Prognosis In Chronic Heart Failure Research Articles

Clinical prognostic impact of C-NLR in heart failure patients with different ejection fractions: a retrospective study

ObjectionInflammatory conditions and immune disorders may worsen the prognosis of chronic heart failure (CHF) patients. The aim of this study was to evaluate the prognostic value of a new indicator, C-NLR, composed of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR), for the risk of all-cause mortality in HF patients with different ejection fractions.MethodsA total of 1221 CHF patients admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021 were enrolled in this study. All patients were divided into 2 groups according to the median C-NLR. Kaplan–Meier survival curves were used to compare the all-cause mortality among CHF patients with different ejection fractions. Cox proportional hazards analysis was used to evaluate the relationships between variables and mortality. The predictive value of the C-NLR was assessed by using receiver operating characteristic (ROC) analyses.ResultsWe collected data from 1192 patients with CHF. Kaplan–Meier survival analysis revealed that patients with low LCR levels had better overall survival (OS). After multivariate adjustment Cox proportional hazards analysis, the level of C-NLR was still independently related to mortality.ConclusionsC-NLR was a competent independent predictor in HF with different ejection fractions, and routine measurement of C-NLR would help clinical doctors identify patients with a poor prognosis.

Relationship between BMI and prognosis of chronic heart failure outpatients in Vietnam: a single-center study

BackgroundInsufficient data exists regarding the relationship between body mass index (BMI) and the prognosis of chronic heart failure (CHF) specifically within low- and middle-income Asian countries. The objective of this study was to evaluate the impact of BMI on adverse outcomes of ambulatory patients with CHF in Vietnam.MethodsBetween 2018 and 2020, we prospectively enrolled consecutive outpatients with clinically stable CHF in an observational cohort, single-center study. The participants were stratified according to Asian-specific BMI thresholds. The relationships between BMI and adverse outcomes (all-cause death and all-cause hospitalization) were analyzed by Kaplan–Meier survival curves and Cox proportional-hazards model.ResultsAmong 320 participants (age 63.5 ± 13.3 years, 57.9% male), the median BMI was 21.4 kg/m2 (IQR 19.5–23.6), and 10.9% were underweight (BMI <18.50 kg/m2). Over a median follow-up time of 32 months, the cumulative incidence of all-cause mortality and hospitalization were 5.6% and 19.1%, respectively. After multivariable adjustment, underweight patients had a significantly higher risk of all-cause mortality than patients with normal BMI (adjusted hazard ratios = 3.03 [95% CI: 1.07–8.55]). Lower BMI remained significantly associated with a worse prognosis when analyzed as a continuous variable (adjusted hazard ratios = 1.27 [95% CI: 1.03–1.55] per 1 kg/m2 decrease for all-cause mortality). However, BMI was not found to be significantly associated with the risk of all-cause hospitalization (p > 0.05).ConclusionIn ambulatory patients with CHF in Vietnam, lower BMI, especially underweight status (BMI < 18.5 kg/m2), was associated with a higher risk of all-cause mortality. These findings suggest that BMI should be considered for use in risk classification, and underweight patients should be managed by a team consisting of cardiologists, nutritionists, and geriatricians.

Effect Of Urinary Kidney Injury Molecule-1 Levels On Short-Term Prognosis Of Chronic Heart Failure.

To explore the influential elements of urinary kidney injury molecule-1 levels in chronic heart failure, and to judge its ability to predict 90-day rehospitalisation. The cross-sectional case-control study was conducted from November 2020 to April 2021, at Hanzhong Central Hospital, China, and comprised adult patients having chronic heart failure with normal renal function in group A and healthy subjects in control group B. Patients in group A received anti-heart failure therapy for 1 week in hospital and were followed up for 90 days after discharge. Blood pressure (BP), kidney injury molecule-1, creatinine and serum pro- B-type natriuretic peptide levels were evaluated at baseline and 1 week after treatment in group A, while the samples were collected only at baseline in the control group B. Data was analysed using SPSS 22. Of the 102 subjects, 68(66.6%) were in group A; 44(64.7%) males and 24 (35.3%) females with mean age 62.38±9.51 years. The remaining 34(33.3%) subjects were in group B; 21(61.7%) males and 13(38.2%) females with mean age vs. 58.82±8.11 years. The urinary kidney injury molecule-1 level in group A was essentially on the increase compared to group B (p<0.05). After 1 week of treatment, the kidney injury molecule-1 level decreased compared to the baseline value in group A (p<0.05). Diastolic blood pressure and pro-B-type natriuretic peptide were the determinants of urinary kidney injury molecule-1 level, and urinary kidney injury molecule-1 level before discharge was significantly associated with rehospitalisation within 90 days (p<0.05). Urinary kidney injury molecule-1 level before discharge was a significant predictor of rehospitalisation within 90 days, and diastolic blood pressure and pro-B-type natriuretic peptide levels were the influencing factors of urinary kidney injury molecule-1. Also, urinary kidney injury molecule-1 levels were significantly raised in chronic heart failure.

СРАВНЕНИЕ ИНФОРМАТИВНОСТИ ОПРЕДЕЛЕНИЯ NT-PROBNP ПОЛУКОЛИЧЕСТВЕННЫМ И КОЛИЧЕСТВЕННЫМ МЕТОДАМИ ДЛЯ РАННЕЙ ДИАГНОСТИКИ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ

Вackground. Heart failure (HF) is one of the main causes of morbidity and mortality worldwide. Since it is important to diagnose CH early and quickly, at the outpatient appointment, there is a need to create and introduce into practice a portable highly sensitive method for the determination of BNP, NT-proBNP. Purpose of the study. To determine the possibility of using reagents for semi-quantitative determination of N-terminal brain natriuretic peptide antigen for early detection of heart failure. Methods of statistical analysis. Microsoft Office Excel 2019 program was used. Patient Characterization and Research Methods. An open cross-sectional non-randomized cohort study included 50 patients (mean age 63.5 years) who applied on an outpatient basis for consultation to a cardiologist. In addition to standard clinical, biochemical and instrumental examinations, the concentration of N-terminal brain natriuretic peptide (NT-proBNP) was determined by quantitative and semi-quantitative immunochromatographic method (LLC NPO "BioTest", Novosibirsk). The diagnosis of chronic heart failure (CHF) was established in accordance with national and European recommendations. Methods of statistical analysis. Microsoft Office Excel 2019 program was used. Results and conclusion. In the course of the study, it was found that semi-quantitative method is highly sensitive for detection of small NT-proBNP elevations, which is important for early diagnosis of heart failure, including subclinical forms. Semi-quantitative method also allows to distinguish a group of patients with high NT-proBNP values. The relationship of NT-proBNP level with the course and prognosis of CHF requires further study.

Obesity paradox in chronic heart failure with moderately reduced or preserved left ventricular ejection fraction: impact on a prognosis for patients according to a five-year follow-up

Aim. To investigate the obesity paradox by studying the impact of overweight and abdominal obesity on the prognosis in chronic heart failure (CHF) patients with moderately reduced or preserved left ventricular ejection fraction (LVEF) by five-year follow-up results. Materials and methods. A prospective, open, parallel-group study included 314 CHF patients with moderately reduced or preserved LVEF, average age was 65.3 ± 11.2 years. Group 1 – 66 patients with normal weight; Group 2 – 67 overweight patients; Group 3 – 90 patients with I degree abdominal obesity; Group 4 – 91 subjects with II–III degrees of obesity. Adverse cardiovascular events (CVEs) were studied as a cumulative endpoint, cardiovascular death, and rehospitalization due to decompensated CHF. Results. It has been found that excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF. In overweight patients, compared to I degree obesity group, the incidence of cumulative end point (by 15.4 %; χ2 = 3.95, p &lt; 0.05) and cases of re-hospitalization (by 19.0 %; χ2 = 5.6, p &lt; 0.05) were more often observed. Concomitant overweight was associated with an increased risk for faster onset of the cumulative end point (HR 1.46, 95 % CI 1.1–2.2, p &lt; 0.05) and re-hospitalization (HR 1.53, 95 % CI 1.1–2.4, p &lt; 0.05). Conclusions. The presence of excess body weight (overweight and I–III degrees of abdominal obesity) did not affect the prevalence and spectrum of adverse CVEs in CHF patients with moderately reduced and preserved LVEF during the five-year follow-up. In the presence of overweight, in comparison with I degree abdominal obesity, the incidence of cumulative end point and re-hospitalization due to the disease decompensation were more often observed, which could be evidence for the existence of the obesity paradox. The most adverse effect on the prognosis in CHF patients with moderately reduced and preserved LVEF caused by concomitant overweight, in the presence of which, there was a significant increase in the risk for more faster onset of cumulative end point and re-hospitalization due to decompensation of the disease.

Nutritional Supplementation and Exercise as Essential Allies in the Treatment of Chronic Heart Failure: The Metabolic and Molecular Bases.

Chronic heart failure (CHF) is one of principal health problems in industrialized countries. Despite therapeutical improvement, based on drugs and exercise training, it is still characterized by elevated mortality and morbidity. Data show that protein energy malnutrition, clinically evident primarily with sarcopenia, is present in more than 50% of CHF patients and is an independent factor of CHF prognosis. Several pathophysiological mechanisms, primarily due to the increase in blood hypercatabolic molecules, have been proposed to explain this phenomenon. Nutritional supplementation with proteins, amino acids, vitamins and antioxidants have all been used to treat malnutrition. However, the success and efficacy of these procedures are often contradictory and not conclusive. Interestingly, data on exercise training show that exercise reduces mortality and increases functional capacity, although it also increases the catabolic state with energy expenditure and nitrogen-providing substrate needs. Therefore, this paper discusses the molecular mechanisms of specific nutritional supplementation and exercise training that may improve anabolic pathways. In our opinion, the relationship between exercise and the mTOR complex subunit as Deptor and/or related signaling proteins, such as AMPK or sestrin, is pivotal. Consequently, concomitantly with traditional medical therapies, we have proposed a combination of personalized and integrated nutritional supplementation, as well as exercise to treat malnutrition, and anthropometric and functional CHF-related disorders.

Microbial metabolites in chronic heart failure and its common comorbidities.

This study aimed to identify microbial signatures that contribute to the shared etiologies between chronic heart failure (CHF), type 2 diabetes, and chronic kidney disease. The serum levels of 151 microbial metabolites were measured in 260 individuals from the Risk Evaluation and Management of heart failure cohort, and it was found that those metabolites varied by an order of 105 fold. Out of 96 metabolites associated with the three cardiometabolic diseases, most were validated in two geographically independent cohorts. In all three cohorts, 16 metabolites including imidazole propionate (ImP) consistently showed significant differences. Notably, baseline ImP levels were three times higher in the Chinese compared with the Swedish cohorts and increased by 1.1-1.6 fold with each additional CHF comorbidity in the Chinese population. Cellular experiments further supported a causal link between ImP and distinct CHF relevant phenotypes. Additionally, key microbial metabolite-based risk scores were superior in CHF prognosis than the traditional Framingham or Get with the Guidelines-Heart Failure risk scores. Interactive visualization of these specific metabolite-disease links is available on our omics data server (https://omicsdata.org/Apps/REM-HF/).

Significance of Pulmonary Hypertension in Cardiac Amyloidosis

Pulmonary hypertension (PH) portends a poor prognosis in chronic heart failure and within distinct cardiomyopathies. There is a paucity of data on the impact of PH in patients with light-chain (AL) and transthyretin (ATTR) cardiac amyloidosis (CA). We sought to define the prevalence and significance of PH and PH subtypes in CA. We retrospectively identified patients with a diagnosis of CA who underwent right-sided cardiac catheterization (RHC) from January 2000 to December 2019. PH was defined as mean pulmonary artery pressure >20 mm Hg. PH was phenotyped as precapillary PH (PC-PH; pulmonary capillary wedge pressure [PCWP] <15, pulmonary vascular resistance [PVR] ≥3), isolated postcapillary PH (IpC-PH; PCWP >15, PVR <3), and combined postcapillary and precapillary PH (CpC-PH; PCWP >15 and PVR ≥3). Survival was assessed in those with CA and PH and for PH phenotypes. A total of 132 patients were included, 69 with AL CA and 63 with ATTR CA. A total of 75% (N=99) had PH (76% of patients with AL and 73% of patients with ATTR, p=0.615) and the predominant PH phenotype was IpC-PH. The degree of PH was comparable between ATTR CA and AL CA, and PH was observed in advanced stage disease (National Amyloid Center or Mayo stage II or greater). The overall survival for patients with CA and PH was similar to to those without PH. Higher mean pulmonary artery pressure independently predicted mortality in CA with PH (odds ratio 1.06, confidence interval 1.01 to 1.12, p=0.03). In conclusion, PH was seen frequently in CA and tended to be IpC-PH; however, its presence did not significantly impact survival.

Effectiveness and safety of four different beta-blockers in patients with chronic heart failure.

In this study, we evaluated the effectivenessand safety of bisoprolol, metoprolol, carvedilol, and nebivolol in the treatment of chronic heart failure. The results demonstrated that bisoprolol improved the prognosis of chronic heart failure in comparison with carvedilol, and carvedilol exerted similar effects as metoprolol succinate and nebivolol and better effect than metoprolol tartrate (evidence levels: bisoprolol>carvedilol=metoprolol succinate=nebivolol>metoprolol tartrate; ">" means "prior to").

Identification of echocardiographic subgroups in patients with coronary heart disease combined with heart failure based on latent variable stratification

BackgroundThe prognosis of chronic heart failure is poor, and it remains a challenge to classify patients for better personalized intervention. This study aimed to explore potential subgroups in patients with coronary heart disease and chronic heart failure using comprehensive echocardiographic indices. Methods5126 patients with coronary heart disease with chronic heart failure were included. Latent class analysis was applied to identify the grouping patterns of patients based on echocardiographic indices. Network maps and radar charts of echocardiographic indices were drawn to visualize the distribution of echocardiographic findings. The incidence of adverse outcomes was presented on the Kaplan–Meier curve and compared using the log-rank test. The Cox regression model was used to analyze the relationship between subgroups and mortality. ResultsThree groups were identified: eccentric hypertrophy, concentric hypertrophy, and decreased diastolic function. Network plots showed a higher correlation between left atrial diameter, left ventricular mass index, and left ventricle ejection fraction in the eccentric hypertrophy group than in the other groups. The Kaplan-Meier curve showed a significant difference in mortality between the three subgroups (P < 0.001). Multivariate Cox analysis indicated that the eccentric hypertrophy group had the highest risk of death (HR = 1.586, 95% CI: 1.310–1.921, P < 0.001) compared with the other groups. ConclusionPatients with coronary heart disease and chronic heart failure can be classified into three subgroups based on echocardiographic indices. This grouping has been shown to be an independent risk factor for mortality in these patients. Accurate subgrouping based on echocardiographic indices is important for identifying high-risk patients.

Urinary sodium concentration predicts time to major adverse coronary events and all-cause mortality in men with heart failure over a 28–33-year period: a prospective cohort study

BackgroundLower urinary sodium concentrations (UNa) may be a biomarker for poor prognosis in chronic heart failure (HF). However, no data exist to determine its prognostic association over the long-term. We investigated whether UNa predicted major adverse coronary events (MACE) and all-cause mortality over 28–33 years.MethodsOne hundred and eighty men with chronic HF from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) were included. Baseline data was collected between 1984 and 1989. MACE and all-cause outcomes were obtained using hospital linkage data (1984–2017) with a follow-up of 28–33 years. Cox proportional hazards models were generated using 24-h UNa tertiles at baseline (1 ≤ 173 mmol/day; 2 = 173-229 mmol/day; 3 = 230-491 mmol/day) as a predictor of time-to-MACE outcomes, adjusted for relevant covariates.ResultsOverall, 63% and 83% of participants (n = 114 and n = 150) had a MACE event (median 10 years) and all-cause mortality event (median 19 years), respectively. On multivariable Cox Model, relative to the lowest UNa tertile, no significant difference was noted in MACE outcome for individuals in tertiles 2 and 3 with events rates of 28% (HR:0.72; 95% CI: 0.46–1.12) and 21% (HR 0.79; 95% CI: 0.5–1.25) respectively.. Relative to the lowest UNa tertile, those in tertile 2 and 3 were 39% (HR: 0.61; 95% CIs: 0.41, 0.91) and 10% (HR: 0.90; 95% CIs: 0.62, 1.33) less likely to experience to experience all-cause mortality. The multivariable Cox model had acceptable prediction precision (Harrell's C concordance measure 0.72).ConclusionUNa was a significant predictor of all-cause mortality but not MACE outcomes over 28–33 years with 173–229 mmol/day appearing to be the optimal level. UNa may represent an emerging long-term prognostic biomarker that warrants further investigation.

Relationship of arterial tonometry and exercise in patients with chronic heart failure: a systematic review with meta-analysis and trial sequential analysis

BackgroundArterial stiffness is a common characteristic in patients with chronic heart failure (CHF), and arterial tonometric technologies related to arterial stiffness are novel and effective methods and have an important value in the diagnosis and prognosis of CHF. In terms of ameliorating arterial stiffness in patients with CHF, exercise training is considered an adjuvant treatment and also an effective means in the diagnosis and judgment of prognosis. However, there are huge controversies and inconsistencies in these aspects. The objective of this meta-analysis was to systematically test the connection of arterial tonometry and exercise in patients with CHF.MethodsDatabases, including MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, were accessed from inception to 7 March 2022. The meta-analysis was then conducted, and trial sequential analysis (TSA) was performed jointly to further verify our tests and reach more convincing conclusions by using RevMan version 5.4 software, STATA version 16.0 software, and TSA version 0.9.5.10 Beta software.ResultsEighteen articles were included, with a total of 876 participants satisfying the inclusion criteria. The pooling revealed that flow-mediated dilation (FMD) was lower in basal condition [standardized mean difference (SMD): − 2.28%, 95% confidence interval (CI) − 3.47 to − 1.08, P < 0.001] and improved significantly after exercise (SMD: 5.96%, 95% CI 2.81 to 9.05, P < 0.001) in patients with heart failure with reduced ejection fraction (HFrEF) compared with healthy participants. The high-intensity training exercise was more beneficial (SMD: 2.88%, 95% CI 1.78 to 3.97, P < 0.001) than the moderate-intensity training exercise to improve FMD in patients with CHF. For augmentation index (AIx), our study indicated no significant differences (SMD: 0.50%, 95% CI − 0.05 to 1.05, P = 0.074) in patients with heart failure with preserved ejection fraction (HFpEF) compared with healthy participants. However, other outcomes of our study were not identified after further verification using TSA, and more high-quality studies are needed to reach definitive conclusions in the future.ConclusionsThis review shows that FMD is lower in basal condition and improves significantly after exercise in patients with HFrEF compared with healthy population; high-intensity training exercise is more beneficial than moderate-intensity training exercise to improve FMD in patients with CHF; besides, there are no significant differences in AIx in patients with HFpEF compared with the healthy population. More high-quality studies on this topic are warranted.

Relationships between biomarkers of hypoxia and inflammation in elderly patients with chronic cardiorenal syndrome

Background and Aims : Multibiomarker models are promising for assessing the prognosis in chronic heart failure (CHF). The aim of this study was to investigate relationships between biomarkers of hypoxia and inflammation in elderly patients with chronic cardiorenal syndrome (ССS).

Testosterone and congestive heart failure

This article summarizes current information about the interrelation between testosterone concentrations and chronic heart failure (CHF). The authors described key publications that address the prevalence of testosterone deficiency in patients with CHF, the effect of endogenous and exogenous testosterone on the cardiovascular system, the relationship between testosterone levels and the severity and prognosis of CHF, and the efficacy of interventional treatments for CHF.

Assessment of the Clinical Profile and Approaches to the Diagnosis and Treatment of Patients Hospitalized with Acute Decompensation of Heart Failure

INTRODUCTION: Acute decompensation of heart failure (ADHF) is one of the leading diagnoses for hospitalization in therapeutic/cardiologic hospitals worldwide and is associated with a poor prognosis.&#x0D; AIM: To study the prevalence, clinical diagnosis, approaches to diagnosis, and treatment of patients hospitalized for ADHF.&#x0D; MATERIALS AND METHODS: A retrospective analysis of 202 medical records of inpatients hospitalized for ADHF in the first cardiology unit of Regional Clinical Cardiologic Dispensary in 2019 was performed. The clinical and instrumental characteristics of the patients, factors that led to hospitalization, and approaches to the diagnosis and treatment were examined.&#x0D; RESULTS: The prevalence of ADHF was 11.2%, the mean age of the patients was 68.4 10.8 years, and 49.0% were men. The most common causes of ADHF were atrial fibrillation (AF, 31.7%), uncontrolled arterial hypertension (AH, 20.8%), С4С5 stage chronic kidney disease (CKD, 19.4%), and non-adherence of clinical prescriptions (14.4%). Among the most commonly registered etiological factors of chronic heart failure (CHF) were AH (89.6%), AF (67.3%), and coronary heart disease (CHD, 64.9%). The left ventricular ejection fraction (LVEF) was preserved in 48.7% of the patients, intermediate in 21.4%, and reduced in 29.9%. In 2019, in real clinical practice, levels of natriuretic peptides were not determined, and blood electrolytes were not determined often enough (71.8%). The frequency of the administration of angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blockers (ARB-II)/neprilysin receptor antagonists (NRA) and beta-adrenoblockers (BAB) did not depend on the LVEF, which were 84.2% and 76.2%, respectively. Mineralocorticoid receptor antagonists (MCRA) were more commonly used in CHF with low LVEF at 89.2% against 78.7% among all patients (p 0.05). On hospital discharge, ACE inhibitor/ARB-II/NRA therapy was recommended in doses of 21.1%, BAB in 7.6%, and MCRA in 72.0% of target values.&#x0D; CONCLUSIONS: The prevalence of ADHF in all patients hospitalized in Cardiologic Hospital of Ryazan Regional Vascular Center was 11.2%. The most common causes of ADHF in patients with CHF were LVEF and AH, AF, and CHD, and the most frequent factor of CHF decompensation was AF. On hospital discharge, the drugs that improve the prognosis of CHF were prescribed at insufficient doses.

Cardiac 123I-mIBG Imaging in Heart Failure.

Cardiac sympathetic upregulation is one of the neurohormonal compensation mechanisms that play an important role in the pathogenesis of chronic heart failure (CHF). In the past decades, cardiac 123I-mIBG scintigraphy has been established as a feasible technique to evaluate the global and regional cardiac sympathetic innervation. Although cardiac 123I-mIBG imaging has been studied in many cardiac and neurological diseases, it has extensively been studied in ischemic and non-ischemic CHF. Therefore, this review will focus on the role of 123I-mIBG imaging in CHF. This non-invasive, widely available technique has been established to evaluate the prognosis in CHF. Standardization, especially among various combinations of gamma camera and collimator, is important for identifying appropriate thresholds for adequate risk stratification. Interestingly, in contrast to the linear relationship between 123I-mIBG-derived parameters and overall prognosis, there seems to be a “bell-shape” curve for 123I-mIBG-derived parameters in relation to ventricular arrhythmia or appropriate implantable cardioverter defibrillator (ICD) therapy in patients with ischemic CHF. In addition, there is a potential clinical role for cardiac 123I-mIBG imaging in optimizing patient selection for implantation of expensive devices such as ICD and cardiac resynchronization therapy (CRT). Based on cardiac 123I-mIBG data risk models and machine learning, models have been developed for appropriate risk assessment in CHF.

Peak Circulatory Power Is A Strong Prognostic Factor In Heart Failure With Preserved Ejection Fraction

<h3>Objectives</h3> Cardiopulmonary exercise testing (CPET) is the gold standard for assessing functional capacity and estimating prognosis in chronic heart failure (CHF). Peak circulatory power (CP) defined as the product of peak oxygen uptake (VO₂ peak) and peak exercise systolic blood pressure (SBP) was originally introduced by Cohen-Solal et al (2002) and eventually evaluated as a prognostic index in systolic CHF, congenital heart disease and idiopathic pulmonary arterial hypertension. The aim of this study was to confirm prognostic value of peak CP in HF with preserved ejection fraction (HFpEF). <h3>Methods</h3> We retrospectively analyzed the subgroup of 50 patients with HFpEF, NYHA classes II-III (17 female, mean age 64,8±11,6 years) previously enrolled in the prospective observational study. All patients received optimal medical treatment. At baseline the patients underwent comprehensive investigation including CPET. Peak CP was assessed as the product of VO₂ peak and peak SBP. Average follow-up period amounted 35 months. Cardiovascular mortality was considered the primary end-point. <h3>Results</h3> Cardiovascular mortality amounted 32% (n=16). ROC-analysis demonstrated significant independent predictive value of peak CP for cardiovascular mortality (AUC=0,741; 95% CI=0,597 to 0,854; p=0,0025). According to Youden index (J = sensitivity + specificity - 1) the patients were subsequently dichotomized by peak CP of 1600 as a cut-off point (sensitivity = 56%, specificity=91%). Kaplan-Meier analysis confirmed unfavorable prognosis in patients with peak CP ≤ 1600 (Log rank chi square = 8,3; p = 0,004). <h3>Conclusion</h3> Peak circulatory power (CP) combining VO₂ peak and peak exercise systolic blood pressure demonstrates significant prognostic value in HFpEF. Low peak CP reflecting poor cardiac power indicates unfavorable prognosis in terms of cardiovascular mortality and may be used as an independent non-invasive marker for long-term risk stratification in HFpEF patients.

Predictors of development and forecasting models in the diagnosis of chronic heart failure against hypertension

Annotation. Chronic heart failure (CHF) is a recognized public health problem with significant morbidity and mortality. Complementing and improving existing ones, as well as finding new methods for diagnosing and predicting the development of CHF is a promising and important area of research. The probable association between plasma concentrations of cerebral (BNP) and vascular (CNP) types of natriuretic peptides, features of clinical status and single nucleotide polymorphism of the BNP gene encoding was studied. The aim of the study was to improve the prognosis of CHF in women of Podolsk region of Ukraine aged 40-65 with hypertension by determining the range of the most important predictors of risk of CHF and creating a prognostic mathematical model for early personalized diagnosis of CHF based on carriers of polymorphic variants of the BNP gene. The survey involved 180 women aged 40-65 living in the Podolsk region of Ukraine: 67 women in the control group without signs of cardiovascular disease, 62 women with uncomplicated EH and 51 women with EH complicated by CHF. All patients were examined using general clinical, instrumental and laboratory methods. Genotyping of the BNP gene was performed by polymerase chain reaction. Plasma concentrations of BNP and CNP were determined by plate solid phase enzyme-linked immunosorbent assay. Mathematical processing was performed on a personal computer using the standard statistical package Statistica 10.0. It is established that among the predictors of the risk of heart failure in women 40-65 years with uncomplicated EH the most important role is played by: the level of plasma concentrations of BNP and CNP, overweight, burdened heredity of EH, the onset of EH up to 40 years, blood pressure, LV EF &lt;40% and the presence of left ventricular diastolic dysfunction type of relaxation disorders. The proposed prognostic mathematical model in the form of a scheme of equations in the future can be a convenient and fast method of early individualized diagnosis of CHF, available for use in online format.

Сучасні підходи щодо лікування хронічної серцевої недостатності у пацієнтів із цукровим діабетом 2 типу

The issues of epidemiology, pathophysiology and basic principles of treatment of chronic heart failure in patients with type 2 diabetes mellitus are considered. Attention is paid to both means of glycemic correction and treatment of chronic heart failure directly, taking into account the effectiveness, cardiovascular safety of drugs, as well as their impact on the course and prognosis of chronic heart failure. The results of randomized clinical trials to study the effectiveness of various groups of drugs for the treatment of chronic heart failure in patients with type 2 diabetes mellitus are presented. It is indicated that the overall goal of the treatment of type 2 diabetes mellitus is to achieve and maintain glycemic control, as well as to reduce the risk of long-term complications, in particular chronic heart failure. The goal of chronic heart failure treatment is to improve the clinical condition and quality of life of patients, to reduce the frequency of hospitalizations and mortality. The appointment of some groups of hypoglycemic drugs has a neutral or negative effect on the course and prognosis of chronic heart failure, so their use is limited or not recommended in the treatment of patients with type 2 diabetes mellitus and chronic heart failure. The emphasis is on those classes of drugs that have demonstrated significant advantages in influencing the morbidity and mortality associated with chronic heart failure and type 2 diabetes mellitus in comparison with other drugs, namely, inhibitors of the sodium-dependent glucose cotransporter type 2 and angiotensin receptor inhibitors II and neprilisin (sacubitril / valsartan). Experts call such classes of drugs as sodium-dependent glucose cotransporter type 2, angiotensin receptor inhibitors II and neprilisin, mineralocorticoid receptor antagonists and beta-blockers as the "Fantastic Four", given the significant positive effect of their combined use on the course and prognosis of chronic heart failure. Modern approaches to the treatment of chronic heart failure in patients with type 2 diabetes mellitus are based on the updated guidelines of the European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure, as well as on the recommendations of the American Diabetes Association for the classification, prevention and treatment of heart failure in patients with diabetes. Conclusion. The most important achievements in recent years, which have significantly improved the treatment outcomes of patients with chronic heart failure and type 2 diabetes mellitus, include: the development of new classes of drugs; conducting large-scale randomized clinical trials that demonstrated the benefits of certain groups of drugs in terms of their impact on the development, course and prognosis of chronic heart failure in type 2 diabetes mellitus, and updated comprehensive and balanced therapy for these patients

Research on the Correlation between Plasma BNP and the Condition and Prognosis of Chronic Heart Failure

This study aimed to analyze the correlation between the level of brain natriuretic peptide (BNP) and the condition and prognosis of chronic heart failure (CHF). For this purpose, between January 2017 and July 2020, we recruited a total of 120 CHF patients who were treated in Cangzhou Central Hospital into this study, consisting of 40 patients in NYHA II, 40 in NYHA III and 40 in NYHA IV, and simultaneously, 40 subjects with normal heart function were enrolled into the control group. General data were collected from the patients and subjects, and laboratory tests regarding the BNP level, LVEDD and LVEF were carried out. Correlation between plasma level of BNP and the evaluation of condition and prognosis of CHF was also analyzed. For further evaluation, the expression of BNP gene expression was considered in the femoral blood of participants by the Real-time PCR technique. The results showed that comparison over the clinical data of subjects among these groups showed no significant difference (P &gt; 0.05). In the research group, the averages of LVEDD and BNP in plasma were (58.53±3.75) mm and (5089.86±22.39) pg/mL, significantly higher than those in the control group, while the LVEF was (45.66±3.42) %, which was lower than that in the control group (all P &lt; 0.05). For the subgroup comparison, as the NYHA class augmented, patients also had a significant increase in the mortality rate and the difference among subgroups had statistical significance (P &lt; 0.05). Furthermore, with 442 pg/mL as a critical point for BNP, patients in the research group were further divided into the BNP&gt;442 pg/mL group and BNP ≤442pg/mL group, and the statistical analysis revealed that in the BNP&gt;442 pg/mL group, the incidence rate of cardiovascular events, re-hospitalization rate and mortality rate were 53.53%, 14.14% and 7.07%, which were all significantly higher than those in the BNP ≤ 442 pg/mL group (all P &lt; 0.05). Also, BMP gene expression was increased in NYHA II, NYHA III, and NYHA IV groups compared to the control group. However, this increase was statistically significant in the NYHA III group (P &lt;0.05) and in the NYHA IV group (P &lt;0.01) compared to the control group. In conclusion, the level of BNP in plasma can reflect the condition of CHF and is critical to the clinical diagnosis, treatment and prognosis evaluation and evaluation of the BNP gene confirmed the result. Thus, it is worth being promoted in clinical practice.