Manifestations Of Heart Failure Research Articles

Targeting the DPP-4-GLP-1 pathway improves exercise tolerance in heart failure patients: a systematic review and meta-analysis

BackgroundThe most significant manifestation of heart failure is exercise intolerance. This systematic review and meta-analysis was performed to investigate whether dipeptidyl peptidase-4 (DPP-4) inhibitors or glucagon-like peptide 1 receptor agonists (GLP-1 RAs), widely used anti-diabetic drugs, could improve exercise tolerance in heart failure patients with or without type 2 diabetes mellitus.MethodsAn electronic search of PubMed, EMBASE and the Cochrane Library was carried out through March 8th, 2019, for eligible trials. Only randomized controlled studies were included. The primary outcome was exercise tolerance [6-min walk test (6MWT) and peak O2 consumption], and the secondary outcomes included quality of life (QoL), adverse events (AEs) and all-cause death.ResultAfter the literature was screened by two reviewers independently, four trials (659 patients) conducted with heart failure patients with or without type 2 diabetes met the eligibility criteria. The results suggested that targeting the DPP-4-GLP-1 pathway can improve exercise tolerance in heart failure patients [MD 24.88 (95% CI 5.45, 44.31), P = 0.01] without decreasing QoL [SMD -0.51 (95% CI -1.13, 0.10), P = 0.10]; additionally, targeting the DPP-4-GLP-1 pathway did not show signs of increasing the incidence of serious AEs or mortality.ConclusionOur results suggest that DPP-4 inhibitors or GLP-1 RAs improve exercise tolerance in heart failure patients. Although the use of these drugs for heart failure has not been approved by any organization, they may be a better choice for type 2 diabetes mellitus patients with heart failure. Furthermore, as this pathway contributes to the improvement of exercise tolerance, it may be worth further investigation in exercise-intolerant patients with other diseases.

PREVALENCE AND PROGNOSTIC SIGNIFICANCE OF DYSGLICEMIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AT THE STAGE OF DECOMPENSATION OF CHRONIC CARDIAC FAILURE

The aim was to study the prevalence of dysglycemia and glycemic variability (GV) during hospitalization for chronic heart failure (CHF) decompensation and their effect on four-years survival. Methods: A retrospective analysis of the hospital records of 279 patients with type 2 diabetes mellitus (DM), hospitalized with CHF decompensation to the First City Clinical Hospital in Arkhangelsk was performed. Mann - Whitney tests were used for numeric variables. Simple and multiple logistic regression analyses were used to determine the effect of glycemia at admission, GV indicators on the early and long-term prognosis. Results: Median blood glucose at hospitalization was 8.80 (6.74; 11.04) mmol/l. Off-target glycemia was observed in 245 (87.8 %) patients. More than half of the measured tests during hospitalization had glycemic values beyond the recommended levels for the hospitalization period (82.6 %). In patients who died in the long-term period (n = 64, 28.1 %), hyperglycemia of more than 10.0 mmol/l was observed in 43.8 % of the measured tests during hospitalization, in 18.3 % - hyperglycemia from 7.8 to 10.0 mmol/l. Patients who died in the long-term period had higher indices of GV in comparison with the survivors (p = 0.004 for glycemic level variation, p = 0.008 for standard deviation and p = 0.001 for variation coefficient). High GV was associated (OR: 1.943; CI 1.013-3.725, p = 0.046) with the outcome, regardless of gender, manifestations of heart failure and renal function. Conclusions. Altogether, 87.8 % of patients had dysglycemia during the period of hospitalization. High GV during hospitalization was observed in 50.2 % of patients. High GV during hospitalization is an independent risk factor for for-years mortality

Clinical Profile Of Atrial Septal Defects In children at Sohag University hospital

Background: Cardiac defects are the most common type of birth defects . Atrial Septal Defect (ASD) is a common cardio-vascular malformation, it is caused by the spontaneous malformation of the interatrial septum resulting in one or more openings, commonly referred to as holes in the heart .Patients and methods : This study is a prospective hospital based study involving all children at the age from 0 to 18 years diagnosed by echo-cardiography as having isolated atrial septal defect and admitted to paediatric department , intermediate care and neonatal intensive care unit (NICU) ; also out patient clinic at Sohag university hospital during the period from January 2012 to January 2013 .Results : We studied [65] patients diagnosed by trans-thoracic echo-cardiography as isolated atrial septal defect (ASD) ,Their ages ranged from 5 days to 13 years with Mean ± SD ( 2.27 ± 2.8 years) . The main presenting Symptoms included ; reccurent chest infections , respiratory distress, feeding difficulties, exertional dyspnea,failure to thrive, manifestations of heart failure , and permanent cyanosis . Echo findings demonstrated that,the majority of cases had ASDII , followed by ASDI , then combined ASD , and less common type was sinus venosus ASD . Conclusion : The great majority of infants with ASDII are most often asymptomatic. Frequently,the condition is detected by a murmur on routine physical examination when they are school-aged children.

484Impact of AF type on the outcome of atrial fibrillation ablation: insights from the CABANA trial

Abstract Background Prior studies suggest that catheter ablation (ABL) for atrial fibrillation (AF) is a treatment option for patients (pts) with paroxysmal AF (PAF). Pts with persistent (Per) or long-standing persistent (LSP) were routinely excluded from most ABL based clinical trials. The effectiveness of ABL compared to drug therapy (MED) in relation to underlying AF type has not been evaluated in a large randomized clinical trial. Objective To assess the impact of AF type on clinical outcomes of ABL vs. MED in pts with AF. Methods The CABANA trial randomized 2204 pts with AF at 126 sites worldwide to ABL vs. MED with rate or rhythm control drugs. The primary endpoint was a composite of death, disabling stroke, severe bleeding, or cardiac arrest. Key secondary endpoints included mortality and recurrence of AF. Outcomes of ABL vs. MED were compared within subgroups defined by AF type using Intention-to-Treat (ITT) analyses. Results Of the 2204 pts, 946 had PAF, 1042 had Per and 215 presented with LSP. There were baseline differences among AF types in age, gender, HTN, LVH, CHF and NYHA Class. For the primary endpoint, there were no significant differences between ABL and MED in pts with PAF (hazard ratio (HR) 0.82; 95% confidence interval (CI) 0.51, 1.31), Per (HR 0.87; 95% CI 0.59, 1.28), or LSP (HR 1.01, 95% CI 0.39, 2.61). Likewise, there were no significant treatment differences in mortality; PAF (HR 0.84; 95% CI 0.46, 1.52), Per (HR 0.90; 95% CI 0.56, 1.46) and LSP (HR 0.67, 95% CI 0.23, 1.94). Post-blanking AF (time to first recurrence) was significantly reduced by ABL compared to MED across all AF types (PAF by 51%), (Per by 47%) and (LSP by 36%). Clinical Characteristics and Outcomes Clinical Outcomes Comparing ABL vs. MED (HR and 95% CI) Interaction p-value Primary Endpoint 0.82 (0.51, 1.31) 0.87 (0.59, 1.28) 1.01 (0.39, 2.61) 0.925 Mortality 0.84 (0.46, 1.52) 0.90 (0.56, 1.46) 0.67 (0.23, 1.94) 0.881 Recurrent AF 0.49 (0.38, 0.62) 0.53 (0.43, 0.65) 0.64 (0.41, 1.01) 0.564 Conclusion Pts with LSP have a lower proportion of women, and a higher proportion with manifestations of heart failure despite lower CHA2DS2VASc scores. By ITT analysis, there is no significant effect of ABL compared to MED in the primary endpoint or mortality in any AF group. However, ABL is more effective than MED for reducing recurrences of AF regardless of AF type, but with a greater effect in PAF vs Per vs LSP. Acknowledgement/Funding NIH, St Jude Medical Foundation and Corporation, Biosense Webster Inc., Medtronic Corporation, and Boston Scientific Corporation

P6326Which results of the cardiopulmonary exercise test deserve greatest attention to establish the prognosis in heart failure?

Abstract Background and aim Limitation of exercise tolerance is one of the cardinal manifestations of heart failure (HF). Cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise integrative physiology involving the pulmonary, muscular, and oxidative cellular systems. We aimed to identify which data collected during a CPET shows the best prognostic performance with respect to predicting mortality or the need for heart transplantation (HT). Methods Single-centre retrospective cohort study of consecutive HF patients performing a CPET for functional and prognostic HF evaluation from October 1996 till May 2018. Left ventricular ejection fraction was not an exclusion criterion. A Cox model was fit with time to death or heart transplantation (whichever recorded first within 5 years) as the dependent variable and CPET parameters as the independent variables. Both unadjusted and adjusted covariate Cox regressions were performed. ROC curve analysis was used to determine whether the significant variables, as a model, could reliably predict the study endpoint. Results The study population consisted of 513 patients, median age 58 (IQ 16) years, and 74.9% male. The majority had reduced ejection fraction (75.4%), and the most common HF aetiology was ischemic heart disease (55.8%). During the 5-years follow up, 126 patients died and 60 underwent heart transplantation. In unadjusted Cox regression, nearly all CPET variables were significantly associated with the study endpoint. After covariate adjustment, with prior exclusion of redundant variables, three measures remained associated with the study endpoint: peak VO2 consumption (hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.81–0.90); VE/VCO2 slope (HR 1.02; 95% CI, 1.00–1.02); presence of oscillatory ventilatory pattern (HR 3.73; 95% CI, 2.43–5.72). As a model, these 3 variables showed a strong discriminatory ability (c-statistic 0.87; 95% CI, 0.83–0.90) (see figure) for the study endpoint. Figure 1 Conclusion When using the CPET for prognostic stratification of HF patients, the presence of an oscillatory ventilatory pattern, the peak VO2 and the VE/VCO2 slope are the most important tools on which clinicians should focus.

'The Future is Probably Now': Understanding of illness, uncertainty and end-of-life discussions in older adults with heart failure and family caregivers.

BackgroundEarlier end‐of‐life communication is critical for people with heart failure given the uncertainty and high‐risk of mortality in illness. Despite this, end‐of‐life communication is uncommon in heart failure. Left unaddressed, lack of end‐of‐life discussions can lead to discordant care at the end of life.ObjectiveThis study explores patients' and caregivers’ understanding of illness, experiences of uncertainty, and perceptions of end‐of‐life discussions in advanced illness.DesignInterpretive descriptive qualitative study of older adults with heart failure and family caregivers. Fourteen semi‐structured interviews were conducted with 19 participants in Ontario, Canada. Interviews were transcribed verbatim and content analysis was used to analyse the data.Main resultsUnderstanding of illness was shaped by participants’ illness‐related experiences (e.g. symptoms, hospitalizations and self‐care routines) and the ability to adapt to challenges of illness. Participants were knowledgeable of heart failure management, and yet, were limited in their understanding of the consequences of illness. Participants adapted to the challenges of illness which appeared to influence their perception of overall health. Uncertainty reflected participants’ inability to connect manifestations of heart failure as part of the progression of illness towards the end of life. Most participants had not engaged in prior end‐of‐life discussions.ConclusionDetailed knowledge of heart failure management does not necessarily translate to an understanding of the consequences of illness. The ability to adapt to illness‐related challenges may delay older adults and family caregivers from engaging in end‐of‐life discussions. Future research is needed to examine the impact of addressing the consequences of illness in facilitating earlier end‐of‐life communication.

Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part II: The role of right heart chambers, vascular system and skeletal muscles

The main clinical manifestation of heart failure with preserved ejection fraction is poor exercise tolerance. In addi-tion to the dysfunction of the left heart chambers, which were presented in the first part of this review, many other disorders are involved in poor exercise tolerance in such patients: impairments of the right heart, vascular system and skeletal muscle. The second part of this review presents the mechanisms for the development of these disorders, as well as possible ways to correct them.

Exercise Intolerance in Heart Failure: Central Role for the Pulmonary System.

We propose that abnormalities of the pulmonary system contribute significantly to the exertional dyspnea and exercise intolerance observed in patients with chronic heart failure. Interventions designed to address the deleterious pulmonary manifestations of heart failure may, therefore, yield promising improvements in exercise tolerance in this population.

Experience of surgical treatment of infective endocarditis in children

Surgical treatment of infectious endocarditis in children, single-center experience. The paper analyzes the experience of surgical treatment of infectious endocarditis (IE) in children. In the period from January 1999 to July 2019, 69 children with IE were operated at National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, 44 of them (63.8%) developed the disease on the background of congenital heart defects (CHD). The mean age of the patients at the time of surgery was 9.1 ± 6.1 years. The average weight is 31.5 ± 21.7 (3.6 to 85 kg). The duration of the disease at the time of hospitalization was 5.3 ± 1.1 months. The average duration of the fever before hospitalization was 10.2 ± 8.5 weeks. Among the causes of IE, we observed three groups of inflammatory diseases: infections of the skin and subcutaneous fat in 15 (21.7%) cases, pathology of ENT – organs – 14 (20.2%) and broncho-pulmonary diseases – 9 (13.1%) cases. The risk factors were: presence of CHD – 44 (63.7%) and also nosocomial factors. The microbiological spectrum of pathogens included gram-positive microorganisms – 33 (71.7%), gram-negative microorganisms 4 (8.7%) and fungal microflora 9 (19.6%). The mean values of bypass circulation were 111.5 ± 62.4 minutes, and the time of aortic clamping was 71.4 ± 43.9 minutes, respectively. Hospital mortality in the general group of patients was 4 (5.8%) cases. In the follow-up period, 59 patients were examined, representing 90.7% of those discharged at the hospital stage. The observation period lasted from one month to 19.4 years (9.6 ± 5.7 years). According to the Kaplan-Meier analysis, the cumulative survival rate of patients in the CHD group at one year after surgery was 97.1%, at 10 years – 93.5%; after 15 years – 93.5%. Survival in the non-CHD group at 5, 10, and 15 years was 100%. In the long term, two patients died (3.4%). The recurrence rate of IE in the distant period was 2 (3.4%) cases. The incidence of long-term reoperation was 8 (13.6%) cases, three were recurrent IE and five were non-recurrent. According to Kaplan-Meier analysis, the proportion of patients without recurrent surgery in the long-term follow-up at 5 years was 87.9%, at 10 years – 84.1%, after 15 years – 77.1% in the CHD group. In the group without CHD 5 years – 95.2%, 10 years – 95.2%, 15 years – 81.6%. In the long term, as a result of performed surgical interventions, the regression of clinical manifestations of heart failure was noted in the majority of patients.

Abstract 264: EPRS is a Critical Translational Control Factor in Cardiac Fibrosis

Increased protein synthesis of pro-fibrotic genes is a common feature of cardiac fibrosis, a major manifestation of heart failure (HF). Despite this observation, critical factors and molecular mechanisms for translational control of cardiac fibrosis remain underexplored. Here, we identify a critical house-keeping translational regulator, glutamyl-prolyl-tRNA synthetase (EPRS), which preferentially regulates the translation of proline-rich (PRR) pro-fibrotic genes. In mammals, EPRS catalyzes the attachment of two amino acids, glutamic acid and proline, to their cognate tRNAs for protein synthesis. By overlapping of aminoacyl-tRNA synthetases (ARSs) induced in TGF-β treated human cardiac fibroblasts, human ARSs with genetic mutations in the congenital heart disease, mouse ARSs associated with isoproterenol (ISO)-induced cardiomyopathy by GWAS, and ISO-induced ARSs in mouse failing hearts, we identified EPRS as the only ARS involved in various cardiac pathogenesis. EPRS is induced in failing human heart compared to non-failing donor heart and functions as an integrated node downstream of multiple hypertrophic and fibrotic stimuli in murine hearts, including ISO infusion and transverse aortic constriction (TAC) surgery. Low-dose halofuginone (Halo), a prolyl-tRNA synthetase (PRS)-specific inhibitor, as well as genetic knockout of one allele of EPRS in mouse genome, reduces cardiac hypertrophy and fibrosis in ISO- and TAC-induced HF mouse models. Using RNA-Seq and polysome profiling-Seq in Halo-treated fibroblasts, we identified several novel PRR genes, including Ltbp2, Furin and Sulf1, in addition to collagens, which are translationally regulated by EPRS. Inhibition of Furin by various inhibitors attenuates cardiac fibroblast activation and collagen deposition in vitro . Finally, we found that inactivation of EPRS reduced translational efficiency and enhanced mRNA decay of PRR genes. Taken together, our results indicate that EPRS controls the translational activation of PRR genes in cardiac fibroblasts, and these data provide novel insights into the translational control mechanisms of cardiac fibrosis, which may promote development of novel therapeutics by inhibiting pro-fibrotic translation factors.

Neurohumoral Pathway in Heart Failure

Heart Failure is now considered as one of the leading cause for mortality and morbidity. It is affecting several organs and cause organ damages due to the myocardial failure to pump inadequate oxygenated blood to the body including metabolites, to end organs and peripheral tissues. Heart failure results from multifactorial mechanism including neurohumoral activations including increased activity of the sympathetic nervous system, renin-angiotensin aldosteron system, vasopression and the atrial natriuretic peptide. This neurohumoral pathway has significant contribution to the development of myocardial dysfunction that lead to clinical manifestation of heart failure. Some of the markers in these pathways have now been considered as an independent predictors of prognosis in heart failure patient.

Outcomes of the minimally invasive aortic valve replacement

The OBJECTIVE was to demonstrate clinical outcomes of minimally invasive aortic valve replacement (MIAVR).MATERIAL AND METHODS. We retrospectively analyzed surgical results of treatment of patients underwent isolated AVR in our Institution between 2006 and 2018. Overall number of operations was 122; 56 of patient were operated via upper ministernotomy approach. Preoperative characteristics were similar in both groups.RESULTS. In our series MIAVR procedures had prolonged CPB and aortic cross clamping time, what significantly contributed to the increase in manifestations of heart failure in the early postoperative period, but didn’t affect the perioperative mortality and major morbidity rates. MIAVR led to reduction in postoperative blood loss and perioperative red blood cell transfusion rate. Most severe complications occurred in frail patients older than 75 years, and in those with extensive aortic annular calcification.CONCLUSION. MIAVR was the safe and reproducible surgical intervention and rarely led to significant complications in low-risk patients. Prolonged CPB time adversely affected the frequency of significant complications, especially in elderly patients. Although, selected high risk patients might benefit with MIAVR.

Ремоделирование левого желудочка у больных гипертонической болезнью

This article is devoted to the study of left ventricular remodeling processes in patients with different duration of hypertension history. The urgency of the problem lies in the fact that not only the increase in the mass of the left ventricle, but also the type of its geometric changes determines the risk of mortality of patients from cardiovascular complications. Cardiac remodeling precedes clinical manifestations of heart failure and accompanies them, as well as independently exacerbates the manifestations of diastolic and systolic ventricular dysfunction, is a serious independent prognostic risk factor for arrhythmias, coronary heart disease, strokes and sudden death. We conducted a retrospective analysis of 40 case histories of patients who were on inpatient treatment in GBUZ RM Republican hospital. Depending on the length of the disease, the subjects were divided into two groups: with the duration of the disease up to and more than 10 years. Echocardiography data were used to describe the nature of left ventricular remodeling. Our results showed that the prevalence of myocardial hypertrophy in patients with hypertension is low and is 20% in the group with anamnesis of GB<10 years and 15% — with anamnesis of GB>10 years. In the group of patients with long-term existing hypertension, more pronounced hypertrophy of the left ventricular walls is observed. In the long-term course of hypertension, the development of concentric remodeling and diastolic dysfunction of the left ventricle is an early marker of geometric restructuring of the left ventricle. Early detection of left ventricular remodeling processes is necessary for correct risk stratification and treatment tactics.

Long-Term Outcomes of Pharmacoinvasive Reperfusion Strategy Depending on the Choice of Thrombolytic Agent in ST-Segment Elevation Myocardial Infarction

There is limited information on the comparative results of using different thrombolytic drugs for pharmacoinvasive reperfusion in acute ST-segment elevation myocardial infarction (STEMI). There is special interest in comparing the efficacy of fibrin-selective and fibrin-non-selective thrombolytics. Aim. To study the prevalence of major adverse cardiovascular events and the status of patients who had STEMI and pharmacoinvasive reperfusion a year ago, depending on the choice of thrombolytic drug. Material and methods . 240 STEMI-patients undergoing pharmacoinvasive reperfusion (reference event) were divided into 4 groups depending on the choice of the thrombolytic drug (alteplase [group 1], teneteplase [group 2], fortetelizin [group 3], streptokinase [group 4]) as well as into 2 groups depending on the fibrin-specificity of thrombolytics. One year after the reference event the prevalence of major cardiovascular events (death, repeated myocardial infarction, stroke, repeated revascularization of the target vessel, and their combination) was assessed. Data of echocardiography and 24-hour ECG monitoring, indicis of rating scale of clinical state in patients with heart failure (RSCS, Mareev V.Y, 2000), results of determination of plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) and of six-minute walk test were also analyzed. Results. One year after the reference event, patients who received fibrin-selective thrombolytics (groups 1,2, 3) compared with patients treated with fibrin-non-selective drug (group 4) had a higher left ventricular ejection fraction (49.8±7.4% vs 47,4±6.8%; p=0.048), lower index of impaired local contractility (1.19 [1.06; 1.38] vs 1.25 [1.175; 1.5], p=0.029), an end-diastolic volume (1 39.1 ±28.6 ml vs 148.7±23.9 ml; p=0.027), the size of the left atrium (39.0±4.6 mm vs 41.1 ±3.1 mm, p=0.007 ), and insignificantly lower prevalence of atrial fibrillation (1.5% vs 6.7%, p=0.068). They also showed a lower prevalence of supraventricular tachycardia (4.5% vs 13.3%, p=0.049) and ventricular extrasystoles (54.5% vs 76.7%, p=0.022) as well as the daily number of ventricular extrasystoles (4.5 [0; 32.0] vs 34, 0 [2.25; 80.25], p=0.001) with more favorable gradations and indicators of heart rate variability. Statistically significantly lower NT-proBNP level (148 [1 20; 208.5] pg/ml vs 241 [189; 287] pg/ml; p=0.000) and chronic heart failure manifestation according to RSCS (p=0.033), as well as a longer distance in the six-minute walk test (p=0.000) were found in patients treated with fibrin-selective drugs. Statistically significant differences between groups 1, 2, 3 for the study period were not found. Significant differences in the prevalence of hard clinical endpoints (death, repeated myocardial infarction, stroke, repeated revascularization of the target artery) were not found in all groups. Conclusion. More favorable clinical, laboratory and instrumental parameters were found one year after STEMI and pharmacoinvasive reperfusion with fibrin-specific thrombolytic agents as compared with fibrin-non-specific thrombolytic. All groups had no statistically significant differences in the effect on hard clinical endpoints during the entire observation period.

The role of multimodal imaging in the diagnostics of non-compaction cardiomyopathy (a clinical case)

Non-compaction cardiomyopathy is a rare heart disease of non-ischemic origin, which is characterized by increased myocardial trabecularity with deep intertrabecular recessions, which contributes to increased thrombogenicity, loss of myocardial contractility and heart failure manifestation. Despite of the increasing number of publications describing this pathology during last years, this form of cardiomyopathy remains underdiagnosed and little known for a wide range of physicians. The purpose of the study was to present the role of speckle tracking echocardiography and cardiac magnetic resonance tomography in the differential diagnosis of non-compaction cardiomyopathy. Results. It was described a clinical case of a 53-year old female with intact coronary arteries, who had been followed up for ten years with a diagnosis of dilated cardiomyopathy after the detection of a left bundle branch block. When performing standard echocardiography, a two-layer structure of the myocardium was found in the apical lateral segments of the left ventricle (LV) with the presence of hypertrabeculated internal layer and diffuse decrease in global LV contractility (three-dimensional ejection fraction 34 %). There was a decrease in LV global longitudinal strain up to 12 % measured by speckle-tracking echocardiography. Analysis of segmental myocardial deformation curves in conditions of left bundle branch block revealed the most prognostically unfavorable dyssynchrony pattern. Cardiac magnetic resonance imaging confirmed the presence of hypertrabecularity with compact to non-compact layer ratio of more than 1/2,5, which verified the diagnosis of non-compaction cardiomyopathy. Conclusions . The clinical manifestations of non-compaction cardiomyopathy are non-specific, therefore instrumental criteria play an important role in the diagnosis. Cardiac magnetic resonance imaging, three-dimensional and speckle-tracking echocardiography are reliable methods for diagnostics and prediction of this disease outcomes.

Is echocardiography mandatory for patients with chronic kidney disease?

This study aims at evaluating the prevalence of left ventricular diastolic dysfunction in a group of 319 hypertensive patients with stage 3b-4-5 chronic kidney disease (according to Kidney Disease Improving Global Outcomes classification), compared with 216 patients with essential hypertension and normal renal function. All patients underwent echocardiographic examination. Patients on stage 1-2-3a chronic kidney disease, dialysis treatment, or with previous manifestations of heart failure or other cardiovascular diseases were excluded. Patients with renal disease had significantly worse diastolic function (both considering trans-mitral flow and tissue Doppler imaging parameters). Diastolic dysfunction is found in 70.5% of the CKD group and in 41.6% of hypertensive patients (p < 0.0001). Multiple regression analysis shows an association between renal function and diastolic function (β 0.223; p < 0.0001), independent of potential confounders. Our study shows that diastolic dysfunction is highly prevalent in patients with advanced chronic kidney disease; we posit that in this population, the risk of diastolic heart failure is very high. We think that patients with a marked decrease of glomerular filtration rate (GFR) must be considered at high risk for diastolic heart failure and should have an echocardiographic examination performed, even if asymptomatic and in the absence of evident cardiovascular disease.

Soluble suppression of tumorigenisity 2 as an indicator of severity of heart failure in children with congenital acyanotic heart diseases

Objective We aimed to evaluate the role of soluble suppression of tumorigenisity 2 (sST2) as an indicator of severity of heart failure (HF) in children with congenital acyanotic heart diseases. Background HF in congenital heart diseases (CHD) is a serious problem encountered in early infancy or later. It is a significant cause of morbidity and mortality in children with CHD. SST2 is currently gaining interest as a biomarker in cardiac disease. Patients and methods A prospective comparative study was conducted on 60 children having CHD with left-to-right shunt from the Pediatric Department of Menoufia University Hospitals between August 2017 and August 2018 and were divided into two groups: group 1: 30 children with manifestation of HF. Group 2: 30 children without manifestation of HF. In addition, 25 age-matched and sex-matched healthy children were set as a control group. All children were subjected to a full clinical history and examination. Serum level of sST2 were determined. Results Level of sST2 was 82.2 ± 22.3 and 25.63 ± 19.33 ng/ml in patients with and without HF, respectively. SST2 was significantly higher in patients who developed HF than in those without HF (P Conclusion SST2 is a promising novel cardiac biomarker that could reflect the severity of HF.

Examining the impacts of 12 weeks of low to moderate-intensity aerobic exercise on depression status in patients with systolic congestive heart failure - A randomized controlled study

OBJECTIVES:Psychiatric depression disorder is common in patients with systolic congestive heart failure (HF), and both conditions share underlying pathophysiological mechanisms. The incidence rate of depression disorder has clearly increased with the increase in HF manifestations in recent decades. Depression disorder is considered an independent predisposing factor for hospitalization, disturbed functional performance, and high rates of morbidity and mortality in HF patients. This randomized controlled study was designed to examine the impacts of low- to moderate-intensity aerobic exercise training on depression status in patients with systolic congestive HF.METHODS:A total of 46 systolic congestive HF patients with depression (40-60 years of age) were randomized to receive twelve weeks of mild- to moderate-intensity aerobic exercise plus standard medical treatment (exercise group) or standard medical treatment without any exercise intervention (control group). Depression status was examined using the validated Patient Health Questionnaire-9 (PHQ9) pre- and post-intervention at the end of the study program.RESULTS:No significant differences were observed between the exercise and control groups in demographic data or clinical characteristics (p>0.05). Both study groups showed a significant reduction in depression status at the end of the 12-week intervention (p<0.05). The comparison between the mean values of the depression scores showed significant differences between the two groups after 6 and 12 weeks of the intervention, indicating a greater reduction in depression scores in the exercise group than in the control group (p<0.05).CONCLUSIONS:Twelve weeks of a low- to moderate-intensity aerobic exercise program was safe and effective for reducing depression severity in patients with systolic congestive HF. Low- to moderate-intensity aerobic training should be recommended for cardiac patients, particularly those with HF-related depression.

Implantable Cardioverter-Defibrillators are the Main Link in the Modern Concept of Sudden Cardiac Death Prevention. Problems and Prospects of the Development of the Method

The article covers the development of the problem of sudden cardiac death prevention with the implantable cardioverter-defibrillators from the moment of creation of these devices to our days. The current concept of primary prevention of sudden cardiac death, based on the severity of manifestation of heart failure and left ventricular dysfunction, is not effective enough. Its practical application is difficult because it requires mass application of implantable defibrillators, with low predictive accuracy of these criteria interms ofdevelopment of life-threatening arrhythmias. The development of methods for visualizing the myocardium, allowing to assess theseverity ofmyocardial fibrosis, as well as the possibilities of medical genetics, at the present stage, allows us to clarify indications for implantation ofcardioverter-defibrillators and thereby significantly improve the concept of preventing sudden cardiac death with these instruments.

Diagnostic capabilities of electrocardiography systolic heart failure

The contractility of the myocardium is determined by the strength and speed of contraction of the ventricles. It can be estimated from the Q-T interval of the electrocardiogram, which is an electrical systole of the ventricles. Set the change in ventricular systole by the deviation of the actual interval of Q-T from the corrected one. Elongation of ventricular systole indicates a violation of myocardial contractility, which causes the development of systolic heart failure. When comparing this indicator with the results of echocardiography, reflecting the contractility of the left ventricle, their direct dependence was established. The greater the degree of breach of myocardial contractility, the higher the percentage of the deviation of the actual Q-T interval from the corrected one. The maximum figures were recorded in patients with a global contractility disorder. This indicator can be used to detect both acute and chronic systolic insufficiency. It was established that in all patients with heart failure there was an increase in the Q-T interval. The magnitude of it depended on the degree of manifestation of heart failure. The increase in the percentage deviation of the actual value from the control occurred in patients with heart failure from I functional class to IV. Only in 1/5 of patients with heart failure of I functional class, the actual value did not differ from the control one, but under physical load, it increased significantly, which indicates the presence of latent systolic insufficiency. It is also found in patients with heart failure with a preserved ejection fraction, the development of which is associated with diastolic dysfunction. Electrocardiography can be used as a method of diagnosing systolic heart failure, which is highly informative and specific.