to examine the influence of surgical treatment of toxic goiter with moderate thyrotoxicosis on the patients’tolerance of physical activity, structural and functional changes in the heart, and severity of cardiac disorders. Material and methods. The studyincluded 97 pa­­tients with toxic goiter of different etiology. The subjects of the study were changes in functional class of heart failure, tolerance to physical activity, structural and functional disorders of the myocardium,cardiac rhythm abnormalities, and general condition. For this purpose, the results of the tests one year after thyroi­dectomy were compared with the data obtained after the achi­evement of euthyroid stateaspreparation for surgery. Patients underwent hormonal tests (TSH, T4 free, Anti-TPOAb, NT-pro-BNP), daily Holter monitoring, echo­cardiography, and six-minute walk test. For sta­­tistical analysis, parametric and nonparametric met­hods were used.The significance of difference between the samples was estimated by the Mann-Whitney U-criterion. Results and discussion. It was found that in 67 patients (69.1 %) had physical activity improved.Also in these patients, functional class of heart failure was improved, cardiac rhythm disorders were not deter­mined, systolic and diastolic functions of the heart were restored. In 28 (28.8 %) patients, improvement of the general condition was noted, tolerance to physical activity slightly increased, and functional class of heart failure did not change. In 2 (2.1 %) cases, general condition, cardiac disorders, structural-functional ab­­nor­malities of heart and the functional class of heart failure remained unchanged. Conclusions. Surgical treatment of patients with moderate thyrotoxicosis allows restoring physical activity and normalize cardiac activityin 2/3 of cases. The reason of the inferior rehabilitation of patients after surgical treatment is the irreversible structural changes in the myocardium that arose as a result of unreasonably extended and insufficiently effective drug treatment of toxic goiter and thyrotoxicosis. The severity of long-term results of surgical treatment worsens with the increase in the duration of drug treatment for patients with thyrotoxicosis.

Use of Free-Living Step Count Monitoring for Heart Failure Functional Classification: Validation Study.

BackgroundThe New York Heart Association (NYHA) functional classification system has poor inter-rater reproducibility. A previously published pilot study showed a statistically significant difference between the daily step counts of heart failure (with reduced ejection fraction) patients classified as NYHA functional class II and III as measured by wrist-worn activity monitors. However, the study’s small sample size severely limits scientific confidence in the generalizability of this finding to a larger heart failure (HF) population.ObjectiveThis study aimed to validate the pilot study on a larger sample of patients with HF with reduced ejection fraction (HFrEF) and attempt to characterize the step count distribution to gain insight into a more objective method of assessing NYHA functional class.MethodsWe repeated the analysis performed during the pilot study on an independently recorded dataset comprising a total of 50 patients with HFrEF (35 NYHA II and 15 NYHA III) patients. Participants were monitored for step count with a Fitbit Flex for a period of 2 weeks in a free-living environment.ResultsComparing group medians, patients exhibiting NYHA class III symptoms had significantly lower recorded 2-week mean daily total step count (3541 vs 5729 [steps], P=.04), lower 2-week maximum daily total step count (10,792 vs 5904 [steps], P=.03), lower 2-week recorded mean daily mean step count (4.0 vs 2.5 [steps/minute], P=.04,), and lower 2-week mean and 2-week maximum daily per minute step count maximums (88.1 vs 96.1 and 111.0 vs 123.0 [steps/minute]; P=.02 and .004, respectively).ConclusionsPatients with NYHA II and III symptoms differed significantly by various aggregate measures of free-living step count including the (1) mean and (2) maximum daily total step count as well as by the (3) mean of daily mean step count and by the (4) mean and (5) maximum of the daily per minute step count maximum. These findings affirm that the degree of exercise intolerance of NYHA II and III patients as a group is quantifiable in a replicable manner. This is a novel and promising finding that suggests the existence of a possible, completely objective measure of assessing HF functional class, something which would be a great boon in the continuing quest to improve patient outcomes for this burdensome and costly disease.

Порівняльний аналіз структурно-функціонального стану серця у хворих із хронічним міокардитом та дилатаційною кардіоміопатією

The aim – to establish differences in the structural and functional state of the heart in patients with chronic myocarditis and dilated cardiomyopathy and to investigate their associations with the presence of cardiac rhythm disorders.Materials and methods. We included 95 patients who were divided into two groups: the first group consisted of 55 patients with chronic myocarditis (CM), the second group included 40 patients with dilated cardiomyopathy (DCM). All patients had heart failure (HF) II or higher functional class (FC) according to the classification of the New York Heart Association (NYHA) and a reduced left ventricular (LV) ejection fraction (EF). All patients underwent the echocardiography (EchoCG) with speckle tracking (ST), Holter electrocardiogram monitoring and cardiac magnetic resonance (CMR) imaging. Results and discussion. A comparative analysis of the EchoCG data revealed that CM was characterized by lower values of LV end-diastolic and end-systolic volume indexes (by 21.7 and 28.6 %, respectively, p&lt;0.01) and by 16.8 % (p&lt;0.05) higher value of LV EF compared to DCM; when studying the results of ST EchoCG, it was found that in patients with CM, the absolute values of the longitudinal, circumferential and radial global systolic LV strain were by 25.0; 23.7 and 28.5 %, respectively, higher compared with patients with DCM (p&lt;0.05–0.01). The obtained data were confirmed by the results of 6-minute walking test, so patients with DCM demonstrated the lower tolerance to physical exercise comparing with CM. When performing CMR in patients with CM, along with inflammatory changes in the myocardium (edema and hyperemia), fibrotic changes were present, while DCM was characterized only by diffuse fibrotic changes of the heart. The association between the presence of delayed enhancement on CMR and episodes of unstable ventricular tachycardia was proved for both CM and DCM – the result of Fisher’s exact test was p=0.019 and p=0.027 respectively.Conclusions. In patients with DCM compared with CM we found more significant impairment of the structural and functional state of the heart, that was manifested by the presence of the worst heart failure functional class and a lower tolerance to exercise test. It has been established that fibrotic changes of the myocardium both in CM and in DCM are associated with the presence of ventricular arrhythmias, including such potentially dangerous ones as episodes of unstable ventricular tachycardia.

The reverse triiodothyronine and heart failure

Objective — to investigate the effects of high levels of reversible triiodothyronine (T3r) on the course of heart failure (HF).Materials and methods. The examinations involved 221 patients with HF against the background of postinfarction cardiosclerosis. The investigations included determinations of the serum levels of thyroid stimulating hormone (TSH), free (T3 (T3fr)) and thyroxin (T4 (T4fr)), reversible T3 (T3r), echocardioscopy and study of the HF course.Results and discussions. The HF patients were divided into 2 groups according to the following criterion: the first group included 175 (79.19 %) patients with normal serum T3r (&lt; 350 pg/ml). The second group included 46 (20.81 %) patients with a high level of this hormone ≥ 350 pg/ml. In patients with HF and with a high level of T3r II functional class (FC) by NYHA HF was 30 % more often compared to frequency in patients with normal level of the hormone (c2 = 7.711, p = 0.021); non­toxic goiter (0 vs. 8.0 %, at c2 = 3.953, p = 0.047). These patients had an increased level of granulocytes (5.3 %, p = 0.043), decreased relative levels of monocytes (7.14 %, p = 0.003); increased content of TSH (35.0 %, p = 0.001) was also found, with a concordant increase in T4fr (17.0 %, p = 0.002) and T3fr (11.7 %, p = 0.041). These patients also had a lower left ventricular ejection fraction (5.26 %, p = 0.037), a thinner interventricular sept (2.5 %, p = 0.007), increased left (2.22 %, p = 0.007) and right (at 1.86 %, p = 0.003) atrium size, compared to those values in patients with normal levels of reversible triiodothyronine. The serum T3r level had a positive relationship with the presence of atrial fibrillation (r = 0.176, p = 0.028), with a relative granulocytes’ levels (r = 0.363, p &lt; 0.001); negative with thickness of the interventricular sept in diastole (r = –0.169, p = 0.048), with relative monocyte levels in blood (r = –0.204, p = 0.018). The model of high T3r level for HF included: FC HF (a = 0.160, p = 0.008), free T3 level (a = 0.095, p = 0.009), age of the first MI development (a = 0.012, p = 0.026).Conclusions. The increased T3r level was revealed in 20.8 % of HF patients with at hospitalization. The patients with increased T3r level had significantly increased granulocytes (by 5.3 %), decreased relative monocytes’ levels (by 7.1 %), increased TSH levels (by 35.0 %) with concordant increasing of T4fr (on 17.0 %) and T3fr (by 11.7 %). Besides, they demonstrated smaller ejection fraction of the left ventricle (5.26 %), decreased size of the left (2.22 %) and right (1.86 %) atriums. The serum T3r level had a positive correlation with the presence of atrial fibrillation (r = 0.176, p = 0.028) and relative granulocytes’ levels (r = 0.363, p &lt; 0.001); negative correlation with the thickness of the interventricular sept in diastole (r = –0.169, p = 0.048), and with the relative blood monocytes’ levels (r = –0.204, p = 0.018). The regressive model of the high T3fr levels included the following parameters: HF FC (a = 0.160, p = 0.008), T3r level (a = 0.095, p = 0.009), and age of the first myocardial infarction (a = 0.012, p = 0.026).

The Relationship Between Functional Class of Heart Failure and Anxiety Level in Patient with Heart Failure

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Randomized controlled trial of influenza vaccine in patients with heart failure to reduce adverse vascular events (IVVE): Rationale and design

BackgroundInfluenza is associated with an increase in the risk of cardiac and other vascular events. Observational data and small randomized trials suggest that influenza vaccination may reduce such adverse vascular events.Research Design and MethodsIn a randomized controlled trial patients with heart failure are randomized to receive either inactivated influenza vaccine or placebo annually for 3 years. Patients aged ≥18 years with a clinical diagnosis of heart failure and NYHA functional class II, III and IV are eligible. Five thousand patients from 10 countries where influenza vaccination is not common (Asia, the Middle East, and Africa) have been enrolled. The primary outcome is a composite of the following: cardiovascular death, non-fatal myocardial infarction, non-fatal stroke and hospitalizations for heart failure using standardized criteria. Analyses will be based on comparing event rates between influenza vaccine and control groups and will include time to event, rate comparisons using Poisson methods, and logistic regression. The analysis will be conducted by intention to treat i.e. patients will be analyzed in the group in which they were assigned. Multivariable secondary analyses to assess whether variables such as age, sex, seasonality modify the benefits of vaccination are also planned for the primary outcome.ConclusionThis is the largest randomized trial to test if influenza vaccine compared to control reduces adverse vascular events in high risk individuals.Trial registration numberClinicaltrials.govNCT02762851

Morphofunctional Features of The Diaphragm in Patients With Chronic Heart Failure

to study changes in the volumes of muscle, fat, and connective tissue in postmortem issue samples (autoptates) from diaphragm, right ventricle, lower limb (gastrocnemius muscle), as well as morphological changes of the diaphragm muscular structure in patients with different functional classes of heart failure (HF), and to compare them with some intravital parameters of external respiration (with maximal inspiratory pressure and its amplitude simultaneously measured by ultrasound method in particular). Autoptates of the diaphragm muscle, right ventricle, lower limb (n=39) from 20 men and 19 women (with in vivo diagnosis CHF NYHA functional class (FC) I-IV, hypertension, ischemic heart disease) were examined within 24 hours after the fatal outcome. Light optical microscopy was used to assess the percentages of muscle, connective, adipose tissue, numbers of fibroblasts, and collagen fibers. Spirometric measurements, measurement of respiratory muscles strength, and examination of the diaphragm contractile function were performed by echolocation 56.7±11.9 days before death. In patients of all NYHA FCs most pronounced changes of volume of muscle tissue were observed in the right ventricle and diaphragm, while less pronounced - in the gastrocnemius muscle. The increase in the volume of adipose tissue in patients with I-III FC CHF was most pronounced in the right ventricle and diaphragm, and less pronounced - in the gastrocnemius muscle. The greatest increase in the adipose tissue volume was recorded in the diaphragm of patients with IV FC. Changes of connective tissue volume did not follow linear dependence. The largest "leap-like" increase in the volume of connective tissue occurred in the diaphragm of patients with III FC, what significantly outstripped this process in peripheral muscles and right ventricular myocardium. There was stable relationship between structure of tissue of the diaphragm, maximal inspiratory thickness of diaphragmatic muscle, and maximal inspiratory pressure. This relation (correlation) was positive for pairs muscle tissue volume - muscle thickness and muscle tissue volume - inspiratory pressure, and negative for pairs connective tissue volume - muscle thickness, connective tissue volume - inspiratory pressure, adipose tissue volume - inspiratory pressure (r&gt;0.85, p&lt;0.01 for all these correlations). Morphofunctional changes in the diaphragm are caused by progressive decrease in the content of muscle tissue, increases of volumes of adipose and connective tissues. These changes correlate with the CHF FC, maximal inspiratory thickness of diaphragmatic muscle, and maximal inspiratory pressure. Severity of these morphological changes is maximal in patients with FC III CHF.

Usefulness of Upper and Lower Limb Muscles Strength in the Evaluation of Clinical Severity of Heart Failure in Elderly Patients

Aim: Assess upper and lower limb functions in elderly with heart failure (HF) and evaluate its relation to HF severity. Methods: Handgrip strength (HGS) in kilograms (kgs.) of both hands using handle mechanical dynamometer and counting the repetitions (rep.) of stand and sit on a chair during 30 seconds [the 30 seconds chair-stand test (CST)] were used in 71 elderly (≥65 years old) patients with clinically stable HF and other matched 32 healthy elderly as a control. HF was diagnosed clinically, by plasma B-Type natriuretic peptide (BNP) and by echocardiography. The New York Heart Association (NYHA) functional classification of HF was used to obtain two groups: NYHA class I-II (33 patients), and NYHA class III (38 patients). Results: Showed significant decrease in both HGS and CST score in all HF patients (9.7 ± 4.4 kgs., 8.8 ± 3.1 rep., respectively) compared to controls (77.8 ± 11 kgs., 13.5 ± 1.1 rep., respectively, p Conclusion: Upper and lower limb muscles strength, assessed by two easy andinexpensive tests (HGS and CST), may reflect clinical severity of HF in elderly patients who cannot usually perform exercise tests. Its prognostic value requires further follow-up studies to verify.

Study of glucocorticoid therapy efficiency in patients with chronic myocarditis

One of the most urgent issues of non-coronary heart disease remains the expediency of prescribing immunosuppressive therapy with glucocorticoids (GC) in patients with chronic myocarditis. The purpose of the study was to perform a comparative analysis of the structural and functional heart state in patients with chronic myocarditis who received or did not receive glucocorticoid therapy. The study included 58 patients with chronic myocarditis with reduced left ventricular ejection fraction (LV) and presence of II or higher functional class of heart failure according to New York Heart Association criteria, which were divided into 2 groups: the 1st group consisted of 30 patients who, in addition to standard heart failure therapy, were treated with methylprednisolone 0.5 mg/kg for 4 months with a gradual subsequent dose reduction, and the 2nd group included 28 patients who did not receive immunosuppressive therapy. All patients underwent for a 6-minute walk test, echocardiography with speckle-tracking and cardiac magnetic resonance imaging (CMR). The examination was carried out before the appointment of the GC and after 6 months of treatment. For statistical processing of the results, the software Exсel XP (Missrosoft Office, USA) and statistical program Statistica for Windows 6.0 (Statsoft, USA) were used. Prior to treatment, both groups were comparable to the results of a 6-minute walk test and all echocardiographic parameters, inflammatory and fibrotic changes in the myocardium were detected with approximately same frequency. After 6 months of GC therapy, it was found that the end-diastolic volume index in the 1st group was 17.5% (P &lt;0.05) less and value LV ejection fraction was 13.5% (P &lt;0.05) higher in comparison with the 2nd group, in addition the value of global longitudinal systolic strain was also 27.5% (P &lt;0.01) higher in the 1st group. The frequency of active inflammatory changes detection on CMR - myocardial edema and hyperemia in the 1st group after 6 months was 16.6% and 20.0% respectively, that presented as almost twice lower than in the 1st group; fibrotic changes in the myocardium in 1st group were observed in 66.6% of cases, which was 1.7 times more frequent than in the 2nd group. Significant influence of the appointment of immunosuppressive therapy on the absence of inflammatory changes in the myocardium was confirmed by correlation analysis: the use of GC was associated with the absence of edema and myocardial hyperemia after 6 months of treatment - (r = -0,82; P &lt;0,01) and (r = -0.76; P &lt;0.01) respectively. In patients with chronic myocarditis receiving immunosuppressive therapy, inflammatory changes in the myocardium (edema and hyperemia) were found to be much less common, the end diastolic volume index was significantly lower, LV ejection fraction and parameters of longitudinal global systolic strain were higher in comparison with patients who did not receive GC treatment.

Chronic heart failure with an&#x0D; intermediate ejection fraction of the left ventricle in patients hospitalized in the cardiology hospital.

Aim. Identification of clinical, anamnestic, etiological, echocardiographic features of chronic heartfailure with an intermediate ejection fraction of the left ventricle among patients hospitalized in the cardiology hospital. Material and methods. Analyzed 423 hospitalization. The diagnosis of CHF was present 378patients (89,6%), the median age was 62 [56; 69]. All patients underwent six-minute walk test, followed by determination of the functional class of heart failure, ultrasound of the heart. Results. In the group of patients Cnppv met significantly less complaints of shortness of breath and weakness, in comparison with patients suffering from Snfu and Ssfv (p&lt;0.05). The severity of violations of the functional state ofpatients with CHF was progressively increased by reducing the levels of LVEF less than 40%. The vast majority of the reason for the development of CHF was a combination of coronary heart disease and arterial hypertension found in 82% of cases in the total cohort. In isolation, these diseases were the cause of heart failure in 3% (coronary heart disease) and 3.4% (arterial hypertension) patients. Conclusion. The incidence of heart failure with an intermediate ejection fraction of the left ventricle among patients with CHF, hospitalized in the cardiology hospital, was 12%. Patients Cnppv had removed the clinical symptoms, despite significant pathological changes in echocardiographic parameters. In addition, the development of Snpf in 93% of cases on a background of myocardial infarction significantly aggravates the prognosis of life ofpatients suffering this pathology.

Cardiac remodeling hypertensive patients with different forms of thyroid dysfunction

Objective . To analyze the changes in the structural and functional characteristics of the heart, clinical severity of heart failure (HF) and the levels of N-terminal fragment of the brain natriuretic peptide (NT-proBNP) in patients with arterial hypertension (HTN) and various forms of the thyroid dysfunction (TD). Design and methods. The total of 101 HTN patients were included in the study: 40 with hypothyroidism; 39 — with hyperthyroidism, 22 — without any TD. Control group consisted of 20 persons without any cardiovascular pathology and TD. Basic structural and functional parameters of the heart, serum levels of NT-proBNP were studied. Results . In patients with TD, HF was revealed significantly more often than in the group of AH without TD. There with patients with hypothyroidism had higher, HF functional class compared to the group of hyperthyroidism. In the group of HTN with hypothyroidism left ventricular (LV) hypertrophy and decrease of E/A ratio were observed, whereas patients with HTN and hyperthyroidism were characterized by LV dilatation and by a significant increase of serum NTproBNP level. Conclusions. In HTN patients with hyperthyroidism cardiac remodeling is characterized by the prevalence of LV dilatation, whereas in hypothyroidism LV hypertrophy with LV diastolic dysfunction dominate. Hyperthyroidism is also associated with increased NT-proBNP serum levels.

Efficiency of vaccine prophylaxis concentrated pneumococcal vaccine in patients with chronic obstructive lung disease and chronic heart failure.

The article uses the analysis of clinical and pharmacoeconomic effectiveness of 13-valent conjugated pneumococcal vaccine in patients with combined course of chronic obstructive pulmonary disease (COPD), ischemic heart disease (IHD) and chronic heart failure (CHF). 429 male patients with diagnoses of COPD, IHD, CHF were included in the study. The main endpoints of observation, for 5 years, for evaluation of effectiveness were dynamic assessment for class CHF, the number of exacerbations, hospitalizations, the number of pneumonias. The 13-valent conjugated pneumococcal vaccine (PCV13) Prevenar-13 was used for vaccine prophylaxis. The increase in age with the combined course of COPD and cardiovascular pathology leads to a deterioration in the basic clinical and functional indicators. With the increase in the clinical symptoms of the defeat of the respiratory system. There is an increase in the functional class of heart failure. Inclusion of vaccine prophylaxis PCV13 in the management plan of patients with combined pathology. Reduce the degree of dyspnea and stabilize the main functional indicators. Vaccination of patients with COPD using PCV13 combined with CHF and IHD made it possible to manage the health system expenses by 74-84%.