Standard Therapy For Chronic Heart Failure Research Articles

Methods of correction of chronic heart failure in patients of older age groups against the background of depressive disorders

Chronic heart failure (CHF) is a common disease in patients of older age groups. Often these patients experience depressive disorders that affect the course of chronic diseases and their standard of living. Purpose. To study methods for increasing the effectiveness of treatment of CHF against the background of depressive disorders in patients of older age groups. Material and methods. The study involved 100 patients aged 60–87 years with functional class II–III CHF and mild to moderate depressive disorders. Patients were divided into groups depending on the therapy received: 1st (n=25) – standard therapy for CHF; 2nd (n=25) – standard therapy for CHF + antidepressant; 3rd (n=25) – standard therapy for CHF + phototherapy; 4th (n=25) – standard therapy for CHF + placebo. The effectiveness of CHF therapy was assessed after 3 and 6 weeks during clinical examination using a 6-minute walk test, ECG, echocardiography, and a clinical condition rating scale. To diagnose depressive disorders, the Geriatric Depression Scale, HADS, Beck scale, and consultations with a psychotherapist were used. Results. After 6 weeks of therapy, patients of all groups noted a decrease in shortness of breath and chest pain, and an increase in tolerance to physical activity. At the same time, the decrease in the level of anxiety and depression was most pronounced in groups 2 and 3 – in 84 and 100% of cases, respectively.

Lyophilized recombinant human brain natriuretic peptide for chronic heart failure: Effects on cardiac function and inflammation.

Chronic heart failure (CHF) is a serious and prevalent condition characterized by impaired cardiac function and inflammation. Standard therapy for CHF has limitations, prompting the exploration of alternative treatments. Recombinant human brain natriuretic peptide (BNP) has emerged as a potential therapy, with evidence suggesting that it can improve cardiac function and reduce inflammation in patients with CHF. However, further research is required to determine the efficacy and safety of lyophilized recombinant human BNP in CHF patients and its impact on microinflammatory status. This study aimed to investigate the effects of lyophilized recombinant human BNP therapy on CHF patients' cardiac function and microinflammatory status. To investigate the effects of freeze-dried recombinant human BNP therapy on cardiac function and microinflammatory status in patients with CHF. In total, 102 CHF patients admitted to our hospital from January 2021 to January 2022 were randomly assigned to control and observation groups (n = 51 patients/group). The control patients were treated with standard HF therapy for 3 d, whereas the observational patients were injected with the recombinant human BNP for 3 d. Clinical efficacy, inflammatory factor levels, myocardial damage, cardiac function before and after the treatment, and adverse reactions during treatment were compared between the two groups. The overall clinical efficacy was higher in the observation group than in the control group. Compared with baseline, serum hypersensitive C-reactive protein, N-terminal proBNP, and troponin I level, and physical, emotional, social, and economic scores were lower in both groups after treatment, with greater reductions in levels and scores noted in the observation group than in the control group. The overall incidence of adverse reactions in the observation group was not significantly different compared with that in the control group (P > 0.05). Freeze-dried recombinant human BNP therapy can improve heart function and enhance microinflammatory status, thereby improving overall quality of life without any obvious side effects. This therapy is safe and reliable.

Safety of dapagliflozin initiation in acute decompensated heart failure patients with reduced left ventricular ejection fraction

Background. Chronic heart failure (CHF) is an immediate cardiological problem. At the same time, acute decompensated heart failure (ADHF) is associated with an extremely unfavorable prognosis and low survival of patients.
 Aim. To evaluate the safety of sodium-glucose cotransporter-2 inhibitor dapagliflozin early administration in patients with ADHF with a reduced left ventricular ejection fraction (LVEF) regardless of type 2 diabetes mellitus (diabetes).
 Materials and methods. We used standard CHF therapy and intravenous diuretic therapy in combination with 10 mg dapagliflozin in 43 patients with NYHA class IIIV ADHF. The study mainly included 39 (90.7%) male patients, the mean age was 6012 years (5663), diabetes was in 14 (32.6%) patients. Dapagliflozin was prescribed by a mean of 2 days (13) from admission to the hospital. The parameters were analyzed at the time of inclusion in the study and when CHF compensation was achieved.
 Results. The median of the length of hospital stay was 7 days (610). LVEF significantly increased during hospitalization from 276 to 307% (p0.001) and the level of NT-proBNP decreased: from 3700 pg/ml (17455331) to 1366 pg/ml (10252878); p=0.007. A decrease in the marker was observed in 90% of patients. Hypotension (decrease in systolic blood pressure BP less than 90 mmHg) was observed in 10 (23.3%) patients. A statistically significant decrease in BP was found: systolic and diastolic BP on admission was 114 mmHg (100126) and 70 mmHg (7080), respectively, when CHF compensation was achieved 110 mmHg (98120) and 70 mmHg (6178); p=0.047 and p=0.013, respectively. The increase in hematocrit during hospitalization was also statistically significant from 43.53.6 to 46.14.9% (p0.001) and this was found in 67% of patients. A total of 4 (9.3%) patients had acute renal injury (decrease in estimated glomerular filtration rate GFR by 25% or more). At the same time, there was no decrease in GFR of less than 15 ml/min/1.73 m2. There was no statistically significant decrease in GFR and an increase in creatinine levels during hospitalization (p=0.214 and 0.173, respectively). Urinary tract infections were observed in 1 (2.3%) patient, transient hypoglycemia in 2 (4.7%) patients, which did not lead to the discontinuation of dapagliflozin. Diabetic ketoacidosis, allergic reactions, syncope, lower extremity amputations were not observed in patients taking dapagliflozin.
 Conclusion. It can be concluded that dapagliflozin has a favorable safety profile when used in patients with ADHF, regardless of the presence or absence of diabetes.

The effect of yoga practice on lipid profiles in patients with chronic heart failure

The aim of the present study was to assess the efficiency of yoga practice in addition to the standard medical therapy in patients with chronic heart failure (HF) and dyslipidemia. One hundred and two patients with chronic HF and dyslipidemia were divided into the control group (CG) – 54 patients and the yoga group (YG) – 48 patients. The CG was prescribed standard therapy for chronic HF (angiotensin converting enzyme inhibitors, β-blockers, aldosterone antagonists, digoxin, loop diuretics, statins, antiplatelet agents) and dyslipidemia. The YG additionally followed lifestyle modification in the form of 1 h daily practice of yoga for a period of 3 months. All patients completed the questionnaire reporting on their age, gender, medical history and treatment. The fasting blood samples were analyzed for total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol, C-reactive protein, interleukin-8 and tumor necrosis factor -α on admission to the department and after 3 months of treatment. The pre-specified duration of the enrollment period was two years and during that time we interviewed 168 patients. Forty-two did not meet the inclusion criteria for the study, 24 patients refused to participate. A total of 102 patients were enrolled, of them, 54 were included into the control group and 48 into the yoga group. At baseline, there were no significant (p>0.05) differences between the groups in clinical characteristics of the patients. On admission to hospital the patients of both groups received standard therapy in comparable doses. By the end of the study, a significant (p<0.05) reduction in TC, TG and LDL-C levels was observed in both groups with a tendency to more considerable changes in YG. Correlation analysis revealed the positive correlation relationship between TC, LDL-C levels and cytokines. The present study has shown that the practice of yoga in addition to the standard therapy in patients with HF and dyslipidemia could be associated with lipid profile improvements.

Damage to the Cardiovascular System in Patients with SARS-CoV-2 Coronavirus Infection. Part 2: Correction of Myocardial Systolic Dysfunction

Aim. To study changes in myocardial contractile function when prescribing mineralocorticoid receptor antagonists of spironolactone in patients after coronavirus infection SARS-CoV-2 with symptoms of chronic heart failure (CHF).Materials and methods. The study included 90 hospitalized patients with a diagnosis of SARS-CoV-2 coronavirus infection. The inclusion criteria were: age from 18 to 85 years; the presence of CHF with a preserved or mildly reduced left ventricular ejection fraction (LVEF). The patients were randomized into two groups: group I (n=60) included patients who, for 6 months after discharge from the hospital, in addition to standard drug therapy for CHF, took spironolactone at a dose of 25 mg per day; group II (comparison group; n=30) included patients who received standard drug therapy without additional prescription of spironolactone. The study groups were comparable in age, gender, prevalence of hypertension, coronary heart disease, diabetes mellitus, obesity and severity of CHF; the drug therapy given to the patients had no significant differences. Assessment of LV systolic function, exercise tolerance (six-minute walk test, TSW), quality of life (questionnaire EQ-5D-5L) were performed.Results. When repeated echocardiography was performed after 6 months of treatment, there was a significant improvement in LV systolic function in group I patients. In group I, after 6 months of treatment, there was a significant decrease in the proportion of patients with moderately reduced LVEF (from 30 [50%] to 12 [20%]; p<0.001), and a significant increase in the number of patients with preserved LVEF (from 30 [50%] to 48 [80%], p=0.002). In group II, the number of patients with moderately reduced LVEF did not significantly change. After 6 months of treatment, all patients showed an increase in exercise tolerance. During the test with a six-minute walk, group I patients showed an increase in the index from 316.8±63.5 to 432.9±41.3 meters; group II patients from 337.6±42.7 to 407.6±38.9 meters. The values of the six-minute walking test after 6 months of treatment were significantly higher in group I patients when compared with group II patients. When assessing the quality of life using the EQ-5D-5L questionnaire, it was found that at the time of inclusion of patients in the study, all patients noted the presence of any health problems in one or more components. The average indicator of health status, measured by a 100-point visual analog scale, after 6 months was 71.8±9.2 in patients of group I and was significantly higher than the same indicator in group II – 63.7±9.1. There were no adverse events in the study groups during the entire observation period.Conclusion. A significantly more pronounced improvement in systolic and diastolic left ventricle function, as well as quality of life, was found in the group of CHF patients with preserved or moderately reduced LVEF, who received spironolactone for 6 months after the SARS-CoV-2 infection in addition to standard therapy, compared with patients without aldosterone antagonists.

Effectiveness and Dose of Carvedilol Therapy In Children with Dilated Cardiomyopathy: A Prospective Randomized Double-Blinded Trial

Background: The efficacy and safety of the beta blocker carvedilol in pediatric patients with chronic heart failure (CHF) has not been fully established till now. Aim of the Work: To assess the role of carvedilol in the treatment of children with dilated cardiomyopathy, to demonstrate its efficacy, tolerability and determine the least effective dose. Patients and Methods: We conducted a double-blind, placebo-controlled study of 53 children with dilated cardiomyopathy. Patients were randomly assigned to receive either placebo (26 patients) or carvedilol (27 patients) added to the standard CHF therapy that consists of angiotensin-converting-enzyme inhibitor and diuretics. The carvedilol group was further subdivided into 2 groups according to the received dose of carvedilol. Subgroup I (11 cases) received carvedilol dose of 0.01-0.09 mg/kg/day and subgroup II (16 cases) received carvedilol with dose increments every 2 weeks from 0.01-0.2 mg/kg/day. All patients were followed up for four months after reaching the target dose. Results: The end results of the study showed that there was a significant improvement in Ross heart failure class, fractional shortening (FS), left ventricle end systolic dimension (LVESD) and left ventricle end diastolic dimension (LVEDD) in patients of the study group which was not achieved in the control group. On the other hand there was no statistically significant difference between sub groups I and II regarding the end point. Carvidolol was well tolerated, with no side effects or drug interaction reported. Conclusion: Addition of carvedilol to standard anti-failure therapy is of beneficial effect and is well tolerated in children with CHF on top of DCM. There may be no need for carvedilol dose up- titration at least for the first months of treatment.

ROLE OF SACUBITRIL/VALSARTAN IN THE TREATMENT OF CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION IN ELDERLY HYPERTENSIVES WITH COMORBIDITY: FROM CLINICAL TRIALS TO REAL WORLD

Objective: Sacubitril/Valsartan (SV) has been shown to reduce cardiovascular mortality in ambulatory patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (HFrEF). However there are few real-word evidences about its efficacy in elderly hypertensives with HFrEF and comorbidities. Design and method: In this prospective open-label study, 54 subjects (mean age 78.6 ± 8.2 years, 75.0% men), with HFrEF (29.8 ± 4.3%), in New York Heart Association (NYHA) class II-III were assigned to receive SV twice daily at different dosage of 24/26, 49/51, 97/103 mg. These patients were gender and age-matched with a control group of patients with HFrEF receiving optimal standard therapy for CHF. The office blood pressure (BP), the NT-pro-BNP, eGFR, blood glucose and glycated haemoglobin (HbA1c), uric acid (UA), left ventricular ejection fraction (LVEF) and NYHA class were evaluated at a mean follow-up of 14-months. Mortality and re-hospitalisation for HF were collected. Categorical variables were compared with the Pearson's test and difference of continuous variables, were evaluated by the analysis of variance for repeated measures. Results: NYHA class significantly improved in the SV than control group (24.9 vs. 6.4% moved from III-- > II and 55.4 vs. 25.2% from II-- > I classes, p < 0.05). A significant improvement of LVEF and eGFR levels was found in the ARNIs than controls (42.4 vs. 34.2%, 73.8 vs. 61.2 ml/min for all p < 0.001, respectively). The NT-pro-BNP, systolic BP, diastolic BP, blood glucose, HbA1c and UA values were lower in SV than controls (3107 vs 4552 pg/ml, 112.2 vs. 120.4 and 68.8 vs 75.6 mmHg, 108.4 vs 122.6 mg/dl, 5.4 vs. 5.9% and 5.9 vs 6.4 mg/dl, p < 0.05). Mortality and re-hospitalisation for CHF was lower in the SV than controls (20.1 vs. 33.6 and vs. 27.7 vs. 46.3%, p < 0.05). Conclusions: In elderly hypertensives with HFrEF and comorbidities SV treatment seems effective and safe. The improvement of LVEF, BP, eGFR, serum glucose, UA and HbA1c could be the mechanisms by which SV plays a beneficial role on clinical outcomes

EFFECT OF COMBINED ORAL FERROTHERAPY WITH L-CARNITINE ON EXERCISE TOLERANCE OF PATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION OF LEFT VENTRICLE WITH CONCOMITANT IRON DEFICIENCY ANEMIA

According to numerous studies, a high prevalence of iron deficiency (ID) with anaemic syndrome and its association with mortality during chronic heart failure (CHF) have been revealed. Ferrocorrection of anaemia during CHF is important both to improve the clinical condition and to optimize the long-term prognosis of patients. However, the pathogenetic justification is the use of agents that have antihypoxic, antioxidant and membrane-stabilizing effects, except iron preparations, and at the same time exert a regulatory effect on the metabolism of physiologically active compounds and improve the functional condition of patients. The aim. The aim of this study was to identify and compare the effect of oral ferrotherapy and combined use of ferrotherapy with L-carnitine on exercise tolerance (ET) of patients with CHF with reduced ejection fraction of left ventricle (LVEF) with concomitant iron deficiency anemia (IDA) was determined and compared. Materials and methods. The study includes 62 patients with CHF with reduced LVEF FC II-III according to NYHA with IDА. Patients with hypertensive and ischemic etiology of HF took part in the study. Among them, 45 (72.6 %) were men and 17 (27.4 %) were women aged 70.0±0.9 years. Two study groups were formed: in addition to the standard therapy, the patients in the 1st group (n=32) were prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid 2 tablets per day for 6 months; the patients in the 2nd group (n=30) received the standard therapy of CHF and not only iron, but also L-carnitine. Results and discussion. The use of two variants of ferrocorrection as an application to the standard treatment of CHF among the total number of studied patients with IDA indicates the sufficient effect both to eliminate the signs of anemia and to eliminate ID. The analysis of the dynamics of the passed test distance with a 6-minute walk in 32 patients with IDA on the background of standard treatment and additional ferrotherapy after 6 months showed an increase of the actual distance by 8.9 % (from 249.4 to 272.3 m, p<0.0001). The analysis of changes in the value of travelled distance among patients with IDA who received combined 6-month ferrotherapy with L-carnitine also revealed a significant positive trend. In addition, the value obtained was significantly higher compared to the results of patients with only additional ferrotherapy, an increase of 19.4 % (from 259.5 to 304.5 m, p<0.0001). Conclusions. The use of metabolic therapy with oral ferrotherapy is accompanied by a greater increase in ET, which is reflected in a significantly longer test distance with a 6-minute walk and greater frequency of decrease of FC of HF among patients, compared with using only iron sulfate ferrocorrection.

Safety and effectiveness of physical training in inotrop-dependent patients with compensation for chronic heart failure at the level of the III-IV functional class

Aim. To assess the safety and effectiveness of physical training in inotrop-dependent patients with stabilization of the course of chronic heart failure (CHF) at the level of the III-IV functional class (FC). Materials and methods. The prospective randomized study included men of 18-65 years old who were committed to Almazov National medical research center "due to decompensated CHF III-IV FC, left ventricular ejection fraction of 30% or less due to coronary heart disease or dilated cardiomyopathy receiving dopamine or dobutamine for 2 weeks or more, stabilizing heart failure at level III-IV FC and arterial pressure 90/60 mm Hg and above against the background of ongoing inotropic therapy. Patients were randomized into 2 groups: 1st - those participating in the physical rehabilitation program (PRP), 2nd - receiving standard CHF therapy. Results. There was no increase in the number of fatal cases and the number of patients with episodes of decompensation of CHF in the 1st group compared with the 2nd group. The number of episodes of CHF decompensation before FC IV was higher in the 2nd group compared to the 1st: 13 (50%) in the 1st group and 20 (80%) in the 2nd (p=0.04). Episodes of CHF decompensation, requiring transfer to the anesthesiology and resuscitation departments, were 2 times less frequent in patients of the 1st group compared to the 2nd: 8 (31%) and 16 (64%), respectively (p=0.03). In patients with the 1st group, malignant ventricular arrhythmias were not registered during physical training and for 3 hours after their completion. There was a tendency (without achieving a statistically significant difference) to a decrease in pulmonary thromboembolism episodes in patients of the 1st group compared with the 2nd (p=0.05). In the 1st group, after 6 months, there was a decrease in the number of lower respiratory tract infections - bronchitis + pneumonia compared with the 2nd group (p=0.0006). Conclusion. Participation of inotropic-dependent patients in individually designed RPF does not increase their mortality and does not increase their number of life-threatening cardiac rhythm disturbances. In the group of inotropic-dependent patients participating in RPF, there was a significant decrease in the number of lower respiratory tract infections and a tendency to a decrease in the number of pulmonary embolism compared with patients not participating in RPF.

Identification of latent disorders of carbohydrate metabolism in conjunction with neurohormonal status in hospitalized patients with chronic heart failure of ischemic etiology

Aim. To reveal latent disorders of carbohydrate metabolism (CHM) in conjunction with neurohormonal status in hospitalized patients with chronic heart failure (CHF) of ischemic etiology. Material and methods . We analyzed 174 patients with NYHA class II-IV CHF of ischemic etiology who received the same standard CHF therapy (P-adrenergic blockers, mineralocorticoid receptor antagonists, angiotensin-converting enzyme inhibitors, diuretics), did not have disorders of CHM and never took hypoglycemic agent. We conducted oral glucose tolerance test (OGTT) and general clinical examination. The levels of brain natriuretic peptide, aldosterone and insulin was determined by enzyme immunoassay. Insulin resistance (IR) is assessed using the HOMA-IR index. Results. Among 174 hospitalized patients with NYHA class II-IV CHF of ischemic etiology disorders of CHM was detected in 52,3% of patients: 33,9% of those had impaired glucose tolerance (IGT), 1,7% — impaired fasting glucose (IFG), 16,7% — newly diagnosed type 2 diabetes mellitus (DM), in 47,7% of the patients disorders of CHM was not found. In all patients with CHF, along with elevated levels of brain natriuretic peptide and aldosterone, insulin levels were also increased. IR elevated with the increase in the severity of disorders of CHM (in the group without disorders of CHM — 10,78 (8,9-12,2), IGT — 14,6 (11,2-18,2), newly diagnosed type 2 DM — 18,6 (15,19-26,7). Also the concentration of aldosterone was higher in the group with DM, compared with the ITG group (p 2-3 <0,01). Conclusion. The presence and progression of IR in patients with CHF of ischemic etiology in conjunction with neurohormonal status emphasizes the importance of timely detection of latent CHM disorders with its future management.

Cough: the evolution of views and modern approaches to an objective assessment.

The article is a review of literature, that provides information on ways to assess cough, how those ways have improved over recent years, the latest data in the field of an objective assessment of cough and the possibility of its use in scientific and clinical practice. Search for articles was carried out in such databases as Pubmed, CyberLeninka, RSCI in English and Russian.

Efficacy and safety of levothyroxine (L-T4) replacement on the exercise capability in chronic systolic heart failure patients with subclinical hypothyroidism: Study protocol for a multi-center, open label, randomized, parallel group trial (ThyroHeart-CHF)

BackgroundSubclinical hypothyroidism is a common condition in patients with heart failure and is defined as elevated serum thyroid hormone (TSH) with normal circulating free thyroxine (FT4). Evidence on the effect of thyroid hormone treatment is lacking. We designed a randomized controlled trial to compare the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism.Methods/designEligible participants were identified from the cardiology units of five study centers based on the following criteria: 18 years or older, systolic heart failure with NewYork Heart Association (NYHA) class II–III, left ventricular ejection fraction ≤ 40%, and subclinical hypothyroidism (TSH > 4.78μIU/ml, < 10 μIU/ml + FT4 level within reference range). Eligible patients will be randomly assigned in a 1:1 manner to receive thyroxine replacement therapy plus standard chronic heart failure (CHF) treatment or only standard CHF therapy. Levothyroxine will be administered at an initial dose of 12.5 μg once daily and will be titrated until TSH is within the normal range. The primary endpoints include the difference in distance of the six-minute walk test between 24 weeks and baseline. The secondary endpoints include differences in plasma NT-proBNP levels and serum lipid profiles, changes in the NYHA classification, cardiovascular death, re-hospitalization, differences in echocardiographic and cardiac magnetic resonance imaging measures, and Minnesota Living With Heart Failure Questionnaire (MLHFQ) results between 24 weeks and baseline.DiscussionThyroHeart-CHF is designed as a prospective, multi-center, randomized, controlled clinical trial to study the efficacy and safety of thyroid hormone supplementation in patients with chronic heart failure complicated with subclinical hypothyroidism. The study findings will have significant implications for discovering the new therapeutic targets and methods of heart failure.Trail RegistrationClinicalTrials.gov, NCT03096613. Registered on 30 March 2017.

ЛЕЧЕНИЕ ХРОНИЧЕСКОЙ СЕРДЕЧНОЙ НЕДОСТАТОЧНОСТИ У МУЖЧИН СРЕДНЕГО ВОЗРАСТА С ДЕПРЕССИЕЙ

Objective: Comparative assessment of the efficiency of standard and combined antidepressant therapy of chronic heart failure (CHF), flowing depression in middle-aged men with mild and moderate arterial hypertension (AH). Methods: Evaluation of the effectiveness of CHF treatment in patients with absence (Group I) and the presence of depressive disorders (Group II) and combined with antidepressants (paroxetine) of standard therapy for CHF occurring with depression (Group III) was spent. Clinical indices and structural parameters of the myocardium and vessels are studied in the dynamics Results: In patients with depression not receiving antidepressants, the lack of depression is accompanied by low adherence to treatment and the meaningful by high BP. Despite the high efficacy of standard CHF treatment, the combination with an antidepressant (the importance of improving the structural parameters of the myocardium, reduction of depression and increased adherence to treatment), adherence to treatment is significantly lower than in patients with initial absence of depression Conclusion: In the absence of depression, standard CHF therapy in middle-aged men with hypertension significantly improves the hemodynamic parameters and the reduced severity of heart failure. Against the background of depression, the effectiveness of CHF treatment (without an antidepressant) is lower: the level of depression, the left ventricular myocardial mass index, and intima-media thickness are much higher, treatment adherence and the ratio of maximum speeds of early and late filling (E/A) are lower than in comparison groups. Combined with paroxetine, standard CHF therapy in middle-aged men with depression, mild depression, and CHF, increases adherence to treatment, improves the structural parameters of the heart. However, adherence to the treatment is meaningful low than in patients who initially lacked depression, which dictates the need to develop effective measures to prevent depressions in patients with the risk of developing CHF. Keywords: Male sex, middle age, chronic heart failure, hypertension, depression, antidepressant therapy.

The pathogenetic role of the nitric oxide system and its metabolites in the development and progression of chronic heart failure

Aim: to study the activity of eNOS, the concentration of L‑arginine and stable nitric oxide metabolites, as well as the degree of endothelium dependent vasodilation with 5‑minute compression test of the brachial artery in patients with chronic heart failure (CHF) of ischemic origin depending on L‑arginine administration in the treatment scheme.Material and methods. In the present study were included 303 patients (204 men and 99 women) observed about CHF ischemic genesis. Patients of the main group A+ (101 persons), in addition to the main treatment, took L‑arginine at a dose of 1 g 3 times per day in syrup (Tivortin), the rest of the patients (202 persons) were included in the comparison group А - . As a control group were examined 20 healthy volunteers. The metabolism of NO and endothelium-dependent vasodilatation were studied by determining the activity of eNOS, and concentration of NO2/NO3, determining the level of L‑arginine in the blood, assessment of endothelial function with a compression test. The endothelial function of vessels was judged according to the dopplerography of the brachial artery using the method of Solomon et al.Results. In patients taking arginine were observed additional positive effect on the arginine concentration in the peripheral blood (51,63% against 43,53% in group A, p<0.01). The distribution of the patients according to the status of LV systolic function showed that the effect of additional application of arginine is observed only in patients with low LVEF (69,63% vs 58,32% in the group with low LVEF, p<0.01). Also it was discovered that the use of arginine promotes a significantly greater increase in eNOS activity (11,53% against 4.76 per cent, p<0.001. In comparison with patients within the groups A+ and A —, classified according to the state of LV systolic function, it was found a significantly more pronounced effect of arginine in patients with normal systolic LV function.Conclusions. Patients with chronic heart failure (CHF) of ischemic origin, with low left ventricle ejection fraction (LV EF), a violation of NO metabolism is noted. Decrease of L‑arginine concentration leads to decrease in endothelial NO-synthase activity, and increase of macrophage NO-synthase activity leads to high concentration of nitric oxide and its stable metabolites in peripheral blood. Endothelial vasomotor dysfunction is associated with decrease of vasodilatation and even paradox vasoconstriction (in our study in 10 patients (3.3%)). Inclusion of L‑arginine to standard therapy of CHF gives additional positive effect on improvement of metabolism of nitric oxide and endothelial vasomotor function.

Short Term Follow-up in Patients with Stable Chronic Heart Failure on 5-Phosphodiesterase Inhibitor Sildenafil

AbstractBackground: The increased Pulmonary Artery (PA) pres-sure is due to disturbances in key vascular mediator pathway including relative deficiencies of vasodilators such as Nitric Oxide (NO) and prostacyclins. Vasodilators such as 5- phosphodiesterase Inhibitor (sildenafil) are a natural initial therapeutic choice.Objectives: The study was designed to investigate whether a 50mg twice daily of sildenafil could improve exercise performance, ventilatory efficiency, oxygen uptake kinetics and pulmonary hypertension in patients with stable Chronic Heart Failure (CHF).Methods: Single center, double-blind, placebo-controlled, parallel-group, randomized clinical trial of one hundred patients with stable CHF, Group (A) including fifty patients who received only the standard therapy of CHF (control group), Group (B) including fifty patients who received Sildenafil in addition to standard CHF therapy (active group) for six months. All patients who met screening criteria under-went baseline studies (history and physical examination, cardiopulmonary exercise tests including [peak exercise (VO2 peak), ventilatory efficiency (VE/VCO2 slope) and Recovery Gas Exchange (T1/2VO2min- T1/2VCO2min)] and echocar-diography for assessment of mean Pulmonary Artery Pressure (mPAP) and LV systolic function) and were then randomly assigned in a 1:1 ratio, to receive either sildenafil or placebo.Results: There was statistically significant difference between Group (A) and Group (B), significant improvement in VO2 peak,VE/VCO2 slope, T-1/2Vo2 (min), T-1/2VCO2 (min) and mean Pulmonary Artery Pressure (mPAP) occurred in Sildenafil group (group B) with p-value <0.05, while in the control group (group A), there was no significant improve-ment in all parameters. After using sildenafil in patient with stable CHF for 6 months the mPAP decreased by 20% in sildenafil group and 2% in the controlled group. There was also improvement in ventilatory efficiency and exercise performance.Conclusion: 5-phosphodiesterase Inhibitor (sildenafil) may be benificial as adjunctive therapy for patients with Chronic Heart Faluire (CHF).

Influence of Pulmonary Rehabilitation on Clinical Characteristics in Patients with Chronic Heart Failure and Chronic Obstructive Pulmonary Disease

Abstract Background: The improvement of treatment strategies in patients with chronic obstructive pulmonary disease (COPD) and especially with comorbid pathology should provide rational conversion of standard schemes of therapy and rehabilitation in accordance with their clinical, pathogenic, functional and economic feasibility. Objective: To assess the influence of pulmonary rehabilitation on clinical characteristics in patients with chronic heart failure (CHF) and concomitant COPD. Methods: The study included 102 patients with CHF and concomitant COPD (males, 62%; mean age, 68.2 ± 4.5 years). All patients were divided into two groups: control group (CG) (n = 54), received only standard therapy of CHF and COPD; and intervention group (IG) (n = 48) were additionally taught the full yogic breathing as a program of pulmonary rehabilitation. Calculation of points by clinical evaluation scale (CES), assessment of CHF functional class (FC) (NYHA) and 6-minute walk test (6MWT - with the evaluation of dyspnea by the Borg scale) were performed in all patients on admission to the department and at discharge. Significant association was defined by p value < 0.05. Results: At baseline, there were no significant differences in clinical characteristics of the patients and studied parameters between the groups. At discharge both groups showed significant reduction of dyspnea by the Borg scale (in CG: from 7.2 ± 0.8 points to 5.2 ± 0.3; in IG: from 7.4 ± 0.6 points to 3.2 ± 0.4), the number of points by CES (in CG: from 10.8 ± 0.3 points to 7.2 ± 0.4; in IG: from 10.7 ± 0.6 points to 5.9 ± 0.6). Increase in exercise tolerance (by the distance of 6MWT) was observed in both groups (in CG: from 215 ± 24 m to 275 ± 22 m; in IG: from 219 ± 21 m to 308 ± 24 m). The changes were more significant in IG compared to CG. We observed the prominent decrease in CHF FC and length of hospital stay in IG. Conclusions: Application of full yogic breathing as the program of pulmonary rehabilitation in addition to standard therapy of the patients with CHF and COPD is associated with a significant decrease in CHF FC, an increase in exercise tolerance and a reduced length of hospital stay.

BUSPIRONE HYDROCHLORIDE EFFECTS ON CLINICAL AND FUNCTIONAL STATE IN PATIENTS WITH CHRONIC HEART FAILURE AND MIXED ANXIETY-DEPRESSIVE DISORDER

Purpose: the assessment of buspirone hydrochloride effect on clinical and functional state in patients with chronic heart failure (CHF) and mixed anxiety-depressive disorder (MADD). Materials and method : the study included 49 patients with heart failure of ischemic etiology and MADD. Patients in Group 1 (n=25) received buspirone hydrochloride (in the starting dose of 15 mg/day with a gradual (within 2 weeks) increasing to the effective (30 mg/day)) in addition to standard CHF and coronary heart disease (CHD) therapy. Patients in group 2 (n=24) received standard therapy of CHF and CHD. After 6 months, we evaluated clinical and functional state in patients from both groups. Result: a statistically significant improvement in clinical and functional status (functional class of heart failure, physical exercise tolerance) were observed in patients with CHF and MADD in group of patients, who received buspirone hydrochloride in addition to standard therapy. Conclusion : buspirone hydrochloride admission in addition to standard therapy is associated with clinical and functional state improvement in patients with CHF and MADD.

BUSPIRONE HYDROCHLORIDE EFFECTS ON HOSPITALIZATIONS FREQUENCY IN PATIENTS WITH CHRONIC HEART FAILURE AND MIXED ANXIETY-DEPRESSIVE DISORDER

Aim . Assessing the impact of buspirone hydrochloride on hospitalizations frequency in patients with chronic heart failure (CHF) and mixed anxietydepressive disorder (MADD). Materials and methods . The study involved 49 patients with heart failure of ischemic etiology and MADD. Patients in Group 1 (n = 25) received buspirone hydrochloride (in the starting dose of 15 mg/day with a gradual (within 2 weeks) increasing to the effective (30 mg/day)) in addition to standard CHF therapy and coronary heart disease (CHD). Patients in group 2 (n = 24) received standard therapy of CHF and CHD. After 6 months, we evaluated hospitalizations frequency and duration in patients from both groups. Results . The risk of hospitalization for heart failure decompensation was significantly lower in patients from group 1 compared with patients from group 2 (HR 0.333, 95% CI 1,12-8,05, p = 0.035). Conclusions. Buspirone hydrochloride admission in addition to standard therapy is associated with reduced risk of hospitalization for decompensation of chronic heart failure in patients with MADD.

Atorvastatin improves cardiac function and remodeling in chronic non-ischemic heart failure: A clinical and pre-clinical study

Abstract Aims The aim was to evaluate the cardio-protective effect of atorvastatin in combination with standard chronic heart failure (CHF) therapy that might improve cardiac function, remodeling, and further delay the progression of CHF in patients and rats. Methods and results CHF patients ( n = 20 per group) with left ventricular ejection fraction (LV-EF) n = 10 per group) received treatment for 4 weeks and were divided as follows: saline treated (control, 1 ml intraperitoneal, IP), doxorubicin treated (2.5 mg/kg, IP), atorvastatin–doxorubicin treated (10 mg/kg, orally), and digoxin–doxorubicin treated (0.02 mg/kg, orally). The same laboratory analysis including histopathology of heart tissues was performed on the rats. In patients, atorvastatin improved heart function (increased LV-EF%, LV-fraction shorting (LV-FS%), and E/A velocity ratio; decreased LV-end diastolic diameter (LV-EDD) and LV-end systolic diameter (LV-ESD)) and significantly reduced serum lipid profiles, cTnT, hs-CRP and MDA versus patient controls. In rats, atorvastatin improved signs of CHF, systolic blood pressure, reduced serum lipid profiles, cTnT, hs-CRP and tissue MDA; less cardiac necrosis and fibrosis with enhancement of neo-vascularization versus other doxorubicin-treated rats. Conclusions Atorvastatin with standard CHF therapy improved cardiac function and remodeling. Cardio-protective “pleiotropic” actions of atorvastatin are anti-inflammatory, anti-fibrotic and anti-oxidative. Thus, atorvastatin has a potential therapeutic value in the management of CHF patients.

Effect of buspirone hydrochloride on dispersion of ventricular repolarization in patients with anxiety and depressive disorders and ischemic heart failure

Objectives: The purpose of the study was to investigate the effect of buspirone hydrochloride on QT interval dispersion (DQT) in patients with chronic heart failure (CHF) of ischemic etiology with anxiety and depressive disorders. Methods: 102 patients (65 males, 37 females; mean age 67.4±9.5) NYHA II-IV were randomized in the study. All the patients were prescribed buspirone hydrochloride 10 mg t.i.d. due to anxiety and depressive disorders. All the patients had II-III functional classes of angina, 67 of them (65.7%) had history of myocardial infarction. Randomized patients received standard CHF and coronary heart disease therapy. Informed consents were signed before the study initiation. Exclusion criteria were history of mental disorders, significant impairment of cognitive functions, alcohol/drug abuse, other psychoactive drug intake, severe concomitant pathology. Initially and in 3 months of buspirone hydrochloride intake rest ECG was recorded in 12 standard leads, 50 mm/s and QT (DQT) and QTc (DQTc) dispersions were calculated by the standard technique (DQT = QTmax-Qcmin, DQTc = QTcmax-QTcmin). Statistical data processing was carried out by using the program Statistica 8.0. Data was reported as mean ± standard deviation. The significance of differences was determined by Student's t-test. Results: Initially mean DQT and DQTc were 41.5 ± 13.0 ms and 36.0 ± 9.8 ms, respectively. At re-examination mean DQT was 43.9 ± 14.8 ms (p>0.05), and DQTc -37.5 ± 10.9 ms (p>0.05). Thus, indices of ventricular repolarization dispersion before and after 3 months of buspirone hydrochloride intake had no statistically significant differences. Conclusion: Buspirone hydrochloride treatment did not lead to an increase in dispersion of ventricular repolarization in the patients with ischemic CHF.