Functional Class II-III Research Articles

ПОРІВНЯЛЬНА ХАРАКТЕРИСТИКА ПОКАЗНИКІВ ЯКОСТІ ЖИТТЯ У ПАЦІЄНТІВ З ХРОНІЧНОЮ СЕРЦЕВОЮ НЕДОСТАТНІСТЮ ЗІ ЗНИЖЕНОЮ ФРАКЦІЄЮ ВИКИДУ ЛІВОГО ШЛУНОЧКА ЗАЛЕЖНО ВІД ВАРІАНТУ ЗАЛІЗОДЕФІЦИТУ

Introduction. Quality of life (QoL) indicators in case of chronic heart failure (CHF) are associated with a number of clinical and instrumental indicators, which makes it possible to consider its assessment as one of the leading indicators of its severity. From a practical point of view, the identification of QoL indicators as the markers of CHF severity in patients with concomitant iron metabolism disorders, including different variants of latent and manifest iron deficiency (ID)is rather interesting. Purpose. To compare QoL parameters by means of MOS SF-36 and MLHFQ questionnaires in patients with CHF with reduced left ventricular ejection fraction with different iron deficiency types. Materials and Methods. 152 patients with CHF functional class (FC) II-III according to NYHA with reduced left ventricular (LV) ejection fraction (EF) of hypertensive and ischemic etiology with/and without iron deficiency (ID) were examined. All patients were divided into three clinical groups: the first clinical group (which is presented as a comparison group) amounted to 30 (19.7 %) patients with CHF with reduced LV EF without ID, the second one amounted to 60 (39.5 %) patients with CHF with reduced LV EF and latent ID, which included a number of patients with functional and absolute ID and the third clinical group amounted to 62 (40.79 %) patients with I-II severity degree of concomitant iron deficiency anemia (IDA). In order to assess QoL, all patients were interviewed using MOS SF-36 and MLHFQ. The comparison of the obtained findings was carried out among groups of patients with CHF with reduced LV EF without iron metabolism disorders, with functional ID and absolute ID, and among groups of patients with CHF with reduced LV EF without iron metabolism disorders, with I degree of IDA and II degree of IDA. Research findings. It was detected that in comparison with the group of patients without ID, QoL indicators according to MLHFQ questionnaire in patients with functional ID and absolute ID were significantly worse – 49.5 versus 53.5 (p = 0.05) and 60 points (p = 0.009), respectively. Physical health (PH) in these groups was 37.9 (p = 0.033) and 37.2 (p = 0.0068), respectively, which significantly differed from PH value in the comparison group – 41.2 points. In patients with functional ID and absolute ID lower PH values were detected due to significantly worse indicators of physical functioning (PF), role-physical functioning (RP) resulting from physical condition and general health (GH). Similar results were obtained during the analysis of QoL in patients with IDA of different degrees. In patients with mild IDA and moderate IDA as compared to the group of patients without ID, QoL indicators, according to MLHFQ questionnaire, were significantly worse (p = 0.007) and (p < 0.00001) 57 and 62 versus 49.5 points, respectively. In addition, it was detected that PH value according to SF-36 questionnaire results in the groups with IDA was also significantly lower than PH value in the group without ID due to low values of PF, RP and GH and amounted to 36.8 (p = 0.01) and 33.6 (p < 0.00001) versus 41.2 points, respectively. According to the conducted analysis, mental health (MH) decreased with the presence of functional and absolute ID and with an increase of IDA from mild to moderate degree, however significantly lower value was detected only in the group with moderate IDA as compared to the group of patients without ID (p = 0.02). In addition, a number of significant relations between QoL indicators according to MLHFQ, PH and MH scale SF-36 and hematological parameters and a number of iron metabolism indicators were detected during the study. This confirms the dependence of the patients’ QoL on existing iron metabolism disorders. Conclusions. Patients with CHF with reduced left ventricular ejection fraction and concomitant ID, regardless of the presence of anemia, are characterized by the worse QoL level as compared to the patient without ID. Whereas, latent functional and absolute ID has the same clinical relevance in terms of deterioration of QoL of patients with CHF. Reduction of iron metabolism levels can be considered as predictors of deterioration of patients' QoL and severe CHF.

Possibilities of cardioselective beta - blocker bisoprolol therapy in patients having coronary artery disease and bronchial asthma

to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

Effect of ferrotherapy on clinical and instrumental indices in patients with chronic heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency

The objective of the study was to assess changes of clinical and instrumental indices in patients with chronic heart failure (CHF) with reduced left ventricular (LV) ejection fraction (EF) and concomitant latent iron deficiency (ID) on the background of the standard treatment in combination with 6-months oral ferrotherapy. 60 patients with CHF with reduced LV EF functional class (FC) II-III according to NYHA with concomitant latent ID were examined. Among them were 41 (68.3%) men and 19 (37.1%) women aged 68.3±0.63 years. Two groups of patients with CHF and latent iron deficiency were formed: the 1st group (n=30) received a standard therapy, the patients in the 2nd group (n=30) were additionally prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid per day for 6 months. Number of red blood cells (Rbc), hemoglobin (Hb) level, serum iron (SI), ferritin, transferrin saturation (ТS), 6-minute walk stress test (6MWT), MLHFQ and MOS SF36 questionnaire and LV morpho-functional parameters by echocardiography were determined. The studied values are presented as a median (upper, lower quartile). After the therapy the values of Hb, Rbc, SI, ferritin and TS have significantly increased in the 2nd group. But in the 1st group due to the lack of ferrocorrection, in most cases, the values have reduced. An increase of the covered 6MWT distance, MLHFQ points, physical (PH) and mental (MH) components of health of MOS SF36 was observed in both groups: in the first group only by 5.3 (р=0.06), 1.2 (р=0.46), 6.9 (р=0.31) and 7.2% (р=0.02), respectively. Whereas in the second group by 13.8 (p&lt;0.001), 13.6 (p&lt;0.001), 24% (p&lt;0.001) and 15% (p&lt;0.001), respectively. EDD (end-diastolic dimension) decreased by 2.1% (p&lt;0.001), EDV (end-diastolic volume) — by 4.8% (p&lt;0.001), ESD (end-systolic dimension) — by 3.9% (p&lt;0.001), ESV (end-systolic volume) — by 13.3% (p&lt;0.0001), EF has increased by 12.7% (p&lt;0.001) in the first group. No difference in the dynamics of the Echo-CG indices between two groups of patients over 6 months of observation was detected (р&gt;0.18). EDD decreased by 2.7% (p&lt;0.001), EDV — by 3.9% (p&lt;0.0001), ESD — by 3.9%, ESV — by 10.9% (p&lt;0.0001), EF has increased by 16.3% (p&lt;0.0001).Thus, the positive hematological changes in case of latent ID correction in patients with CHF with reduced LV EF, despite the similar dynamics of myocardium morpho-functional indices in case of absent ferrocorrection, are accompanied by more significant positive dynamics of effort tolerance and quality of life.

Characteristics of chronic ischemic heart failure clinical course against the background of anemic syndrome according to retrospective analysis

Objective. To study the anemia relative frequency in hospitalized patients with chronic ischemic heart failure (CIHF), to assess its impact on the clinical course of the disease, to identify the frequency of risk factors and comorbid background that are associated with the presence of anemia.Material and methods. A retrospective analysis of 986 medical charts of inpatients with CIHF, who underwent inpatient treatment during the period from January 2016 to March 2019, has been carried out. The median age of the patients is 76 (53; 94) years. General clinical data, the results of laboratory and instrumental research methods have been evaluated. The statistical processing of the results has been performed using the software package “Statistica 13.0” according to modern requirements.Results. Among patients with CIHF, concomitant anemic syndrome occurred in 10.75% of cases, among which 57% were the ones with mild and moderate iron deficiency anemia. The distribution of patients with iron deficiency by the stage and functional class (FC) of CIHF has revealed that the majority of patients had CIHF stage IIA, FC II-III. More than half of the patients had a reduced left ventricular ejection fraction (LVEF). The severity of anemia affected the development of systolic dysfunction of the left ventricle, which was confirmed by the direct correlations of moderate strength between LVEF and hemoglobin and serum iron levels (rs = 0,51, rs = 0,36, respectively; p &lt;0,05). The presence of concomitant iron deficiency in patients with CIHF increased verifiably the incidence of extrasystole ventriculaire almost by 1,4 times, atrial fibrillation by 1,6 times. Conclusion. The increase in the relative frequency of anemic syndrome among patients with CIHF is observed, while mild-to-moderate iron deficiency anemia is prevailing in its structure. Among patients with iron deficiency anemia, CHF IIA stage FC III with reduced LVEF prevails. A decrease in hemoglobin and serum iron levels is associated with a decrease in LVEF. Concomitant iron deficiency increases verifiably the incidence of arrhythmic disorders in patients with CHF.

DIGITALIZATION OF ELECTROCARDIOGRAPHY AND PHOTOPLETHYSMOGRAPHY: CLINICAL IMPLEMENTATION OF A QUANTITY ANALYSIS OF THE HEART RHYTM

In order to study the possibility of determining the pulse variability (PV) when analysedphotoplethysmography (PPG) recorded by smartphone compared to the calculation ofcardiac heart rate variability (HRV) when analyzed digitalized ECG, and theobjectification of HRV depending on the constellation of diagnosis of coronary heartdisease (CHD) with or without arterial hypertensian (AH) and its complication - acutecerebrovascular disorder (ACD) and comparison of the informativeness of the PV andHRV calculation.Material and methods. 39 patients with diagnoses stable angina II-III functional classes(StA) with, or without associated AH. 13 of them had complications in the form of ACD.Results. It was found that HRV, depending on the method of assessment, for registering aPV or recording digitalized ECG does not differ according to the SDNN and rMSSDindices. Vagus-mediated changes in HRV in the short term are more pronounced forcoronary heart disease and hypertension (pNN50). The depletion of reactivity for CHDwith or without AH has been proved, in contrast to patients with ACD according to thedecrease in the amplitude of low frequency heart rate variability (LF).Conclusions. So, when we need a quick analysis method at the patient's bed withinterpretation of the results, using a smartphone for this purpose can be effective, thevariety of software is sufficient, and the possibility of using this method by the patient isimportant. The using of the Smart-ECG own software requires further research andimplementation.

Continuous-Flow Left Ventricular Assist Device (LVAD) Implantation as Destination Therapy in a Patient with End-Stage Heart Failure Complicated with Cardiorenal Syndrome

End-stage heart failure (HF) has a one-year mortality rate of &gt;50% and the only definitive management is heart transplant. However, left ventricular assist device (LVAD) as destination therapy has demonstrated a significant mortality benefit compared to optimal medical therapy in patients who are deemed ineligible for heart transplant. We present the case of a 70-year old Filipino, male, known to have severe left ventricular systolic dysfunction and had repeated admissions due to decompensated HF. His condition was complicated with cardiorenal syndrome (CRS) necessitating hemodialysis. A continuous-flow LVAD (Heartmate II) was implanted as destination therapy. The patient remained hemodynamically and clinically stable post-operatively and eventually discontinued hemodialysis. He was discharged with improved functional capacity (New York Heart Association [NYHA] functional class II-III) and was no longer readmitted for worsening of HF thereafter. No further hemodialysis was needed after six months. This is the first reported case of a successful continuous-flow LVAD implantation in the Philippines in a patient with end-stage HF complicated with CRS. KEYWORDS: Left ventricular assist device, LVAD, Heartmate II, destination therapy, end-stage heart failure

Clinical and anatomical myocardium features according to invasive and non-invasive examination methods in patients with coronary artery disease in combination with diabetes mellitus

Aim.To study the clinical and anatomical myocardium features according to invasive and non-invasive examination methods in men and women with coronary artery disease (CAD) in combination with diabetes mellitus (DM).Material and methods.A single-step clinical study included 77 men and 68 women with angina of the II-III functional classes, observed in the Republican clinical hospital in Nazran. Depending on the presence of type 2 DM and gender, patients were divided into 4 groups: Group I — men with CAD+DM (n=34), Group II — women with CAD+DM (n=36), Group III — men with CAD without DM (n=43), group IV — women with CAD without DM (n=32). All patients underwent electrocardiography (ECG), echocardiography (EchoCG) and coronary angiography.Results.Hypertrophy of the left ventricle on ECG was most often diagnosed in men with CAD+DM (38%). Similar, but less pronounced tendency is observed in men without DM (23%). Among women, these parameters were &lt;20%. Left ventricular hypertrophy on EchoCG was determined two times more than the ECG results. Defect of local contractility and myocardial hypokinesis according to EchoCG data was found in both men and women with DM — 29% and 22%, respectively. Among patients without DM, these parameters were 40% less. In general, the frequency of cicatricial ECG changes in all groups had a similar trend. According to coronary angiography, anterior interventricular stenosis was the most frequent vascular lesion. Among men with CAD+DM, it was noted in 62% of cases, in men without DM — in 30%. Among women with CAD+DM, anterior interventricular branch stenosis is detected in 28% of cases, without ~20%. Stenosis of the circumflex branch is detected in no more than 20% of cases in men and women with CAD+DM, and in the groups without DM — in 10%. Stenosis of the right coronary artery is detected in every fourth patient, regardless of the glycemic status. The majority of patients (60%) have constriction of the coronary vessels, the absolute number of such constrictions in the groups of men with CAD and with or without DM was ~70 cases. Among women, this figure was less than 50 cases. Constriction of one or more coronary arteries &gt;80% more often occurred among men with CAD without DM, among men and women with CAD+DM, the absolute number of such constrictions was 21-25 cases. The greatest number of stenoses ≥2 coronary arteries was observed in men with CAD+DM (~30 cases), in the group of men with CAD without DM constriction &gt;2 vessels are found in ~20 cases. Among women, stenosis ≥2 vessels are detected twice as less as compared with men. At the same time, in the group of women with CAD+DM, the frequency of multiple stenoses was 15% higher than those of women with CAD without DM.Conclusion.Thus, using non-invasive and invasive examination methods in CAD patients, a number of complementary changes in the myocardium and coronary arteries were found. The presence of DM worsens these changes, both among men and women.

Results of Holter monitoring in patients with angina pectoris treated by combination of trimethazidine with fabomotisol in the area of former armed conflict

Aim. To assess the effectiveness of trimetazidine and fabomotisol adding to standard treatment in patients with stable angina in the area of former armed conflict in point of improving of Holter monitoring parameters.Material and methods. One hundred and twelve patients with stable angina of the II-III functional classes (FC) living in the area of former armed conflict were randomly divided into two groups. For 6 months 54 patients (control group) received standard treatment (isosorbide dinitrate 40 mg/day, metoprolole tartras 50-100 mg/day, acetylsalicylic acid 100 mg/day, simvastatin 40 mg/day). Fifty eight patients (study group) in addition to a standard treatment, took trimetazidine 70 mg/day and fabomotisol 30 mg/day. Initially and after 6 months they underwent Holter monitoring.Results. In patients of the control group the number of episodes of silent myocardial ischemia was statistically significantly reduced (p&lt;0,05). The duration of episodes of silent and manifest myocardial ischemia, ST segment depression &gt;1 mm, and the number of patients with supraventricular and ventricular extrasystoles decreased not statistically significant (p&gt;0,05). The number of episodes of manifest myocardial ischemia did not change. In the study group, the number of silent ischemia episodes, the duration of silent and manifest myocardial ischemia significantly decreased. ST segment depression and the frequency of ventricular extrasystoles were also decreased (p&lt;0,05). At the same time, the changes in number of supraventricular extrasystoles was not statistically significant (p&gt;0,05). Conclusion. Using a combination of trimetazidine with fabomotisol in comparison with standard treatment in patients with angina reduces the frequency of angina episodes, the duration of myocardial ischemia, ST segment depression, the frequency of supraventricular and ventricular extrasystoles.

Cough: the evolution of views and modern approaches to an objective assessment.

The article is a review of literature, that provides information on ways to assess cough, how those ways have improved over recent years, the latest data in the field of an objective assessment of cough and the possibility of its use in scientific and clinical practice. Search for articles was carried out in such databases as Pubmed, CyberLeninka, RSCI in English and Russian.

The effectiveness of trimetazidine and fabomotizole in the prevention of angina progression and improvement of life quality in patients in area of armed conflict

Aim.To assess the effectiveness of trimetazidine and fabomotizole adding to standard treatment in prevention of stable angina progression and improving of quality of life (QOL) in patients in area of armed conflict.Material and methods. One hundred and twelve patients with stable angina of II-III functional class (FC) living in the area of armed conflict in Chechen Republic. All participants were randomized into two groups. Within 6 months 54 patients from control group used standard therapy (isosorbide dinitrate 40 mg/day, metoprolol tartrate 50-100 mg/day, acetylsalicylic acid 100 mg/day, simvastatin 40 mg/day). In the study group 58 patients additionally took trimetazidine 70 mg/day and fabomotizole 30 mg/day. We used Seattle Angina Questionnaire initially and after 6 months of treatment to determine QOL: frequency of angina attacks, nitroglycerin taking per week and adverse events were evaluated.Results.The frequency of angina attacks and nitroglycerin taking in patients of study group significantly decreased after treatment compared with control group (p&lt;0,05). In the study group, as a result of treatment, there was a statistically significant increase in QOL compared with their initial values. In the control group there was a positive trend in following questionnaire scales: physical activity (p&lt;0,01), angina frequency (p&lt;0,001) and disease perception (p&lt;0,05). According to scales of treatment satisfaction, physical limitation and disease perception, improvement of QOL in the study group were statistically significant comparing with control group (p=0,01; p&lt;0,01 and p&lt;0,01, respectively).Conclusion. In the control group, there is a positive dynamics of QOL parameters on physical activity (p&lt;0,01), frequency of angina attacks (p&lt;0,001) and disease perception (p&lt;0,05) scales. The inclusion of trimetazidine and fabomotizole to the standard treatment carries statistically significant improvement of treatment satisfaction, physical limitation and disease perception scales. The frequency of angina attacks and nitroglycerin taking in patients of study group significantly decreased after treatment compared with control group (p&lt;0,05).

Impact of external counterpulsation on microcirculation in patients with coronary heart disease complicated by chronic heart failure after surgical and endovascular myocardial revascularization

To study the impact of external counterpulsation (ECP) on endothelial function and microcirculation in patients after myocardial revascularization (stenting and coronary artery bypass grafting) for functional class (FC) II-III chronic heart failure (CHF). Sixty patients aged 50 to 75 years after myocardial revascularization for FC II-III CHF were examined. All the patients received one-hour ECP sessions 5 times per week. The treatment cycle consisted of 35 sessions. To evaluate the microcirculatory bed, capillary blood flow was studied by laser Doppler flowmetry. The cycle of ECP in patients with FC II-III CHF after myocardial revascularization had a corrective effect on the microhemodynamic system. Microcirculatory changes were due to the normalized myogenic and neurogenic tone of arterioles and to increased oscillations in the endothelial range. The pronounced beneficial effect of ECP on the cardiovascular system in the examined patients was confirmed by a significant increase in exercise tolerance and by a statistically significant improvement in the results of 6-minute walk test. There was a decrease in FC heart failure. ECP is an effective, non-invasive treatment in patients with heart failure.

Galectin-3 - a modern biomarker for the diagnosis of left ventricular hypertrophy and chronic heart failure and control of treatment of patients with hypertension

The development of new methods for the prevention and treatment of chronic heart failure and its control is an urgent medical and social problem. In this regard, using of new biological markers of the disease may be useful for early diagnosis of the disease, predict a clinical course, monitor the effects of pharmacotherapy (personalized medicine) and play an important role in stratifying the patient's risk. In 2013, according to the recommendation of the American Heart Association, a galectin-3 was introduced into the pool of such biomarkers for prevention and treatment of chronic heart failure. Objective: to improve prediction of the course and effectiveness of the therapy for hypertension and chronic heart failure as the hypertension complication in men 40-60 years old by applying the level of galectin-3 as a biomarker. There were observed the men 40-60 years old with hypertension and chronic heart failure for the concentration of galectin-3. Also, there were observed subjects without cardiovascular pathology (n=79), the men with hypertonic disease with myocardial hypertension (n=62) and the men with chronic heart failure II-III functional class of NYHA (n=50) for the indicators of central and systemic hemodynamics. The level of galectin-3 was determined by immunoassay analysis on the equipment "Stat Fact 300". Structural and functional parameters of myocardium were assessed by an ultrasound method using the equipment "RADMIR ULTIMARA". Data statistical analysis was performed on a personal computer using standard statistical package "Statistica 10.0". All data is presented in the form of average (M) and standard deviation (± σ). It has been established that the concentration of galectin-3 significantly decreases against the background of treatment. The level of galectin-3 in the patients with the II stage of hypertonic disease with good treatment effect was close to normal values compared to those with moderate treatment effect. In terms of patients with hypertension III stage, the level of galectin-3 also decreased, indicating the possibility of therapy monitoring using this biomarker. The mathematical model of the galectin-3 influencing factors also has been determined in patients with hypertension. The boundary level of the galectin-3 has been calculated, it is counted 46.51 pg/ml. It might be assumed a moderate effect of the treatment of hypertensive patients and chronic heart failure in males.

THE VARIABILITY OF HEART RHYTHM IN PATIENTS WITH STABLE ISCHEMIC HEART DISEASE AND DIABETES MELLITUS TYPE 2

The purpose of this study is to evaluate the time and spectral parameters of heart rate variability (HRV) in patients with stable type of coronary heart disease and type 2 diabetes mellitus by findings obtained by daily ECG Holter monitoring. Material and methods. The study involved 61 individuals aged 42-64 years (mean age 46.4±4.6 years) with IHD, stable exertional angina pectoris of II-III functional classes, of them 34 individuals (I group) were diagnosed to have diabetes mellitus 2 types, and 27 individuals (II group) were found to have no disorders of carbohydrate metabolism. The control group consisted of 15 individuals with essential hypertension of stage II without IHD and diabetes mellitus. All patients underwent 24-hour Holter electrocardiogram monitoring (HM ECG) with subsequent analysis of HRV parameters and evaluation of heart rhythm disturbances. Results and discussion. It was found that in both groups of IHD patients regardless the presence of diabetes, there was a decrease in the circadian index in comparison with patients with essential hypertension that probably indicates a vegetative "denervation" of the heart, the development of rigidity of the circadian circadian heart rate profile in IHD patients. With an increase in the level of glycosylated hemoglobin in the patients of I group, the temporal indices of the variability of the heart rhythm and the circadian index declined. The number of supraventricular and ventricular extrasystoles per day was statistically significantly higher in patients of I group (p &lt;0.001, p &lt;0.002, respectively) compared with the patients with IHD without diabetes. In the patients with coronary artery disease and diabetes, HM ECG data showed a decrease in HRV timing. This category of patients was found to have a general decrease in HRV: a SDNN decline, changes in spectral characteristics (a decrease in the high-frequency component of the spectrum (HF), an increase in the LF/HF ratio) with a shift of balance toward the sympathetic (low-frequency) component. Conclusions. Patients with stable form of ischemic heart disease and diabetes mellitus type 2 have a decrease in both temporal and spectral HRV indices that indicates a decrease in the total activity of neurohumoral effects on the heart rhythm. These changes are associated with an increase in the ectopic activity of the myocardium.

Interleukins 4 and 6 as factors of modulation of subpopulation composition of blood monocytes in patients with ischemic cardiomyopathy

Aim. To evaluate the ratio of the fractions of classical, intermediate, non-classical and transitional monocytes in correlation with the concentration of interleukins 4 and 6 in the blood of patients with ischemic cardiomyopathy. Methods. 18 patients with ischemic cardiomyopathy (17 men and 1 woman) aged 47-66 years with circulatory insufficiency of functional class II-III according to the classification of heart failure of the New York Heart Association, were examined. The control group included 14 healthy donors matched by gender and age to patients with ischemic cardiomyopathy without any diseases of cardiovascular system and other systems in an exacerbation stage. In blood of the patients with ischemic cardiomyopathy, the relative content of classical (CD14++CD16-), intermediate (CD14++CD16+), non-classical (CD14+CD16+) and transitional (CD14+CD16-) monocytes was assessed by flow cytometry and the concentration of interleukins 4 and 6 by enzyme-linked immunosorbent assay (ELISA). Results. It was shown that the number of non-classical monocytes in the blood of patients with ischemic cardiomyopathy was 2 times lower than normal (5.05 % [4.08; 6.58] and 10.07 % [9.34; 13.84], respectively, p &lt; 0.01), as well as the concentration of interleukin-4 (0.02 pg/ml [0; 0.04] and 0.15 pg/ml [0.05; 0.65], respectively, p &lt; 0.05). The number of classical monocytes in the blood of patients had a tendency to decrease, and the proportion of intermediate monocytes and the concentration of interleukin-6, on the contrary, were slightly higher than in healthy individuals, and were interdependent (r = 0.61; p &lt; 0.05). The relative content of transitional monocytes in the blood was comparable with that of healthy donors. Conclusions. The subpopulation composition of blood monocytes in patients with ischemic cardiomyopathy is characterized by a deficiency of the fraction of non-classical monocytes with protective properties against endothelium, and interleukin-4 in the blood with a certain increase in the content of interleukin-6 and the number of intermediate cells with ability to cooperate with T-lymphocytes, which predisposes to diffuse atheromatosis of small coronary arteries and diffuse hypoxic myocardial damage in ischemic cardiomyopathy.

STRUCTURAL AND FUNCTIONAL FEATURES OF LEFT VENTRICLE IN PATIENTS WITH HEART FAILURE, CORONARY HEART DISEASE AND THYROTOXICOSIS

Aim.This study was designed to determine the structural and functional features of left ventricle in patients with heart failure, coronary heart disease and thyrotoxicosis.Materials and methods.85 patients aged 58.3±5.6 years were divided into 3 groups: the main one – 25 patients with coronary heart disease (CHD), chronic heart failure (CHF) II-III functional classes (FC) and thyrotoxicosis, average age –59.23±3.81; the 1st comparison group – 30 patients with CHD and CHF FC II-III without thyroid dysfunction, the average age – 57.6±2.73; the 2nd comparison group – 30 patients with thyrotoxicosis without concomitant cardiovascular diseases (CVD), the average age – 45.4±3.51. The structure and function of the thyroid gland were examined in all patients. The echocardiographic (EchoCG) examination was performed to evaluate the structural and functional indicators of the left ventricle (LV).Results.The LV pathologic remodeling in patients of the main group is represented by two types: concentric left ventricle hypertrophy (CLVH) and eccentric left ventricle hypertrophy (ELVH), CLVH was more common than in patients without thyroid dysfunction but with CHF and CHD (84.0%, р=0.01). The LV myocardium contractility was reduced in patients of both groups with CHF, the values of the ejection fraction corresponded with the intermediate type of HF, there was no significant difference between the indices (p = 0.1). The main group had significantly more pronounced decrease in the ratio of the blood flow velocity of early diastolic filling of the LV and the maximal atrial systolic velocity (E / A) − 0.63 and the increase in the isovolumic relaxation time (IVRT) – 84.69 ms in comparison with the indicators of the CHD and CHF patients without thyroid dysfunction (p = 0.021, p = 0.034).Conclusion.For patients with CHF, CHD and thyrotoxicosis, predominance of LV remodeling according to the type of CLVH (84.0% of cases) is typical as well as a moderate decrease in the contractility of the LV and a more pronounced diastolic dysfunction. It determines the structural and functional features of the left ventricle in patients with CHF with this comorbidity.

Chronic pancreatitis in patients with coronary heart disease: a lipid spectrum of blood, a possibility of correction

Aim of research is to evaluate significance of changes in the lipid spectrum of blood in patients with chronic pancreatitis with coronary heart disease in the pathogenesis of the comorbidity of these diseases and in the dynamics of treatment with polycosanol.&#x0D; Materials and methods. The study was conducted in 22 patients (10 patients with chronic pancreatitis and dyslipidemia, 12 patients with comorbidity of chronic pancreatitis and coronary heart disease in CHD II-II A-B syndrome of stage II-III functional class) and in 10 almost healthy individuals. There were 13 men, 9 women, 31–69 years old. Patients of two groups in addition to protocol treatment were prescribed polycosanol 10 mg 1 time in the evening during dinner, up to 3 months. To study the characteristics of the lipid spectrum of the blood, the level of total cholesterol, high-density lipoprotein cholesterol, triglycerols was determined (using the Zlatix-Zack-based Lachema reagents (Czech Republic)). The level of low-density lipoprotein cholesterol was determined using the Friedewald calculation method, taking into account that the triglycerol concentration did not exceed 4.5 mmol/l. In addition, very low density lipoprotein cholesterol and an atherogenicity index were determined using conventional calculation methods.&#x0D; Results. In patients with a combined course of chronic pancreatitis with coronary heart disease, in most cases there is a significant (p&lt;0.05) increase in total cholesterol, low and very low-density lipoproteins and triglycerols. When analyzing the types of dyslipidemia, it was found that ІІа and ІІв types were more common (22 і 25%, respectively), but with comorbidity ІІ and ІV type of dyslipidemia was more often detected. In the dynamics of a three-month treatment with polycosanol in patients with chronic pancreatitis, the cholesterol levels of high-density lipoproteins increased significantly and the triglycerol values ​​significantly decreased, indicating a hypolipidemic effect of the drug and the possibility of using it in combination with statins in order to reduce the risk of cardiovascular events.&#x0D; Conclusion. The comorbidity of chronic pancreatitis with ischemic heart disease increases the risk of progression of dyslipidemia and atherosclerosis. This is confirmed by an increased atherogenic index in this group of patients, along with the severity of lipid spectrum disorders. The addition of polycosanol to patients with chronic pancreatitis and dyslipidemia, as well as in combination with coronary heart disease, contributes to the reduction and normalization of certain parameters of the lipid spectrum of the blood. This allows us to recommend a drug for long-term treatment of these groups of patients, including in combination with statin therapy.

CORRECTION OF CYTOKINE AND HORMONAL IMBALANCE IN THE TREATMENT OF ANGINA PECTORIS

Aim. To evaluate the dynamics of cytokine status (IL-1ß, IL-4, IL-6, IL-10) and hormonal profile (cortisol, ACTH, β-endorphins) in patients with stable angina II-III functional class in the course of standard treatment and combined use of TES-therapy.Materials and methods. All patients were divided into 2 groups: 1st (n=30) therapy of angina according to the Protocol and 2nd (n=30) combined therapy of angina according to the Protocol and TES-therapy.Results. The results showed that normalization of the studied cytokines level in patients of the 1st group is not improved.In the 2nd group of patients statistically the levels of the studied cytokines was significantly decreasing (p≤0.01) and the levels of ACTH, cortisol and β-endorphin were significantly (p≤0.01) increasing.Conclusion. The obtained results suggest that TES-therapy conducted in the 2nd group of patients, contributes to the correction of cytokine imbalance and hormonal profile, which indicates the necessity of its inclusion in standard therapy of angina.

Validating Left Ventricular Filling Pressure Measurements in Patients with Congestive Heart Failure: CardioMEMS™ Pulmonary Arterial Diastolic Pressure versus Left Atrial Pressure Measurement by Transthoracic Echocardiography.

Background Routine ambulatory echocardiographic estimates of left ventricular (LV) filling pressures are not cost-effective and are occasionally fraught with anatomic, physiologic as well as logistical limitations. The use of implantable hemodynamic devices such as CardioMEMS Heart Failure (HF) System has been shown to reduce HF-related readmission rates by remote monitoring of LV filling pressures. Little is known about the correlation between CardioMEMS and echocardiography-derived estimates of central hemodynamics. Methods We performed a prospective, single-center study enrolling seventeen participants with New York Heart Association functional class II-III HF and preimplanted CardioMEMS sensor. Simultaneous CardioMEMS readings and a limited echocardiogram were performed at individual clinic visits. Estimated left atrial pressure (LAP) by echocardiogram was calculated by the Nagueh formula. Linear regression was used as a measure of agreement. Variability between methods was evaluated by Bland–Altman analysis. Results Mean age was 74 ± 9 years; 59% (10/17) were males. LV systolic dysfunction was present in 76% (13/17) of subjects. Mean PAdP was 18 ± 4 mmHg and 19 ± 5 mmHg for CardioMEMS and echocardiographic-derived estimates, respectively, with a significant correlation between both methods (r2=0.798, p ≤ 0.001). Conclusions Our study illustrates a direct linear correlation between PAdP measured by CardioMEMS and simultaneous measurement of LV filling pressures derived by echocardiography.

Endothelial dysfunction and smoking factor in patients with coronary heart disease while testing the radial artery prior to coronary bypass surgery

Patients (111 males) with coronary heart disease (CHD) and angina, II-III functional class, accompanied by arterial hypertension (AH), I-III degree, in 77 % of cases (mean age was 62.00.76 years) were examined prior to coronary bypass surgery. The patients were divided into two groups: group 1 consisted of 56 nonsmoking patients (112 upper extremities) and group 2 - 55 smoking patients (110 upper extremities) with the experience of smoking being 331.6 years on average. The thumb of both the right and left hand was tested for peripheral microcirculatory blood flow (MBF) by using a laser-Doppler flowmetry method (LDF). This quantitative method was developed at our clinic to assess the adequacy of collateral circulation in the hand. The method compares MBF provided by the ulnar artery, with the radial artery occluded, with the background level. Some features of various clinical parameters in the group of smokers suffering from coronary artery disease were analyzed in comparison with those of non-smokers. Significant differences were found in the indicators of lipid profile: increased levels of total cholesterol and low-density lipoprotein (LDL) against the background of low high-density lipoprotein (HDL) in the group of smoking patients. We found out that the smokers had to apply for surgical treatment by 7 years (on average) earlier; they had a significantly greater number of heart attacks and showed the lowest body mass index (BMI). The LDF test helped to establish that smoking in patients with CHD enhances the endothelial dysfunction, while significantly reducing the reactivity of the microvascular bed under the influence of hyperemic stimulus. Sampling the radial artery for coronary artery bypass grafting in smokers tended to give negative results.

Entrenamiento de la musculatura inspiratoria y la electroestimulación muscular funcional en el tratamiento de la insuficiencia cardiaca con función sistólica conservada: estudio TRAINING-HF

Introduction and objectivesDespite the prevalence of heart failure with preserved ejection fraction (HFpEF), there is currently no evidence-based effective therapy for this disease. This study sought to evaluate whether inspiratory muscle training (IMT), functional electrical stimulation (FES), or a combination of both (IMT + FES) improves 12- and 24-week exercise capacity as well as left ventricular diastolic function, biomarker profile, and quality of life in HFpEF. MethodsA total of 61 stable symptomatic patients (New York Heart Association functional class II-III) with HFpEF were randomized (1:1:1:1) to receive a 12-week program of IMT, FES, or IMT + FES vs usual care. The primary endpoint of the study was to evaluate change in peak exercise oxygen uptake at 12 and 24 weeks. Secondary endpoints were changes in quality of life, echocardiogram parameters, and prognostic biomarkers. We used a mixed-effects model for repeated-measures to compare endpoints changes. ResultsMean age and peak exercise oxygen uptake were 74 ± 9 years and 9.9 ± 2.5mL/min/kg, respectively. The proportion of women was 58%. At 12 weeks, the mean increase in peak exercise oxygen uptake (mL/kg/min) compared with usual care was 2.98, 2.93, and 2.47 for IMT, FES, and IMT + FES, respectively (P < .001) and this beneficial effect persisted after 24 weeks (1.95, 2.08, and 1.56; P < .001). Significant increases in quality of life scores were found at 12 weeks (P < .001). No other changes were found. ConclusionsIn HFpEF patients with low aerobic capacity, IMT and FES were associated with a significant improvement in exercise capacity and quality of life.This trial was registered at ClinicalTrials.gov (Identifier: NCT02638961).Full English text available from: www.revespcardiol.org/en