Risk Of Chronic Heart Failure Research Articles

Validation of the Meta-Analysis Global Group in Chronic Heart Failure risk score for the prediction of 1-year mortality in a Chinese cohort.

The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score was developed in 2013 to predict survival in heart failure (HF) patients. However, it has yet to be validated in a Chinese population. Our study aimed to investigate the ability of the score to predict 1-year mortality in a Chinese population. Consecutive patients with HF were retrospectively selected from the inpatient electronic medical records of the cardiology department in a regional hospital in China. A total integer score was calculated for each enrolled patient based on the value of each risk factor in the MAGGIC scoring system. Each enrolled patient was followed for at least 1 year. The observational endpoint of this study was all-cause mortality. The predictive ability of the MAGGIC score was assessed by comparing observed and predicted mortality within 1 year. Between January 2018 and December 2020, a total of 635 patients were included in the study: 57 (9.0%) of whom died within 1 year after discharge. The average age of all patients was 74.6 ± 11.2 years, 264 of them (41.6%) were male, and the average left ventricular ejection fraction was 50.7% ± 13.2%. The area under the receiver operating characteristic curve was 0.840 (95% confidence interval: 0.779, 0.901), which indicated a fair discriminatory ability of the score. The Hosmer-Lemeshow test result ( χ2 = 12.902, degree of freedom = 8, P = 0.115) indicated that the MAGGIC score had good calibration. The decision curve analysis showed that the MAGGIC score yielded a good clinical net benefit and net reduction in interventions. This validation of the MAGGIC score showed that it has a good ability to predict 1-year mortality in Chinese patients with HF after discharge. Due to regional and inter-hospital differences, external validation studies need to be further confirmed in other centers.

Gelatin coating enhances therapeutic cell adhesion to the infarcted myocardium via ECM binding.

Acute myocardial infarction (AMI) results in weakening of the heart muscle and an increased risk for chronic heart failure. Therapeutic stem cells have been shown to reduce inflammatory signaling and scar tissue expansion, despite most of these studies being limited by poor retention of cells. Gelatin methacrylate (GelMA) coatings have been shown to increase the retention of these therapeutic cells near the infarct. In this work, we evaluate two different potential binding partners for GelMA-coated bone marrow cells (BMCs) and myocardial tissue: the extracellular matrix (ECM) and interstitial non-cardiomyocytes. While cells containing β1 integrins mediate cell-ECM adhesion in vivo, these cells do not promote binding to our collagen-degraded, GelMA coating. Specifically, microscopic imagining shows that even with high integrin expression, GelMA-coated BMCs do not bind to cells within the myocardium. Alternatively, BMC incubation with decellularized heart tissue results in higher adhesion of coated cells versus uncoated cells supporting our GelMA-ECM binding mode. To further evaluate the ECM binding mode, cells were incubated on slides modified with one of three different major heart ECM components: collagen, laminin, or fibronectin. While all three components promoted higher adhesion than unmodified glass, collagen-coated slides resulted in a significantly higher adhesion of GelMA-coated BMCs over laminin and fibronectin. Incubation with unmodified BMCs confirmed that without a GelMA coating minimal adhesion of BMCs occurred. We conclude that GelMA cellular coatings significantly increase the binding of cells to collagen within the ECM. Our results provide progress towards a biocompatible and easily translatable method to enhance the retention of transplanted cells in human studies.

Abstract 11803: Applicability of the New Proposed Criteria for Iron Deficiency in Japanese Patients With Heart Failure

Backgrounds: Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF). A recent study from a large single-center chronic HF cohort including predominantly white British population showed that ID defined by current guideline criteria was not associated with poor outcome, and a new ID criteria targeting for HF population was proposed. However, its external applicability is unclear. Methods: We prospectively examined consecutive 711 chronic HF patients and measured serum iron, transferrin saturation (TSAT) and serum ferritin from a Japanese multicenter registry. The proposed ID criteria were TSAT <20% and serum iron ≤13 mmol/L and the guideline ID criteria were serum ferritin <100 ng/mL or, when ferritin was 100-299 ng/mL, TSAT <20%. The primary outcome was all-cause death. Results: Of studied patients (433 male, mean age 71 ± 13 years, mean left ventricular ejection fraction 47 ± 16%), 198 (28%) and 416 (59%) met the proposed and guideline ID criteria, respectively. During a median follow-up period of 441 (IQR 306-564) days, the primary outcome occurred in 50 patients. There was no significant difference on primary outcome between the patients with and without guideline ID criteria ( P = 0.24) ( Figure A ), while patients with serum iron ≤10 mmol/L showed a higher mortality than those without ( P = 0.004) ( Figure B ). In multivariable Cox regressions, the proposed ID criteria, but not guideline ID criteria, were independently associated with higher mortality (HR 1.92, 95% CI 1.06-3.47; and HR 1.42; 95% CI 0.79-1.24, respectively) adjusted for significant covariates including age, hemoglobin, estimated glomerular filtration rate and log NT-proBNP, and the Meta-Analysis Global Group in Chronic Heart Failure risk score. Conclusions: As defined by the proposed criteria, but not the guideline criteria, ID was associated with higher mortality in patients with chronic HF, suggesting that the proposed ID criteria might be applicable to Japanese population.

Should HFrEF patients with NYHA class II expect benefit from CCM therapy? Results from the MAINTAINED observational study.

Cardiac contractility modulation (CCM) is an FDA-approved device therapy for patients with refractory systolic heart failure and normal QRS width. Randomized trials demonstrated benefits of CCM primarily for patients with severe heart failure (> NYHA class II). To better understand individualized indication in clinical practice, we compared the effect of CCM in patients with baseline NYHA class II vs. NYHA classIII or ambulatory IV over the 5-year period in our large clinical registry (MAINTAINED Observational Study). Changes in NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP level, and KDIGO chronic kidney diseasestage were compared as functional parameters. In addition, mortality within 3years was compared with the prediction of the Meta-Analysis Global Group in Chronic heart failure risk score. A total of 172 patients were included in the analyses (10% with NYHA class II). Only patients with NYHA class III/IV showed a significant improvement in NYHA class over 5years of CCM (II: 0.1 ± 0.6; p = 0.96 vs. III/IV: -0.6 ± 0.6; p < 0.0001). In both groups, LVEF improved significantly (II: 4.7 ± 8.3; p = 0.0072 vs. III/IV: 7.0 ± 10.7%; p < 0.0001), while TAPSE improved significantly only in NYHA class III/IV patients (II: 2.2 ± 1.6; p = 0.20 vs. III/IV: 1.8 ± 5.2mm; p = 0.0397). LVEF improvement was comparable in both groups over 5years of CCM (p = 0.83). NYHA class II patients had significantly lower NT-proBNP levels at baseline (858 [175/6887] vs. 2632 [17/28830] ng/L; p = 0.0044), which was offset under therapy (399 [323/1497] vs. 901 [13/18155] ng/L; p = 0.61). Actual 3-year mortality was 17 and 26% vs. a predicted mortality of 31 and 42%, respectively (p = 0.0038 for NYHAclass III/IVpatients). NYHA classIII/IV patients experienced more direct and extensive functional improvements with CCM and a survival benefit compared with the predicted risk. However, our data suggest that NYHA classII patients may also benefit from the sustained positive effects of LVEF improvement.

The Relationship Between the Blood-Brain-Barrier and the Central Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter-2 Inhibitors.

Diabetes and obesity are growing problems worldwide and are associated with a range of acute and chronic complications, including acute myocardial infarction (AMI) and stroke. Novel anti-diabetic medications designed to treat T2DM, such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT-2is), exert beneficial effects on metabolism and the cardiovascular system. However, the underlying mechanisms are poorly understood. GLP-1RAs induce anorexic effects by inhibiting the central regulation of food intake to reduce body weight. Central/peripheral administration of GLP-1RAs inhibits food intake, accompanied by an increase in c-Fos expression in neurons within the paraventricular nucleus (PVN), amygdala, the nucleus of the solitary tract (NTS), area postrema (AP), lateral parabrachial nucleus (LPB) and arcuate nucleus (ARC), induced by the activation of GLP-1 receptors in the central nervous system (CNS). Therefore, GLP-1RAs need to pass through the blood-brain barrier to exert their pharmacological effects. In addition, studies revealed that SGLT-2is could reduce the risk of chronic heart failure in people with type 2 diabetes. SGLT-2 is extensively expressed throughout the CNS, and c-Fos expression was also observed within 2 hours of administration of SGLT-2is in mice. Recent clinical studies reported that SGLT-2is improved hypertension and atrial fibrillation by modulating the “overstimulated” renin-angiotensin-aldosterone system (RAAS) and suppressing the sympathetic nervous system (SNS) by directly/indirectly acting on the rostral ventrolateral medulla. Despite extensive research into the central mechanism of GLP-1RAs and SGLT-2is, the penetration of the blood-brain barrier (BBB) remains controversial. This review discusses the interaction between GLP-1RAs and SGLT-2is and the BBB to induce pharmacological effects via the CNS.

Vericiguat and NT-proBNP in patients with heart failure with reduced ejection fraction: analyses from the VICTORIA trial.

Treatment response to vericiguat, based on baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) subgroups specified in the protocol, was evaluated in the heart failure (HF) VICTORIA trial population by post hoc analysis of combined lower three quartiles [Q1-Q3] vs. the upper quartile [Q4]. VICTORIA participants with available baseline NT-proBNP levels (n=4805; 95.1% of total) were included. Compared with patients in Q1-Q3 (NT-proBNP: Q1, ≤1556pg/mL; Q2, >1556-2816pg/mL; and Q3, >2816-5314pg/mL), patients in Q4 (NT-proBNP: >5314pg/mL) were older (69.2±12.0 vs. 66.6±12.1years), had lower mean ejection fraction (27.2±8.3% vs. 29.5±8.2%; P<0.0001), and were more likely to be in New York Heart Association (NYHA) Class III (51.8 vs. 35.6%) or IV (2.4 vs. 1.0%). Compared with Q1-Q3, patients in Q4 had higher mean Meta-Analysis Global Group in Chronic Heart Failure risk score (27.3±6.6 vs. 23.5±6.4; P<0.0001), had lower mean estimated glomerular filtration rate (eGFR; 51.5±25.5 vs. 65.0±26.8mL/min/1.73m2 ; P<0.0001) and haemoglobin (12.8±2.0 vs. 13.6±1.9g/dL; P<0.0001), and more had atrial fibrillation (48.7% vs. 43.1%; P=0.0007) and were randomized while hospitalized for HF (14.8 vs. 9.9%; P<0.0001). Target dose was achieved in 72.3 and 63.7% of patients in Q1-Q3 and Q4, respectively (P<0.0001). Primary outcome (composite of time to cardiovascular death or first HF hospitalization) rates were 24.5 and 31.7 per 100 patient-years for vericiguat and placebo in Q1-Q3 [hazard ratio (HR) 0.78; 95% confidence interval (CI) 0.69-0.88, P<0.001] and 73.6 and 63.6 in Q4 (HR 1.15; 95% CI 0.99-1.34, P=0.070). Serious adverse events were more frequent in NT-proBNP Q4 (total population) compared with Q1-Q3 (38.3 vs. 32.3%; P=0.0001), driven mainly by the placebo group. Adverse events leading to death were more frequent in Q4 than Q1-Q3 (5.8 vs. 2.4%; P<0.0001). Plasma NT-proBNP may help identify patients with worsening HF with reduced ejection fraction, in whom the beneficial effects of vericiguat may be highest. Patients with highest NT-proBNP values are probably too far advanced, suffering more co-morbidities, or still clinically unstable after decompensation to derive benefit from vericiguat.

Current approaches to risk assessment of chronic heart failure after myocardial infarction

In the last decade, there has been an increase in the number of survivors of myocardial infarction (MI). However, the risk of developing chronic heart failure (CHF) remains high in this category of patients. Population aging and comorbidity further contribute to adverse outcomes. Optimization of approaches to identify predictors of postinfarction CHF is an important clinical task of modern medicine.The aim of the investigation is to develop a method to assess the risk of CHF development after MI.Material and Methods. The present analysis included 186 patients who underwent MI from January 2019 to January 2020: 86 patients with signs of CHF above functional class (FC) 2 (NYHA) (mean age 64.3 years) and 100 patients without signs of CHF or with CHF 1 (NYHA) (mean age 62.6 years) by day 30 of MI. A mathematical model of CHF risk after MI was built by factor and correlation analysis methods.Results. A method for assessing CHF risk after a previous MI was developed. The proposed formula is programmed in Excel table processor and includes 5 indicators: presence of atrial fibrillation, Killip class of acute heart failure, triglycerides level, ST-segment elevation of electrocardiogram, left ventricular ejection fraction less than 45 %. The authors’ approach allows long-term personalized monitoring, taking into account the ranked contribution of each factor in a particular patient; it is characterized by high sensitivity, specificity, and accuracy.Conclusion. The present study investigated the factors of formation of postinfarct chronic heart failure syndrome. An original mathematical formula for CHF risk estimation, including routine indices of MI patients, has been proposed. The approach allows personalized management of selected cohorts of patients – with increased and standard risk of postinfarction CHF.

Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes.

Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS.

DETAILED ANALYSIS OF VASCULAR STIFFNESS IN PATIENTS WITH CHRONIC HEART FAILURE

Objective: Risk factors for chronic heart failure (CHF) lead as well to vascular stiffness of the large arteries, increasing thereby the afterload imposed on the left ventricle and deteriorating the clinical condition of CHF. The aim of this project was twofold: to compare vascular stiffness of patients with CHF (CHF+) to those without CHF (CHF-) and to analyse whether vascular stiffness is related to the severity of CHF. Design and method: In this cross-sectional project a total of 223 patients were included (CHF+: n = 105, CHF-: n = 118). Patients in an euvolaemic state with a reduced left ventricular ejection fraction (LVEF) were included in the CHF+ group. The measurement of the pulse wave velocity (PWV), the most accepted vascular stiffness parameter, and the recording of the arterial pulse wave were performed using the SphygmoCor TM XCEL System under resting conditions. Under ambulatory conditions, blood pressure (BP) and vascular stiffness parameters were assessed by a validated device (Mobil-O-Graph, I.E.M.) over 24 hours. Additionally, blood and spot urine samples were used to measure laboratory markers, in particular NT-pro-BNP. Results: Vascular stiffness parameters between the CHF+ and the CHF- group differed for resting central SBP (CHF+: 116.66 ± 15.18 mmHg, CHF-: 122.83 ± 15.87 mmHg, p = 0.004) and central augmentation index (CHF+: 21.24 ± 11.76 %, CHF-: 13.69 ± 11.49 %, p = &lt;0.001) as well as for ambulatory central SBP (CHF+: 114.46 ± 15.35 mmHg, CHF-: 120.69 ± 13.97 mmHg, p = 0.007) and PWV (CHF+: 9.39 ± 1.56 m/s, CHF-: 8.19 ± 1.65 m/s, p = &lt;0.001). In patients with CHF, greater levels of NT-pro-BNP were related to a higher central SBP (r = 0.292, p = 0.005), higher PWV (r = 0.340, p = &lt;0.001) and a trend to higher central PP (r = 0.198, p = 0.058), after full adjustment for CHF risk factors and gender. In accordance, higher levels of NT-pro-BNP were related to a higher ambulatory peripheral PP (r = 0.322, p = 0.002) and total peripheral resistance (r = 0.227, p = 0.041). Conclusions: In patients with stable CHF we observed a worse vascular stiffness and function, compared to patients with no CHF. The extent of vascular stiffness and dysfunction was related to the severity of CHF.

Risk Factors Leading to Acute Decompensation of Chronic Heart Failure in Patients Presenting to a Tertiary Care Hospital, Islamabad, Pakistan

Objectives: To determine the risk factors leading to acute decompensation of chronic heart failure in patients presenting to a tertiary care hospital, Islamabad, Pakistan Methodology: Study was conducted at Pakistan Institute of Medical Sciences, Cardiology department, Islamabad, Pakistan, 164 chronic heart failure patients aged ≥18 years; diagnosed with CHF from both genders were included. Patients with sudden onset of disease and unstable vital signs, impaired mobility; diagnosis with major depression or those having cognitive functioning disorder were excluded from study.Medical records were analyzed for the patient’s chronic heart failure risk factor profile i.e., history of diabetes, hypertension, hyperlipidemiaand smoking. Details of the coronary angiogram, laboratory investigations, and metabolic and cardiac biomarker were noted. Data was entered and analyzed using statistical package for social sciences (SPSS) version 2.0. P&lt; 0.05 will be considered as significant. Results: In study analysis it was found that out of total 164 participants, study included 78 males (47.6%) and 86 females (52.4%). out of which 157 (95.7%) were having history of hypertension and 85 (51.8%) were found to be having history of diabetes. Participant included in study who used to smoke were 92 (56.1%), patients having dyslipidemia were found to be 85 (51.8%) and 85 (51.8%) were obese. Out of all patients 157 (95.7%) were found to be having a sedentary life, while 19 (8.5%) participants have developed new ischemia. Out of all participants 93 (56.71%) were found to be having ECG changes and 72 (43.9%) were found to have cardiac enzyme changes. Mean age of participant was found to be 59.51±45.54. Mean HB level was found to be 12.8±1.8 and mean respiratory rate was found to be 19.12 ±3.4. Mean pulse was found to be 94.7±3.4. Mean BP was found to be 118.22±10.7.

Relationships between sympathetic markers and heart rate thresholds for cardiovascular risk in chronic heart failure

BackgroundResults of recent clinical trials have shown that in heart failure (HF) heart rate (HR) values > 70 beats/minute are associated with an increased cardiovascular risk. No information is available on whether the sympathetic nervous system is differently activated in HF patients displaying resting HR values above or below this cutoff.MethodsIn 103 HF patients aged 62.7 ± 0.9 (mean ± SEM) years and in 62 heathy controls of similar age we evaluated muscle sympathetic nerve traffic (MSNA, microneurography) and venous plasma norepinephrine (NE, HPLC assay), subdividing the subjects in different groups according to their resting clinic and 24-h HR values.ResultsIn HF progressively greater values of clinic or 24-h HR were associated with a progressive increase in both MSNA and NE. HR cutoff values adopted in large scale clinical trials for determining cardiovascular risk, i.e., 70 beats/minute, were associated with MSNA values significantly greater than the ones detected in patients with lower HR, this being the case also for NE. In HF both MSNA and NE were significantly related to clinic (r = 0.92, P < 0.0001 and r = 0.81, P < 0.0001, respectively) and 24-h (r = 0.91, P < 0.0001 and r = 0.79, P < 0.0001, respectively) HR. The behavior of sympathetic markers described in HF was specific for this clinical condition, being not observed in healthy controls.ConclusionsBoth clinic and 24-h HR values greater than 70 beats/minute are associated with an increased sympathetic activation, which parallels for magnitude the HR elevations. These findings support the relevance of using in the therapeutic approach to HF drugs exerting sympathomoderating properties.Graphical abstract

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.

A deep learning model for early risk prediction of heart failure with preserved ejection fraction by DNA methylation profiles combined with clinical features

BackgroundHeart failure with preserved ejection fraction (HFpEF), affected collectively by genetic and environmental factors, is the common subtype of chronic heart failure. Although the available risk assessment methods for HFpEF have achieved some progress, they were based on clinical or genetic features alone. Here, we have developed a deep learning framework, HFmeRisk, using both 5 clinical features and 25 DNA methylation loci to predict the early risk of HFpEF in the Framingham Heart Study Cohort.ResultsThe framework incorporates Least Absolute Shrinkage and Selection Operator and Extreme Gradient Boosting-based feature selection, as well as a Factorization-Machine based neural network-based recommender system. Model discrimination and calibration were assessed using the AUC and Hosmer–Lemeshow test. HFmeRisk, including 25 CpGs and 5 clinical features, have achieved the AUC of 0.90 (95% confidence interval 0.88–0.92) and Hosmer–Lemeshow statistic was 6.17 (P = 0.632), which outperformed models with clinical characteristics or DNA methylation levels alone, published chronic heart failure risk prediction models and other benchmark machine learning models. Out of them, the DNA methylation levels of two CpGs were significantly correlated with the paired transcriptome levels (R < −0.3, P < 0.05). Besides, DNA methylation locus in HFmeRisk were associated with intercellular signaling and interaction, amino acid metabolism, transport and activation and the clinical variables were all related with the mechanism of occurrence of HFpEF. Together, these findings give new evidence into the HFmeRisk model.ConclusionOur study proposes an early risk assessment framework for HFpEF integrating both clinical and epigenetic features, providing a promising path for clinical decision making.

МУЛЬТИМОДАЛЬНЫЙ ПОДХОД ДЛЯ ОЦЕНКИ РИСКА РАЗВИТИЯ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА (ЧАСТЬ 1). КЛИНИЧЕСКИЕ И ЛАБОРАТОРНЫЕ ПРЕДИКТОРЫ

According to the Russian epidemiological study EPOСHA-CHF (1998–2017), during a 20-year follow-up, the prevalence of chronic heart failure (CHF) increased from 6.1 to 8.2%. Arterial hypertension, coronary heart disease, atrial fibrillation, diabetes mellitus remain the main causes of CHF. At the same time, acute myocardial infarction (AMI) as a cause of heart failure increased by 3 times. The median survival time among the patients with CHF I-II functional class (FC) is 8.4 years, and 3.8 years among the patients with CHF III-IV FC, which indicates a poor prognosis of CHF of any functional class. Currently, a number of clinical, biochemical, angiographic, and imaging approaches have been proposed to stratify the risk of CHF after AMI, but only a few of them are used in routine clinical practice. Given the increasing contribution of CHF to morbidity and mortality after myocardial infarction, early multimodal risk stratification is needed to develop preventive strategies aimed at averting this complication. This report presents current ideas about the role of clinical risk factors, biochemical and genetic markers of CHF, considered as early predictors of heart failure in patients with acute myocardial infarction.

Fibrosis biomarkers and echocardiographic parameters in patients with type 2 diabetes depending on the degree of albuminuria

Background. Diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) is associated with a risk of developing chronic heart failure (CHF). The degree of albuminuria is a marker of DN and is associated with an increased risk of chronic heart failure (CHF).Aim. To evaluate fibrosis biomarkers and echocardiographic parameters in patients with T2DM without CHF, depending on urinary albumin excretion.Materials and methods. The study included 42 patients with T2DM without verified CHF. The patients were divided into two groups: 1) a group with normoalbuminuria and 2) a group with a moderate increase in albuminuria (albumin / creatinine ratio of 30–300 mg / g). Echocardiography was performed and galectin-3, ST-2, PIСP, MMP-9, and TIMP-1 concentrations were measured.Results. The groups did not differ by age, sex, body mass index (BMI), glycated hemoglobin (HbA1c), and glomerular filtration rate (GFR). Galectin-3 concentrations were significantly higher in the group with a moderate increase in albuminuria than in the group of patients without albuminuria – 13.6 (11.2; 15.1) ng / ml and 7.4 (6.7; 7.9) ng / ml, respectively, p = 0.002. The groups also did not differ in the values of biomarkers, such as P1CP, TIMP-1, and MMP-9. Besides, the group with normoalbuminuria had lower E/e’ values than the group with a moderate increase in albuminuria – 8 (7; 9) and 10 (9; 12.5), p = 0.02.Conclusion. The patients with type 2 diabetes and a moderate increase in albuminuria have higher values of galectin-3 and a more pronounced diastolic dysfunction. The identified changes may reflect a higher risk of chronic heart failure in this group of patients.

Males with abdominal aortic aneurysm have reduced left ventricular systolic and diastolic function.

Abdominal aortic aneurysm (AAA) increases the risk of chronic heart failure and other major cardiovascular events. Knowledge about left ventricular function in patients with AAA is lacking. This echocardiographic study aimed to investigate whether AAA is associated with left ventricular systolic and diastolic dysfunction. Echocardiography was performed in 307 males (199 AAA and 108 controls) recruited from a regional ultrasound surveillance programme of known AAA, or from an ongoing ultrasound screening programme, during 2011-2016. Subjects with AAA had thicker septal and posterior walls and a reduced left ventricular function compared to controls. Left ventricular ejection fraction (AAA 55±8%, controls 57±7%) and global longitudinal strain (AAA 19±3%, controls 20±3%) were lower in the group with AAA (both p<0·05). Moreover, decreased mitral annular plane systolic excursion (12±2mm versus 13±2mm) and higher E/e' (13±5 versus 11±4) were observed in subjects with AAA (both p<0·05). The aortic sinus (38±4mm versus 35±2mm) and ascending aorta (36±4mm versus 34±5mm) were also wider in the AAA group compared to controls (both p<0·01). AAAs are associated with reduced left ventricular systolic and diastolic function in males. The larger diameter of the aortic sinus and ascending aorta among AAA patients suggests that AAA is a general aortic disease.

Development and Validation of a Nomogram to Predict the 180-Day Readmission Risk for Chronic Heart Failure: A Multicenter Prospective Study.

Background: The existing prediction models lack the generalized applicability for chronic heart failure (CHF) readmission. We aimed to develop and validate a widely applicable nomogram for the prediction of 180-day readmission to the patients.Methods: We prospectively enrolled 2,980 consecutive patients with CHF from two hospitals. A nomogram was created to predict 180-day readmission based on the selected variables. The patients were divided into three datasets for development, internal validation, and external validation (mean age: 74.2 ± 14.1, 73.8 ± 14.2, and 71.0 ± 11.7 years, respectively; sex: 50.2, 48.8, and 55.2% male, respectively). At baseline, 102 variables were submitted to the least absolute shrinkage and selection operator (Lasso) regression algorithm for variable selection. The selected variables were processed by the multivariable Cox proportional hazards regression modeling combined with univariate analysis and stepwise regression. The model was evaluated by the concordance index (C-index) and calibration plot. Finally, the nomogram was provided to visualize the results. The improvement in the regression model was calculated by the net reclassification index (NRI) (with tenfold cross-validation and 200 bootstraps).Results: Among the selected 2,980 patients, 1,696 (56.9%) were readmitted within 180 days, and 1,502 (50.4%) were men. A nomogram was established by the results of Lasso regression, univariate analysis, stepwise regression and multivariate Cox regression, as well as variables with clinical significance. The values of the C-index were 0.75 [95% confidence interval (CI): 0.72–0.79], 0.75 [95% CI: 0.69–0.81], and 0.73 [95% CI: 0.64–0.83] for the development, internal validation, and external validation datasets, respectively. Calibration plots were provided for both the internal and external validation sets. Five variables including history of acute heart failure, emergency department visit, age, blood urea nitrogen level, and beta blocker usage were considered in the final prediction model. When adding variables involving hospital discharge way, alcohol taken and left bundle branch block, the calculated values of NRI demonstrated no significant improvements.Conclusions: A nomogram for the prediction of 180-day readmission of patients with CHF was developed and validated based on five variables. The proposed methodology can improve the accurate prediction of patient readmission and have the wide applications for CHF.

Prevalence of Chronic Heart Failure, Associated Factors, and Therapeutic Management in Primary Care Patients in Spain, IBERICAN Study.

Background: The prevalence of chronic heart failure (CHF) in patients assisted in primary care is not well known. We investigated the prevalence of CHF, its associated factors, and its therapeutic management. Methods and findings: This was a cross-sectional, multicenter study conducted in primary care (PC) in baseline patients of the IBERICAN study (Identification of the Spanish Population at Cardiovascular and Renal Risk). CHF was defined as the presence of this condition in the medical history, classifying patients according to the type of ventricular dysfunction in CHF with preserved ejection fraction (pEF), or CHF with reduced ejection fraction (rEF). Clinical characteristics, relationship between CHF and main cardiovascular risk factors (CVRF), and drug treatments used according to ejection fraction (EF) were analyzed. Results: A total of 8066 patients were included (54.5% women), average age (SD) was 57.9 (14.8) years, of which 3.1% (95% CI: 2.3–3.7) presented CHF, without differences between men and women. CHF with pEF (61.8%; 95% CI: 55.5–67.6) was more frequent in women, and CHF with rEF (38.1%; 95% CI: 33.2–45.5) (p = 0.028) was similar in both genders (65.9%; 95% CI: 57.1–73.4 vs. 57.3%; 95% CI: 47.7–65.8) (p = 0.188). A progressive increase of the prevalence with age (15.2% in ≥80 years) and with the aggregation of CVRF was observed. The most prescribed treatments were beta-blockers (54.7%) followed by angiotensin converting enzyme inhibitors (42.8%) and angiotensin II receptor antagonists (41.3%), without differences between pEF and rEF. The variables that are most associated with the probability of suffering CHF were a personal history of left ventricular hypertrophy (OR: 5.968; p < 0.001), of atrial fibrillation (OR: 3.494; p < 0.001), and of peripheral vascular disease (OR: 2.029; p < 0.001). Conclusions: Three in every 100 patients included in the IBERICAN study presented CHF, of which two thirds had pEF. The condition increased exponentially with age and aggregation of CVRF. We did not find any differences in drug treatment according to the type of ventricular dysfunction. The treatment of HF with rEF has much room for improvement.

Особливості взаємозв’язків між вмістом тиреотропного гормону і деякими маркерами серцево-судинного ризику при субклінічному гіпотиреозі

Вступ. Гіпотиреоз, у тому числі субклінічний, асоціюється з підвищенням ризику розвитку хронічної серцевої недостатності. Згідно з даними дослідження Cardiovascular Health Study, підвищений рівень тиреотропного гормона (ТТГ) можна розглядати як фактор ризику розвитку серцевої недостатності. Мета дослідження — вивчення взаємозв’язків між рівнем ТТГ і наявністю серцево-судинних порушень у пацієнток із субклінічним гіпотиреозом. Матеріали та методи. В одномоментне поперечне дослідження були включені 26 жінок репродуктивного віку (від 32 до 47 років) із субклінічним гіпотиреозом (група 1) і 25 жінок без порушення функціонального стану щитоподібної залози (ЩЗ) і кардіальної патології в анамнезі (група 2). У всіх жінок оцінювали наявність факторів і маркерів серцево-судинного ризику, ранніх ознак ураження міокарда. Для порівняння груп пацієнток із нормальною функцією ЩЗ та із субклінічним гіпотиреозом (групи 1 і 2) був застосований ROC-аналіз для ідентифікації рівнів ТТГ, асоційованих із найбільшою ймовірністю виявлення досліджуваних порушень. Результати. За даними ROC-аналізу, рівень ТТГ ≥ 4,67 мМО/л прогнозував розвиток діастолічної дисфункції лівого та/або правого шлуночків із чутливістю 70,6 (49,8; 89,1) % і специфічністю 69,3 (53,2; 80,6) % (AUC 0,672 (0,561; 0,787), p = 0,032). Аналогічно значення ТТГ ≥ 4,8 мМО/л вказувало на можливість виявлення сегментарних порушень релаксації з чутливістю 61,9 (46,2; 77,7) % і специфічністю 73,1 (42,9; 91,0) % (AUC 0,680 (0,543; 0,831), p = 0,042). Висновки. Початкові прояви серцево-судинних порушень частіше виникають при значеннях ТТГ у діапазоні 4,6–5,9 мМО/л. Рівень ТТГ понад 5,45 мМО/л може розглядатися як предиктор розвитку асоційованих із субклінічним гіпотиреозом кардіоваскулярних розладів.

Participation in a Heart Failure Clinical Trial: Perspectives and Opportunities From the VICTORIA Trial and VICTORIA Simultaneous Registry.

Randomized controlled trials (RCTs) often target enrollment of patients with demographics and outcomes less representative of the broader population of interest. To provide context for the VICTORIA trial (Vericiguat Global Study in Subjects With Heart Failure With Reduced Ejection Fraction), we designed a registry of hospitalized patients with worsening heart failure to characterize their clinical profile, outcomes, and reasons for their nonparticipation in a RCT. Fifty-one RCT sites in Canada and the United States participated. Eligible patients included those with chronic heart failure, hospitalized for heart failure, and an ejection fraction <45%; no other exclusions were applied. Sites identified patients between 2017 and 2019 during the RCT enrollment period. RCT eligibility criteria were applied, and non-mutually exclusive reasons for nonenrollment were captured. Mortality at 1 year was estimated via the Meta-Analysis Global Group in Chronic Heart Failure risk score or as observed in the RCT. Overall, 2056 patients were enrolled in the registry; 61% (n=1256) were ineligible for the RCT, 37% (n=766) were eligible but not enrolled, and 2% (n=34) were also enrolled in the RCT. Registry participants had a median age of 70, 33% were women, and 63% were White. The median risk score predicted a 20.9% 1-year mortality, higher than in the RCT (predicted 14.7% and observed 11.5%). Major reasons for ineligibility in the RCT included the use of nitrates (23%), systolic blood pressure <100 mm Hg (12%), and substance use (11%) with other exclusion criteria <10%. For eligible patients, reasons for nonparticipation in the RCT included lack of interest in participating (28%), poor compliance (25%), inability to complete follow-up (23%), too sick (20%), unable to provide consent (17%), and distance from site (15%). Patients with worsening heart failure in routine clinical practice exhibit high-risk features, and approximately one-third were eligible for an RCT but excluded. The majority of these nonparticipating patients had modifiable reasons. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02861534.