Heart Failure Functional Class Research Articles

National experience of alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy: A long-term multicenter retrospective study

ObjectivesHypertrophic cardiomyopathy (HCM) is a widespread disease with an incidence of 1:200 in the general population and its surgical and interventional treatment is well-developed in western countries. This study is focusing on outcomes of HCM patients after alcohol septal ablation in Russian Federation. MethodsWe conducted a multicenter registry to evaluate outcomes of obstructive hypertrophic cardiomyopathy (oHCM) patients after ASA.Our study was focused on the following outcomes: (i) 30-day mortality, (ii) 30-day permanent pacemaker implantations, (iii) a residual obstruction occurrence, (iv) final maximal left ventricular outflow tract gradient, (v) long-term mortality, (vi) final heart failure functional class, (vii) freedom from sudden cardiac death. We conducted secondary analysis to assess outcomes in patients with single versus repeated ASA. The mean follow-up was 71±47 months. ResultsA total of 597 consecutive patients (54.9% female) were enrolled in the Russian Alcohol Septal Reduction (RASA) registry from three interventional groups. The mean age was 56±14 years. Thirty-day mortality rate was 0.7% (4 patients). Permanent pacemakers were implanted in 42 (7%) cases in 30-days follow-up. The resting LVOT gradient reduced from 64±28 to 20±13 mmHg (P<0.0001), and the mean NYHA class decreased from 2.3±0.7 to 1.3±0.5 (P<0.001). Long-term survival rates were as follows: 97.4 (95%CI: 96.2-98.7) %, 93.2 (95%CI: 91.0-95.3) %, 84.9 (95%CI: 80.7-89.4) % at 1-, 5-, 10-year follow-up, respectively. Patients after repeated ASAhad similar long-term survival comparing to those who underwent single ASA (weighted log rank P value = 0.254). Heart failure class in the long-term and final gradient at the last follow-up were not statistically different between groups under study (P>0.05). ConclusionsIn our registry, alcohol septal ablation in patients with obstructive hypertrophic cardiomyopathy was safe in the short- and long-term follow-up. Outcomes of patients underwent repeated ASA were non-inferior to those after single ASA.

Depression, health-related quality of life and life satisfaction in patients with heart failure

Background: The Patient Health Questionnaire 9 (PHQ9) has been recognized as an effective tool for identification of patients with heart failure (HF) at risk for lower health-related quality of life (HRQoL). We aimed to compare HRQoL levels, overall satisfaction with health and life, disease severity variables, sociodemographic variables and behavioural risk factors between patients with HF with different levels of depressive symptomatology. Methods: In a &gt;55 years-old general population cross-sectional HF prevalence study, 1851 subjects were screened and those with NTproBNP ≥125 pg/mL (n=930) underwent detailed diagnostic visit to confirm or rule out HF as per 2016 European Society of Cardiology guidelines. HRQoL (the ShortForm 12 Health Survey, SF12; EQ5D3L), depressive symptoms (Patient Health Questionnaire, PHQ9) and satisfaction with life (Satisfaction With Life Scale, SWLS) were also assessed. Patient with HF (75±8 years, 54 % male, New York Heart Association (NYHA) functional class IIII, with mean left ventricular ejection fraction (LVEF) 56±13) were divided into three groups based on the severity of depressive symptomatology as per PHQ9 score (none: score 04, mild: score 59, and moderate-to-severe: score 1027). Multiple group comparisons and pairwise post hoc analyses were performed. Results: Results indicated significant between group differences in NYHA status (p&lt;0.001), number of comorbidities (p=0.006), functional capacity (p=0.01), as well as HRQoL variables (p=0.05 to 0.001) and SWLS score (p&lt;0.05), with nondepressed group generally showing better physical and subjective indicators of health and wellbeing compared with the mild and moderate-to-severe group. Conclusions: Results indicate that even patients with HF with clinically non-significant levels of depressive symptomatology show significantly impaired psychosocial status (diminished HRQoL, lower life satisfaction).

Hospitalized Advanced HeartFailure With Preserved vs Reduced Left Ventricular Ejection Fraction: A Global Perspective.

Outcomes of hospitalized patients with heart failure (HF) and characteristics of advanced HF stage may vary across left ventricular ejection fraction (LVEF) and world regions. This study sought to analyze characteristics of hospitalized advanced HF patients across LVEF spectrum, world regions, and country income. Among 18,553 hospitalized patients with acute HF (7,902 new-onset HF and 10,651 decompensated chronic HF) enrolled in the global registry REPORT-HF (International Registry to Assess Medical Practice With Longitudinal Observation for Treatment of HeartFailure), we analyzed characteristics and outcomes of patients with advanced HF, defined as previously diagnosed HF; severe symptoms before current admission (NYHA functional class III/IV); and≥1 HF-related hospitalization in the preceding 12months, excluding the current. Differences among hospitalized advanced HF subgroups stratified by LVEF, world region, and country income were examined. Among 6,999 patients with decompensated chronic HF and available previous NYHA functional class and HF hospitalization status, 3,397 (48.5%; 18.3% of the total population) had advanced HF. Of these, 44.5% had severely reduced (≤30%), 34.9% mildly/moderately reduced (31%-49%), and 20.7% preserved (≥50%) LVEF. Patients from Eastern Europe had the lowest 1-year mortality (23%), whereas those from Southeast Asia had the highest (37%). Patients from lower-middle-income countries were younger, with shorter HF duration and lower comorbidity prevalence, received fewer beta-blockers and HF-devices, and had higher 1-year mortality (34%) than upper-middle- (26%) or high-income countries (27%; P=0.018). Adjusted 1-year mortality risk did not differ among LVEF subgroups (all P > 0.05), nor did 1-year HF hospitalization rate (P=0.56). Hospitalized patients with advanced HF and preserved LVEF had similarly adverse outcomes as those with reduced LVEF. Patients from lower-middle-income countries had less implementation of HF therapies and higher 1-year mortality.

To the question of thrombotic and hemorrhagic complications in patients with COVID-19

COVID-19 is characterized by various adverse consequences and complications, the prevention of which affects the outcome of the disease. Aim of the study was to investigate the thrombohemorrhagic events of COVID-19 infection. Material and methods. This study involved 403 patients with novel coronavirus infection; the patients were divided into 2 groups: 75 with COVID-19 complications and 328 patients without complications. Metabolic disorders, features of lung damage, comorbidity, signs of inflammation and coagulation, treatment outcomes, peculiarities of thrombotic events and hemorrhages development were studied. Results and its discussion. Thrombohemorrhagic complications of COVID-19 occurred mostly in patients with angina pectoris, coronary artery sclerosis and chronic heart failure of functional class II–III, as well as decompensated diabetes mellitus and obesity. These coronavirus infection effects are often accompanied by an increase in content of inflammatory markers such as CRP and ferritin, as well as of hypercoagulability (D-dimers). Conclusions. Manifestations of inflammatory coagulopathy in patients infected by COVID-19 increases risk of thrombohemorrhagic complications.

Pulmonary hypertension in ischemic heart failure: a pilot study

Aim. To evaluate the role of cardiopulmonary system assessment in a group of patients with pulmonary hypertension (PH) associated with ischemic heart failure (HF) with the right ventricular-pulmonary arterial (RV-PA) coupling.Material and methods. Forty stable patients were examined. The patients were divided into 3 groups depending on the left ventricle ejection fraction (LVEF). PH was established by using expert transthoracic echocardiography. RV-PA coupling was calculated by 2 following ways: as tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) ratio and as TAPSE´Pulmonary Artery Aceleration Time (pACT) multiplication.Results. The patients included in the study were mainly men (73,8%), functional class PH II-III (95,2%), stage IIB CHF (62%). The highest values of TAPSE (18,6±3 mm) and RV-PA coupling (0,64±0,42 mm/mm Hg) were found in the patients with preserved LVEF. In the general cohort, high level of NT-proBNP corresponds to reduced values of RVPA coupling (rs=-0,563) and TAPSE (rs=-0,666; p&lt;0,01). The severity of PH directly affects the level of NT-proBNP (p&lt;0,01). As the stage of HF and PH functional class increases, the indicators of PASP, inferior vena cava diameter and NT-proBNP level significantly increase, as well as TAPSE and RV-PA coupling decrease (p&lt;0,05). Different calculating methods of RV-PA coupling has a strong correlation (rs=0,832; p&lt;0,01).Conclusion. The right heart and RV-PA coupling assessment in patients with ischemic HF of origin is of significant value for the early diagnosis of PH and timely clinical decision-making.

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

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

Cluster approach to identifying the 5-year prognosis of patients with chronic heart failure of ischemic etiology

BACKGROUND: The phenotypic and pathophysiological heterogeneity of patients with chronic heart failure increases the interest of researchers in grouping according to similar clinical and genetic characteristics based on cluster analysis. AIM: To identify phenotypic subgroups in a multivariate cohort of patients with chronic heart failure secondary to coronary artery disease using uncontrolled cluster analysis of clinical, instrumental and genetic components. MATERIAL AND METHODS: 470 patients with chronic heart failure of functional class I–IV, stable course, ischemic etiology of both sexes at the age of 66.4±10.4 years were examined. A clinical study was conducted, genotyping single nucleotide polymorphisms rs10927875 of the ZBTB17 gene, rs247616 of the CETP gene, rs1143634 of the IL-1β gene, rs1800629 of the TNF gene, rs1800795 of the IL-6 gene was carried out, and patient outcomes were assessed for 5 years. Quantitative data were presented as mean and standard deviation or median and interquartile range; categorical — as frequencies and percentages. Categorical intergroup differences were tested using the χ2 test, and quantitative differences were tested using the Student/Mann–Whitney test. Hierarchical clustering was carried out according to 44 demographic, clinical, genetic variables, time to event was analyzed by the Kaplan–Meier method, risk ratio — by Cox regression. Statistical processing was carried out in the R4.3.1 program. RESULTS: Two clusters of patients with heart failure were identified. Cluster 1 (66%) included older patients of both sexes, predominantly functional class III–IV chronic heart failure, with enlarged heart chambers, reduced left ventricular ejection fraction, higher heart rate, atrial fibrillation and left ventricular hypertrophy. In this cluster, more carriers of the GG genotype of the rs1800795 polymorphism of the IL-6 gene (p 0.001) and the CT genotype of the rs247616 polymorphism of the CETP gene (p=0.014) were identified. Cluster 2 (34%) was represented predominantly by younger women, with a higher metabolic index, a history of myocardial infarction and coronary intervention, smokers, and a larger proportion of the TT genotype of the rs247616 polymorphism of the CETP gene (p=0.029). CONCLUSION: 2 clusters of patients with chronic heart failure, characterized by a different set of 44 variables that determine the risk of death from all causes, were identified.

Set of heart failure early mortality prevention methods

Heart failure is a common chronic disease with a poor prognosis that often ends in death. The research thus aims to thoroughly investigate ways in which the prognosis of heart failure could be improved. For this purpose, a 9-month study was conducted with a group of people who followed the Mediterranean diet, and the effects of this diet on the cardiovascular system and the state of the body as a whole were assessed. The study found that adherence to the principles of the Mediterranean diet improved the quality of life of patients, according to the quality-of-life questionnaire (the average score was 81.3 at the beginning of the study and 87 points at the end of the study), and the level of adherence to the Mediterranean diet in the study group increased from 30 points to 39.7, according to the MedDietScore (MDS) scale. There was also an improvement in appetite and sleep quality. A decrease in the average blood pressure in the group was recorded (from 140/95 to 137/88 mmHg). It was found that due to proper nutrition, the participant’s Body Mass Index (BMI) was reduced (from 31.2 kg/m2 to 29.6 kg/m2), and the percentage of overweight people in the study group was also reduced from 44% to 26%. It was noted that no deterioration in heart failure class or functional class was recorded during the study. The left ventricular ejection fraction remained unchanged.

Association of point-of-care testing for sST2 with clinical outcomes in patients hospitalized with heart failure.

This study aimed to investigate the association of soluble suppression of tumorigenicity-2 (sST2) measured by point-of-care testing assay with clinical outcomes in patients hospitalized with heart failure after adjusting for other predictors including N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T (hs-cTnT). A total of 1726 consecutive patients hospitalized with heart failure from July 2015 to December 2021 were enrolled. Baseline serum sST2 concentrations were measured by immunofluorescence assay. Primary endpoint event was the composite of all-cause death, heart transplantation, or left ventricular assist device. During the median follow-up duration of 682days, 434 patients (25.1%) suffered from primary endpoint events. Baseline sST2 remained an independent predictor of the primary endpoint event in patients hospitalized with heart failure after adjusting for other predictors including NT-proBNP and hs-cTnT [per log (unit) increase, adjusted hazard ratio (HR) (95% confidence interval) (CI): 1.20 (1.09, 1.32), P<0.001]. And baseline sST2 had a better prognostic value for patients with chronic decompensated heart failure [per log (unit) increase, adjusted HR (95% CI): 1.19 (1.07, 1.31)] than for those with acute new onset heart failure [per log (unit) increase, adjusted HR (95% CI): 1.28 (0.94, 1.75), P value for interaction <0.001], as well as a better prognostic value for patients with New York Heart Association (NYHA) functional class I-II [per log (unit) increase, adjusted HR (95% CI): 1.67 (1.11, 2.52)] than for those with NYHA functional class III-IV [per log (unit) increase, adjusted HR (95% CI): 1.18 (1.07, 1.31), P value for interaction <0.001]. Baseline sST2 was also a good predictor of the primary endpoint event in patients hospitalized with heart failure at 1month, 3months, 1year and 2years (area under the curve: 0.789, 0.775, 0.736 and 0.733, respectively), and the best cut-off values were 27.2ng/ml, 27.1ng/ml, 27.1ng/ml and 25.1ng/ml, respectively. Furthermore, baseline sST2 could provide additional prognostic value when added to baseline NT-proBNP and hs-cTnT (all P values <0.05). According to the category of elevated biomarkers (including NT-proBNP, hs-cTnT, and sST2), patients with three elevated biomarkers had a higher risk of the primary endpoint event compared with those with one or two elevated biomarkers (all P values <0.05). Baseline sST2 remained an independent predictor of adverse events after adjusting for other predictors including NT-proBNP and hs-cTnT, particularly in patients with chronic decompensated heart failure and NYHA functional class I-II. And in the basis of baseline NT-proBNP and hs-cTnT, adding baseline sST2 could provide additional prognostic value for patients hospitalized with heart failure.

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Вибір блокатора ренін-ангіотензин-альдостеронової системи для лікування серцевої недостатності при гострому міокардиті

Landscape therapy: rehabilitation potential in patients with post-infarction cardiosclerosis.

Aim: To evaluate the rehabilitation potential, effectiveness and safety of landscape therapy in the complex rehabilitation treatment of patients with post-infarction cardiosclerosis (PC) complicated by chronic post-infarction cardiac aneurysm (CPCA) at the sanatorium stage. Materials and Methods: We examined 62 patients with PC complicated by CPCA aged 38 to 65 years. Patients were randomized into two groups: the 1st group was undergoing the "Progressive gait" physical activity protocol in the city, and the 2nd group - in the rehabilitation department in a sanatorium. Survey, six-minute walk test, electrocardiography, echocardiography, coronary angiography were performed. Results: The average distance that 2nd group patients walked in 6 minutes increased from 301.00 ±17.00 to 467.00 ±32.00 m (p<0.05). Only in patients of 2nd group during 3 weeks of complex rehabilitation there was a decrease in body mass index from 23.70 ±1.60 to 18.90 ±1.50 and the diameter of the calf muscle significantly increased from 33.90 ±2.30 cm to 38.10 ±3.10 cm (p < 0.05). Ejection fraction in the 2nd group was 51.00 ±4.50% compared to the 1st group - 44.70 ±3.60% (p < 0.05), which was accompanied by a decrease in the functional class of heart failure in patients of the 2nd group. Conclusions: The rehabilitation potential of landscape therapy in the complex rehabilitation treatment of patients with complicated PC at the sanatorium stage is determined by a significant improvement in myocardial contractility and physical endurance of patients, and improving the quality of life.

Classification of Infiltrative Heart Diseases MORAL-STAGE System.

Infiltrative heart disease (InHD) is a group of diseases characterized by the deposition of abnormal substances in the heart tissue, causing diastolic, less often systolic, dysfunction of the ventricle(s). Their classification still does not exist. In 2013, the MOGE(S) classification of cardiomyopathies was published, taking into account, along with the morphological and functional characteristics of the heart, damage to other organs, the presence of genetic mutations, acquired causes (e.g., myocardial inflammation, autoimmune diseases, storage diseases, amyloidosis), etc. By analogy with it we offer the MORAL-STAGE classification for InHD. It includes ten features: morphofunctional characteristics (M), organ damage (O), risk of cardiac death (R), age of clinical presentation, age of disease-specific therapy initiation (A), localization of the infiltrative process (inside or outside the cell, L), information about the functional class heart failure and stage of infiltrative heart disease (S), treatment (T), abnormal rhythm or conduction (A), genetic or familial nature of inheritance (G), etiology of the process (E). This article summarizes the cornerstones of the MORAL-STAGE classification and its clinical relevance. In addition, new issues are discussed that can be considered in future versions of the MORAL-STAGE classification.

Is the obesity paradox in outpatients with heart failure reduced ejection fraction real?

The obesity occurrence has achieved epidemic levels worldwide and several studies indicate a paradoxical similarity among obesity and the prognosis in heart failure (HF). The primary objective was to understand the association between body mass index (BMI) and heart failure with reduced ejection fraction (HFREF) of ischemic etiology in outpatients, using mortality as a parameter. The secondary objectives were to determine the differences in HF functional class, pharmacological therapy and evaluate the prognostic value of MAGGIC Score in this population. We analyzed 1,556 medical records from the HF outpatient clinic of a quaternary hospital and 242 were selected according to the criteria. Most were male, average age 62.6 (56-70), BMI 18.5-24.9 = 35.1%, 25-29.9 = 37.2%, 30-34.9 = 17.8%, 35-39.9 = 7%; BMI <18.5 and >40 groups were eliminated from the central analyzes because of scarce testing. BMI 30-34.9 and BMI 18.5-24.9 had the best prognosis, BMI 25-29.9 had an average performance, and BMI -39.9 group provided the worst outcome (p = 0.123). In the subcategory analysis, BMI 30-34.9 group had a better prognosis compared to the BMI 35-39.9 group (p = 0.033). In the multivariate analysis The MAGGIC score was not able to foretell mortality in this population according to BMI. In not hospitalized patients with HFREF of ischemic etiology, obesity was not a protective factor.

Dapagliflozin in the therapy of chronic heart failure of functional class II–III with moderately reduced ejection fraction

The authors discuss the treatment of chronic heart failure (CHF) and present the results of our own study on the use of dapagliflozin in combination with standard therapy in patients with CHF. The comparison group consisted of patients receiving standard therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-adrenoblockers and mineralocorticoid receptor antagonists.

Multicenter registry and test bed for extended outpatient hemodynamic monitoring: the hemodynamic frontiers in heart failure (HF2) initiative

BackgroundHemodynamic Frontiers in Heart Failure (HF2) is a multicenter academic research consortium comprised of 14 US institutions with mature remote monitoring programs for ambulatory patients with heart failure (HF). The consortium developed a retrospective and prospective registry of patients implanted with a wireless pulmonary artery pressure (PAP) sensor.Goals/aimsHF2 registry collects demographic, clinical, laboratory, echocardiographic (ECHO), and hemodynamic data from patients with PAP sensors. The aims of HF2 are to advance understanding of HF and to accelerate development of novel diagnostic and therapeutic innovations.MethodsHF2 includes adult patients implanted with a PAP sensor as per FDA indications (New York Heart Association (NYHA) Class III HF functional class with a prior hospitalization, or patients with NYHA Class II or brain natriuretic peptide (BNP) elevation without hospitalization) at a HF2 member site between 1/1/19 to present. HF2 registry is maintained at University of Kansas Medical Center (KUMC). The registry was approved by the institutional review board (IRB) at all participating institutions with required data use agreements. Institutions report data into the electronic registry database using REDCap, housed at KUMC.ResultsThis initial data set includes 254 patients implanted from the start of 2019 until May 2023. At time of device implant, the cohort average age is 73 years old, 59.8% are male, 72% have NYHA Class III HF, 40% have left ventricular ejection fraction (LVEF) &amp;lt; 40%, 35% have LVEF &amp;gt; 50%, mean BNP is 560 pg/ml, mean N-Terminal pro-BNP (NTproBNP) is 5,490 pg/ml, mean creatinine is 1.65 mg/dl. Average baseline hemodynamics at device implant are right atrial pressure (RAP) of 11 mmHg, pulmonary artery systolic pressure (PASP) of 47 mmHg, pulmonary artery diastolic pressure (PADP) 21 mmHg, mean pulmonary artery pressure (mPAP) of 20 mmHg, pulmonary capillary wedge pressure (PCWP) of 19 mmHg, cardiac output (CO) of 5.3 L/min, and cardiac index (CI) of 2.5 L/min/m2.ConclusionA real-world registry of patients implanted with a PAP sensor enables long-term evaluation of hemodynamic and clinic outcomes in highly-phenotyped ambulatory HF patients, and creates a unique opportunity to validate and test novel diagnostic and therapeutic approaches to HF.

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

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

Atrial fibrillation in patients with dilated cardiomyopathy: prevalence, risk factors and prognostic significance

Aim. To study the epidemiological profile and long-term prognostic significance of atrial fibrillation (AF) as a risk factor for adverse clinical outcomes in patients with dilated cardiomyopathy (DCM).Material and methods. The study included 270 patients with DCM (206/76,3% men, age 47 [37; 56] years, left ventricular (LV) ejection fraction 29 [21; 35]%). The observation period was 6 years (Me 76 [57; 119] months). To assess the effect of AF on DCM prognosis, Kaplan-Meier curves and Cox regression of clinical outcomes, including cardiovascular death, heart transplantation, and ventricular assist device implantation, were analyzed.Results. Of 270 patients with DCM, paroxysmal AF was detected in 10 (3,7%) patients (initial, 5/1,85%; during the first follow-up year, 5/1,85%). After 5 years, another 65 (24,1%) individuals had AF (paroxysmal, persistent or permanent). Ventricular tachyarrhythmias were registered in 163 (60,4%) patients. Compared with patients maintaining sinus rhythm, patients with AF were older (51,4±10 vs 43,6±13 years, p=0,001) and had lower exercise tolerance (6-minute walk test: 379±45 vs 445±43 meters; p=0,0002) and a higher heart failure functional class (NYHA class III-IV: 38/50,7% vs 52/26,7%; χ2=13,6; p=0 ,0003). In patients with AF, initially more pronounced manifestations of right ventricular contractile dysfunction (TAPSE: 13,1±3,4 vs 15,5±4,6 mm; p=0,0001) and LV diastolic dysfunction (E/A: 2,9±1,5 vs 2,1±1,3; p=0,006; E/e' 15,6±6,9 vs 11,8±7,2; p=0,019), more dilated left atrium (left atrial volume index: 63,3±19 vs 50±18,7 ml/m2; p=0,006). During the 6-year median follow-up, AF was observed in 75 patients (0,46 new cases/100 patients/year). As a result of Cox regression analysis, AF as a time-dependent factor was identified as an independent predictor of cardiovascular death (hazard ratio 3,99; 95% confidence interval, 1,67-8,59; p=0,0001).Conclusion. AF, as one of the most common sustained atrial tachyarrhythmias in the population, demonstrated a lower prevalence (27,8%) in the DCM cohort compared to ventricular tachyarrhythmias (60,4%), but a high prognostic significance of the negative impact on the risk of fatal outcomes. The development of AF in patients with DCM is associated with a 4-fold increase in cardiovascular death risk over a 6-year period.

ИСХОДЫ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ИШЕМИЧЕСКОЙ БОЛЕЗНЬЮ СЕРДЦА: ПРОСПЕКТИВНОЕ 5-ЛЕТНЕЕ ИССЛЕДОВАНИЕ

Introduction. Epidemiology and trends in survival of patients with chronic heart failure have changed over the past decades. As an important reason for prognostic deviations is recognized, among other things, the steady worldwide increase in the prevalence of obesity and concomitant conditions associated with it, such as diabetes mellitus, arterial hypertension, and atrial fibrillation, especially in young patients with chronic heart failure, which creates the so- called survival paradox. The aim of the study is to assess the structure of 5-year outcomes in patients with ischemic heart failure and identify some new long-term prognosis markers (mortality and cardiovascular events). Materials and Methods. 313 patients with ischemic heart failure of functional class I-IV were examined. A clinical study was conducted, and 5-year prognosis endpoints were assessed (all-cause mortality, cardiovascular mortality, and non-fatal cardiovascular events). The composite endpoint included cardiovascular mortality and nonfatal cardiovascular events. Results. All-cause 5-year mortality was 28.1%, including the cardiovascular mortality of 24.6%. In patients of functional class III-IV chronic heart failure, the 5-year risk of death from any cause and cardiovascular death was higher than in class I-II patients. All-cause death, cardiovascular mortality, and the composite endpoint risks were higher in patients with reduced ejection fraction than in those with moderately reduced or reduced left ventricular ejection fraction. The risk of death within 5 years from all causes and cardiovascular death was higher in women with a body mass index of &lt;25 kg/m² and &gt;30 kg/m² than in those who were moderately overweight. Mortality from all causes was lower in functional class III-IV patients with some overweight than in those with a body mass index of &lt;25 kg/m² (p=0.03). With moderately reduced and reduced left ventricular ejection fraction, all-cause mortality and cardiovascular mortality were lower in overweight patients than in those with a body mass index of &lt;25 kg/m² (p=0.009 and p=0.022). In patients with heart failure with reduced left ventricular ejection fraction, their overweight was a protective factor for all-cause mortality (OR=0.07, CI: 0.001-0.76) as compared to those with a body mass index of &lt;25 kg/m²

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

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

#5434 EFFICACY OF SACUBITRIL/VALSARTAN IN MAINTENANCE HEMODIALYSIS PATIENTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION

Abstract Background and Aims Growing evidences have confirmed the effect of Sacubitril/Valsartan (SV) on hypertension and heart failure espacially EFrHF in general population. However, data on ARNI treatment in maintenance hemodialysis (MHD) patients with EfpHF are lacking. The present study was conducted to assess the efficacy and safety of sacubitril-valsartan in patients with HFpEF undergoing MHD. Method End-stage kidney disease (ESKD) patients undergoing MHD for more than 3 months with New York Heart Association (NYHA) class II–IV heart failure ejection fraction of 50% or higher, and elevated levels of N-terminal pro–B-type natriuretic peptide (NT-proBNP) were assigned to receive sacubitril-valsartan. Patients were followed up regularly after medication treatment. The alterations in clinical and biochemical parameters before and after taking sacubitril-valsartan (generally 50–200mg b.i.d) were investigated, and safety was also assessed. Results 120 patients were recruited in this study. Compared with baseline levels, NT-proBNP levels [7540.5 (3575.7–18373.0) vs. 4649.0 (2259.0–8187.0), P&amp;lt;0.001], systolic blood pressure[(157.8 ± 20.5) vs.(141.5 ± 16.8), P&amp;lt;0.001], diastolic blood pressure [(85.2 ± 14.9) vs.(78.5 ± 10.2), P&amp;lt;0.001], heart rate[(78.1 ± 9.0) vs.(74.5 ± 6.9), P&amp;lt;0.001], total cholesterol [4.7 ± 1.1 vs. 3.9 ± 1.3, P = 0.01] and Low Density Lipoprotein [2.4 ± 0.9 vs. 2.2 ± 1.1, P = 0.04] were markedly decreased after treatment with sacubitril-valsartan. The results of KCCQ scores[53.4 ± 16.1vs. 61.4 ± 15.7, P&amp;lt;0.001] and NYHA classification [P = 0.01] showed obviously improvement after a median follow-up of 13 months. None of the patients showed adverse drug reactions. Conclusion Sacubitril/valsartan treatment improves significantly quality of life, symptoms of heart failure, NT-ProBNP and NYHA functional class in patients with HFpEF undergoing hemodialysis. Sacubitril/valsartan was safe and well tolerated.