Symptoms Of Chronic Heart Failure Research Articles

Upregulation of serum miR-4429 discriminates chronic heart failure patients and regulates cardiomyocyte injury via modulating HAPLN1.

Chronic heart failure (CHF) is the outcome of various cardiac diseases. Due to the unobvious symptoms of early-stage CHF, the screening of CHF remains a challenging problem. This study focused on the dysregulated miR-4429 and evaluated its significance in the diagnosis and development of CHF, aiming to explore a novel biomarker for CHF. A total of 103 CHF patients and 71 healthy individuals with matched clinicopathological features were enrolled. Serum miR-4429 levels were analyzed by PCR and its significance in discriminating CHF patients was evaluated by receiver operatinf curve (ROC). Cardiomyocyte was treated with H<inf>2</inf>O<inf>2</inf> to mimic cell injury during CHF, the regulatory effect and the underlying mechanism of miR-4429 was investigated by cell transfection and cell counting kit-8 assay. miR-4429 was significantly upregulated in CHF patients (P< 0.0001), which sensitively and specifically discriminated CHF patients from healthy individuals (AUC=0.803, 95% CI=0.735-0.872). miR-4429 was closely associated with the decreased cardiac function of CHF patients (r>0.5, P<0.0001). H<inf>2</inf>O<inf>2</inf> induced increased miR-4429 and reduced HAPLN1 in cardiomyocytes (P<0.001). H<inf>2</inf>O<inf>2</inf>-treated cardiomyocytes showed inhibited proliferation and increased reactive oxygen species (ROS) levels, and silencing miR-4429 could alleviate cardiomyocyte injury caused by H<inf>2</inf>O<inf>2</inf> (P<0.0001). miR-4429 negatively regulated HAPLN1, and the knockdown of HAPLN1 could reverse the protective effect of silencing miR-4429 on cardiomyocyte injury (P<0.0001). The upregulation of miR-4429 served as a biomarker discriminating CHF patients and indicating severe disease conditions. Silencing miR-4429 could alleviate cardiomyocyte injury via negatively regulating HAPLN1.

Medication adherence and associated factors among chronic heart failure patients on follow-up in north Shewa public hospitals, Oromia region, Ethiopia

BackgroundChronic heart failure affects approximately 26 million people globally. World Health Organization data show that only approximately half of chronically ill patients in developed countries adhere to recommended medication, with even lower rates in developing countries. Medication adherence is critical for managing chronic heart failure symptoms, delaying disease progression, and preventing hospitalizations. However, poor adherence increases rehospitalization, morbidity, mortality, and healthcare costs.ObjectiveTo assess medication adherence and associated factors among chronic heart failure patients on follow-up at North Shewa Public Hospitals, Oromia Region, Ethiopia, in 2023.MethodsThis institutional-based cross-sectional study was conducted from March 1 to April 30, 2023, G.C. A total of 603 individuals were selected consecutively among those who underwent chronic OPD after being proportionally allocated to five hospitals in the zone. The data were collected using an interviewer-administered questionnaire and a medical chart review. The data were entered into Epi-data version 3.1 and then exported to SPSS version 26 for analysis. The multivariable logistic regression model included variables with a P value < 0.25 in the bivariate analysis. The degree of association was expressed using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a P value < 0.05.ResultsAmong the 603 patients, 56% had optimal medication adherence, with a 95% CI of 52.1 to 60. Being able to read and write (AOR: 2.20; 95% CI: 1.34, 3.61), having a secondary education (AOR: 1.97; 95% CI: 1.06, 3.67), having community-based health insurance (AOR: 1.82; 95% CI: 1.22, 2.71), not having comorbidities (AOR: 1.82; 95% CI: 1.18, 2.52), taking several drugs < 2 (AOR: 2.11; 95% CI: 1.20, 2.45), not adding salt when cooking (AOR: 1.72; 95% CI: 1.20, 2.45), and asking a doctor or nurse without fear (AOR: 1.87; 95% CI: 1.03, 3.40) were factors associated with medication adherence among CHF patients.ConclusionThis study revealed that 56% of chronic heart failure patients had optimal medication adherence. Factors associated with higher adherence included higher education, community health insurance, lack of comorbidities, fewer medications, avoiding added salt, and comfortable communication with providers. Health professionals should provide education to strengthen medication adherence.

Abstract PO3-01-02: Real world outcomes of neoadjuvant therapy with Trastuzumab and Pertuzumab associated with carboplatin and docetaxel (TCHP) in HER2+ early breast cancer patients unfit for anthracyclines: a retrospective cohort comparative study

Abstract Backgound Neoadjuvant chemotherapy (CT) with anti-HER2 blockade using trastuzumab (H) and pertuzumab (P) is a standard of care for patients (pts) with HER2-positive early-stage Breast Cancer (eBC). Historically, taxanes (T) and anthracyclines (A) have been the mainstays of (neo)adjuvant CT in this setting, but the added benefit of A in the era of anti-HER2 therapy has been questioned. This study aimed to assess the effectiveness, cardiac safety, and cost-effectiveness of an anthracycline-free regimen (TCHP) in a real-world population of pts deemed unfit for A, compared to pts treated with the standard regimen of doxorubicin and cyclophosphamide plus dual-blockade associated with docetaxel (AC-DHP) at a single Portuguese Comprehensive Cancer Center. Methods This retrospective cohort study included a consecutive series of female eBC HER2+ pts who initiated primary treatment with TCHP between July 2018 and August 2022. The primary endpoint was pathological complete response (pCR), and secondary endpoints were cardiac safety and disease-free survival (DFS). The outcomes were compared with a historical database of eBC HER2+ pts who started primary treatment with AC-DHP between August 2015 and May 2021. Clinical data was collected from medical and administrative records. Descriptive statistics were used to describe categorical and continuous variables, and the Kaplan-Meier method was used for DFS analysis. Costs analysis employed the micro-costing technique, considering individual medical direct costs from diagnosis until surgery. Multivariate logistic regression models were used for effectiveness analysis and the gamma general model for costs analysis. The incremental cost-effectiveness ratio (ICER) was calculated using the pCR rate as a measure of effectiveness. Results A total of 233 and 23 pts were included in the TCHP and AC-DHP groups respectively. Reasons for choosing the anthracycline-free regimen in the TCHP group were primarily age-related frailty (52%), medical comorbidities (26%), and previous exposure to anthracyclines (22%). The TCHP pts were older (median age 71 years, range [45-77] vs. 47 years [24-70]) and had lower baseline Left Ventricular Ejection Fractions (LVEF) (median 65% [51-80] vs. 60% [56-73]), with a higher proportion of hormone receptor (HR) negative pts (78.3% vs. 33.0%). Clinical stages were balanced between groups, but the TCHP group had a higher nodal involvement (N+) (73.9% vs. 61.8%). The pCR rates were higher in the TCHP group (65.2% vs. 46.1%, HR 0.98 [95% CI 0.36 - 2.70]). Subgroup analysis by HR status showed comparable pCR rates: 77.1% vs. 74.1% in HR- pts and 40% vs. 39.7% in HR+ pts. Cardiac safety analysis indicated a median decrease in LVEF of 9% in both the TCHP and AC-DHP groups, with 43.5% of TCHP pts experiencing a decline of 10% or more, and 13.0% dropping below 50%. In comparison, these figures were 44.2% and 3.9%, respectively, in the AC-DHP group. At the end of the follow-up, only one patient in the TCHP group with a LVEF &amp;lt; 50% persisted with mild symptoms of chronic heart failure. The median follow-up time for DFS events, starting from surgery, was 31.1 months in the TCHP group and 45.7 months in the AC-DHP group, with 1-year DFS rates of 91.3% and 100%, respectively. The ICER analysis indicated that TCHP was cost-effective, as the incremental cost for achieving an additional pCR in similar subgroups can be outweighed by later cost savings, mainly due to further adjuvant treatment with trastuzumab instead of TDM-1. Conclusions In a real-world population of HER2+ eBC patients unfit for anthracyclines, the TCHP regimen demonstrated a higher overall pCR rate compared to a historical control treated with the AC-DHP regimen, along with an acceptable cardiac safety profile. These results support the broader use of the TCHP regimen in HER2+ eBC pts, as recommended by current NCCN guidelines. However, larger studies involving similar populations are needed to provide higher levels of evidence. Citation Format: Ricardo Pinto, Rita Calisto, Patrícia Redondo, Ana Silva, Pedro Castro, Rute Fernandes, Raquel Teixeira, Diana Mata, Ana Ferreira, Maria Bento, Cláudia Vieira. Real world outcomes of neoadjuvant therapy with Trastuzumab and Pertuzumab associated with carboplatin and docetaxel (TCHP) in HER2+ early breast cancer patients unfit for anthracyclines: a retrospective cohort comparative study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-01-02.

Enhanced External Counterpulsation Outcomes Study: Retrospective Analyses of Data Obtained from Patients at a Single Medical Center in United States.

The aim was to explore the effectiveness of enhanced external counterpulsation (EECP) therapy in patients with severe angina pectoris/ chronic heart failure symptoms, who were not suitable candidates for invasive treatment. This retrospective study employed a comprehensive methodology that includes individualized treatment, continuous monitoring, and thorough pre- and postprogram evaluations to assess the efficacy of EECP therapy. The standard protocol involved 35 one-hour treatments, with flexibility for extensions based on therapeutic progress. When pre- and posttreatment results were analyzed, EECP improved the original functional class compared with pretreatment. The mean difference in the functional class was 1.32 (0.92), p < 0.0001. Six-minute walk (6MW) distance improved from 383.6 m (110.24) to 423.1 m (121.50) with mean difference of 37.1 (44.99), p < 0.0001. Duke Activity Status Index (DASI) score improved from 3.9 (2.75) to 6.0 (4.17) with mean difference of 2.16 (3.8), p < 0.0001. Training metabolic equivalents (METs) improved from 3.0 (0.74) to 4.0 (1.57) with mean difference of 1.04 (1.2), p < 0.0001. Weekly anginal events decreased from 13.1 (13.19) to 3.2 (7.38) with mean difference of -9.78 (11.7), p < 0.0001. EECP resulted in improvement of angina pectoris functional class, the 6MW distance, reduction in the number of hospitalizations in first year posttreatment, a significant decrease in sublingual nitroglycerin use, improvement of systolic and diastolic blood pressure, and improvement of DASI score.

Symptom severity reflected by NYHA grade is independently associated with pruritus in chronic heart failure patients.

Pruritus is a symptom profoundly impairing patients' quality of life (QoL). It is a common symptom in chronic heart failure (CHF) patients of yet unknown nature. The aim of this study was to evaluate the risk factors of pruritus in CHF patients. For this monocentric, prospective cohort study, CHF patients were recruited and CHF symptoms, comorbidities and drug intake were assessed using a structured report. Additionally, a questionnaire evaluated pruritus symptoms. Detailed medical histories including laboratory test results were retrieved from patient files for all participants. We evaluated data from 550 CHF patients. Of those, 25.3% reported pruritus to occur frequently (3-5 times per week), often (1-2 times per week) or daily. Patients of higher NYHA classes (NYHA III + IV) experienced significantly more pruritus (31.2%) than lower NYHA classes (NYHA I + II) (21.1%, p = 0.024). Patients with pruritus reported disproportionately often concomitant stasis dermatitis (p = 0.026) and chronic lung disease (p = 0.014). Other parameters reflecting cardiac, liver, kidney and thyroid function, as well as medical therapies showed no significant differences between patients with and without pruritus. In the multivariate logistic regression analysis, only NYHA class (p = 0.016, OR 1.55, 95% confidence interval (CI): [1.09; 2.20]) and elevated leukocyte count (p = 0.007, OR 1.11, CI [1.03; 1.21]) remained significantly associated with pruritus in CHF patients. NYHA class is an independent predictor for pruritus in CHF patients. Besides NYHA class, leukocyte count was also associated with increased pruritus. Pruritus may impair QoL in CHF patients and should thus be included in the assessment of those patients. We suggest that providing best care for CHF patients can be achieved through an interdisciplinary approach of cardiologists and dermatologists and should include a pruritus assessment.

Hemoglobin is an independent predictor of improvement exercise tolerance in male patients with non-ischemic cardiomyopathy.

Exercise intolerance is a symptom of chronic heart failure (CHF). The magnitude of exercise tolerance, as measured by peak oxygen uptake (peak VO2), is strongly associated with prognosis in patients with CHF. We aimed to evaluate the factors associated with improved exercise tolerance in patients with HF. In this prospective study, we recruited patients who were diagnosed with non-ischemic cardiomyopathy between September 2017 and September 2021. All patients underwent cardiopulmonary exercise testing at discharge and 6months after enrollment. The patients were stratified according to whether peak VO2 was increased or not at 6months. One hundred patients with a reduced left-ventricular ejection fraction (LVEF < 50%) were enrolled. Improvement of peak VO2 was observed in 74 patients. In male patients, hemoglobin level was higher in the increased peak VO2 group than in the non-increased group (15.0 ± 1.9g/dL vs. 13.1 ± 2.1g/dL; p < 0.01). Baseline hemoglobin level was positively correlated with the percentage change in peak VO2 (Spearman's r = 0.248, p = 0.040). Kaplan-Meier analysis demonstrated that adverse cardiac events were significantly less frequent in the increased peak VO2 group than in the non-increased group (log-rank test, p = 0.032). Multivariate logistic regression analysis identified hemoglobin level as an independent predictor of improved peak VO2 [odds ratio (OR) 1.60; 95% confidence interval (CI) 1.05-2.44; p = 0.027]. Baseline hemoglobin level is an independent predictor of improved peak VO2 in male patients with non-ischemic cardiomyopathy.

Network analysis of symptoms, physiological, psychological and environmental risk factors based on unpleasant symptom theory in patients with chronic heart failure.

Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other. The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure. A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors. The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes. Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.

Creation of registers as one of the mechanisms for improving medical care for patients with chronic heart failure. Problem state

The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 26-29%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.

Intravenous Iron Technique Evaluation in Chronic Heart Failure With Iron Deficiency Anemia.

This study aimed to investigate and assess whether IV iron improves symptoms of chronic heart failure (CHF) in patients with iron deficiency anemia (IDA). A total of 66 subjects with heart failure (HF) seeking therapy in the Department of Medicine's Inpatient Department (IPD) and Outpatient Department (OPD) were included. The data were collected during an outpatient or inpatient visit, documented in a predesigned and pretested proformaand then evaluated. All subjects received history-taking, examinationsand regular laboratory tests after being informed and signing an agreement. On admission, the following data was collected: name, age, genderand comorbidities. The examination of subjects included a general examination and a systematic examination. Hematological parameters includinghemoglobin (Haemometer, Top Tech Bio Medicals Mumbai), serum iron (Roche Cobas c501, USA), total iron binding capacity (TIBC, Beckman Coulter AU480, India), transferrin saturation percentage (TSAT% = (serum iron/TIBC) × 100), left ventricular ejection fraction (LVEF, 2D echocardiography, Nivan Healthcare Solutions, India) and ferritin (Abbott Architect Ferritin Assay, Delhi) are also important. Other blood tests like liver and renal function tests include an electrocardiogram (12-lead ECG) and two-dimensional echocardiography on admission and follow-up. In our study, 66 patients in total received IV iron as a treatment option to improve the symptoms of CHF with IDA; the New York Heart Association (NYHA) classification showed significant improvement (p-value <0.001). Before the intervention, 57.58% of patients had NYHA class II and 42.4% of patients had NYHA class III. After treatment, 33.33% of patients showed NYHA class II and 19.70% of patients showed NYHA class III. After iron therapy treatment, out of 29 cases of NYHA class III, nine (31.03%) cases converted to NYHA class I, seven (24.14%) cases converted to NYHA class II, and 13 (44.83%) cases belonged to the same NYHA class. Out of 37 cases of NYHA class II, 22 (59.45%) cases converted to NYHA class I, and 15 (40.54%) cases belong to the same NYHA class. Thus, we come to the conclusion that the NYHA classification has exhibited notable enhancement subsequent to the administration of parenteral iron therapy. Sufficient evidence exists to substantiate the advantageous effects of intravenous iron therapy in the treatment of iron deficiency anemia.The administration of iron therapy has been observed to yield favorable outcomes in the mitigation of symptoms among individuals afflicted with cardiac insufficiency.

Iron deficiency anemia in a patient with coronary heart disease: is mimicry possible?

Relevance. Anemia is detected in chronic heart failure (CHF) in 50–60% of patients, second in frequency only to arterial hypertension and coronary artery disease. Most often it is iron deficiency anemia (IDA), the cause of which is both absolute and functional iron deficiency (ID). IDA with absolute ID in patients with coronary artery disease may manifest symptoms similar to the manifestations of CHF, which leads to unfounded prescription of iron preparations for intravenous administration.Purpose. Determine the need for a thorough examination of patients with coronary artery disease and IDA, taking into account existing clinical guidelines to exclude overdiagnosis of CHF.Materials. A clinical observation is presented demonstrating that a full examination of patients, including the determination of erythrocyte and ferrokinetic parameters, the level of natriuretic peptides and the left ventricular ejection fraction, makes it possible to distinguish between absolute and functional ID and differentiate the symptoms of IDA and CHF. Identification of the cause of ID, often associated with the use of anticoagulants and disagregants, and its correction using oral forms of iron sulfate avoids both overdiagnosis of CHF and unfounded prescription of drugs for parenteral administration. This avoids undesirable effects of therapy, improves prognosis and improves the patient’s quality of life, and reduces the burden on the health care system.

Клинические особенности течения хронической сердечной недостаточности при новой коронавирусной инфекции

According to statistics, the number of patients with chronic heart failure (CHF) is growing in Russia. The cause of CHF can be various comorbid conditions that will aggravate the course of CHF. Objective. To determine the clinical features of the course of CHF in the context of COVID-19. Materials and methods. The retrospective study included 210 patients with a confirmed diagnosis of CHF and COVID-19 hospitalized in the pulmonology department. To assess the course of CHF, we used data on the severity of CHF symptoms (severity of shortness of breath on the mMRC scale, chest pain, presence of edema, level of physical activity) and objective examination data (blood pressure level, pulse dynamics). Results and conclusions. The risk group for severe COVID-19 included patients over 60 years of age with concomitant diseases. The clinical picture is noteworthy: severe shortness of breath, significant limitation of physical activity, and swelling in some patients. Patients with CHF during the treatment of COVID-19 require mandatory correction of both the underlying and concomitant diseases to prevent decompensation of CHF and death from all causes.

HiSorb sorptive extraction for determining salivary short chain fatty acids and hydroxy acids in heart failure patients

Variations in salivary short-chain fatty acids and hydroxy acids (e.g., lactic acid, and 3-hydroxybutyric acid) levels have been suggested to reflect the dysbiosis of human gut microbiota, which represents an additional factor involved in the onset of heart failure (HF) disease. The physical–chemical properties of these metabolites combined with the complex composition of biological matrices mean that sample pre-treatment procedures are almost unavoidable. This work describes a reliable, simple, and organic solvent free protocol for determining short-chain fatty acids and hydroxy acids in stimulated saliva samples collected from heart failure, obese, and hypertensive patients. The procedure is based on in-situ pentafluorobenzyl bromide (PFB-Br) derivatization and HiSorb sorptive extraction coupled to thermal desorption and gas chromatography-tandem mass spectrometry. The HiSorb extraction device is completely compatible with aqueous matrices, thus saving on time and materials associated with organic solvent-extraction methods. A Central Composite Face-Centred experimental design was used for the optimization of the molar ratio between PFB-Br and target analytes, the derivatization temperature, and the reaction time which were 100, 60 °C, and 180 min, respectively. Detection limits in the range 0.1–100 µM were reached using a small amount of saliva (20 µL). The use of sodium acetate-1-13C as an internal standard improved the intra- and inter-day precision of the method which ranged from 10 to 23%. The optimized protocol was successfully applied for what we believe is the first time to evaluate the salivary levels of short chain fatty acids and hydroxy acids in saliva samples of four groups of patients: i) patients admitted to hospital with acute HF symptoms, ii) patients with chronic HF symptoms, iii) patients without HF symptoms but with obesity, and iv) patients without HF symptoms but with hypertension. The first group of patients showed significantly higher levels of salivary acetic acid and lactic acid at hospital admission as well as the lowest values of hexanoic acid and heptanoic acid. Moreover, the significant high levels of acetic acid, propionic acid, and butyric acid observed in HF respect to the other patients suggest the potential link between oral bacteria and gut dysbiosis.

Reduction in global tissue deformation of the left ventricle as a cause of heart failure and worse quality of life in patients with takotsubo syndrome in the long period of the disease: prospective cohort study

Objective. This study evaluates the severity of chronic heart failure (CHF), ejection fraction (EF), and global contractility of the left ventricle (LV) using Speckletracking (STE) in patients with takotsubo syndrome (TS) in the early and late disease stages of the disease and compares these data with an assessment of the quality of life (QoL) of patients.&#x0D; Material and methods. The study included 60 patients with TS, with a mean age of 65.513.4 years. The severity of CHF symptoms was assessed using the SHOKS scale (assessment of the clinical condition in CHF). The Minnesota Questionnaire and the HeartQol questionnaire were used to study QoL. Echocardiography data (ECHOCG) were recorded during the acute period and at discharge from the hospital. In the late disease period, ECHOCG was performed using the STE method. After 1 year, endothelial function was studied using the EndoPAT 2000 device to determine the reactive hyperemia index.&#x0D; Results. According to the SHOKS scale, the severity of CHF symptoms corresponded to 12 functional class (FC) in all patients with TS in the long-term disease; however, before the development of TS, only 15 people had signs of CHF at the level of 12 FC. According to ECHOCG, LVEF in patients with TS was 44.59.7% at admission, 60.27.6% at discharge, 61.69.2% after a year, and 60.09.0% after 2 years. The average values of global longitudinal and global circular deformation of the left ventricle in patients with TS were 14.03.1 and 15.04.1%, respectively, after 1 year from disease onset and 12.31.9 and 13.11.9%, respectively, after 2 years. When comparing the data of the Minnesota Questionnaire and HeartQol questionnaires, QoL in the long-term of ST was significantly lower than the initial one before disease development. Mean reactive hyperemia index values after 1 year were 1.740.19.&#x0D; Conclusion. Despite the complete restoration of LVEF in patients with TS, clinical manifestations of CHF persist. Using the STE technique during the long term, 90% of patients had abnormalities in the global tissue deformity of the left ventricle. These changes may explain the CHF clinical manifestations and QoL decrease in patients with TS during long-term disease.

A novel and simple cardiac magnetic resonance score (PE2RT) predicts outcome in takotsubo syndrome

ObjectivesTo find simple imaging-based features on cardiac magnetic resonance (CMR) that are associated with major adverse cardiovascular events (MACE) in takotsubo syndrome (TTS).MethodsPatients with TTS referred for CMR between 2007 and 2021 were retrospectively evaluated. Besides standard CMR analysis, commonly known complications of TTS based on expert knowledge were assessed and summarised via a newly developed PE2RT score (one point each for pleural effusion, pericardial effusion, right ventricular involvement, and ventricular thrombus). Clinical follow-up data was reviewed up to three years after discharge. The relationship between PE2RT features and the occurrence of MACE (cardiovascular death or new hospitalisation due to acute myocardial injury, arrhythmia, or chronic heart failure) was examined using Cox regression analysis and Kaplan–Meier estimator.ResultsSeventy-nine patients (mean age, 68 ± 14 years; 72 women) with TTS were included. CMR was performed in a median of 4 days (IQR, 2–6) after symptom onset. Over a median follow-up of 13.3 months (IQR, 0.4–36.0), MACE occurred in 14/79 (18%) patients: re-hospitalisation due to acute symptoms (9/79, 11%) or chronic heart failure symptoms (4/79, 5%), and cardiac death (1/79, 1%). Patients with MACE had a higher PE2RT score (median [IQR], 2 [2–3] vs 1 [0–1]; p < 0.001). PE2RT score was associated with MACE on Cox regression analysis (hazard ratio per PE2RT feature, 2.44; 95%CI: 1.62–3.68; p < 0.001). Two or more PE2RT complications were strongly associated with the occurrence of MACE (log-rank p < 0.001).ConclusionsThe introduced PE2RT complication score might enable an easy-to-assess outcome evaluation of TTS patients by CMR.Key Points• Complications like pericardial effusion, pleural effusion, right ventricular involvement, and ventricular thrombus (summarised as PE2RT features) are relatively common in takotsubo syndrome.• The proposed PE2RT score (one point per complication) was associated with the occurrence of major adverse cardiac events on follow-up.• Complications easily detected by cardiac magnetic resonance imaging can help clinicians derive long-term prognostic information on patients with takotsubo syndrome.

Distribution of traditional Chinese medicine syndromes and syndrome elements of chronic heart failure based on network analysis and hierarchical cluster analysis

Objective: To explore the distributions of syndromes and syndrome elements of chronic heart failure (CHF), so as to provide a point of reference to the research on diagnosis and treatment of CHF, the study on syndrome standardization, and objective research of TCM diagnosis. Methods: The clinical research articles on CHF syndromes in recent 40 years were retrieved from Wanfang Data, CNKI, CqVIP, SinoMed, PubMed, Scopus, Web of Science, and Embase. The cumulative frequencies of CHF syndromes, syndrome elements, and their corresponding cases were counted and compared. The syndrome elements were analyzed by network analysis, and the symptoms were analyzed by hierarchical cluster analysis. Results: A total of 278 Chinese articles with 71 syndromes and 31 syndrome elements were included after two rounds of screening. The research on CHF syndrome has kept a regular activeness till now, but its development was geographically uneven. The distribution of CHF syndromes gained from the cumulative frequencies of syndromes appeared in the articles were in line with that gained from the cumulative frequencies of the cases corresponding to syndromes. The network analysis found four communities of syndrome elements, indicating the deficiency-excess in complexity of CHF pathology, which can be inferred as some common CHF syndromes. The hierarchical cluster analysis on CHF symptoms showed that the distribution of CHF syndromes included five types. Conclusion: The distribution of CHF syndromes includes syndrome of qi deficiency with blood stasis, syndrome of qi and yin deficiency, syndrome of yang deficiency with water retention, syndrome of heart blood stasis obstruction, syndrome of turbid phlegm, and syndrome of collapse due to primordial yang deficiency. The syndrome elements on location of illness are heart, kidney, lung, and spleen, and the syndrome elements on nature of illness are qi deficiency, blood stasis, yang deficiency, yin deficiency, water retention, and turbid phlegm.

Features of post-infarction chronic heart failure in patients with a new coronavirus infection COVID-19

Background. The coronavirus pandemic has caused a rapid increase in the number of cases and high deaths worldwide. A new coronavirus infection in the presence of an initial cardiac pathology can provoke decompensation of chronic heart failure.&#x0D; Aim. To study the clinical features of postinfarction chronic heart failure occurring against the background of a new coronavirus infection.&#x0D; Material and methods. The study included 80 patients with decompensated chronic heart failure. Three groups have been formed. In patients of the first group (n=40), who underwent inpatient treatment for a new coronavirus infection, the cause of chronic heart failure was a previous Q-myocardial infarction. In patients of the second group (n=20), who did not tolerate COVID-19 earlier and at the time of the current hospitalization, the cause of chronic heart failure was a previous Q-myocardial infarction. The third group (n=20) consisted of patients with chronic heart failure of ischemic etiology without postinfarction cardiosclerosis, not previously and at the time of examination infected with the SARS-Cov-2 virus. Statistical analysis was carried out using the IBM SPSS Statistics V26 program. The KolmogorovSmirnov, KruskalWallis, and Pearson 2 tests were used.&#x0D; Results. Symptoms of left and right ventricular heart failure were equally common in all groups. Patients of the studied groups had a history of paroxysmal and permanent forms of atrial fibrillation, while the latter variant was more common in patients of the first group with chronic heart failure with postinfarction cardiosclerosis and coronavirus infection. According to echocardiography, the most pronounced structural and functional changes in the myocardium were also found in patients of the first group with postinfarction heart failure and a new coronavirus infection. Thus, statistically significant differences related to the size of the left atrium, end diastolic volume and end systolic volume of the left ventricle, systolic pressure in the pulmonary artery. An increase in the end systolic volume of the left ventricle by 94.6% was registered in the first group compared with the third group of patients (p=0.001). Systolic pressure in the pulmonary artery in the first group was 14.2% higher than the normal values (p 0.001), while in patients of the second and third groups this indicator was within the normal range.&#x0D; Conclusion. In patients with postinfarction cardiosclerosis suffering from a new coronavirus infection, symptoms of chronic heart failure are more pronounced, characterized by a significant decrease in exercise tolerance; cardiac arrhythmias are more often recorded, and structural and functional changes in the myocardium are of a maladaptive nature.

Хирургическое лечение клапанного аортального стеноза в сочетании с узким корнем аорты. Место задней аортопластики у взрослых. Обзор потребности в этой операции, техник ее выполнения и нашего опыта

Aim: to describe the current state of the problem of surgical expansion of the aortic root during aortic valve replacement. Aortic valve replacement is a radical operation aimed at reducing the symptoms of chronic heart failure, reducing left ventricular overload, regressing its hypertrophy, and thereby increasing the quality and life expectancy of the patient. For the greatest success of the operation, the replacement should be made with the appropriate valve size suitable for the particular patient. Materials and methods. The latest literature data on the place of surgical expansion of the aortic root in the problem of treating aortic stenosis were studied. The own experience of these operations during the implantation of mechanical and biological prostheses in the aortic position in the practice of the cardiosurgical department of the Belgorod Regional Clinical Hospital is presented. Results. The study is devoted to the actual problem of choosing the right size of the prosthesis, the frequency of additional surgical procedures for its placement. Many studies have established an association between prosthesis-patient mismatch (PPM) and surgical outcome. The association of prosthesis-patient mismatch with long-term survival is inverse, although sometimes reported as ambiguous. We reviewed the literature and our experience with the surgical management of narrow aortic root situations to determine the incidence of PPM and the need for an additional surgical procedure of posterior aortoplasty to accommodate the appropriate size of the prosthesis. The results of modern meta-analyses, multicenter studies and limited series of operations presented in the literature are reviewed. The experience of the cardiosurgical department of the Belgorod Regional Clinical Hospital for the period 01.01.2015-30.04.2023 in aortic valve replacement with a small size of the aortic ring (17-20 mm) is presented. The study material consisted of 303 patients. As prosthesis-patient mismatch, we defined all cases of posterior aortoplasty with implantation of an appropriately sized aortic prosthesis. According to modern studies, the incidence of prosthesis-patient mismatch in aortic valve replacement without aortic root plasty is 11-33%. The frequency of posterior aortoplasty in adults is, according to different authors, 5-40%. Our experience has shown that the situation of PPM, which required aortic plasty, occurred in 14.8% of cases of implantation of stented biological prostheses, in 17.3% of cases of implantation of mechanical bicuspid prostheses. In general, on average, aortic plasty was performed in 15.8% of cases. Prosthetic-patient mismatch in aortic valve replacement occurs at a relatively constant rate. Posterior aortoplasty allows implanting the calculated size of the prosthesis and avoiding this problem. Conclusion. Surgery to patch the aortic root to accommodate an adequately sized prosthesis in the aortic position is required in 15-30% of patients with narrow aortic annulus. It allows you to get good hemodynamic results. The surgical risk of the operation is low.

Study Of The Functional State Of The Endothelium In Patients With Post-Infarction Cardiosclerosis Complicated With Chronic Heart Failure

One of the main factors determining the prognosis in patients with chronic heart failure (CHF) is endothelial dysfunction. The aim of the work was to determine the antithrombogenic and vasodilating activity of the vascular wall in patients with CHF. We examined 70 people, of whom 50 were the main group - patients with prior Q-myocardial infarction and 20 people - the comparison group. To determine the antithrombogenic properties of the vessel wall, we used a "cuff" test. The vasomotor function of the endothelium was studied in samples with reactive hyperemia (HR) and nitroglycerin (NTG). In patients with CHF, there is a decrease in the antithrombogenic and vasodilating activity of the vascular wall. In patients with IV FC CHF, with a long duration of symptoms of CHF, FW&lt;.

Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study.

Natriuretic peptide (NP) testing is recommended for patients presenting to primary care with symptoms of chronic heart failure (HF) to prioritise referral for diagnosis. To report NP test performance at European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guideline referral thresholds. Diagnostic accuracy study using linked primary and secondary care data (2004 to 2018). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NP testing for HF diagnosis was assessed. In total, 229 580 patients had an NP test and 21 102 (9.2%) were diagnosed with HF within 6 months. The ESC NT-proBNP threshold ≥125 pg/mL had a sensitivity of 94.6% (95% confidence interval [CI] = 94.2 to 95.0) and specificity of 50.0% (95% CI = 49.7 to 50.3), compared with sensitivity of 81.7% (95% CI = 81.0 to 82.3) and specificity of 80.3% (95% CI = 80.0 to 80.5) for the NICE NT-proBNP ≥400 pg/mL threshold. PPVs for an NT-proBNP test were 16.4% (95% CI = 16.1 to 16.6) and 30.0% (95% CI = 29.6 to 30.5) for ESC and NICE thresholds, respectively. For both guidelines, nearly all patients with an NT-proBNP level below the threshold did not have HF (NPV: ESC 98.9%, 95% CI = 98.8 to 99.0 and NICE 97.7%, 95% CI = 97.6 to 97.8). At the higher NICE chronic HF guideline NP thresholds, one in five cases are initially missed in primary care but the lower ESC thresholds require more diagnostic assessments. NP is a reliable 'rule-out' test at both cut-points. The optimal NP threshold will depend on the priorities and capacity of the healthcare system.

A case report of surgical treatment of amiodarone-induced thyrotoxicosis in a patient with multiple organ failure

Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.