Myocardial Mass Index Research Articles

Significant regression of left ventricular hypertrophy in patient with arterial hypertension during antihypertensive treatment with perindopril and atorvastatin

Left ventricular hypertrophy (LVH) in arterial hypertension (AH) is one of the modifiable risk factors for cardiovascular events and serves as a justified goal for antihypertensive therapy. The article presents follow-up of a 60-year-old female with AH, hyperlipidemia, and discovered of LVH on the data of electrocardiography and echocardiography. In addition to the SokolowLyon and Cornell voltage criteria, the baseline echocardiographic examination revealed and increase in thickness of the ventricular septum and the left ventricular (LV) posterior wall, an increase in LV myocardial mass and LV myocardial mass index. The patient was recommended to take a drug of the class of angiotensin converting enzyme inhibitors perindopril and atorvastatin. The patient regularly received therapy and periodically underwent repeated echocardiographic examinations. After 40 months follow-up there are a significant decrease in septal hypertrophy (from 1.22 to 0.76 cm, -37.7%), LV posterior wall (from 1.05 to 0.49, -53.3%), as well as LV myocardial mass (from 197.9 to 96 g, -51.5%) and LV myocardial mass index (from 111.18 to 59.11 g/ m2, -51.5%). Thus, during the entire period of follow-up, the LV mass decreased almost twice. There was a decrease in the size of the left atrium, the relative wall thickness, with the same parameters of LV volumes, characteristics of systolic and diastolic function. Among the favorable factors contributing to significant LVH regression, high adherence to treatment, the efficacy of angiotensin converting enzyme inhibitors and the possible antihypertrophic influence of atorvastatin are discussed.

Prevalence of amyloidosis among patients with mild to severe aortic stenosis. Validation of screening parameters

Abstract Background Cardiac amyloidosis (CA) is an increasingly recognized cause of human heart failure. Up to 16% of patients with severe aortic stenosis (AS) undergoing transcatheter valve replacement have been reported to suffer concomitant transthyretin CA (ATTR). Since the diagnosis of CA implies distinct therapies with prognostic relevance, early diagnosis of CA is crucial. Different parameters have been described to improve screening accuracy for detection of CA, but it is unknown whether these parameters are valid, and the prevalence of CA is stable throughout the spectrum of AS. Purpose To validate screening parameters for the detection of CA in mild, moderate and severe AS. Methods Patient 65 years and above undergoing echocardiography with mild to severe AS, defined as calculated valve orifice area <2 cm2 by velocity-time-integral, and an intraventricular septum thickness > 11mm, fulfilling at least one of two additional criteria (Sokolow-Lyon-Index to left ventricular mass index ratio < 1.5 or stroke volume index < 35 ml/m2) were prospectively included and screened for CA using bone scintigraphy and immunofixation in blood and urine. Results 57 patients were included and completed the diagnostic work-up. Mean age was 83 ± 0.7 years and 71% were male. Overall, 15 (26%) of patients were diagnosed with CA (12 with ATTR and 3 with light-chain CA, Figure1A). 17 patients had mild, 21 had moderate and 19 patients were diagnosed with severe AS. Among patients with mild AS 41% were diagnosed with CA, whereas only 24% of patients with moderate and 16% of patients with severe AS suffered CA (Figure 1B), these results did not show statistically significant differences (p= 0.2, by Chi-Square Quadrat test). Patients with CA were less likely to have NYHA classes I or II (20 vs. 57%, p= 0.03), had higher values of NT-proBNP (4572 [2323; 6044] vs. 817 [589; 2571], p< 0.001) and high-sensitive troponin (66 [47; 103.5] vs. 22.5 [17; 33.6], p< 0.001) and were more likely to have an atrioventricular block of any degree (60 vs. 26%, p=0.04). Conclusion Prevalence of CA among patients fulfilling the criteria of this screening algorithm seems to be high independent of AS severity. Clinicians should not only focus on patients with severe AS to detect CA early. Further research is needed to estimate the prevalence of CA among all patients with AS. Figure 1 A: Among patients with an age >65 years, IVS >11mm, AS and SLI/LVMMI >1.5 or SVI <35 ml/m2 26% (red area) of patients were diagnosed with CA (n= 57). B: In patients with mild AS 41% were diagnosed with CA, whereas in patients with moderate AS only 24% and in patients with severe AS 16% had CA. These differences did not show statistical significance (p= 0.2). IVS: intraventricular septum, AS: aortic stenosis, SLI: Skolow-Lyon-Index, LVMM= left ventricular myocardial mass index, SVI: stroke volume index, CA: cardiac-amyloidosis. (Statistics performed by chi-square test using GraphPad Prism 9.0).

Cardioprotective efficacy of combined therapy with azilsartan, indapamide, and nitrendipine in patients with essential hypertension

Abstract Objective To conduct a comparative assessment of the six-month cardioprotective efficacy of combined therapy using azilsartan with indapamide and nitrendipine in patients with essential hypertension (EH). Materials and Methods The study included 101 male and female patients with grade I–II arterial hypertension (AH) according to the classification (ESC/ESH, 2018), who were undergoing outpatient treatment at the Republican Specialized Scientific-Practical Medical Center of Cardiology. The mean age of the patients was 53.1±11.2 years, and the mean duration of AH was 8.5±7.2 years. Initially and after 6 months of therapy, echocardiography was performed to determine the left ventricular myocardial mass index (LVMMI) and left ventricular (LV) echo geometry types. Echocardiography (ECHO) was performed using the "En VisorC" ultrasound system (Philips, Netherlands). Statistical significance was considered for all analyses with p <0.05. Results All patients were divided into 2 groups: Group 1 - patients on combined antihypertensive therapy (AHT) with azilsartan and indapamide (n=50) and Group 2 - patients on therapy with azilsartan and nitrendipine (n=51). The mean daily dose of azilsartan was 49.3±6.0 mg, nitrendipine was 10.88±4.3 mg, and indapamide was 1.69±0.5 mg. In Group 1, the LVMMI initially was 127.4±32.9 g/m2, and after treatment, it was 110.3±29.0 g/m2 (p<0.001); in Group 2, it was 138.7±31.9 g/m2 and 116.6±30.3 g/m2, respectively (p<0.001). The degree of LVMMI reduction in Group 1 was -13.3±15.6% compared to Group 2, which was -14.4±17.9% (p>0.05). During therapy with azilsartan, indapamide, and nitrendipine, the reduction of LVMMI in EH patients was associated with a decrease in the concentric type of left ventricular hypertrophy (LVH) in both therapy groups: in both groups, a significant increase in the LV diastolic filling pattern index/LVMMI was observed, which was 0.51±0.07 ml/g before treatment and 0.57±0.14 ml/g after treatment in Group 1 (p<0.001), and 0.50±0.11 ml/g before treatment and 0.54±0.12 ml/g after treatment in Group 2 (p<0.02). Significant regression of LVH with 6-month combined therapy in both groups was accompanied by an improvement in LV echo geometry. Initially, there were 12 patients (11.9%) with unchanged LV echo geometry, concentric remodeling was detected in 9 patients (8.91%), eccentric LVH in 30 patients (29.7%), and concentric LVH in 50 patients (49.5%). In the dynamics, the number of patients with normal LV echo geometry increased to 41 patients (40.6%), with concentric LVH decreased to 34 patients (33.6%), with concentric remodeling decreased to 7 patients (7%), and with eccentric LVH decreased to 19 patients (18.8%) (χ2=21.635, p<0.001). Conclusion Achieving target blood pressure levels provided high cardioprotective efficacy of combined therapy with azilsartan, indapamide, and nitrendipine with improvement in LV echo geometry in both groups.

Chronopharmacotherapy and correction of central pressure in the aorta, structural and functional state of the left ventricular in patients with arterial hypertension and ischemic stroke

Objective. To evaluate the dynamics of central aortic pressure and the cardioprotective effect of antihypertensive chronopharmacotherapy in patients with arterial hypertension (AH) and ischemic stroke. Materials and methods. The study included 119 patients with AH who has suffered an ischemic stroke; patients were randomized in 2 groups depending on the chronopharmacotherapy option: group 1 (n = 60) – patients who received indapamide retard 1.5 mg and valsartan 160 mg in the morning; group 2 (n = 59) – indapamide retard 1.5 mg in the morning and valsartan 80 mg each in the morning and before bedtime. After 2 months of pharmacotherapy, the achievement of the target level of blood pressure was assessed. In group 1, blood pressure was recorded in 47 (78.3 %), in group 2 – in 56 (94.9 %) patients (p < 0.05). The rest of the respondents, who did not reach the blood pressure target, underwent correction of antihypertensive therapy and were excluded from further follow-up. Accordingly, further follow-up was carried out in 47 patients of group 1 (group 1a) and 56 patients of group 2 (group 2a). Initially and after 12 months of therapy, echocardiography parameters ("ALOKA SSD 2500", Japan), as well as daily blood pressure monitoring with determination of central aortic pressure (Peter Telegin LLC BPLabVasotens, Russia) were performed. The results of the study were processed using the Statistica 12.0 program (StatSoftInc, USA). Results. At the time of inclusion in the study, the main parameters of the central aortic pressure and echocardiography parameters in both groups of patients were equivalent. After 12 months a statistically more significant decrease in the main parameters of the central aortic pressure (average daily systolic and diastolic pressure in the aorta, pulse pressure in the aorta, augmentation index in the aorta, amplification of pulse pressure, duration of the expulsion period, subendocardial blood flow efficiency index), as well as echocardiography indicators was recorded in group 2a (end-systolic and end-diastolic dimensions, thickness of the interventricular septum, thickness of the posterior wall of the left ventricular myocardium, left ventricular myocardial mass, left ventricular myocardial mass index and ejection fraction) (p < 0.05). The left ventricular myocardial geometry normalized during therapy was recorded significantly more often in group 2a than in group 1a (p < 0.05). Conclusion. Two times a day intake of valsartan with thiazidelike diuretic in the morning facilitated more significant improvement of central aortic pressure, echocardiography parameters and as well as an improvement in the geometry of the left ventricular myocardium comparing to just morning intake.

Possibility of correction of the blood-heart barrier damage as a consequence of the impact of the SARS-CoV-2 virus on the cardiovascular system in patients with coronary artery disease in combination with COVID-19.

damage to the blood-heart barrier (BHB) and endothelial dysfunction is a characteristic feature of congestive (cardiopulmonary) chronic heart failure (CHF), the main cause of death in elderly people with CHF caused by new coronavirus variants (SARS-CoV-2), but the mechanism of this phenomenon remains unclear. The aim of this project is to determine the mechanism of BHB damage in coronary artery disease (CAD) with COVID-19, as well as the possibility of its correction with the use of sulodexide. The endocardial endothelium (EE) is a barrier that prevents blood leakage from the endocardium to the interstitium; however, this barrier is impaired during the course of COVID-19 in patients with CAD. Previous studies have shown that one of the pathophysiological mechanisms is the activation of matrix metalloproteinases (MMPs) in CAD with CHF. MMP-9 degrades connexins, which leads to EE dysfunction. One study [Rubens P. et al. 2021] found a juxtacrine connection of EE with the myocyte and mitochondria (Mito), but how this works is still an open question. Materials and methods. We examined 65 patients with coronary artery disease diagnosed with COVID-19. Patients were divided into two groups: Group I (n=35) - patients who had been taking sulodexide at a dose of 500 LE x 2p/day for 6 months against the background of standard therapy of coronary artery disease; Group II (n=30) - patients without sulodexide. Echocardiography and laser Doppler flowmetry were performed at baseline and 6 months later. Echocardiography at the time of inclusion in the study revealed that 30 (50%) patients in group I and 14 (47%) patients in group II had reduced left ventricular ejection fraction (LV EF) values of 40 to 50%. After 6 months of treatment with sulodexide, a tendency to improve LV systolic function and decrease in left ventricular myocardial mass index (LFMMI) was noted in patients of group I. There were no differences between the groups at the time of inclusion in the study in terms of the level of the capillary flow reserve – occlusion test (CFRo) and the capillary flow reserve – nitroglycerin test (CFRn). A repeated study of CFR revealed a significant increase in CFRo and CFRn levels only in group I. In patients of group II, no significant changes in CFRo and CFRn were found. An inverse relationship between the level of CFRo and C-reactive protein (CRP) was found in patients of group I (r=0.52, p<0.05). After 6 months of treatment, plasma CRP concentrations decreased significantly: from 17.7 [1.3; 50.1] to 5.7 [1.0; 12.0] mg/L in group I (p=0.01) and from 14.2 [1.2; 27.0] to 4.2 [1.0; 11.0] mg/L in group II (p=0.01). No significant correlations between CRP level and CFRo after 6 months of treatment were found. There were correlations of CFRo and CFRn with left ventricular systolic function, as well as inverse relationships with the size of the left and right ventricles and systolic pressure in the pulmonary artery. There was a tendency to improve systolic and diastolic left ventricular function in the first group, where sulodexide was used, and no significant changes in echocardiography were noted in the second group. At the initial examination of patients, the ratio of CFRo and CFRn had no significant differences. After 6 months of treatment, a significant increase in the ratio of CFRo and CFRn was observed only in patients taking sulodexide, and no positive dynamics of this ratio was observed in group II. The results indicate that MMP-9 activation, endothelial damage, endothelial-myocyte (E-M) uncoupling, and mitochondrial-myocyte uncoupling in heart failure in patients with CAD combined with COVID-19 were detected to a significant extent; however, treatment with sulodexide successfully mitigated the destructive changes in the heart in CAD with CHF. The results obtained are directly relevant to the range of cardiac manifestations and phenotypes arising from COVID-19 complications in people with CAD. Conclusion. The obtained results confirm the improvement of microcirculation, as well as a tendency to improve systolic function and left ventricular myocardial mass index after 6 months of sulodexide treatment in patients with coronary artery disease with preserved and moderately reduced left ventricular ejection fraction (LV EF) who have undergone COVID-19. The described effects of improving endothelial function, as well as improving the state of the blood-brain barrier due to the use of sulodexide, make it possible to recommend the use of this drug in the category of patients with CAD to reduce the negative impact of COVID-19 on the cardiovascular system.

Impact of successful secondary hyperparathyroidism treatment on cardiovascular morbidity in patients with chronic kidney disease KDIGO stages G3b-5.

Chronic kidney disease is common, with a projected increase to 5.4 million people in need of kidney replacement therapy by 2030. As many as 61.7% of patients on hemodialysis have secondary hyperparathyroidism (SHPT). This has been associated with high cardiovascular morbidity. The present study investigates the effect of SHPT treatment success on cardiovascular morbidity in patients with CKD KDIGO stages G3b, 4, and 5. A retrospective single center analysis of 211 chronic kidney disease stages G3b-5 patients undergoing computed tomography for coronary artery calcium (CAC) scoring at the University Hospital of Zurich between 2015 and 2019was performed. The presence of and control of SHPT was assessed at the timepoint of CAC scoring and 6-12 months prior. Information on left ventricular ejection fraction (LVEF), left ventricular hypertrophy (LVH), and left ventricular myocardial mass index (LVMMI) were calculated from echocardiography values obtained at the timepoint of CAC scoring. Occurrence of major acute cardiovascular events, including acute coronary syndrome (ACS), within 1 year of CAC scoring was drawn from the charts. Independent predictive factors for ACS and LVH were assessed by multivariable analysis. Thirty-four percent (n=72) of the patients had uncontrolled SHPT, whereas 66% (n=139) had either no (n=18%, n=39) or a controlled SHPT (n=48%, n=100). The CKD stage G3b-5 patients with uncontrolled SHPT had a significantly lower LVEF (p=0.028) and significantly more pronounced LVH (p=0.003) and a higher LVMMI (p=0.002) than the group with either no SHPT or well-controlled SHPT. Uncontrolled SHPT in the observed CKD cohort had a significantly higher risk for developing ACS (p=0.011, HR 2.76, 95%CI 1.26-6.05) compared to no or controlled SHPT patients (41.7% vs 31.7%). While patients with uncontrolled SHPT showed a median CAC score of 290 (IQR 18-866), those with no or controlled SHPT had a lower median CAC score of 194 (IQR 14-869), although not significant (p=0.490). Patients with CAC scores >400 displayed a significantly higher incidence of ACS (56.8% vs 33.1%, p=0.010). SHPT is common (82%) in advanced CKD (≥G3b) patients and insufficiently controlled in one-third of patients. Insufficient control of SHPT is associated with higher cardiovascular morbidity, lower LVEF, increased LVH, and a higher incidence of ACS. Thus, increased focus on SHPT control in CKD patients may have a beneficial impact on cardiovascular outcomes.

Myocardial remodeling in wistar rats with renal dysfunction fed a high-salt diet

BACKGROUND. Dietary adjustment is an important point in the treatment of chronic kidney disease (CKD). However, at present, the effect of a diet with a high NaCl content on the state of the cardiovascular system in patients with early stages of CKD has not been sufficiently studied.The AIM: to evaluate blood pressure levels and changes in the myocardium of Wistar rats with early stage renal dysfunction fed a high-salt diet for a long time.MATERIALS AND METHODS: The study was performed on male Wistar rats. The control group consisted of sham-operated animals (LO-group), receiving a standard diet (0.34 % NaCl), the second – rats subjected to resection of ¾ of the kidney parenchyma, receiving a standard diet (NE-group), the third – rats, subjected to ¾ NE, receiving high sodium diet (4 % NaCl, NE+HSD). After 4 months, the rats were assessed for blood pressure (BP), levels of urea, creatinine, sodium in the blood serum, daily diuresis, albumin content in the urine, myocardial mass index (IMM) and left ventricular myocardial mass index (IMLV), and a histological examination of the myocardium was performed.RESULTS: In rats with kidney dysfunction, an increase in blood pressure was detected, most pronounced in the NE+HSD group. In rats of this group, albumin excretion, connective tissue volume, arterial diameter, thickness of the adventitia and media of myocardial vessels increased relative to the indicators of rats with NE receiving a standard diet. IMLV in NE+HSD rats was higher by 16.4 %, and IMM by 10.9 % than in animals with NE on a standard diet. The groups with NE did not differ from each other in the content of urea and creatinine in the blood serum, although these indicators were higher than in LO animals. There were no differences between groups in serum sodium levels.CONCLUSION: Prolonged consumption of a diet with a high content of table salt contributes to the development of the initial stages of CKD in Wistar rats, promotes blood pressure growth and myocardial remodeling, manifested primarily in the progression of cardiomyocyte hypertrophy and myocardial fibrosis.

Assessment of structural and functional changes in recipient's transplanted heart in the long-term postoperative period

Introduction. Heart transplantation is an effective way of treating patients with end-stage heart failure. Echocardiography allows for the assessment of the transplanted heart functions at all stages of follow-up. The clinical implementation of myocardial deformation imaging by the speckle tracking echocardiography has made it possible to detect subtle changes in myocardial contractility.Objective. To study the structural and functional state of myocardium in recipients in the long term after orthotopic heart transplantation.Material and methods. The study included 13 orthotopic heart transplant recipients (11 men and 2 women) at a mean age of 54.1±9.1 years who underwent orthotopic heart transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The mean follow-up period after orthotopic heart transplantation was 6±0.7 years. All patients underwent transthoracic echocardiography according to the standard protocol, including determination of left ventricular myocardial deformation.Results. The median volume of the left atrium was 60 (53;76) ml, the left ventricular end-diastolic volume was 76 (70;90) ml, and the end-systolic volume was 30 (24;36) ml. The median ejection fraction of the left ventricle in the studied sample was 64 (57;66)%. The median interventricular septum thickness was 12 (11;13) mm, the left ventricular posterior wall thickness was 9 (8;10) mm. At the same time, the left ventricular myocardial mass and the left ventricular myocardial mass index were within the normal range and amounted to 140 (121;155) g and 65 (58;76) g/m2, respectively. The right heart chambers were not dilated, as the volume of the right atrium was 41 (40;56) ml, and the right ventricular enddiastolic dimension was 32 (30;33) mm. The right ventricular systolic function was unimpaired: the tricuspid annular plane systolic excursion was 18 (17;19) mm, and the right ventricular fractional area change was 46 (37.5;47.0)%. The calculated systolic pulmonary artery pressure was within the normal range 24 (21;28) mm Hg. The measurements of left ventricle global longitudinal and circumferential strains were -19.6 (-18.6;-21.2)% and -30.9 (-28.8;-32.0) %, respectively. Patients in the study sample showed a decrease in the left ventricular global function index to 25 (24.2;29.6)%. The diastolic dysfunction of a restrictive type was present in 10 patients (76.9%).Conclusions. In the long-term period after heart transplantation, the recipients were found to have a low left ventricular ejection fraction and a diastolic dysfunction of the restrictive type. Considering the normal values of left ventricular myocardial strains, we can assume that after 6 years post-orthotopic heart transplantation, the recipients have restored the heart adaptive functions, and a favorable outcome has been achieved. However, long-term monitoring is required.

Left ventricular remodeling and its correlation with serum cardiac troponin I in patients with end-stage renal disease treated.

To investigate the effects of different blood purification modes on left ventricular remodeling and its relationship with serum cardiac troponin I (cTnI) in patients with end-stage renal disease (ESRD). A total of 108 patients with ESRD were selected, 55 cases were divided into hemodialysis combined with hemoperfusion (HD + HP) group, in which patients participants accepted routine hemodialysis for three times/week and hemoperfusion for three times/month; 53 cases in hemodialysis combined with hemodialysis filtration (HD + HDF) group, routine hemodialysis three times/week + hemodialysis filtration three times/month. The total duration of dialysis in the study was 1 year. Cardiac troponin I (cTnI) levels were measured before dialysis and 1 year after treatment, and related parameters were measured by echocardiography, including ventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVEDs), and left ventricular myocardial mass index (LVMI). The paired t test was used within the group. Correlation analysis was performed using Spearman correlation analysis. After treatment, the levels of cTnI, IVST, LVPWT, LVEDd, LVEDs, and LVMI in the two groups were increased, and the results were statistically significant (all p < 0.05). In addition, cTnI of the two groups was significantly correlated with IVST, LVPWT, LVEDd, LVEDs, and LVMI (all p < 0.05). Left ventricular remodeling is common in patients with ESRD, HD + Hp, and HD + HDF cannot reduce the phenomenon of left ventricular remodeling, cTnI can be used as a predictor of left ventricular hypertrophy and enlargement.

#1515 Myocardial remodeling is associated with redistribution of phosphate, PIT1/ERK1/2 up-regulation and signaling pathways alterations in mild CKD model

Abstract Background and Aims Patients with CKD have significantly increased cardiovascular risk, and heart failure is a leading cause of morbidity and mortality in these patients. Myocardial hypertrophy is a hallmark of cardiac remodeling and dysfunction in CKD and is known to be mediated by angiotensin II, catecholamines, hyperphosphatemia, hyperparathyroidism, increase in FGF23, decrease in Klotho and alterations in various signaling pathways including calcineurin, mitogen-activated protein kinase ERK1/2, calmodulin-dependent protein kinase II etc. Less well understood are the mechanisms of fibrosis and intramyocardial arterial remodeling in CKD, which may be related to hyperphosphatemia and decreased renal and systemic Klotho. The aim of this study was to evaluate the molecular and cellular features of myocardial remodeling in experimental mild CKD. Method We induced CKD by 3/4 nephrectomy (Nx) in adult male spontaneously hypertensive rats (SHR) with a follow-up period of 4 months. Animals were fed standard chow containing 0.6% phosphate. Sham-operated Wistar rats and SHR served as controls. We measured serum creatinine, renal interstitial fibrosis area, systolic blood pressure (BP), myocardial mass index (MMI), histological indices of myocardial hypertrophy, interstitial fibrosis and intramyocardial artery (IA) remodeling (H&amp;E, Masson's trichrome, von Kossa stain), myocardial phosphorus content, serum levels of inorganic phosphate (Pi), PTH and FGF23. Myocardial expression of phosphate transporters PiT1, ERK1/2, WNT, BMP, Notch, Hedgehog signaling pathways and LRG4 molecules was evaluated by PCR-RT, IHC and IF (Zeiss LSM 710; study performed at the Centre for Collective Use “Confocal Microscopy” of the Pavlov Institute of Physiology, Russian Academy of Sciences). Results Chronic kidney injury and phosphate regulatory factors did not differ, whereas BP and MMI were higher in sham SHR vs. Wistar rats (Fig. 1). Nx rats showed features of mild chronic kidney injury before the elevation of serum PTH, FGF23 levels (Fig. 1). Myocardial P content and serum Pi were higher in Nx and in the combined SHR group and directly correlated with indices of IA remodeling. Cardiomyocyte diameter, myocardial interstitial and perivascular fibrosis were higher in Nx (Figs 1, 2a) and accompanied with upregulation in Ppp3ca mRNA (calcineurin A, Fig. 2b), Mapk1 mRNA (ERK2, Fig. 2b), phospho-ERK1/2 (Figs 1, 3), PiT1 (Figs 1, 2c), Lgr4 (Fig. 2c) and downregulation of Hes1 mRNA (Fig. 2b). PiT1 and pospho-ERK1/2 were co-expressed in IA media from SHR (Fig. 2c). In Nx, nestin and LGR4 were expressed by IA adventitia and media cells, myocardial interstitial cells, and occasionally co-localized (Fig. 2c). Hes1 expression was detected in IA and capillary endothelial cells and co-localised with Gli1 in IA media; Gli1 was also detected in cardiomyocyte nuclei (Fig. 2c). In SHR, beta-catenin expression in cardiomyocytes was more pronounced in Nx (Fig. 2c). Conclusion Mild CKD is associated with histological and molecular features of cardiomyocyte hypertrophy, myocardial fibrosis and intramyocardial arterial remodeling, which are probably modulated by phosphate redistribution and its tissue retention involving upregulation of PiT1 and ERK1/2, as well as alterations in signals related to progenitor regulation and myocyte hypertrophy.

#1749 Influence of high saline diet on myocardial remodeling, microRNA-21i and NFkB expression in myocardium

Abstract Background and Aims There is now increased interest in the study of morpho-functional myocardial changes in excess NaCl consumption, which develop independently of AD dynamics. Myocardial remodeling may involve microRNAs that modulate gene expression at the post-transcription level. However, their role in this process has not been fully explored. The purpose of the study is to assess the levels of expression of the nucleic transcription factor kV (NFkB), microRNA-21 and structural changes in the myocardium at long-term consumption of Wistar diet with high (8%) table salt content. Method Male Wistar rats (body mass 280.5 42.7 g) were divided into two groups of 10 animals. For 4 months, the control rats (NaCl) received a standard diet (0.34% NaCl), and the animals of the other group received a high salt diet (8% NaCl) (HS). Laboratory food varied only in NaCl content. 4 months later in rats systolic AD was measured, myocardial mass index (IMM) was evaluated, myocardial histology was performed (paraffin coloration - hematoxylin-eosin, Masson), relative expression levels of my RNA-determined 21 and NFkB in the myocardium, sodium content in the urine and blood serum. Statistical analysis used the t-Student criterion and the Mann-Whitney test. The differences were considered significant at p &amp;lt; 0.05. Results Excess NaCl (8%) in the diet had no effect on animal body weight (370.5 32.0 g in HS group, 393.0 21.4 g in NS group, p &amp;gt; 0.05) and systolic AD. In the HS-Group, the average AD was 134.5 8.9 mm old, and in the NS-Group - 134.8 5.2 mm old. (p &amp;gt; 0.05). However, HS-group IMM rats were 25% higher than NS-group rats (p &amp;lt; 0.05). The daily water consumption in the HS group was on average 33% higher than in the control, the daily diuresis also increased (10.5 5.7 ml against 5.7 2.9 ml in the NS-group, p &amp;lt; 0.001) and the sodium content in the urine (81.25.72 mmol/l against 161.18.57 mmol in the NS-01). There was no difference in the sodium content of the blood serum. Hypertrophy of cardiomyocytes, protein dystrophy, and increased wall thickness of arterial vessels (NS-20,42 3,53, HS-27,61 4,93, µm were identified in the HS-group; p &amp;lt; 0.01). The area of perivascular fibrosis in rats of the HS group (14876 ± 3803.7 µm2) was almost 1.8 times higher than that in the NS group (8426.0 ± 3012.2 µm2, p &amp;lt; 0.03). The thickness of cardiomyocytes (NS-12.97 1.53, HS-20.28 1.90 µm, p &amp;lt; 0.001) also increased in rats on the HS diet. In animals of the HS group, the relative expression levels of NFkB (more than 2 times) and microRNA-21 (almost 6 times) in the myocardium increased compared to the NS group. It can be assumed that the adverse effect on the cardiovascular system of high-salt diets is partially realized through NFκB-associated signaling pathways and the activation of microRNA-21. Conclusion Long-term use of a high-salt diet in Wistar rats results in myocardial remodeling unrelated to changes in AD levels. In this case, the high salt intake effects on the myocardium may be mediated by an increase in NFkBy and microRNA-21 expression levels.

#2616 AVF volume blood flow reduction in NYHA III patients—is it too late?

Abstract Background and Aims Heart failure (HF) with preserved / high cardiac output (CO) is a well-known syndrome in patients with high-flow AVF. However, the threshold for classifying an AVF as high-flow is currently undefined. Cardio-fistular recirculation (CFR) is often used as a criterion, with values greater than 25-30% considered cardiotoxic and associated with adverse outcomes. Additionally, CFR is one of the few easily modifiable risk factors through surgical reduction of AVF volume blood flow (Qa). The study aimed to evaluate the extent of involution of heart structural and functional changes following Qa reduction. Method A prospective cohort study included 86 adult HD patients who met the inclusion criteria: HF with preserved / high CO, CFR &amp;gt; 25%, eKt/V &amp;gt; 1.2. Non-inclusion criteria: arrhythmias (except grade I AV block), valvular disease (except mitral regurgitation I-II). Patients were divided into two groups according to the severity of symptoms: NYHA I-II (N = 39) and NYHA III-IV (N = 47). All patients underwent a thorough examination, Qa assessment and ECHO-CG with tissue Doppler on the interdialytic day immediately prior to surgery. Qa reduction was achieved by external PTFE banding, PTFE graft segment placement or aneurysmorrhaphy (in case of coexisting AVF aneurysm). Long-term results were evaluated at 6 months after surgery. As the aim was to evaluate the dynamics, patients who died during follow-up, underwent conversion of KRT, or had a change in vascular access were excluded. Results Table 1 presents the descriptive statistics of the patients prior to surgery. Both groups of patients showed a significant decrease in Qa, CO, cardiac index, end-systolic and end-diastolic volume indices, and LV myocardial mass index, while EF remained unchanged (data not shown). At the same time, there were no significant differences in the dynamics of the above parameters (group*time interaction in the mixed-effects model). Fig. 1 shows that there was a significant group*time interaction: there was a significant difference in CFR before surgery (p = 0.001), but not after (p = 0.958). In both groups, CFR was adjusted to achieve optimal values. The E/A ratio was not different before the surgery (p = 0.209), but it was different after the surgery (p &amp;lt; 0.001). NT-proBNP levels were higher in the NYHA III-IV group both preoperatively (p &amp;lt; 0.001) and postoperatively (p &amp;lt; 0.001). We have observed a similar pattern in the dynamics of the PASP as well (p &amp;lt; 0.001 at both time points). The likelihood of complete weaning from CHF therapy at 6 months after Qa reduction is almost twice as high in the NYHA I-II group (RR = 1.93 [95% CI 1.2; 3.18], p = 0.009). Conclusion Defining AVF as high-flow based solely on Qa value is not accurate. Instead, it is more appropriate to define cardiotoxicity based on both CFR and the severity of clinical symptoms. Patients in NYHA III-IV benefit less from Qa reduction than patients in NYHA I-II and are more likely to retain diastolic dysfunction and pulmonary hypertension. We recommend reducing Qa in the early stages of HF.

LEVELS OF MICRO RNA-21-3R IN THE BLOOD OF HYPERTENSIVE PATIENTS WITH NORMAL BODY WEIGHT AND WITH ABDOMINAL OBESITY

Objective: The combination of arterial hypertension (AH) with abdominal obesity (AO) significantly increases the severity of hypertension and accelerates the development of hypertension-mediated organ damage, in particular, left ventricular hypertrophy (LVH). MicroRNAs are small non-coding RNA molecules that are involved in the regulation of post-transcriptional gene expression. A number of experimental studies have revealed the antihypertensive, antihypertrophic and antifibrosing properties of microRNA-21-3p. The goal is to study the plasma levels of microRNA-21-3p in hypertensive patients with normal body weight (NBW) and with abdominal obesity (AO). Design and method: 27 patients (16 men) with stage 2-3 hypertension (13 with NBW and 14 with stage II AO) aged from 42 to 60 years were examined. The control group consisted of 12 practically healthy individuals. All patients underwent general clinical laboratory and instrumental examination. Circulating plasma microRNA-133a levels were obtained by polymerase chain reaction using the CFX96 Touch System, “TaqMan microRNA Assay” and “TaqMan® Universal PCR Master Mix” reagent kits. Results: A significant decrease in the levels of micoRNA-21-3p in the blood plasma was established in the whole group of patients with hypertension (with NBW and with AO) (1.43±0.08), p&lt;0.05) in comparison with practically healthy individuals (3.24 ±0.07). At the same time, the levels of this miRNA in the blood plasma of patients with hypertension and AO (1.13±0.06) were significantly lower (p&lt;0.05) than in patients with hypertension and NBW (1.67±0.07). A correlation analysis revealed negative correlations between the levels of micoRNA-21-3p in the blood plasma and the levels of “office” systolic blood pressure (R=-0.44; p=0.04), as well as the left ventricular myocardial mass index (LVMMI) (R= -0.38; p=0.03) in the whole group of patients with AH (with NBW and AO). Conclusions: The results of this study may indicate the presence of a significant deficiency in the production of mircRNA-21-3p in patients with hypertension, especially when it is combined with AO, as well as the involvement of this miRNA in the mechanisms of progression of hypertension and the development of LVH.

Circulating microRNA-21-3p in patients with arterial hypertension

Objective — to study changes in the blood plasma levels of microRNA‑21‑3p in patients with arterial hypertension (AH) and their relationship with the characteristics of the course of the disease.&#x0D; Materials and methods. Examinations involved 24 patients with hypertension stage II and degree 2—3 (11 men, 13 women) aged from 42 to 60 years. The control group consisted of 12 practically healthy individuals, age and gender matching. The examinations were carried out in the Department of Hypertension and Kidney Diseases of the GI «L. T. Mala National Therapy Institute of NAMS of Ukraine». The degree, stage of hypertension and the presence of risk factors for cardiovascular diseases (CVD), established CVD and kidney disease were assessed in accordance with current recommendations. All patients underwent general clinical laboratory and instrumental examinations. The blood plasma level of circulating microRNA‑21‑3p was determined by quantitative reverse transcriptase‑polymerase chain reaction (qRT‑PCR) using reagent kits for monitoring and analyzing microRNA expression «TaqMan microRNA Assay» (ThermoFisher Scientific, USA). Small nuclear RNA U6 was used as a reference. Relative expression was calculated in relative units (r.u.) using the ΔΔCt method. Statistical analysis of the obtained data was carried out using standard methods with application packages Microsoft Excel and SPSS 19.0.&#x0D; Results. A significant decrease in the plasma levels of microRNA‑21‑3p in patients with hypertension was established in comparison with practically healthy individuals. The most pronounced decrease in plasma microRNA‑21‑3p levels was observed in patients with the most severe hypertension (stage 3 AH) and in subjects, in whom antihypertensive therapy did not result in the achieving target levels of «office» blood pressure (BP). Significant negative correlations were found between the plasma microRNA‑21‑3p levels and hemodynamic parameters (BP levels) and the left ventricular myocardial mass index — an indicator of the severity of left ventricular hypertrophy, one of the key lesions of target organs. The obtained results indicate the presence in patients with hypertension of a significant deficiency in the production of microRNA‑21‑3p, which, according to the literature data, has pronounced antihypertensive and cardiovascular‑ and renoprotective properties.&#x0D; Conclusions. A significant decrease in the blood plasma levels of microRNA‑21‑3p, the endogenous regulator of gene expression with antihypertensive and organoprotective properties, was established in patients with hypertension in comparison with practically healthy subjects. The revealed decrease in the blood plasma levels of this microRNA was enhanced at severe and uncontrolled hypertension and associated with the degree of hypertensive heart damage. The data obtained indicate the important role of microRNA‑21‑3p in the hypertension pathogenesis and the prospects of finding methods for correcting its production.

Features of structural and geometric cardiac remodeling in patients with diabetes mellitus depending on chronic kidney disease stages

Objective. To study the features of structural and geometric cardiac remodeling in patients with diabetes mellitus (DM) depending on the stage of chronic kidney disease (CKD). Materials and methods. We examined 499 patients (127 men and 322 women) with type 1 DM (133 people) and type 2 DM (316 people) aged 62 [52;69] years. The comparison group consisted of 65 randomly selected volunteering individuals (54 women and 11 men) without disorders of carbohydrate metabolism and kidney damage aged 59 [46;66] years. The laboratory examination of the patients included the measurement of serum creatinine, eGFR according to the CKD-EPI equation. An echocardiographic investigation was performed to study structural and geometric heart parameters. Left ventricular hypertrophy (LVH) was diagnosed when the left ventricular myocardial mass index (LVMI) exceeded 115 g/m2 in men and 95 g/m2 in women. Results. LVH was detected in 57.7 % of patients with DM, while in the comparison group – in 35.4 %. The frequency of LVH increased with a decrease in eGFR and was diagnosed in 100 % of cases with CKD 5. In patients with DM, the left ventricular concentric remodeling significantly predominated (29.2%). Multiple linear regression analysis demonstrated the influence of age (ß=0.30, p=0.01) and serum creatinine (ß = 0.15, p &lt; 0.0001) on the LVMI, independent of other factors, which confirms their independent pathogenetic significance. Conclusion. Thus, patients with DM regardless of the CKD stage have structural and functional changes in the LV myocardium. Regardless of the nitrogen-excretion function of the kidneys, the predominant pattern of LV remodeling is concentric. The study of the features of structural and functional restructuring of the left heart in patients with diabetes should be taken into account in determining the cardiovascular prognosis.

Indicators of intracardiac haemodynamics in patients with chronic coronary syndrome with concomitant coronavirus disease (COVID-19)

the nature of cardiovascular damage caused by SARS-CoV-2 coronavirus infection due to acute severe respiratory distress syndrome is associated with high mortality. However, the pathophysiological impact of COVID-19 (C19) on intracardiac haemodynamics remains unknown. The aim of our study was to evaluate intracardiac haemodynamics in patients with chronic coronary syndrome (CCS) in combination with coronavirus disease (COVID-19). The prospective study included: 30 patients with CAD with a negative PCR test for COVID-19 (1Agroup), 38 patients with CAD with a positive PCR test for COVID-19 (1Bgroup), of whom 12 were diagnosed with an increase in the level of troponin I (1B/T+), 26 patients had a normal level of troponin I (1B/T-). As a comparison, 30 patients with COVID-19 with PCR(+), without signs of CAD - group 2, as well as 30 healthy volunteers without signs of CAD and with negative PCR were studied. Clinical and laboratory data, treatment, and intracardiac haemodynamics were assessed by echocardiography in all groups. The left ventricular myocardial mass index, left ventricular end-diastolic volume, right ventricular size, and pulmonary artery systolic pressure were highest in the group of CAD with COVID-19 with a positive troponin test (1B/T+), compared with the (1B/T-) group, also in the (1B/T+) group, the ejection fraction and total longitudinal strain by speckle tracking were lower than in the (1B/T-) group. When compared with group 1A, LVEF was lower in the (1B/T+) group, and STla was higher in the (1B/T+) group. When comparing the indicators of group 1A and (1B/T-), a similar pattern of changes in intracardiac haemodynamics was noted: LV myocardial mass index, right ventricular diameter, systolic pressure in the pulmonary artery were higher, while longitudinal strain was slightly lower in (1B/T-) than in group 1A. When comparing the echocardiography parameters of patients in the (1B/T+) subgroup with group 2, larger left ventricular end-diastolic volume, left atrium, left ventricular myocardial mass index were found in (1B/T+), but the ejection fraction was lower in (1B/T+), while the right ventricular size and pulmonary artery systolic pressure were slightly higher than in group 2. In the subgroup (1B/T-), the nature of the changes was similar, but the size of the RV and PASP did not differ from those in group 2. The echocardiographic parameters of group 1A differed from those of group 2 by higher values of LVEF, LVEDV, LVMMS and lower EF, but the size of the RV and PASP were larger in patients with COVID-19. Cardiac damage associated with SARS-CoV-2 in patients with concomitant CAD has an effect on the myocardium, which is manifested in an increase in left ventricular EF due to increased preload, at the expense of a decrease in global strain and systolic function of the LV myocardium, due to the direct cytotoxic effect of SARS-CoV-2 on the one hand, and destabilisation of existing atherosclerotic plaques, as well as hypoxia and worsening of endothelial dysfunction on the other. An increase in the size of the right ventricle is associated with an increase in peripheral vascular resistance in the small circle as a consequence of increased systolic pressure in the pulmonary artery in covidassociated pneumonia. The impact of SARS-CoV-2 infection on the heart is associated with cardiovascular risk factors and the severity of the inflammatory process.

Renal function and cardiovascular risk in overweight patients

Background. Currently, in most countries of the world, there is a tendency for an annual increase in the proportion of overweight people (OW). Studies performed in various age groups and devoted to the relationship of OW with the functional state of the kidneys show contradictory results.The aim: to study the functional state of the kidneys and the prevalence of risk factors for cardiovascular complications in OW, taking into account gender differences.Patients and Methods. A cross–sectional single-center study was conducted with the participation of 154 patients (73 men and 81 women) with body mass index (BMI) 25.0–29.9 kg/m2), whose average age was 53.9±12.6 years. Anthropometric and biochemical parameters were evaluated in all patients, the functional state of the kidneys (according to serum creatinine and cystatin C) was studied, and an analysis of cardiovascular risk factors was carried out.Results. Analysis of excretory renal function by cystatin C showed that in most of the examined individuals, regardless of gender, there was a decrease in eGFR to CKD stages 2 and 3a. OW among men was statistically significantly more often associated with hypertriglyceridemia (32.8 %), tachycardia (38.3 %) and atherosclerotic lesion of the carotid arteries (24.6 %). In the subgroup of women with ischemic heart disease, the average age, the content of low-density lipoproteins, the double product index, the frequency of hypercholesterolemia, dyslipidemia and hypertrophy of the left ventricle (LVH), mainly of the eccentric type, were significantly higher, and the hemoglobin content and the number of red blood cells were significantly lower. Significant correlations of eGFR with concentrations of hemoglobin and C-reactive protein, as well as with the value of the left ventricular myocardial mass index (LVMI) were found in men with ischemic heart disease. Correlations of eGFR with the levels of systolic, mean, pulse and central blood pressure, index of functional changes, LDL-C, triglycerides, hemoglobin, fibrinogen, metabolic index, as well as LVMI were found in women with ischemic heart disease. The value of LVH in women was significantly associated with the level of central blood pressure, cystatin C, LDL, hemolobin, fibrinogen, metabolic index, and eGFR. In the general sample of patients with ischemic heart disease, the content of serum cystatin C was positively correlated with LVH and inversely with eGFR calculated by cystatin C. There was a weak negative relationship between the level of central arterial pressure and eGFR by cystatin C.Conclusion. Evaluation of excretory renal function, according to cystatin C and serum creatinine, in individuals with ISM has a higher diagnostic value than evaluation using methods based on the use of serum creatinine alone. In males, the presence of OW is associated with tachycardia, hypertriglyceridemia, a significant decrease in GFR and an increase in the frequency of atherosclerotic changes in the carotid arteries. The following cardiovascular risk factors are associated in women with ischemic heart disease: old age, anemia, increased fibrinogen concentration, dyslipidemia, increased values of the double product index, metabolic index and index of functional changes, as well as hemodynamic and LVH parameters.

Myocardial Remodeling Markers in Hypertensive and Overweight or Obese Patients

Pro-inflammatory and anti-inflammatory cytokines can be used as markers of the severity of the arterial hypertension (AH) and the risk of its complications. The objective: to analyze the significance of interleukin-10 (IL-10) and interleukin-1β (IL-1β) as markers of myocardial remodeling in patients with arterial hypertension (AH) and overweight or obesity. Materials and methods. 103 patients with AH (60 women and 43 men) took part in the study. The average age of the participants was 53.21±8.5 years, the average duration of AH – 8.2±6.3 years. The patients were divided into two groups according to the level of IL-10. The first group included 80 (78%) patients with AH and body mass index (BMI) ≥25 kg/m2 who had a normal level of IL-10 (up to 32 pg/ml), the second group included 23 (22%) individuals with increased anti-inflammatory cytokine. Also, the patients were divided into two groups according to cytokine levels. The first group included 74 (72%) patients with AH and overweight or obesity (the level of IL-1β was up to 11 pg/ml), the second group included 29 (28%) patients with an elevated level of IL-1β. All subjects underwent an anthropometric measurement, clinical and laboratory examination, and determination of the level of anti-inflammatory cytokine IL-10 and pro-inflammatory cytokine IL-1β by enzyme immunoassay method. Results. The results of pro-inflammatory and anti-inflammatory cytokine concentrations (IL-1β and IL-10, respectively) were different. It was found that the level of IL-10 does not depend on the age of patients and the duration of AH, but there is a direct relationship between the level of the anti-inflammatory cytokine and BMI (35.8±5.7 kg/m2 vs. 32.4±5.7 kg/m2; p&lt;0.05) with fasting glycemia level (r=0.3; p&lt;0.05). It is also indicated that patients AH and increased BMI have on average a significantly longer QT interval (0.40±0.07 s vs. 0.36±0.04 s; p&lt;0.05). It was determined that 13% of patients with elevated anti-inflammatory cytokine levels had QT prolongation. In 39% of cases, an increase in the mass index of the myocardium of the left ventricle was found (twice more among women). A direct correlation between the level of homocysteine and pro-inflammatory (r=0.31; p&lt;0.05) and anti-inflammatory cytokines (r=0.47; p&lt;0.05) was determined. At the same time, patients with elevated levels of IL-1β had a direct correlation with left ventricular myocardial mass index (r=0.42; p&lt;0.05) and average daily mean arterial pressure (r=0.85; p&lt;0.005). Conclusions. The anti-inflammatory cytokine IL-10 has greater prognostic significance than the pro-inflammatory cytokine IL-1β. An increased level of IL-10 in patients with AH and BMI ≥25 kg/m2 may indicate an adaptive reaction of the organism’s immune response. A high level of IL-10 in this cohort of patients is associated with worse control of blood pressure levels and can be considered as a predictor of the development of cardiac arrhythmias.

Власний досвід застосування нейромережевого аналізу в прогнозуванні довготермінового виживання пацієнтів із хронічною серцевою недостатністю

The aim – predicting the risk of fatal outcome within 3 years in patients with CHF and reduced left ventricular ejection fraction (LVEF) with neural network.Materials and methods. The retrospective analysis of 490 medical histories of patients who were hospitalized in the heart failure department between 2011 and 2018 years with CHF II–IV functional class according to NYHA with LVEF ≤ 40 % on the background of coronary heart disease was conducted. Patients with clinical signs of heart failure II NYHA functional class – 455 (92.8 %) patients and with clinical signs of CHF III NYHA functional class – 35 (7.2 %) patients. The analysis was conducted for 490 patients: 228 (46.5 %) patients had a fatal event within three years, 262 (53.5 %) patients survived three years. Results and discussion. Factor features was selected for building a neural network. The information about 8 factor characteristics (ACE inhibitor (X1), atrium fibrillation (X2), renal dysfunction (X3), age (X4), arterial pressure (X5), (X6), LV diastolic volume index ( X7), LV myocardial mass index (X8)) was used for building of neural network models. Three-layer Multiplayer Perceptron (MLP) model with one hidden layer (logistic activation function) was built in the final. This neural network is a type of multi-layer neural network (multi-network perceptron). Each neuron of this system uses a nonlinear activation function. The sensitivity and specificity of this neural network model was evaluated. The education of this neural network did by the method of backpropagation. The quality of the classification of this model was evaluated with the test set of cases. The area under the curve of the operating characteristics of the neural MLP model for predicting the risk of a fatal event exceeds that area of the 9-factor logistic regression model (p&lt;0.001).Conclusions. The use of neural network analysis increase the accuracy of predicting a fatal outcome for a 3-year period compared to a multifactor logistic regression model. According to the construction of the neural network MLP model, a strong connection of the risk of a fatal event over the course of 3 years with the presence of atrium fibrillation, renal dysfunction, age, LV diastolic volume index, LV myocardial mass index and ACE inhibitor in the treatment was revealed. The quality of the neural network MLP model is high (area under the curve AUC=0.842). Youden Index (Ycrit=0.3049), the sensitivity of the MLP model is 76.8 % (95 % CI 70.7–82.1 %), the specificity of the model is 81.3 % (95 % CI 76.0–85.8 %), predictive significance +PV – 78.1 % (95 % CI 73.3–82.3 %), predictive significance –PV – 80.1 % (95 % CI 75.9–83.7 %). The accuracy of predicting the risk of a fatal outcome within 3 years for the neural network MLP model is higher than for the 9-factor logistic regression model (р&lt;0.001).

Results of 3-year mortality risk prediction in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim – predicting the risk of fatal outcome within 3 years in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) using appropriate regression logistic models.Materials and methods. The retrospective analysis of 490 medical histories of patients who were hospitalized in the heart failure department between 2011 and 2018 years with CHF II–IV functional class according to NYHA with LVEF ≤ 40 % on the background of coronary heart disease was conducted. There were 373 (76.1 %) men and 117 (23.9 %) women among the subjects. The median age of the patients was 64 years [56.00; 69.00]. Patients with clinical signs of heart failure and II NYHA functional class – 455 (92.8 %) patients and with clinical signs of CHF and III NYHA functional class – 35 (7.2 %) patients. The analysis was conducted for 490 patients: 228 (46.5 %) patients had a fatal event within three years, 262 (53.5 %) patients survived three years. The univariate analysis of the risk of death was performed for 42 risk factors in logistic regression models. To optimize the acceptance/rejection threshold, the receiver operating characteristic curve (ROC) analysis method was used. The logistic regression model was used to analyze the relationship between the risk of fatality and factor characteristics.Results and discussion. The analysis revealed the reliable negative relationship between the risk of a fatal outcome and the parameters of TSAT, blood pressure, LVEF, and GFR, the risk of a fatal event decreases (p&lt;0.05) when these indicators increase. Positive relationship was found between the risk of the fatal outcome and the duration of HF, age, the size of right ventricle and left atrium, LV diastolic volume index, LV systolic volume index, PASP, LV myocardial mass index. The risk of fatal outcome increases when these indicators increase (p&lt;0.05). Such indicators as levels of ferritin, hemoglobin, potassium, sodium, bilirubin, ALT, AST, cholesterol, blood glucose and BMI, gender, presence of COPD, arterial hypertension, diabetes did not demonstrate reliable prognostic information. The use of ACE inhibitors and beta-blockers show the tendency to the better prognosis. Multivariate logistic regression model was used to build a three-year fatality risk prediction model with better prognostic characteristics. Nine factor signs were identified: mineralocorticoid receptor antagonists, ischemic heart disease, body mass index, blood pressure, LV diastolic volume index, LV systolic volume index, PASP, LV myocardial mass index, GFR. This model is adequate (χ2=80.4, p&lt;0.001).Conclusions. In patients with CHF with reduced LVEF, according to the data of a univariate logistic regression model, the predictors of a fatal outcome within 3 years are age, ischemic artery disease, renal dysfunction, atrium fibrillation, duration of HF symptoms, PASP, LV ejection fraction, left atrium size, LV diastolic volume index, LV systolic volume index, right ventricle size, LV myocardial mass index, GFR, TSAT. The risk of a fatal outcome begins to increase with blood pressure ​​≤ 118 mm Hg, LVEF &lt; 30 %, TSAT ≤ 20 %, GFR ≤ 64 ml/min/1, 73 m2, patient’s age &gt; 64 years old, right ventricle’s size &gt; 3.66 cm, left ventricle’s size &gt; 4.94 cm, LV diastolic volume index &gt; 116.9 ml, LV systolic volume index &gt; 87.88 ml, pulmonary artery systolic pressure &gt; 57 mm Hg, LV myocardial mass index &gt; 172.27 g/m2. According to the multifactorial logistic regression model, the predictors of the occurrence of a fatal outcome within 3 years are BMI (OR 1.04, p&lt;0.05), BP (OR 0.97, p&lt;0.004), LV diastolic volume index (OR 0.97, р&lt;0.022), LV systolic volume index (OR 1.05, р&lt;0.004), pulmonary artery systolic pressure (OR 1.02, р&lt;0.024), LV myocardial mass index (OR 1.01, р&lt;0.005), GFR (OR 0.98, p&lt;0.009), MRA in the treatment (OR 0.45, p&lt;0.016). Youden Index (Ycrit=0.5044), the sensitivity of the 9-factor model is 65.4 % (95 % CI 57.6–72.7 %), the specificity of the model is 79.2 % (95 % CI 72.8–84.6 %), predictive significance +PV – 72.1 % (95 % CI 65.8–77.6 %), predictive significance –PV – 73.6 % (95 % CI 69.0–77.7 %).