Stages Of Chronic Heart Failure Research Articles

Diagnosis of hemostatic system disorders in patients with chronic heart failure using classical and integral methods

BACKGROUND: The state of the hemostatic system in patients with chronic heart failure (CHF) remains an insufficiently studied problem. PURPOSE OF THE STUDY: to present the results of an original study of the coagulation system of patients with CHF using an integral technique — low-frequency piеzothromboelastography (LPTEG). MATERIAL AND METHODS: The study involved 90 patients with CHF due to hypertension and coronary artery disease aged 50–75 years. The subjects were divided into groups with CHF I–IIa (n = 30), CHF stages IIb–III (n = 60). All patients underwent a study of the hemostasis system using classical (coagulogram) and integral (NPTEG) methods before prescribing antiplatelet and anticoagulant therapy. The comparison group consisted of healthy patients of the same age group without CHF (n = 30). RESULTS: In patients with CHF, a general blood test revealed a statistically significant decrease in the number of platelets (group 1 — 215; group 2 — 185) compared to the control group — 241. When analyzing the coagulogram, a decrease in the levels of prothrombin (group 1 — 89; group 2 — 86; control group 105), antithrombin-III (group — 76.5; group 2 — 73; control group — 91) and increased INR (group 1 — 1.03; group 2 — 1.12; control group 1.01) in patients in groups with CHF compared to the control group (p 0.05). When using the NPTEG method in patients with CHF, a decrease in indicators characterizing the rate of clot polymerization (intensity of clot polymerization) and clot density (maximum amplitude) was determined when compared with the control group (p 0.05). CONCLUSION: In patients with CHF, changes in the hemostatic system are determined, characterized by a tendency to hypocoagulation, the frequency a severity of which increases with the progression of the stage of the disease.

Palliative care for chronic heart failure: non-pharmacological methods of relieving the main symptoms

Chronic heart failure is one of the main causes of the increase in mortality and disability of the population around the world. In the final stages of chronic heart failure, when the debilitating symptoms of patients no longer respond to treatment, the issue of palliative care arises. To date, current clinical recommendations and guidelines do not contain data on palliative measures for this category of patients – in such conditions, doctors often do not understand what tactics of patient management they need to choose. Therefore, the importance of integrating palliative care into the treatment of chronic heart failure is increasing. Many symptoms associated with the terminal stages of chronic heart failure have a negative impact on the general condition and quality of life of patients. The main ones are shortness of breath, pain, manifestations of asthenia, as well as anxiety-depressive disorders. In order to maximize the possible improvement in the quality of life of such patients, palliative care should be comprehensive: regular pharmacotherapy prescribed in accordance with current clinical recommendations, combined with various non-drug methods for relieving the main symptoms. As such methods, the main cardiac rehabilitation measures can be considered, including regular physical training, training in compliance with the treatment regimen, stress management techniques, and psychological support. The relationship of patients and caregivers with medical professionals is important in the organization of palliative care. Adequate and timely communication is necessary to improve self-control and compliance with medication, prevent unplanned hospitalization, inform decision-making and, ultimately, ensure a safe death. The article discusses the basic concepts of organizing and providing palliative care to patients with chronic heart failure, as well as non-pharmacological palliative measures proposed by European, American, and Russian specialists.

NONINVASIVE DIAGNOSIS OF HEART REJECTION AS A PREDICTOR OF LONG-TERM TRANSPLANT SURVIVAL

Background. Currently, in Kazakhstan, the issue of chronic heart failure is becoming increasingly relevant, with high mortality from the terminal stage of chronic heart failure, especially in patients with III-IV functional class. Heart transplantation represents the "gold" standard of surgical treatment for terminal chronic heart failure, but endomyocardial biopsy, used for monitoring the transplanted heart, is an invasive and inconvenient procedure. Aim of this study is to generate data which can aid in more precise antibody-mediated rejection diagnosis, assisting in distinguishing between antibody-mediated rejectionand acute cellular rejection and helping us determine the appropriate treatment strategy Materials and Methods. This article explores the potential of safe and accurate monitoring of acute transplant rejection using circulating donor-derived cell-free DNA(dd-cfDNA). The study included 40 patients who underwent heart transplantation. Results. It was found that 60% of them had a repeat operation, while 40% had a primary one. Various cardiomyopathies, predominantly dilated and ischemic, were the cause of terminal chronic heart failure. The donor-derived cell-free DNA method demonstrates potential in differentiating T-cell-mediated and antibody-mediated rejection, with different patterns donor-derived cell-free DNA elevation. These differences have high clinical significance for diagnosis and treatment tactics. Conclusion. Despite the prospects of using donor-derived cell-free DNA, further research is needed to establish threshold values and confirm its effectiveness in clinical practice.

Chronic heart failure induces early defenestration of liver sinusoidal endothelial cells (LSECs) in mice.

Chronic heart failure (CHF) is often linked to liver malfunction and systemic endothelial dysfunction. However, whether cardio-hepatic interactions in heart failure involve dysfunction of liver sinusoidal endothelial cells (LSECs) is not known. Here we characterize LSECs phenotype in early and end stages of chronic heart failure in a murine model. Right ventricle (RV) function, features of congestive hepatopathy, and the phenotype of primary LSECs were characterized in Tgαq*44 mice, with cardiomyocyte-specific overexpression of the Gαq protein, at the age of 4- and 12-month representative for early and end-stage phases of CHF, respectively. 4- and 12-month-old Tgαq*44 mice displayed progressive impairment of RV function and alterations in hepatic blood flow velocity resulting in hepatic congestion with elevated GGT and bilirubin plasma levels and decreased albumin concentration without gross liver pathology. LSECs isolated from 4- and 12-month-old Tgαq*44 mice displayed significant loss of fenestrae with impaired functional response to cytochalasin B, significant changes in proteome related to cytoskeleton remodeling, and altered vasoprotective function. However, LSECs barrier function and bioenergetics were largely preserved. In 4- and 12-month-old Tgαq*44 mice, LSECs defenestration was associated with prolonged postprandial hypertriglyceridemia and in 12-month-old Tgαq*44 mice with proteomic changes of hepatocytes indicative of altered lipid metabolism. Tgαq*44 mice displayed right-sided HF and altered hepatic blood flow leading to LSECs dysfunction involving defenestration, shift in eicosanoid profile, and proteomic changes. LSECs dysfunction appears as an early and persistent event in CHF, preceding congestive hepatopathy and contributing to alterations in lipoprotein transport and CHF pathophysiology.

Morphological assessment of actin and desmin expression at different cold myocardial ischemia times: observational study

Background. Heart transplantation is currently the treatment of choice for patients in terminal stages of chronic heart failure. The critical shortage of donor organs and the growing need for heart transplantation necessitate the expansion of donor selection criteria, including the estimated ischemia time of the donor heart. Despite numerous studies, the issue remains regarding the safe cold ischemia time; no definite limit to the acceptable preservation time is known and no relevant pathomorphological data are available on the state of the donor heart myocardium at different time parameters. Objective. To comparatively assess the features of cardiomyocyte pathomorphology and expression of protein markers (actin and desmin) in the myocardium of a donor heart prior to the main stage of orthotopic heart transplantation. Methods. The work adopted the design of an observational clinical study, which was prospective in nature. The study used intraoperative myocardial biopsy specimens of the left atrial appendage from donors aged up to 60 years, following cold ischemia of the transplant in Bretschneider solution (Dr. Franz Köhler Chemie GmbH, Germany) lasting up to 240 minutes (Group 1, n = 10) and over 240 minutes (Group 2, n = 7). The nature of pathomorphological myocardial transformation in the left atrial appendage of the donor heart was determined at different cold ischemia times. Histological myocardial sections were stained with hematoxylin and eosin according to standard procedures. After that, they were further studied using light and polarization microscopy; the immunohistochemical method was used to analyze the expression of actin and desmin. Morphometry was performed using the ImageJ 1.48v software (USA). In the analysis of actin and desmin amount, the area of DAB(3,3′-diaminobenzidine)-positive products of the immunohistochemical reaction was estimated as a percentage of the image area. The volume density of immunohistochemically detectable actin and desmin was determined using 20 images at a magnification of 40×10. In order to study the intensity of the immune reaction, a semiquantitative method was used, which involved counting the number of cells in 25 randomly selected fields of view. The types of myocardial contracture damage were assessed via polarization microscopy. Results. Patients included in the first and second groups were comparable in terms of mean age and anthropometric indices. The mean age of patients amounted to 50 [44;59] years in Group 1 and 50 [49;50] years in Group 2, р = 0.193. The body mass index was 25 [22;27] in Group1 and 25 [21;31] in Group 2, р = 0.288. Both groups showed male predominance: 8 (80%) in Group 1 and 6 (85.7%) in Group 2, р = 0.256. The comprehensive morphological assessment of ischemic myocardial damage at different cold ischemia times revealed the uniformity and reversibility of changes in cellular structures (in both groups) that take the form of I–II class contractures, lysis changes in individual cardiomyocytes (only in Group 2), preserved immunohistochemical reactions to actin and desmin in both groups at their average intensity and the complete absence of areas showing no reaction to desmin, which gives an idea about the degree of preservation of their macromolecular structure. Conclusion. The obtained study results showed that due to having a balanced elemental composition that determines the metabolic protection of cells and their ionic balance, the Bretschneider solution effectively protects the donor heart during its transportation, with the myocardial cold ischemia lasting up to 240 min and more.

Underuse of heart failure medications and poor long-term prognosis in chronic heart failure patients with polypharmacy – A report from the CHART-2 study

BackgroundIn patients with chronic heart failure (CHF), comorbidities are often managed with multiple medications, characterized by polypharmacy, leading to increased risk of potentially inappropriate medication and adverse effects. MethodsWe studied 4,876 consecutive patients with CHF (Stage C/D, age 69.0 ± 12.3 years) in the CHART-2 study to evaluate the association among polypharmacy, underuse of HF medications, and all-cause death. Polypharmacy was defined as the daily use of ≥ 8 medications for the survival classification and regression tree analysis. ResultsThe average number of medications was 10 in the polypharmacy group and 5 in the non-polypharmacy group, respectively. Over a median of 8.3 (4.1–11.7) years, the incidence rate of all-cause death was significantly higher in the polypharmacy group (n = 2,108) than in the non-polypharmacy group (57.3 % vs. 40.6 %; adjusted hazard ratio [aHR] 1.34 (95 %CI, 1.22–1.48), P < 0.001), even in age < 55 years (26.6 % vs. 14.3 %; adjusted hazard ratio [aHR] 1.61 (95 %CI, 1.04–2.50), P = 0.033). In patients with polypharmacy, those without renin-angiotensin system inhibitors (RAS-I) and/or beta-blockers (N = 1,023) were associated with increased incidence of all-cause death as compared with those with both medications (aHR 1.18; 95 %CI 1.04–1.35, P = 0.012). ConclusionsPolypharmacy was associated with poor long-term prognosis, even in younger patients with CHF. Among 4,876 patients with CHF, 1023 (20.9%) with polypharmacy and underuse of RAS-I and/or beta-blocker were associated with increased risk of all-cause death.

Systemic mapping of organ plasma extravasation at multiple stages of chronic heart failure.

Introduction: Chronic Heart failure (CHF) is a highly prevalent disease that leads to significant morbidity and mortality. Diffuse vasculopathy is a commonmorbidity associated with CHF. Increased vascular permeability leading to plasma extravasation (PEx) occurs in surrounding tissues following endothelial dysfunction. Such micro- and macrovascular complications develop over time and lead to edema, inflammation, and multi-organ dysfunction in CHF. However, a systemic examination of PEx in vital organs among different time windows of CHF has never been performed. In the present study, we investigated time-dependent PEx in several major visceral organs including heart, lung, liver, spleen, kidney, duodenum, ileum, cecum, and pancreas between sham-operated and CHF rats induced by myocardial infarction (MI). Methods: Plasma extravasation was determined by colorimetric evaluation of Evans Blue (EB) concentrations at 3days, ∼10weeks and 4months following MI. Results: Data show that cardiac PEx was initially high at day 3 post MI and then gradually decreased but remained at a moderately high level at ∼10weeks and 4months post MI. Lung PEx began at day 3 and remained significantly elevated at both ∼10weeks and 4months post MI. Spleen PExwas significantly increased at ∼10weeks and 4months but not on day 3 post MI. Liver PEx occurred early at day 3 and remain significantly increased at ∼10weeks and 4months post MI. For the gastrointestinal (GI) organs including duodenum, ileum and cecum, there was a general trend that PEx level gradually increased following MI and reached statistical significance at either 10weeks or 4months post MI. Similar to GI PEx, renal PEx was significantly elevated at 4months post MI. Discussion: In summary, we found that MI generally incites a timedependent PEx of multiple visceral organs. However, the PEx time window for individual organs in response to the MI challenge was different, suggesting that different mechanisms are involved in the pathogenesis of PEx in these vital organs during the development of CHF.

Polymorphism of the coding gene LGALS-3 rs2274273 as an endogenous factor of the predictive effectiveness of the plasma concentration of galectin-3 in relation to the risk of development of chf on the background of eh in women

Objective. The purpose of the study is to improve the early diagnosis of the development of left ventricular myocardial hypertrophy (LVH) and the formation of prerequisites for chronic heart failure (CHF) in women with essential hypertension, residents of the Podillya region of Ukraine by determining the plasma concentration of galectin-3 in carriers of different polymorphic variants of the LGALS-3 (rs2274273) gene. Material and methods. 180 women of postmenopausal age, average age of 57.34±0.45, residents of the Podillya region of Ukraine, who lived in this territory in the third generation, were examined. The control group consisted of 67 women, average age of 56.43±0.64 years, without signs of cardiovascular pathology and signs of left ventricular hypertrophy (LVH) for other reasons were detected. The main group included 113 women with essential hypertension, of which 62 had essential hypertension with LVH without heart failure (EH II), 51 had essential hypertension with chronic heart failure stage C according to the ESH/ESC 2023 classification. General clinical examination, enzyme immunoassay method for determining the level of galectin-3 in blood plasma, genotyping of the LGALS3 (rs2274273) gene using polymerase chain reaction, and ultrasound of the heart were performed. The statistical processing of the obtained results was carried out using the package of statistical programs SPSS, STATISTICA v. 10.0. Mathematical methods were used: multiple regression stepwise analysis of proportional risks with 95% CI confidence interval, Fisher's linear discriminant analysis with the creation of a mathematical prognostic model, and cluster analysis. Compliance of the frequency distribution of genotypes in the studied populations to the Hardy-Weinberg equilibrium was checked using the MedCalc Software Ltd. Odds ratio calculator. https://www.medcalc.org/calc/odds_ratio.php and calculated the odds ratio (OR) of developing left ventricular myocardial hypertrophy (LVH) and chronic heart failure (CHF).Results. In patients with EH and CHF, carrying the A allele of the LGALS-3 (rs2274273) gene was associated with a more severe degree of diastolic dysfunction and reduced LVEF compared with carriers of the GG genotype, and higher plasma levels of galectin-3 were also recorded, which were associated with a more significant deterioration structural and functional indicators of the myocardium. With the help of cluster analysis, it was found that carriers of the A allele of the LGALS-3 (rs2274273) gene are more likely to be included in unfavorable cluster 1. In contrast, in cluster 2, with a more favorable course of the disease, carriers of the GG genotype and carriers of the A allele occur with almost the same frequency. Conclusions. In postmenopausal women, residents of the Podillya region of Ukraine, carrying the A allele of the LGALS-3 (rs2274273) gene is associated with a more severe course of EH with the development of LVH, a higher concentration of galectin-3 in the blood plasma, and the formation of CHF with reduced LVEF when compared with carriers of the genotype GG.

Assessment of disturbed functions in patients with chronic heart failure using International classification of functioning ICF categories

BACKGROUND: The evaluation of impaired functions in patients with cardiac diseases is traditionally based on the clinical signs of the disease and instrumental hemodynamic parameters, without affecting all other disorders that occur with this pathology. The International classification of functioning is based on the functioning of the patient in his/her environment; therefore, a consistent assessment of the entire complex of impaired functions of the patient is appropriate, allowing for a more accurate formulation of the goals of rehabilitation and controlling the main stages of rehabilitation.&#x0D; AIM: To evaluate the International classification of functioning for assessing all impaired functions in patients with chronic heart failure.&#x0D; MATERIALS AND METHODS: The study included 68 patients with decompensated chronic heart failure. The analyzed sample included patients with chronic heart failure stages 2B and 3 (NYHA classes IIIIV). The average patient age was 63.9 years, and the average disease duration was approximately 7 years. The sample was predominantly men (66.5%). The etiology of chronic heart failure was represented by uncontrolled arterial hypertension (92%), post-infarction cardiosclerosis (74%), ischemic cardiomyopathy (25%), and chronic obstructive pulmonary disease (12%). Radiation diagnostic methods were used to confirm the severity of cardiac decompensation. The study assessed impaired functions in accordance with the domains of the International classification of functioning, mainly in functions of the cardiovascular system.&#x0D; RESULTS: In this study, 68 patients had decompensated chronic heart failure stages 2B and 3 (NYHA classes IIIIV). Group 1 included 40 patients, and group 2 included 28 patients. The instrumental examination revealed a more pronounced decrease in left-ventricular ejection fraction in group 1 compared with group 2 (42.84.4 and 49.25.6, respectively), showing a significant difference (p 0.05). Other hemodynamic parameters did not differ significantly in the groups. In the analysis of a basic set of the International classification of functioning domains for patients with chronic heart failure, the following domains turned out to be the most significant: heart function (b410), forced myocardial contraction (b4102); heart rate (b4100); blood supply to the heart (b4103); blood pressure functions (b420): increase (b4200), decrease (b4201), maintenance (b4202); functions of the respiratory system (b440) including the respiratory rate (b4400); additional functions and sensations from the cardiovascular and respiratory systems (b450-469); exercise tolerance functions (b455); water balance (b5450), including water retention (b45500), characterizing the presence of edematous syndrome; and muscle strength functions (b730). The indicated domains were also supplemented with Section d (activity and participation) walking long distances (d4501) and doing housework (d640); and Domain e (environmental factors), i.e., help from the next of kin (e310).&#x0D; CONCLUSIONS: A set of domains of the International classification of functioning for patients with decompensated heart failure has been developed and proposed, which makes it possible to more effectively identify the key problems of people with disability and more objectively form a plan for complex rehabilitation, which largely determines the prognosis in these patients.

КЛИНИЧЕСКИЕ ОСОБЕННОСТИ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ С НИЗКОЙ ФРАКЦИЕЙ ВЫБРОСА В СОЧЕТАНИИ С АНЕМИЕЙ

Introduction. In patients with chronic heart failure (CHF), anemia is more common than in the general population, and its prevalence, according to various authors, ranges from 15 to 61%. Decreased hemoglobin levels are an independent factor contributing to mortality in this cohort. According to a retrospective analysis of the Val-HeFT study, patients with CHF with a decrease in hemoglobin during 12 months of follow-up had a higher rate of readmissions, complications and death compared with patients without a decrease in hemoglobin (Hb). The aim of our work was to study the clinical features and laboratory and instrumental manifestations in patients with CHF with low ejection fraction (CHFrEF) and anemia. Material and methods. We conducted a continuous sample and analyzed 105 case histories of patients for 2022, who were admitted with CHFlEF (EF &lt; 40%) to the cardiology department of the City Clinical Hospital No. 3. The functional class (FC) of CHF was established according to the scale for assessing the clinical condition in CHF (SHOKS, modified by Mareeva V.Yu., 2000), stage - according to the Strazhesko-Vasilenko classification. The edematous syndrome was assessed by points (1 - feet, 2 - lower leg, 3 - scrotum / inguinal region, 4 - abdomen, 5 - chest wall). The presence of anemia was determined by the level of Hb: &lt;130 g/l for men, &lt;120 g/l for women. All patients underwent Holter monitoring of the electrocardiogram (HM ECG) and echocardiography (EchoCG). The indicators of patients with CHFrEF with and without anemia were studied and compared. For this purpose, the Mann–Whitney, Wilcoxon, and c2 tests were used for nonparametric data. The Statistica 12.0 software package (Statsoft, USA) was used. Results. The general group of patients with CHFrEF included 72.4% of men (n=76) and 27.6% of women (n=29), mean age 66.9±12.3. Of these, anemia was detected in 25.7% of cases (n=27), the proportion of men was 66.7% (n=18, mean age 69.1±9.4), women - 33.3% (n=9 , mean age 68.9±16.7). The mean age of patients with CHFrEF in the group with and without anemia did not differ significantly (69.0±12.0 and 66.1±12.3, respectively, р˃0.05). In patients with CHFrEF and anemia, hemoglobin values were significantly lower (106.9±12.7 and 151.6±15.8 g/l, respectively, p&lt;0.001), mean hemoglobin content in erythrocytes (29.1±13, 2 and 31.2±7.7 pg, respectively, p&lt;0.001), the number of erythrocytes (4.2±1.0 and 5.0±0.6 1012/l, respectively, p&lt;0.001), serum iron ( 9.9±9.6 and 10.4±4.1 µmol/l, respectively, p&lt;0.001), erythrocyte sedimentation rate (ESR) (20.9±13.7 and 8.8±8.8 mm/ hour, respectively, p&lt;0.001). Patients with anemia had lower FC (10.3±2.2 and 8.9±2.7 points, respectively, p=0.022) and CHF stage (IIa - 19%, IIB - III - 81% versus IIa - 57 %, IIB - III - 43%, respectively, p=0.02), more pronounced edematous syndrome (2.3±1.0 and 1.8±1.1 points, respectively, p=0.039). According to HM ECG data, patients with anemia had a greater number of ventricular extrasystoles (3445.4±4439 versus 1727.4±3059.0, respectively, p=0.05). EchoCG parameters did not differ in both groups. Conclusion. Every fourth patient with CHFrEF has anemia, while there are no significant differences in age and gender. The combination of CHFrEF with anemia significantly aggravates the course of CHF (according to SHOKS, stage of CHF, severity of edematous syndrome).

The Compensatory Alterations оf the Relaxability and Distensibility of the Myocardium at Weakening of Its Contractility

Abstract—The contractile function of the heart is carried out due to the coordinated interaction of the basic properties of the myocardium – distensibility, contractility and relaxability. Violation of myocardial contractility due to any reason creates a situation of chronic heart failure (CHF). The severity of CHF is determined by the ability of the circulatory system to a certain extent to compensate for the weakening of the contractility of the heart, the criterion of which is the value of the ejection fraction. The form of CHF with preserved ejection fraction is defined as diastolic dysfunction. It is the first stage of CHF, its distinctive features are delayed relaxation and increased diastolic pressure in the left ventricle. The review is devoted to the consideration of the structure of diastole in 4 types of CHF – ischemic heart disease in myocardial infarction or microinfarctions caused by isoproterenol, myocardial damage induced by doxorubicin and type 1 diabetes. A common sign of all types of CHF is an increase in myocardial extensibility and a slowdown in relaxation. It has been shown that they are based on a change in the properties of connectin (titin) – a sacromeric protein that connects the ends of myosin filaments with the boundaries of the sarcomere. Its properties determine the distensibility and relaxation of the myocardium, and these changes underlie the primary compensatory reaction of the heart at weakening its contractility. Also mechanisms are mobilized that increase the inflow to the heart and reduce peripheral resistance. The degree of their mobilization depends on the degree of reduction in myocardial contractility. Along with this, each form of CHF has its own specifics, which must be taken into account when choosing the means of therapy.

FEATURES OF COGNITIVE FUNCTIONS IN HYPERTENSIVE PATIENTS WITH THE PRESENCE/ABSENCE OF CHRONIC HEART FAILURE

Objective: to evaluate cognitive functions in hypertensive patients with the presence/absence of chronic heart failure (CHF). Design and method: 100 male and female patients with I-III degree of arterial hypertension (AH) (ESH / ESC, 2018), who are on outpatient treatment at Republican Specialized Scientific and Practical Medical Center of Cardiology, were examined. The stage of CHF was diagnosed according to classification (ESH / ESC, 2020), the exclusion criteria was CHF stage IIB-III. The mean age of patients was 55.8±12.2 years, AH duration was 9.4±6.7 years. All patients initially measured office systolic blood pressure (SBP) and diastolic blood pressure (DBP). Cognitive functions were evaluated using neuro-psychological tests: the Mini-Cog test, Montreal Cognitive Assessment (MoCA). The hospital anxiety and depression scale (HADS) was used to assess levels of anxiety and depression. The results are presented as M ± SD. Results: All patients were divided into two groups: 1 - patients with AH without CHF (n = 78) and 2 - patients with AH with CHF stage I-IIA (n = 22). The analysis of cognitive functions in AH patients revealed good indicators of cognitive functions in AH patients without CHF in comparison with AH patients with stage I-IIA CHF. In particular, the overall score on the Mini-Cog test: in 1st group it was 4.05±0.92 points, in 2nd group - 3.45±1.4 points (p&lt;0.05), the drawing function was much better: 1.72±0.55 points versus 1.4±0.85 points (p&lt;0.05). The total score on the MOCA scale was slightly higher in group 1 than in group 2: 24.59±2.65 versus 23.31±3.83 points, p = 0.075. At the same time, self-assessment of attention was better in 1st group than in 2nd group: 8.76±1.51 versus 7.84±2.46 points, p&lt;0.05. Visual-constructive performance skills were also better in group 1 than in group 2: 4.13±1.05 versus 3.5±1.47 points, p&lt;0.05. Coping with work in the 1st group of patients was somewhat better than in the 2nd group: 9.09±1.37 versus 8.31±2.39 points, p = 0.072. Conclusions: Thus, in hypertensive patients with CHF stage I-IIA is noted the severity of cognitive impairment, in contrast to patients without CHF.

The traditional Chinese medicines treat chronic heart failure and their main bioactive constituents and mechanisms.

Chronic heart failure (CHF) is a severe public health problem with increasing morbidity and mortality, any treatment targeting a single session is insufficient to tackle this. CHF is characterized by reduced cardiac output resulting from neurohumoral dysregulation and cardiac remodeling, which might be related to oxidative stress, inflammation, endoplasmic reticulum stress, apoptosis, autophagy, mitochondrial function, and angiogenesis. These molecular mechanisms interact with each other through crosstalk. Historically, Chinese medicinal herbs have been widely applied in the treatment of CHF, and therapeutic effects of Chinese medicinal herbs and their ingredients have been scientifically confirmed over the past decades. Traditional Chinese medicine (TCM) with multiple components can confront the different pathogenesis of CHF through multiple targets. This review analyzes commonly used TCM patent drugs and TCM decoctions that are applicable to different stages of CHF based on clinical trials. Diverse bioactive ingredients in Chinese medicinal herbs have been found to treat CHF via multiple molecular mechanisms. This review comprehensively covers the key works on the effects and underlying mechanisms of TCM, herbal ingredients and synergistic effects of constituent compatibility in treating CHF, providing additional ideas to address this threat.

Long-term changes in cognitive status of patients with type 2 diabetes mellitus after coronary artery bypass graft surgery

Aim. To study long-term changes (5 to 7 years after coronary artery bypass graft (CABG) surgery) in cognitive status of patients with type 2 diabetes.Materials and Methods. The study included 47 male patients admitted to the Research Institute for Complex Issues of Cardiovascular Diseases for the CABG surgery. Criteria of inclusion were signed informed consent, age from 40 to 75 years, male gender, planned on-pump CABG surgery, and right-handedness. Criteria of exclusion were brain pathology at multislice computed tomography, chronic cerebral ischemia grade II-IV, Beck Depression Inventory score &gt; 16 points, the Mini-Mental State Examination (MMSE) score &lt; 24 points and the Frontal Assessment Battery score &lt; 11 points, arrhythmia, class IIB-IV chronic heart failure stage IIB, chronic obstructive pulmonary disease, cancer, and past medical history of brain injury or stroke. Pre-operative examination of patients classified them into two groups: with (n = 21) and without (n = 26) type 2 diabetes mellitus (DM).Results. 5-7 years after CABG surgery, patients with type 2 DM had a cognitive decline according to MMSE scale as compared to the preoperative level (28,0 [27,0; 29,0] and 27,0 [26,0; 28,0], p = 0.04). In keeping with these findings, odds ratio (OR) of mild cognitive impairment (MCI) in patients with type 2 DM was 1.92 (95% CI = 1.09- 3.37, p = 0.02). Psychomotor and executive functions were reduced in patients with type 2 DM both at baseline and in particular 5-7 years after CABG (p ≤ 0.05). The correlation between glycated hemoglobin (HbA1c) and cognitive parameters were found only in patients with type 2 DM. Higher HbA1c level was also associated with deteriorated executive functions and short-term memory.Conclusion. 5−7 years after CABG surgery, patients with type 2 DM suffer from a cognitive decline and reduced psychomotor and executive functions.

Гендерные и возрастные особенности больных с хронической сердечной недостаточностью в реальной клинической практике

Aim: to assess and describe gender- and age-specific characteristics of patients with chronic heart failure (CHF). Patients and Methods: in this retrospective study with a prospective component the authors analyzed medical records of 197 patients with CHF, including: CHF stage and functional class, co-morbidities, and echocardiography (Echo) findings. Twenty four (21, 28) months after discharging patients from the hospital, telephone follow-up calls were made to the patients and/or their relatives, and medical documentation of the medical information system was reviewed to assess the vital status of patients or the causes of lethal outcomes. For evaluating the obtained results, patients were divided into groups by gender and age. The middle-aged group comprised of males (45 to 59 years) and females (45 to 54 years) — 18 (9.1%) patients. The group of elderly persons included males (60 to 74 years) and females (55 to 74 years) — 69 (35.1%) patients. The senile group consisted of persons aged 75 years and over — 110 (55.8%) patients. Results: the median and interquartile range of patient age were 74.7 (68, 82) years. In the groups of middle-aged and elderly persons there were more men than women (р=0.001), while women prevailed in the senile group (р&lt;0.001). The diagnosis of HF with reduced ejection fraction (HFrEF) was established more frequently in males than in females, and the difference was statistically significant (p=0.006). There were no statistically significant differences between male and female patients as regards the prevalence of HF with moderately reduced LVEF (HFmrEF). HF with preserved LVEF (HFpEF) was diagnosed more frequently in females than in males, and the difference was statistically significant (p=0.007). Using pair-wise comparison of LVEF in women of different age groups, it was shown that HFmrEF was more prevalent in middle-aged than in elderly (р=0.024) or senile (р=0.011) patients. The prevalence of HFpEF was higher in senile than in middle-aged women (р=0.012). No statistically significant differences in LVEF were found between the male patients of different age groups. There were no significant differences between males and females of middle-aged and elderly groups as regards the prevalence of co-morbidities. However, among senile persons co- morbidities were found more frequently in women than in men, and the difference was statistically significant (p&lt;0.001). Conclusion: more than half of the patients with CHF were senile persons. Most patients with CHF in the elderly group were males, and in the senile group — females. It is necessary to consider gender and age-specific characteristics in the management of CHF patients, risk stratification and in the selection of adequate therapy. KEYWORDS: chronic heart failure, comorbidity, concomitant diseases, age ranges, gender characteristics. FOR CITATION: Reznik E.V., Ushakova N.A., Ershov N.S. et al. Gender- and age-specific characteristics of patients with chronic heart failure in real clinical practice. Russian Medical Inquiry. 2023;7(1):13–21 (in Russ.). DOI: 10.32364/2587-6821-2023-7-1-13-21.

Diuretic resistance in patients with chronic heart failure: mechanisms, prevention, and treatment

The authors analyzed the problem of diuretic resistance (DR) in patients with chronic heart failure (CHF). Most of the symptoms and signs of CHF are associated with hypervolemia and vascular congestion in the systemic and pulmonary circulation. The severity of the latter is the main factor which negatively affects the overall assessment of life satisfaction in patients with CHF. Since the patient, even at the incurable stage of CHF, primarily expects a rapid decrease in the severity of manifestations of decompensation from the prescribed therapy, achieving euvolemia is the essence of its short-term objective. Without diuretics, these immediate effects, according to which most CHF patients judge the qualifications of the doctor, are almost impossible to achieve. Unfortunately, apparently, not a single clinician was able to avoid disappointment in the effectiveness of CHF therapy associated with DR in their practice. As a rule, DR reflects the progressive course of CHF and is often associated with a poor prognosis. The review consistently covers the issues of terminology, diagnosis, pathogenesis, and prevention of DR, which aggravates CHF, and discusses measures aimed at restoring sensitivity to diuretics.

Oridonin Relieves Angiotensin II-Induced Cardiac Remodeling via Inhibiting GSDMD-Mediated Inflammation.

Myocardial remodeling is one of the main lesions in the late stage of chronic heart failure and seriously affects the prognosis of patients. Continuous activation of the renin-angiotensin-aldosterone system (RAAS) contributes to the development of myocardial remodeling greatly, and angiotensin II (Ang II), its main constituent, can directly lead to cardiac remodeling through an inflammatory response and oxidative stress. Since Ang II-induced myocardial remodeling is closely related to inflammation, we tried to explore whether the anti-inflammatory drug oridonin (Ori) can reverse this process and its possible mechanism. Our study investigated that hypertrophy and fibrosis can be induced after being treated with Ang II in cardiomyocytes (H9c2 cells and primary rat cardiomyocytes) and C57BL/6J mice. The anti-inflammatory drug oridonin could effectively attenuate the degree of cardiac remodeling both in vivo and vitro by inhibiting GSDMD, a key protein of intracellular inflammation which can further activate kinds of inflammation factors such as IL-1β and IL-18. We illustrated that oridonin reversed cardiac remodeling by inhibiting the process of inflammatory signaling through GSDMD. After inhibiting the expression of GSDMD in cardiomyocytes by siRNA, it was found that Ang II-induced hypertrophy was attenuated. These results suggest that oridonin is proved to be a potential protective drug against GSDMD-mediated inflammation and myocardial remodeling.

Serum Proteomic Changes in Dogs with Different Stages of Chronic Heart Failure.

Simple SummaryCanine MMVD is a progressive chronic disease with variable clinical signs, with some patients remaining completely asymptomatic while others develop CHF. Here, the aims of the pilot study were to evaluate serum proteins by proteomic analysis in dogs at different stages of chronic heart failure (CHF) due to degenerative mitral valve disease (MMVD), and how these proteins can change after a conventional treatment. Study revealed 157 different proteins; 11 were up- and 21 down-regulated at a statistically significant level in dogs with CHF compared to controls. Based on the bioinformatic analysis, protein–protein interactions between complement proteins, fibrinogen subtypes and others (albumin precursor, serpins, inter-alpha-trypsin inhibitor heavy chain, fetuin, clusterin, apolipoproteins, and alpha-glycoproteins) showed that pathophysiology of CHF seems to be more sophisticated than we had thought. These proteins are associated with several cellular, biologic, and metabolic processes such as immune-inflammatory responses, hemostasis, oxidative stress, and energy metabolism, which might be detrimental in the progression of canine CHF. Their molecular and biological functions as well as roles in the signaling pathways, such as inflammation, cadherin signaling, nicotinic acetylcholine receptor signaling and Wnt signaling make them possible biomarkers and therapeutic targets for the diagnosis and treatments in dogs with different stages of CHF.MMVD, the most common cause of CHF in dogs, is a chronic disease with variable clinical signs, with some patients remaining asymptomatic while others develop CHF. Here, we aimed to evaluate serum proteins by proteomic analysis in dogs at different stages of CHF due to MMVD, and proteome behaviors after conventional treatment. A total of 32 dogs were divided equally into four groups—stage A (healthy/controls), stage B2 (asymptomatic), stage C and stage D (symptomatic)—according to the ACVIM consensus. Serum proteomes were evaluated using LC/MS-based label-free differential proteome analysis. The study revealed 157 different proteins; 11 were up- and 21 down-regulated in dogs with CHF compared to controls. In stage B2 dogs, angiotensinogen (AGT) was up-regulated, but immunoglobulin iota chain-like, lipopolysaccharide-binding protein, and carboxypeptidase (CPN) were down-regulated. In stage C dogs, complement C3 (C3) and inter-alpha-trypsin inhibitor heavy chain were up-regulated, but hemopexin, and actin-cytoplasmic-1 (ACT-1) were down-regulated. In stage D dogs, AGT was up-regulated, whereas tetranectin, paraoxonase-1, adiponectin and ACT-1 were down-regulated. A decrease in CPN, C3 and AGT and an increase in ACT-1 were observed after treatment of dogs in stage C. This pilot study identified that dogs at different stages of CHF show different serum protein composition which has potential to be biomarker for diagnose and treatment monitorization.

Urolithiasis complicated by chronic obstructive pyelonephritis in patients with concomitant diseases of the cardiovascular system

Purpose of the study. To study the features of chronic obstructive pyelonephritis in patients with recurrent nephrolithiasis and concomitant diseases of the cardiovascular system.Materials and methods. The study included a total of 618 patients suffering from recurrent nephrolithiasis complicated by ChOP. The 3 groups were formed: the first (I) of them included 42 patients with ChOP and uncomplicated coronary heart disease (CHD); the second (II)- 38 patients with CHD complicated by chronic heart failure (CHF); III (control) group consisted of 24 respondents with recurrent urolithiasis.Results. The sample was dominated by men (78 %). In total, there were 474 (76.7 %) patients with intact cardiovascular system. Cardiovascular disease (CVD) suffered from 144 (23.3 %) patients, 38 (26.4 %) of whom had CHF of varying severity. Exacerbations of ChOP in patients of group I developed 1.5 times more often (once in 2.8-3 years) than in patients from the control group (on average after 18 months versus 28), and in group II almost annually (1 time in 13 months). In the entire cohort (n = 618), pyelonephritis was transformed into purulent-destructive in 19 (3.1 %) cases; with concomitant CVD, this complication developed in 7 (4.9 % of 144) cases, the remaining 12 (2.5 % of 474) respondents did not suffer from CVD. In group II, the purulent-destructive form occurred in 4 (10.5 %) patients; their share in the general group of patients with CVD was 2.8 % (the differences were significant - p &lt; 0.05). Of the 19 patients with purulent-destructive pyelonephritis on the background of nephrolithiasis, more than a third (7 people - 36.8 %) had concomitant CHD, and of the 7 patients with this terrible complication that developed on the background of concomitant CHD, more than half (4 people - 57.1 %) had CHF of varying severity. The chemical composition of the urine samples was determined using a NICOLET iS10 spectral analyzer (Thermo scientific, USA). The stages of CHF were determined in accordance with the Strazhesco-Vasilenko classification [N. D. Strazhesco, V. H. Vasilenko, 1935]. Statistical data processing was carried out using the SPSS program 19. Absolute and relative indicators were calculated, as well as the exact Fisher criterion, taking into account the Bonferroni correction; the differences were considered reliable at p &lt; 0.05.Conclusion. in patients with recurrent nephrolithiasis and concomitant CVD (especially with complicated CHF), exacerbations of obstructive pyelonephritis develop more often, the inflammatory process often turns into a purulent-destructive form.

Possibilities of bioimpedance method of investigation of elderly patients with chronic heart failure

Introduction.Diagnostics of congestive events in chronic heart failure (CHF) in elderly people is increasingly relevant due to the general aging of the population, which determines the search for new research methods.The aimis to evaluate the diagnostic capabilities of bioimpedance method in determining the severity of congestion in elderly patients with CHF.Materials and methods.86 elderly patients with CHF of different clinical stages were examined, 36.0% of them were burdened with varicose vein disease of the lower limbs. Total body water content was assessed by active impedance at 50 kHz, extracellular fluid content — at 5 kHz.Results.Active resistance at 50 kHz in patients with CHF II B was 473.92±29.39, with CHF II A - 569.24±58.97, with CHF I — 601.33±24.64 ohms, respectively, at 5 kHz — 555.52±27.44, 633.50±51.32 and 722.50±15.85 ohms respectively. No total and/or extracellular fluid retention was detected in CHF II A without lower limb varicosity, and in 10 (58.8%) patients — in cases of its presence. Retention of total and/or extracellular fluid was detected in 74.4% of CHF stage II B patients, and 48.3% of them had varicose vein disease of the lower limbs.Discussion.Patients with CHF stage II B have the highest amount of total and extracellular fluid in the body compared to patients with CHF stage II A and CHF stage I, but the method is insensitive for diagnosis of fluid retention in the small circle of the circulation and differential diagnosis of the genesis of edema in varicose vein disease of the lower limbs.Conclusion.Bioimpedance imaging can be used for additional diagnostics of CHF in elderly patients in order to estimate the amount of total/extracellular fluid in the body to build personalized treatment and prevention programs.