Severe Chronic Heart Failure Research Articles

КАЧЕСТВО ЖИЗНИ И КОГНИТИВНЫЕ НАРУШЕНИЯ У БОЛЬНЫХ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТЬЮ

Abstract. Вackground. Chronic heart failure (CHF) has a high prevalence in the Russian population. It is one of the main causes of reduced quality of life in cardiology patients due to the gradual progression of the disease and the development of complications, as well as the development of cognitive impairment. Early recognition of these disorders will optimize the management of patients with CHF. Purpose of the study. To evaluate the quality of life and cognitive functions in patients with different severity of chronic heart failure. Characterization of patients and methods of the study. 105 patients with confirmed diagnosis of CHF with different functional classes according to NYHA were included in the open cross-sectional non-randomized cohort study. Cognitive screening was performed using the Montreal Cognitive Assessment (MoCA), and quality of life was assessed by the Quality of Life Questionnaire (EQ-5D). Statistical Analysis Methods. Excel data analysis package and SPSS 23.0 data analysis package were used. Results and Conclusion. A pilot study was conducted to detect mild or severe cognitive impairment using the Montreal Cognitive Scale and quality of life using the EQ-5D questionnaire in patients with different functional classes of CHF. A significant correlation was found between cognitive function and left ventricular ejection fraction. Quality of life did not depend on the severity of CHF, sex, age, concomitant pathology. The obtained data should be taken into account in personalized management of patients with CHF.

In Search of Optimal Criteria for Iron Deficiency in CHF Patients. Post-hoc Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)".

Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 μmol/l. An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 μg/l or ferritin from 100 to 299 μg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed. ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml). Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 μg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

The Influence of Adherence to a Mediterranean Diet on Decompensation in Patients with Chronic Heart Failure.

Chronic heart failure (CHF) is a major health problem, representing the main cause of hospitalization in people over 65 years of age. Several studies have associated the Mediterranean diet with a cardioprotective function, improving prognoses in patients with high cardiovascular risk. Our main objective is to determine whether higher adherence to the Mediterranean diet is associated with a lower severity of CHF, based on the number of decompensations and disease complications. This study was a single-center retrospective cohort study conducted at the Virgen del Rocío Hospital (Seville). Adherence to a Mediterranean diet was determined by the Mediterranean Diet Adherence Screener (MEDAS) in patients with chronic heart failure in a state of clinical stability, the number of decompensations in the 12 months before inclusion, cardiac biomarkers (NT-proBNP and CA125), evaluation of dyspnea, and quality of life assessment according to NYHA and KCCQ scales and analytical profiles. Seventy-two patients were included (35 with high adherence to the Mediterranean diet and 37 with low adherence). The mean age was 81.29 ± 0.86 years. A trend towards fewer decompensations (1.49 ± 0.14 vs. 1.92 ± 0.17, p = 0.054) and lower NT-proBNP values (2897.02 ± 617.16 vs. 5227.96 ± 1047.12; p = 0.088) was observed in patients with high adherence compared to those with low adherence to the Mediterranean diet. Our results suggest that patients with CHF and high adherence to the Mediterranean diet have a tendency towards an improved cardiac profile, indicated by fewer decompensations and lower NT-proBNP levels. Future clinical trials are needed to substantiate these hypotheses.

Adherence to long-term telemonitoring-supported physical activity in patients with chronic heart failure

Chronic heart failure (CHF) is one of the most common diseases with a prevalence of 1–2% in adults, disproportionately affecting the elderly. Despite consistent drug therapy, physical activity (PA) is an integral part of current guidelines. Yet adherence to regular PA and exercise interventions is poor and potential predictors and barriers to PA remain elusive. We examined the effects of a telemonitoring-based exercise intervention in 699 CHF patients in a prospective, randomized-controlled (1:1), multicenter trial. The study was registered in the German Clinical Trials Register under DRKS00019022 on 28.05.2020. For both, the exercise and control group, self-reported PA (MET*h/week) increased and sedentary behavior declined during the 12-month intervention period. In the exercise group, daily step count as analyzed via activity trackers remained stable (pre: 6459 [4016] steps/day, post: 6532 [3858] steps/day; p = 0.621). The average number of completed exercise instruction videos provided via an online application was 1.50 [1.44] videos/week at the beginning and gradually decreased to 1.00 [1.50] videos/week; p < 0.001). Multivariate regression model revealed that exercise-related PA (MET*h/week) and exercise capacity (Wmax) at baseline, CHF severity, atrial fibrillation and age predicted changes in self-reported exercise-related PA (R2 = 0.396). Furthermore, the BMI and the average number of completed videos per week at baseline were associated with the change in completed videos over the course of the study (R2 = 0.251). Our results show the influence of certain baseline characteristics as barriers and predictors of PA progression. Therefore, exercise programs should pay attention to patients’ individual conditions to set achievable goals, and eventually affect the adherence and sustainability of exercise-focused interventions.

Diagnostic and prognostic significance of miR-320a-3p in patients with chronic heart failure

AimThe purpose of this study was to investigate the diagnostic and prognostic value of miR-320a-3p in chronic heart failure (CHF).MethodsA total of 103 patients with CHF and 95 healthy controls were included in the study population. The expression level of serum miR-320a-3p was detected by qRT-PCR. The diagnostic effect of miR-320a-3p on CHF was evaluated by receiver operating characteristic curve. Kaplan-Meier curve and Cox regression were used to analyze the risk factors for 4-year prognosis of CHF patients. Bioinformatics analysis was used to analyze the possible target genes of miR-320a-3p and related signaling pathways.ResultsSerum miR-320a-3p expression was increased in CHF patients, and the levels of BNP and LVEF were positively and negatively correlated with miR-320a-3p, respectively. The AUC value of ROC curve was 0.866, indicating that miR-320a-3p had high diagnostic accuracy for CHF. Survival curve and Cox analysis showed that high expression of miR-320a-3p was associated with poor prognosis in CHF patients, and age and miR-320a-3p were independent risk factors for prognosis in CHF patients. GO and KEGG analysis showed that the downstream target genes of miR-320a-3p were involved in biological processes such as cell adhesion, stem cell differentiation and neural development, and were enriched in mTOR, TNF, AMPK and other signaling pathways.ConclusionsmiR-320a-3p increased abnormally in CHF and was related to the severity of CHF. miR-320a-3p has the potential to be a diagnostic and prognostic marker for CHF.

AST/ALT Ratio as an indicator of functional severity in chronic heart failure with reduced left ventricular ejection fraction: A prospective cross-sectional study

ObjectiveThe study was carried out to evaluate the role of the AST (Aspartate transaminase)/ALT (Alanine transaminase) ratio as an indicator of the functional severity in people with chronic heart failure (CHF) with reduced left ventricular ejection fraction. MethodsA prospective cross-sectional study was conducted in a tertiary care centre in South India among the individuals who had left ventricular ejection fraction (LVEF) of ≤40 %. The study period was between January 2021 and December 2021. Consecutive patients with the criteria were enrolled in the study. Study participants were grouped based on their AST/ALT ratio value (ratio<1 and ratio≥1). ResultsIn present study of 100 participants, there was a statistically significant difference between two groups with respect to ALT, AST/ALT ratio, and ALP (Alkaline phosphatase). There was a significant correlation between the APRI (AST to platelet ratio index) and FIB-4 (Fibrosis-4) with AST/ALT ratio. Diagnostic analysis of AST/ALT ratio to predict the severity of CHF with reduced EF, the area under the curve (AUC) was 0.547 (p-value = 0.5654) with a 95 % confidence interval of 0.299–0.795 with an optimal cut-off value of 0.6, sensitivity of 96.70 %, and specificity of 33.33 %. ConclusionThe AST/ALT ratio is increased in patients with CHF patients with reduced left ventricular ejection fraction. It is a simple predictor of left ventricular dysfunction in patients with heart failure with reduced ejection fraction.

#485 Studying the features of heart remodeling processes depending on the degree of renal dysfunction

Abstract Background and Aims Chronic kidney disease (CKD) and heart failure (HF) affect many people worldwide and both diseases remain associated with considerable morbidity and mortality. Aim of the study was to features of changes in cardiac remodelling parameters depending on the degree of kidney dysfunction. Method A comprehensive examination of 105 patients with coronary heart disease (CHD) with functional class I-III and chronic heart failure (CHF) was carried out, assessing the clinical condition, exercise tolerance, left ventricular remodelling processes, and the functional state of the kidneys. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n=51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n=54) The average age of patients in group I was 58.77 ± 0.94 years, in group II 61.3±0.68 years and 62.14 ± 0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. All examined patients were divided into groups according to the FC of CHF: with FC I CHF (35 patients), with FC II CHF (32 patients and with FC III CHF (38 patients). The patients were also subdivided according to the level of glomerular filtration rate of the kidneys (Group I patients with CHF I-III FC eGFR CKD-EPI ≥6 ml/min/1.73 m2 (n = 51) Group II patients with CHF I-III FC eGFR CKD-EPI ≥60 ml/min/1.73 m2 (n = 54) The average age of patients in group I was 58.77±0.94 years, in group II 61.3 ± 0.68 years and 62.14±0.79 in group III patients. The duration of the disease in patients in group I was 5.81 ± 0.75 years; 6.6 ± 0.63 years in group II and in patients of group III 7.16 ± 0.92 years. Results The progression of the severity of CHF with eGFR ≤60 ml/min/1.73 m2 was accompanied by an increase in LV volume parameters, pronounced structural changes, as well as a pronounced degree of LV dilatation. At the same time, in the group of patients with FC III CHF, there was an increase in ESR by 26.8% (p &amp;lt; 0.001) and EDV by 10.64% (p &amp;lt; 0.01) in relation to the data of group I with FC I CHF. Analysis of the parameters of LV systolic function (SV and EF), as well as fractional shortening of the LV in systole, showed that in group II there was a significant decrease in LVEF, SV and Fs% in patients with class II CHF by 10.7%, 14.4% and by 9.0% (p &amp;gt; 0.05) in relation to the data of CHF I FC. In patients with FC III CHF, there was also a pronounced decrease in EF by 28.8% (p &amp;lt; 0.01) and Fs% by 31.75% (p &amp;lt; 0.001) in relation to the FC I CHF data. Analysis of diastolic function indicators in patients with CHF with GFR ≤60 ml/min. Severe disturbances in LV diastolic function are observed in the group of patients with FC II CHF, where there is an increase in the maximum rate of late atrial filling (RA) by 25.1% (p &amp;lt; 0.001) and a significant decrease in the maximum rate of early filling of the left ventricle (PE) compared to study group I by 12.6% (p &amp;gt; 0.05). Conclusion The results of the analysis of indicators of the sizes of the LV and LA cavities, as well as the LV walls, established the peculiarity of structural and geometric changes in the left parts of the heart in patients with FC I-III CHF (increase in LVMM by 10.25%; p &amp;lt; 0.001) in relation to data with eGFR&amp;gt;60 ml/min/1.73 m2. A decrease in the level of LVEF in patients with eGFR ≤60 ml/min/1.73 m2 is evidence of the role of the severity of DP in reducing systolic function in patients with CHF (EF by 25.4% and Fs% by 11.2% (p &amp;lt; 0.001)). 2. Analysis of diastolic function indicators in patients of group II with eGFR ≤60 ml/min/1.73 m2 showed an increase in the maximum rate of early left ventricular filling (PE) by 13.25% (p &amp;lt; 0.001), which led to an increase in E/ and by 20.5% in patients with CHF eGFR ≤60 ml/min/1.73 m2 compared to CHF with eGFR&amp;gt;60 ml/min/1.73 m2 (p &amp;lt; 0.001).

The Impact of Acute Heart Failure on Frailty Degree and Outcomes in Elderly Patients with Severe Aortic Stenosis and Chronic Heart Failure with Preserved Ejection Fraction.

Frailty degree plays a critical role in the decision-making and outcomes of elderly patients with severe aortic stenosis (AS). Acute heart failure (AHF) results in a severely worse clinical hemodynamic status in this population. This study aimed to evaluate the impact of AHF on frailty degree and outcomes in older patients referred for tailored interventional treatment due to AS. A total of 109 patients (68% female; mean age 83.3 ± 5.4), evaluated by a multidisciplinary path for "frailty-based management" of valve disease, were divided into two groups, one with (AHF+) and one without AHF (AHF-) and preserved ejection fraction (mean value EF: 57.4 ± 8.6). AHF occurred a mean value of 55 days before geriatric, clinical, and surgical assessment. A follow-up for all-cause mortality and readmission was conducted at 20 months. AHF+ patients showed a higher frequency of advanced frailty (53.3% vs. 46.7%, respectively), rehospitalization (35.5% vs. 12.8; p = 0.007), and death (41.9% vs. 12.8%; p < 0.001). In stepwise logistic regression analysis, AHF emerged as an independent risk factor for advanced frailty (OR: 3.8 CI 1.3-10.7; p = 0.01) and hospital readmission (OR: 3.6 CI 1.1-11.6; p = 0.03). In addition, preceding AHF was an independent determinant associated with a higher risk of mortality (HR 2.65; CI 95% 1.04-6.74; p-value 0.04). AHF is independently associated with advanced frailty and poor outcomes in elderly patients with severe AS. So, this population needs careful clinical and geriatric monitoring and the implementation of interventional therapy for AS in the early stages of frailty to avoid the occurrence of AHF and poor outcomes.

Role of caspase-6 in the formation of severe chronic heart failure in patients infected with the human immunodeficiency virus

Caspases are a group of cysteine proteases that play a leading role in the processes of apoptosis. There is evidence that apoptosis of cardiomyocytes is the morphological basis for the formation of chronic heart failure (CHF). The aim of the study was to study the role of caspase-6 in the blood serum of patients with severe CHF infected with the human immunodeficiency virus (HIV). In 2019–2022, on the basis of a large hospital, a one-stage screening clinical study was performed with the inclusion of 240 patients infected with HIV, 160 of them (66.6 %) were diagnosed with CHF. Inclusion criteria for the study were the presence of confirmed CHF, the presence of HIV infection, stabilization of the condition due to the disease that required hospitalization, and the patient's consent to participate in the study. The criteria for exclusion from the study were social deprivation and refusal to sign informed voluntary consent, acute decompensation of CHF, acute heart failure, and oncology. The criterion for severe CHF was an increase in the level of NT-proBNP in blood plasma ≥ 1500 pg/ml. According to the results of the study, a direct close relationship was revealed between the formation of severe CHF and the content of caspase-6 in the blood serum, which may indicate an intensification of the processes of cardiomyocyte apoptosis. When the content of caspase-6 is equal to 148.35 pg/ml and above, there is a high risk of developing severe CHF with NT-pro BNP ≥ 1500 pg/ml, the chances of developing the following complications increase – CHF with low left ventricular ejection fraction (LVEF) &lt; 40 % – 11.77 times, left ventricular hypertrophy (LVH) – 1.31 times, cachexia with a body mass index (BMI) &lt; 18 – 18.91 times, valvular heart disease – 2.32 times, arterial hypotension - 5.96 times. In patients with CHF and HIV infection, the patterns obtained allow us to state the role of the effector enzyme apoptosis-caspase-6 as a prognostic factor for the development of such complications as LVEF &lt; 40 %, cachexia, arterial hypotension, valvular heart disease and LVH.

Mechanisms of NLRP3 inflammasome-mediated pyroptosis in chronic heart failure and research progress in traditional Chinese medicine

Chronic heart failure(CHF) is a severe cardiovascular disease characterized by a complex pathogenesis involving myocardial structural and functional abnormalities and the activation of inflammatory responses. The NOD-like receptor thermal protein domain-associated protein 3(NLRP3) inflammasome, acting as a sensor for inflammatory cells, plays a pivotal role in the development of CHF. Research indicates that the activation of the NLRP3 inflammasome can induce inflammatory responses, leading to cardiac inflammation and impairing myocardial function, and it is correlated with the severity of CHF. Traditional Chinese medicine(TCM) has garnered increasing attention as a traditional therapeutic approach in recent years. Various TCM drugs and treatment methods have exhibited potential efficacy in suppressing inflammatory responses, alleviating myocardial cell pyroptosis, improving myocardial structure and function, and inhibiting myocardial fibrosis. Several TCM drugs and their extracts have been utilized in CHF treatment, with mechanisms potentially involving the inhibition of NLRP3 inflammasomes and the mitigation of inflammatory responses. The article provided an overview of the composition, structural characteristics, initiation, and activation modes of the NLRP3 inflammasome, its mechanisms in CHF, and the research progress of TCM in CHF treatment. It aims to offer references and foundations for a deeper understanding of CHF pathogenesis and subsequent development of new therapeutic strategies.

Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction &lt;40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

Somatic symptom profile in patients with chronic heart failure with and without depressive comorbidity.

Patients with chronic heart failure (CHF) frequently suffer from depressive comorbidity. CHF and depressive comorbidity can cause somatic symptoms. The correct attribution of somatic symptoms is important. Thus, we aimed to assess potential differences in somatic symptom severity between CHF patients with and without depressive comorbidity. We evaluated depressive comorbidity using the Patient Health Questionnaire-9 (PHQ-9), somatic symptom severity with the Patient Health Questionnaire-15 (PHQ-15), and sociodemographic and medical variables in 308 CHF outpatients. To compare somatic symptom severity between CHF patients with and without depressive comorbidity, we conducted item-level analyses of covariance. Of the 308 participating patients, 93 (30.3%) met the PHQ-9 criteria for depressive comorbidity. These patients did not differ from those without depressive comorbidity with regard to age, sex, left ventricular function, and multimorbidity. Patients with depressive comorbidity scored significantly higher on ten out of thirteen PHQ-15 items than patients without depressive comorbidity. The largest effect sizes (0.71-0.80) were shown for symptoms of headache, chest pain, shortness of breath, and palpitations, and the latter three were potentially attributable to heart failure. Among patients with CHF, somatic symptoms are more pronounced in those with depressive comorbidity than those without depressive comorbidity. This finding is especially true for cardiac symptoms independent of CHF severity. The potential interpretation of somatic symptoms as correlates of depressive comorbidity must be recognized in clinical practice.

The severity of chronic heart failure and the parameters of daily blood pressure profile in patients with coronary heart disease

Aim: Although the prevalence of coronary heart disease (CHD) and hypertension which are the most common causes of the development and progression of chronic heart failure (CHF) is high, 24-hour ambulatory blood pressure (BP) monitoring (ABPM) in patients with CHF is not mandatory to be performed. The growing number of evidence suggests that excessive decrease in BP which clearly reflects increased BP variability (BPV) affects the survival of patients with heart failure (HF). The objective of the study was to investigate the relationship between the parameters specific to CHF severity and features of daily BP profiles in patients with ischemic CHF and hypertension. Methods: Ninety patients with functional class II–IV of CHF and CHD (the main group) and 50 non-CHF patients with hypertension (the comparative group) were examined. The transthoracic echocardiography (TTE) [atrial end-systolic dimension (ESD), ventricular end-diastolic dimension (EDD), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF)] and 24-hour ABPM (BPV parameters and proportions of hypotensive episodes) were performed. The relationships between the abovementioned parameters were evaluated using the univariate correlation analysis and stepwise multiple linear regression. Results: Higher functional class of CHF is found to be associated with a higher incidence of daytime systolic BP (SBP) decline and nighttime SBP and diastolic BP (DBP) variability while higher LVEF is related to the hypotensive episodes regardless of CHF. Conclusions: It appears that the larger trials involving CHF patients with reduced LVEF should be conducted to clarify the obtained results.

Cost-effectiveness analysis of HeartMate3 system in patients with severe chronic heart failure and reduced left ventricular ejection fraction

Cost-effectiveness analysis of HeartMate3 system in patients with severe chronic heart failure and reduced left ventricular ejection fraction

Assessment value of the modified early warning score for long-term prognosis of older patients with chronic heart failure.

The aim of the study was to explore the assessment value of the modified early warning score (MEWS) for the long-term prognosis of older patients with chronic heart failure (CHF). A total of 180 CHF patients, treated from January 2016 to January 2018, were divided into a grade I group (n = 28), a grade II group (n = 37), a grade III group (n = 68) and a grade IV group (n = 47) according to the New York Heart Association (NYHA) functional classification. The MEWS was compared on admission and discharge. Based on the clinical outcomes during follow up, the patients were divided into a non-survival group (n = 48) and a survival group (n = 132). Their general clinical data and the MEWS were compared. The predictive values of the MEWS, troponin I (cTnI) and B-type natriuretic (BNP) peptide for long-term prognosis were assessed using receiver operator characteristic (ROC) curves. The MEWS on patient discharge was significantly lower than that on admission, and it increased with increasing NYHA grade (p < 0.05). The MEWS in the non-survival group was significantly higher than that in the survival group. Different clinical outcomes were positively correlated with NYHA grade, MEWS, six-minute walking distance and left ventricular ejection fraction (r = 0.368, r = 0.471, r = 0.387, r = 0.423, p < 0.05), and negatively correlated with cTnI and BNP (r = -0.411, r = -0.425). The area under the ROC curve of the MEWS was 0.852, indicating higher accuracy. The optimal cut-off value, sensitivity and specificity of the MEWS for determining prognosis were 5.6, 0.854 and 0.797 points, respectively. The MEWS rose with increasing NYHA grade and reflected the severity of CHF in older patients, which has higher predictive value for long-term prognosis.

Laparoscopic Colorectal Cancer Surgery for Patients With Severe Chronic Heart Failure.

Laparoscopic surgery with pneumoperitoneum is not usually recommended for patients with heart failure due to the potential risks associated with cardiopulmonary stress. Few studies, however, have directly examined whether a laparoscopic approach can be used safely in patients with severe chronic heart failure. We retrospectively evaluated the safety and feasibility of laparoscopic colorectal cancer surgery in 13 patients with severe chronic heart failure, defined as left ventricular ejection fraction <40% and/or brain natriuretic peptide >100 pg/ml (NT-proBNP >400 pg/ml). Intraoperative hemodynamics, including systolic blood pressure, diastolic blood pressure, mean blood pressure, and heart rate, were carefully monitored. The median left ventricular ejection fraction value was 35% (18-62%), and the median brain natriuretic peptide value was 171.7 pg/ml (109.5-961.4 pg/ml). The time-series mean ratio of the patients' blood pressure and heart rate during surgery indicated that soon after the induction of general anesthesia, mean blood pressure was significantly decreased (p<0.05) from baseline. In all 13 cases, laparoscopic surgery was performed successfully, with no significant complications. The present study showed that laparoscopic surgery for colorectal cancer can be performed safely in patients with severe chronic heart failure.

Improving quality of life in patients with CHD and CHF: Focusing on mildronate

This article describes clinical cases of patients with ischemic heart disease complicated by severe chronic heart failure during basic therapy with the inclusion of Mildronate. The results of the treatment prove the effectiveness of the use of this drug, in the form of an increase in exercise tolerance, regression of CHF phenomena, and improvement in the quality of life of patients with a burdened cardiovascular history.

Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)» study.

Aim To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.

Galectin -3: an independent cardiac marker of left ventricular (LV) remodeling in chronic heart failure

Introduction and Aim: Heart failure (HF) with increased morbidity and mortality is a critical condition where the cardiac pumping capacity fails to meet up with the body’s demand. Its development is silent due to slow, progressive remodeling presenting with symptoms later. Brain Natriuretic peptides (BNP) denotes ventricular loading status which do not reveal other mechanisms whereas a novel marker Galectin-3 (Gal-3) provides information about cardiac structural changes which includes inflammation, fibrosis, remodeling for guiding treatment. Research studies demonstrated that there is upregulation of Galectin- 3 in both acute and chronic heart failure (CHF) individuals. The objectives of our study were to compare Galectin- 3 levels in moderate and severe LVD CHF patients and determine whether serum Galectin -3 can be used as an independent cardiac marker of ventricular structural remodeling in such HF individuals. Materials and Methods: 80 patients between 20 - 80 years diagnosed with CHF using Framingham criteria with ejection fraction (EF) of 45% and classified into two groups:(i) moderate LVD and (ii) severe LVD. Those with abnormal kidney functions were excluded. Comparison was done between serum Galectin - 3 and BNP; Gal- 3 was determined to be an independent marker of structural remodeling of LV between the two categories. Results: Galectin-3 and BNP were significantly increased in HF with severe LVD than moderate LVD. Multivariate linear regression showed Galectin-3 as an independent predictor of LV remodeling with respect to changes in LV end- diastolic dimension with statistically significant p 0.001 whereas BNP did not show any such significance. Conclusion: Galectin -3 and BNP levels were elevated in severe LV dysfunction than moderate LVD and concluded that Gal-3 is an independent cardiac biomarker of LV remodeling in Chronic heart failure.

The association between erector spinae muscle content and chronic heart failure and its severity.

Previous studies have shown a significant reduction in skeletal muscle content in patients with chronic heart failure (CHF). The present study focused on the erector spinae muscle (ESM) to determine whether ESM content is associated with the development and severity of CHF. A total of 652 patients were included in this trial for the study. According to the diagnostic criteria of CHF, 652 patients were divided into two groups, namely, the control group (268 patients) and the CHF group (384 patients). Meanwhile, to assess whether the ESM is associated with the severity of CHF, patients in the CHF group were divided into two groups according to left ventricular ejection fraction (LVEF) values: heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%, 256 patients) and heart failure with reduced ejection fraction (HFrEF, LVEF ≤40%, 68 patients). Receiver operating curve analysis was performed to assess whether ESM content could predict CHF and determine its severity. Compared with the control group, the patients in the CHF group were older, the prevalence of coronary heart disease (CHD) and atrial fibrillation was higher, the colour ultrasound results showed that LVEF decreased significantly, and the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly. Besides, patients in the CHF group had significantly lower ESM content, and ESM is an independent predictor of heart failure, with an odds ratio of 0.713 (CHF group vs. control group, 95% confidence interval 0.626-0.811, P<0.001). Compared with the HFpEF group, the HFrEF group has a lower prevalence of CHD, LVEF decreased significantly, the left ventricular end-diastolic internal diameter and left ventricular end-systolic internal diameter increased significantly, also patients in the HFrEF group had significantly lower ESM content compared with patients in the HFpEF group, and ESM is an independent predictor of the severity of heart failure, with an odds ratio of 0.514 (HFrEF group vs. HFpEF group, 95% confidence interval (0.418-0.633, P<0.05). The results of receiver operating curve analysis showed that the sensitivity and specificity of ESM content for the diagnosis of CHF were 65.6% and 71.6%, respectively, while the sensitivity and specificity of ESM content for predicting the severity of CHF were 47.1% and 89.1%, respectively. The ESM is of great value in predicting the onset and severity of CHF.