The Effectiveness of Outpatient Treatment Under the Control of the Soluble ST2 Receptor Concentration in Patients With Heart Failure With Reduced Ejection Fraction After Acute Decompensation of Heart Failure

Aim    To study the effectiveness of a treatment based on monitoring the soluble ST2 receptor (sST2) concentration in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) after acute decompensated heart failure (ADHF).Material and methods    The study included 37 patients hospitalized for ADHF with LVEF ≤40% and sST2 concentration ≥37.8 ng/ml at the time of discharge from the hospital. Patients were randomized into two groups: a sST2 monitoring (sST2M) group (19 patients) and a standard therapy (ST) group (18 patients). The follow-up period was 12 months. At baseline, the groups practically did not differ by clinical, functional, laboratory, and instrumental characteristics. For the sST2M group, the goal was reducing the sST2 concentration by >30% of baseline or to <30 ng/ml.Results    Therapy in both groups was comparable both in doses and in frequency of administration of basic drugs. However, the diuretic therapy was more frequently adjusted in the sST2M group (3.0 [1.0; 4.0] vs. 1.0 [0; 3.0] adjustments per patient, p = 0.047), which required more visits to the clinic (7.0 [6.0; 9.0] vs. 6.0 [6.0; 6.0] visits per patient, p=0.024). In the sST2M group at 6 months, the sST2 concentration was decreased by 43.3% (p=0.001), and 13 patients (72.2%) achieved the goal. In the ST group, the sST2 concentration was decreased by 38.5% (p=0.001), and 11 patients (68.8%) reached the target values. After 12 months, the downward trend continued in both groups. In both groups, the NT-proBNP concentration decreased: in the sST2M group by 27.7% (p=0.014), and in the ST group by 31.9% (p = 0.006). By the 12th month, the decrease remained only in the sST2M group. Only the sST2M group had an increase in LVEF (+28.5%, p=0.003), a decrease in left ventricular end-systolic volume (LVESV) (-12.0%, p=0.017), and a decrease in left atrial volume (-13.4%, p=0.045); at 12 months, LVEF remained increased (26%, p=0.006), and LA volume remained decreased (-14.3%, p=0.028). Quality of life and results of 6-minute walk test (6MWT) improved in both groups. For 6 months of treatment, the sST2M group had a significantly lower incidence of composite endpoints (CEP, cardiovascular death and decompensation/hospitalization due to HF), 26.3% (5 events) of the sST2M group compared to the ST group, 83.3% (15 events) (p=0.029), primarily due to a lower incidence of decompensated HF. For 12 months of follow-up, the incidence of CEP in the ST group was 122.2% (22 events), and 47.4% (9 events) in the sST2M group (p=0.035).Conclusions    The tactics of sST2 monitoring used in the treatment of "high-risk" HFrEF patients (with high sST2 concentrations) is associated with increased LVEF, improved functional status of patients, a beneficial effect on LV remodeling, and decreased incidence of CEP.

[Difficulties in differential diagnosis of the AL- and ATTR-cardiac amyloidosis. Case report]

The article presents a clinical case describing a complex differential diagnosis of cardiac amyloidosis types and verification of the diagnosis of AL-amyloidosis.

[A clinical and economic analysis of the use of dapagliflozin in patients with chronic heart failure in the entire spectrum of left ventricular ejection fraction in the Russian Federation]

AIM

To estimate the cost-effectiveness of dapagliflozin across the range of ejection fraction in patients with heart failure (HF) in Russian Federation.

MATERIALS AND METHODS

Cost-effectiveness model was developed for estimate the use of dapagliflozin as part of standard therapy in patients with HF regardless of ejection fraction is unknown. The calculation of costs was carried out in a mathematical model adapted to the conditions of Russian healthcare system by using Russian costs inputs and patient population characteristics.

RESULTS

In the model, dapagliflozin therapy yielded a mean of 0.209 additional life-years compared with standard of care in 10 years horizon. The incremental cost of 1 additional life-year was 665,715 RUB, which does not exceed the threshold of willingness to pay 2,235,202 RUB.

CONCLUSION

Thus, the intensification of chronic HF therapy with dapagliflozin is cost effective. The use of dapagliflozin in a cohort of 1000 target patients over 10 years will avoid 146 hospitalizations and 39 emergency visits due to HF, as well as prevent 32 deaths from cardiovascular diseases.

[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.

[Sacubitril/valsartan in patients with mildly reduced or preserved ejection fraction and worsening heart failure: A review]

Heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction are associated with significant morbidity and mortality, as well as growing economic burden. This review describes recent studies on the use of sacubitril/valsartan in heart failure patients with mildly reduced or preserved ejection fraction.

[Possibilities of instrumental determination of volemic status in patients with acute decompensation of chronic heart failure]

AIM

To evaluate and compare the accuracy of volemic status determination by remote dielectric sensing with computed tomography (CT) in patients with acute decompensated heart failure.

MATERIALS AND METHODS

In 28 patients volemic status was determined by ReDS (remote dielectric sensing), chest computed tomography (CCT), and chest X-ray twice during hospitalization (the day of admission and the day of discharge from the hospital). The ReDS measurements were then compared with CT data using software that allows the use of semi-automated tools to determine mean lung density (MLD). MLD results from Hounsfield Units [HU] were then converted to fluid levels (FU%), allowing them to be compared with ReDS values. In addition, to assess the effect of physical activity on the dynamics of pulmonary stasis there was performed 6-minute walk test (6MWT) followed by determination of volumic status by ReDS method.

RESULTS

Correlation analysis revealed an average direct significant correlation (r=+0,5; p=0.001) between the CCT and ReDS data. Hypervolemia indexes according to the CCT revealed statistically significant decrease in the dynamics, which was also reflected in the ReDS index decrease. Lung fluid content according to ReDS averaged 38.2±4.6% on admission, and 34.5±3.9% on discharge (p=0.005). According to CT scan of the CCT, MLD at admission was 23.03±3.9%, at discharge 19.6±3.3% (p=0.003). The positive dynamics of the study methods was also reflected in the positive dynamics of NT-proBNP, which decreased by 46%. In the analysis of ReDS data before and after exercise, there was an increase in ReDS value after the performed 6MWT and it was 35.09±3.9% compared with the initial value of 34.5±3.9%. A strong direct significant correlation (r=+0.7; p=0.0001) was found between the ReDS before and after 6MWT at discharge.

[Effect of dapagliflozin on the dynamics of magnetic resonance imaging in patients with heart failure and atrial fibrillation]

AIM

To determine the effect of dapagliflozin therapy on myocardial remodeling and fibrosis according to magnetic resonance imaging (MRI) with contrast in patients with chronic heart failure (CHF) and atrial fibrillation (AF).

MATERIALS AND METHODS

In the group of 22 patients with a combination of CHF and AF we analyzed the dynamics of remodeling parameters and assessed myocardial fibrosis during 6-month therapy with dapagliflozin according to cardiac MRI with contrast.

RESULTS

  After 6 months of dapagliflozin therapy there was a statistically significant increase in LVEF (27 [23-32]-32 [26.5-36.5] p-0.04) and a tendency to decrease volume and linear dimensions of LV, LP. There was no progression of myocardial fibrosis according to the results of cardiac MRI with contrast in patients with HFrFV and AF.

CONCLUSIONS

Dapagliflozin therapy in patients with HFrEF and AF led to favorable myocardial remodeling changes.

Heart failure as a complication of myocardial infarction: rational therapy. Case report

Heart failure (HF) is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development and early initiation of guideline-directed HF therapy in these patients, can decrease the HF burden. This article aims at summarizing clinical data on established pharmacological therapies in treating post-MI patients with left ventricular systolic dysfunction and signs and symptoms of HF.

The effectiveness of cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: results of the 12-month follow-up

Aim. To evaluate the efficacy, safety and effect on the prognosis of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and atrial fibrillation compared with the group of only optimal drug therapy (ODT) of the 12-month follow-up. Materials and methods. Patients (n=200) were sequentially included in two groups: group 1 patients with CHF who are on ODT in combination with implanted CCM devices (n=100), group 2 comparison patients with CHF who receive only ODT (n=100). Initially and after 12 months, 12-channel electrocardiography (ECG), transthoracic echocardiography, daily ECG-monitoring, determination of the level of NT-proBNP, a six-minute walk test and an assessment of the quality of life according to the Minnesota Questionnaire were performed. Results. In the CCM therapy group, a significant clinical improvement was revealed, which was expressed in the form of a decrease in functional class CHF by NYHA (New York Heart Association), an increase in the distance of a six-minute walk test and an improvement in the quality of life according to Minnesota Questionnaire, as well as an improvement in left ventricle contractile function compared to the ODT group. The absence of a proarrhythmogenic effect of the CCM was shown. There was a significant decrease in the frequency of the readmission due to CHF and the probability of achieving the combined endpoint in the CCM therapy group compared with only ODT. Conclusion. The use of CCM in patients with CHF and atrial fibrillation is an effective and safe method of therapy that leads to the development of reverse remodeling of the myocardium, improves the clinical status of patients and reduces the frequency of readmission due to decompensation of CHF.

Acute decompensation of heart failure: state of the problem

Are presented the key aspects of the management of patients with acute decompensation of heart failure leading to improved clinical outcomes. Are described the existing problems and possible solutions.

[Heart failure and obesity]

Obesity is an independent predictor of cardiovascular diseases (CVD), including heart failure (HF). Nevertheless, numerous studies have shown that patients with CVD who are overweight and slightly obese have a better short-term and moderate prognosis than thinner patients with CVD. This phenomenon has been called the obesity paradox. Understanding the obesity paradox is important in patients with HF, given the high prevalence of obesity in patients with HF. The article presents an overview of clinical studies devoted to the study of obesity as a risk factor for HF, the pathogenesis of HF in obesity, and highlights the issues of the obesity paradox and the treatment of obesity in this category of patients.

Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction

BACKGROUND

Sodium-glucose cotransporter 2 (SGLT2) inhibitors reduce the risk of hospitalization for heart failure and cardiovascular death among patients with chronic heart failure and a left ventricular ejection fraction of 40% or less. Whether SGLT2 inhibitors are effective in patients with a higher left ventricular ejection fraction remains less certain.

METHODS

We randomly assigned 6263 patients with heart failure and a left ventricular ejection fraction of more than 40% to receive dapagliflozin (at a dose of 10 mg once daily) or matching placebo, in addition to usual therapy. The primary outcome was a composite of worsening heart failure (which was defined as either an unplanned hospitalization for heart failure or an urgent visit for heart failure) or cardiovascular death, as assessed in a time-to-event analysis.

RESULTS

Over a median of 2.3 years, the primary outcome occurred in 512 of 3131 patients (16.4%) in the dapagliflozin group and in 610 of 3132 patients (19.5%) in the placebo group (hazard ratio, 0.82; 95% confidence interval [CI], 0.73 to 0.92; P<0.001). Worsening heart failure occurred in 368 patients (11.8%) in the dapagliflozin group and in 455 patients (14.5%) in the placebo group (hazard ratio, 0.79; 95% CI, 0.69 to 0.91); cardiovascular death occurred in 231 patients (7.4%) and 261 patients (8.3%), respectively (hazard ratio, 0.88; 95% CI, 0.74 to 1.05). Total events and symptom burden were lower in the dapagliflozin group than in the placebo group. Results were similar among patients with a left ventricular ejection fraction of 60% or more and those with a left ventricular ejection fraction of less than 60%, and results were similar in prespecified subgroups, including patients with or without diabetes. The incidence of adverse events was similar in the two groups.

CONCLUSIONS

Dapagliflozin reduced the combined risk of worsening heart failure or cardiovascular death among patients with heart failure and a mildly reduced or preserved ejection fraction. (Funded by AstraZeneca; DELIVER ClinicalTrials.gov number, NCT03619213.).

SGLT2 inhibitors in acute decompensated heart failure, what do we know?

The current worldwide prevalence of heart failure is growing, while its combination with cardiovascular and other conditions determines a poor prognosis in these patients. Furthermore, acute decompensated heart failure is associated with a low survival rate mostly caused by target organ damage. The effects of early administration of SGLT2 inhibitors on renal function in patients with acute decompensated heart failure are being studied to determine the possibility of improving response to treatment, as well as partial or complete recovery of renal function. The goal of the review was to synthesize currently available evidence for the use of SGLT2 inhibitors in patients with acute decompensated heart failure. A systematic search for studies published from 2018 to 2021 and their analysis was carried out in the following databases: Web of Science, Scopus, PubMed/MEDLINE.

Practical guidelines for the diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis)

This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.

Predictive value of <i>QRS</i> complex duration in patients with chronic heart failure and atrial fibrillation: retrospective study

Aim. To study of the features of the clinical course and prognosis in patients with chronic heart failure with low ejection fraction (HFrEF) and atrial fibrillation (AF) depending on the width of the QRS complex. Materials and methods. We studied the case histories of 514 patients (aged 60.213.84 years, 78% men) with HFrEF, hospitalized at the Chazov National Medical Research Center of Cardiology (Moscow) for the period from Jan 1, 2017 to Dec 31, 2018. Patients were divided into 2 groups depending on the duration of the QRS complex. Results. Clinical and statistical retrospective analysis of the medical histories of patients with HFrEF, depending on the QRS duration, showed the predominance of patients with a QRS complex size of less than 130 ms (60.7%). In HFrEF, the expansion of the QRS complex is accompanied by an increase in the rate of readmission in patients with sinus rhythm (p=0.004). In patients with AF, the rehospitalization rate is significantly higher than in sinus rhythm and does not depend on the QRS duration (p=0.001). The incidence of unfavorable outcomes increases in connection with the addition of AF, which is most likely a more significant risk factor than QRS width. Conclusion. These results highlight that patients with AF and a narrow QRS complex have the same poor prognosis as those with a wide QRS complex and require the close attention of cardiologists.

Myocardial scintigraphy with ^99mTc-pyrophosphate in the diagnosis of cardiac amyloidosis: place in the diagnostic algorithm, features of the implementation and interpretation of the study

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.

The possibilities of improving the treatment of chronic heart failure according to the results of a multicenter observational study BYHEART

Aim. To study the efficacy and safety of exogenous phosphocreatine (EF) in patients with chronic heart failure (CHF). Materials and methods. The all-Russian prospective observational study BYHEART included 842 patients who were treated with EF. Before and after the course of EF therapy, the following studies were conducted: a questionnaire on the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and a clinical condition assessment scale (SHOCK), transthoracic echocardiography with an assessment of the left ventricular ejection fraction, a 6-minute walk test, determination of the level of pro-natriuretic N-terminal peptide (NT-proBNP), glomerular filtration rate. All patients before the course of EF received long-term optimal drug therapy of CHF. Results. Statistical analysis was carried out in the general group of patients (n=842), as well as in groups of patients A (n=418, the course of treatment of EF is less than 20 g /course) and group B (n=424, the course of treatment of EF is greater than or equal to 20 g/course). The results obtained demonstrate a positive effect of the use of the course of therapy of EF in patients with CHF on the quality of life (QOL), reverse left ventricular remodeling, functional class of CHF, as well as the concentration of NT-pro-BNP, especially in the group of patients who received more than 20 grams of the medication. Conclusion. The use of EF is a promising pharmacological method of treatment in addition to optimal drug therapy in patients with CHF.

Empagliflozin and heart failure: position paper of the experts on the results of the online meeting and discussion of the EMPEROR-Preserved Trial

At an international online expert meeting held on September 16, 2021, the results of the empagliflozin research program EMPA-REG Outcome, EMPEROR-Reduced and EMPEROR-Preserved were reviewed. We analyzed cardiovascular and renal outcomes during the treatment with empagliflozin in patients with chronic heart failure, regardless of the presence of type 2 diabetes mellitus. The positive results of the EMPEROR-Preserved study are updated and their significance for clinical practice is discussed. Several proposals have been adopted that will accelerate the introduction of empagliflozin therapy into practice in patients with heart failure and overcome clinical inertia.

Myocardial remodeling in patients with chronic heart failure and implanted cardiac contractility modulators

Aim. To study the effect of cardiac contractility modulation on reverse remodeling and myocardial function in patients with chronic heart failure (HF) according to echocardiography (EchoCG). Materials and methods. In a group of 40 patients with a combination of chronic HF and atrial fibrillation (AF), the dynamics of standard EchoCG parameters and the effectiveness of myocardial work of the left ventricle (LV) against the background of 12-month therapy of cardiac contractility modulation (CCM) were analyzed. Results. The results obtained indicate a statistically significant positive effect of CCM on LV remodeling parameters and the effectiveness of myocardial work according to EchoCG. Conclusion. Transthoracic echocardiography is the main imaging method and provides great opportunities for evaluating the effectiveness of HF treatment, including non-drug methods such as CCM. Evaluation of LV myocardial function in patients with HF and implanted CCM devices is a promising scientific and practical research method.

Acute decompensated heart failure. What has changed in the clinical guidelines in 2021?

In September 2021, the European Society of Cardiology issued new guidelines on the management of patients with heart failure (HF). In the current version, experts have focused on the 4 most common variants: acute HF decompensation, acute pulmonary edema, cardiogenic shock, and isolated right ventricular failure. There has been a change in approaches to the initial management of patients with acute HF decompensation towards a decrease in the evidence-based use of peripheral vasodilators and a "return" to loop diuretics as the basis of treatment. This raises the question of monitoring the efficacy of diuretic therapy. The paper presents an algorithm proposed by the European Society of Cardiology.

Rational drug therapy of chronic heart failure: the role of mineralocorticoid receptor antagonists: review

Mineralocorticoid receptor antagonists (MRAs) are part of basic medical therapy for heart failure. The clinical efficacy of MRAs has been proven by randomized clinical trials. To review comparative efficacy and tolerability data between the two main MRAs, spironolactone and eplerenone, in patients with systolic heart failure.

Chronic heart failure – modification of treatment paradigm

The relevance of chronic heart failure (CHF) remains high. Despite significant advances in basic therapy for CHF patients, the prognosis remains poor. The prescription of inhibitors of sodium-glucose cotransporter type 2 dapagliflozin made it possible to change the paradigm of treatment of patients with CHF with low left ventricular ejection fraction.

ACTIV SARS-CoV-2 registry (Analysis of Chronic Non-infectious Diseases Dynamics After COVID-19 Infection in Adult Patients). Assessment of impact of combined original comorbid diseases in patients with COVID-19 on the prognosis

Aim. Study the impact of various combinations of comorbid original diseases in patients infected with COVID-19 later on the disease progression and outcomes of the new coronavirus infection. Materials and methods. The ACTIV registry was created on the Eurasian Association of Therapists initiative. 5,808 patients have been included in the registry: men and women with COVID-19 treated at hospital or at home. ClinicalTrials.gov ID NCT04492384. Results. Most patients with COVID-19 have original comorbid diseases (oCDs). Polymorbidity assessed by way of simple counting of oCDs is an independent factor in negative outcomes of COVID-19. Search for most frequent combinations of 2, 3 and 4 oCDs has revealed absolute domination of cardiovascular diseases (all possible variants). The most unfavorable combination of 2 oCDs includes atrial hypertension (AH) and chronic heart failure (CHF). The most unfavorable combination of 3 oCDs includes AH, coronary heart disease (CHD) and CHF; the worst combination of 4 oCDs includes AH, CHD, CHF and diabetes mellitus. Such combinations increased the risk of lethal outcomes 3.963, 4.082 and 4.215 times respectively. Conclusion. Polymorbidity determined by way of simple counting of diseases may be estimated as a factor in the lethal outcome risk in the acute phase of COVID-19 in real practice. Most frequent combinations of 2, 3 and 4 diseases in patients with COVID-19 primarily include cardiovascular diseases (AH, CHD and CHF), diabetes mellitus and obesity. Combinations of such diseases increase the COVID-19 lethal outcome risk.

[Evaluation of the effectiveness of the chronic heart failure therapy using the device cardiac contractility modulation according to the new non-invasive method of the myocardium work analysis]

Aim      To analyze echocardiographic parameters that reflect left ventricular (LV) myocardial contractility, using a novel method for evaluation of myocardial performance in patients with chronic heart failure (CHF) and atrial fibrillation (AF) during heart contractility modulation (HCM).Material and methods  Standard echocardiographic parameters and indexes of myocardial strain and work were analyzed for 66 patients (52 men and 14 women; median age, 60 [54; 66] years). 36 patients had paroxysmal AF and 30 patients had permanent AF. All patients had CHF with a duration of 17 [4; 60] months; duration of AF was 12 [6; 36] months. At baseline, the left ventricular ejection fraction (LV EF) was 33 [27; 37] %.Results After one year of HCM, LV EF significantly increased from 33 [27; 37] to 38 [33; 44] % (р=0.001). Also, there were improvements in the myocardial global longitudinal strain (from -6.00 [ - 8; - 4] to -8 [ - 10; - 6] %; р=0.001) and parameters of myocardial work, including the global work efficiency (from 74 [65; 79] to 80 [73; 87] mm Hg%; р=0.001), global constructive work (from 699 [516; 940] to 882 [714; 1242] mm Hg%; р=0.001), and global myocardial work index (from 460 [339; 723] to 668 [497; 943] mm Hg%; р=0.001). A segmentary analysis of LV work parameters showed positive changes in the myocardial constructive work in the area of the interventricular septal apical segment (at baseline, 844 [614; 1224]; after HCM, 1027 [800; 1520] mm Hg%; р=0.05) and the medium segment of the LV anteroseptal wall (at baseline, 593 [312; 1000]; after HCM, 877 [494; 1145] mm Hg%; р=0.05).Conclusion      This method for analysis of the myocardial work provides a more detailed examination of LV structural and functional remodeling and mechanisms for its effects on the LV contractile function in patients with CHF. This method is promising and merits further study in various clinical situations.

Analysis of influence of background therapy for comorbidities in the period before infection on the risk of the lethal COVID outcome. Data from the international ACTIV SARS-CoV-2 registry («Analysis of chronic non-infectious diseases dynamics after COVID-19 infection in adult patients SARS-CoV-2»)

Aim      To study the effect of regular drug therapy for cardiovascular and other diseases preceding the COVID-19 infection on severity and outcome of COVID-19 based on data of the ACTIVE (Analysis of dynamics of Comorbidities in paTIents who surVived SARS-CoV-2 infEction) registry.Material and methods  The ACTIVE registry was created at the initiative of the Eurasian Association of Therapists. The registry includes 5 808 male and female patients diagnosed with COVID-19 treated in a hospital or at home with a due protection of patients' privacy (data of nasal and throat smears; antibody titer; typical CT imaging features). The register territory included 7 countries: the Russian Federation, the Republic of Armenia, the Republic of Belarus, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Moldova, and the Republic of Uzbekistan. The registry design: a closed, multicenter registry with two nonoverlapping arms (outpatient arm and in-patient arm). The registry scheduled 6 visits, 3 in-person visits during the acute period and 3 virtual visits (telephone calls) at 3, 6, and 12 mos. Patient enrollment started on June 29, 2020 and was completed on October 29, 2020. The registry completion is scheduled for October 29, 2022. The registry ID: ClinicalTrials.gov: NCT04492384. In this fragment of the study of registry data, the work group analyzed the effect of therapy for comorbidities at baseline on severity and outcomes of the novel coronavirus infection. The study population included only the patients who took their medicines on a regular basis while the comparison population consisted of noncompliant patients (irregular drug intake or not taking drugs at all despite indications for the treatment).Results The analysis of the ACTIVE registry database included 5808 patients. The vast majority of patients with COVID-19 had comorbidities with prevalence of cardiovascular diseases. Medicines used for the treatment of COVID-19 comorbidities influenced the course of the infectious disease in different ways. A lower risk of fatal outcome was associated with the statin treatment in patients with ischemic heart disease (IHD); with angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor antagonists and with beta-blockers in patients with IHD, arterial hypertension, chronic heart failure (CHF), and atrial fibrillation; with oral anticoagulants (OAC), primarily direct OAC, clopidogrel/prasugrel/ticagrelor in patients with IHD; with oral antihyperglycemic therapy in patients with type 2 diabetes mellitus (DM); and with long-acting insulins in patients with type 1 DM. A higher risk of fatal outcome was associated with the spironolactone treatment in patients with CHF and with inhaled corticosteroids (iCS) in patients with chronic obstructive pulmonary disease (COPD).Conclusion      In the epoch of COVID-19 pandemic, a lower risk of severe course of the coronavirus infection was observed for patients with chronic noninfectious comorbidities highly compliant with the base treatment of the comorbidity.

Dynamics of Holter electrocardiogram monitoring in patients with chronic heart failure and atrial fibrillation on the background of cardiac contractility modulation

Aim. To evaluate the dynamics of cardiac arrhythmias on the background of cardiac contractility modulation (MCC) in patients with chronic heart failure (CHF) and various forms of atrial fibrillation (AF) on the basis of daily electrocardiogram (ECG) monitoring. Materials and methods. In 100 patients with CHF and AF, the following studies were performed before implantation of the MCC device and after 12 months of follow-up: 12-channel ECG with an estimate of the width of the QRS complex, transthoracic echocardiography (EchoCG), and Holter ECG monitoring. All patients received long-term optimal drug therapy for CHF before surgery. Results. The results obtained indicate that there is no effect of MCC on the development and progression of ventricular arrhythmias in patients with CHF and AF during the year of follow-up, both extrasystole and tachyarrhythmias, regardless of the etiology and LVEF (less than 35% or more than 35%), and a decrease in the frequency of AF paroxysms in patients with CHF during treatment. These results are due to the reverse remodeling of the LV myocardium under the influence of the MCC device. Conclusion. The use of MСС in patients with CHF and AF is a safe method of therapy that does not induce cardiac arrhythmias, including ventricular extrasystole. Large-scale comparative studies are required to evaluate these results.

Prognostic impact of uric acid in patients with acute decompensated heart failure

Aim. To evaluate the prognostic impact of serum uric acid (SUA) on clinical outcomes in patients with acute decompensated heart failure, as well as identify the correlation between hyperuricemia and renal function and diuretic resistance in these patients. Materials and methods. The study included 175 patients (125 men and 50 women) with NYHA class IIIV acute decompensated heart failure. Median age was 64 (5675) years. The Information regarding the survival was obtained 3 years after the admission by telephone calls. Results. 57 patients reached the end point (death from all causes); therefore, all patients were divided into groups: "alive", "dead". The SUA levels did not differ in the groups. The only significant difference in the studied parameters was the estimated glomerular filtration rate (eGFR), which was significantly higher in the "alive" group [70.5 (52.894) and 56 (4079), respectively; p=0.006]. A moderate negative correlation was found between SUA levels and eGFR in the correlation analysis (r=-0.313, p0.001). A comparative analysis showed, that SUA level on admission was significantly higher in patients who subsequently received increased doses of diuretics than in patients with a satisfactory response to standard doses of diuretics [567.8 (479.6791.9) and 512 (422.4619.4), respectively; p=0.011]. Also, higher eGFR level on admission was observed in patients from the normal SUA level group than in patients from the hyperuricemia group [94 (74.5101.5) and 63 (48.881.3), respectively; p=0.002]. Conclusion. We found no significant differences in the uric acid level in patients who reached the end point and those who did not reach it during the three-year follow-up. However, the found correlation between uric acid levels and diuretic resistance calls for further research.

[Remote monitoring of patients with heart failure in real clinical practice]

Prevalence of chronic heart failure (CHF) is continuously growing and is associated with increased incidence of hospitalizations, morbidity and mortality. Furthermore, the increase in the number of rehospitalizations results in greater expenses and worsening of quality of life. In order to decrease the number of unscheduled hospitalizations and the death rate, the outpatient care should be improved, which can be achieved by using telemedical technologies. The aim of this review was collection and analysis of currently available information about the use of telemonitoring for patients with CHF. A systematic search and analysis of reports published from 2010 through 2020 in Web of Science, Scopus, and PubMed/MEDLINE databases was performed.

[Left ventricular global function index as a predictor of adverse cardiovascular events in patients with acute coronary syndrome]

Aim      To evaluate the prognostic significance of the left ventricular global function index (LV GFI) in patients with acute coronary syndrome (ACS) using echocardiography (EchoCG).Material and methods             The LV GFI is an index that integrates LV cavity volumes, stroke volume, and myocardial volume. This study included 2169 patients with ACS (1340 (61.8%) men) aged 64.1±12.6 years from two observational multicenter studies, ORACLE I and ORACLE II. 1800 (83 %) cases were associated with increased concentrations of myocardial injury markers, including 826 (38.1 %) cases of ST segment elevation myocardial infarction (MI). The observation was started on the 10th day of clinical condition stabilization and lasted for one year. EchoCG was performed with evaluation of LV GFI, which was calculated as a ratio of LV stroke volume to LV global volume. The LV global volume was calculated as a sum of mean LV cavity volume (LV end-diastolic volume + LV end-systolic volume / 2) and LV myocardial volume.Results The main outcome of the study was all-cause death (n=193); recurrent coronary complications (n=253) were analyzed separately. The only EchoCG parameter indicating an adverse outcome during the one-year follow-up was a LV GFI decrease to below 22.6 % with a sensitivity of 72 % and a specificity of 60% (area under the curve, AUC=0.63). A LV GFI &lt;22.6 % was an independent predictor of all-cause death (p=0.019) along with age (p=0.0001), history of MI (p=0.034), and presence of heart failure (HF) (p=0.044), diabetes mellitus (p=0.012), and peripheral atherosclerosis (p=0.001). The LV GFI &lt;22.6 %, (p=0.044), heart rate upon discharge from the hospital (p=0.050), history of MI (p=0.006), presence of HF (p=0.014), and peripheral atherosclerosis (p=0.001) were also independent predictors for recurrent coronary complications. Decreased LV GFI was associated with the risk of fatal outcomes independent of the LV ejection fraction at baseline.Conclusion      In patients with ACS, the left ventricular global function index is an independent predictor for all-cause death and recurrent coronary complications and may be used for risk stratification.

[Modulation of cardiac contractility in patients with chronic heart failure and atrial fibrillation]

AIM

to evaluate the effectiveness of cardiac contractility modulation (MSS) in patients with chronic heart failure (CHF) and atrial fibrillation (AF).

MATERIALS AND METHODS

The following studies were performed in 40 patients with CHF and AF before implantation of the MSS device and after 2 and 6 months of follow-up: 12-channel ECG, transthoracic EchoCG, 6-minute walk test, determination of the level of Pro-natriuretic N-terminal peptide (NT-proBNP), daily ECG monitoring, and a questionnaire based on the Minnesota quality of life questionnaire for patients with CHF (MHFLQ). All patients received long-term optimal drug therapy for CHF before surgery.

RESULTS

The results obtained indicate a statistically significant positive effect of the use of MSS in patients with CHF and AF on LV FV, the functional class of CHF, and levels of NT-proBNP regardless of the etiology of CHF.

CONCLUSION

The use of MSS may be promising for the treatment of heart failure in patients with CHF and AF.

[Changes in the management of patients with acute coronary syndrome - have the disease outcomes changed?]

Aim        To analyze results of changing the management tactics in patients with acute coronary syndrome (ACS) in clinical practice from 2004 through 2018 expressed as improvement in prognosis.Material and methods        Results of two observational studies were analyzed: ORACLE I (2004-2007), which included 1193 patients with ACS (mean age, 61.1±11.69 years; men, 63.3 %) and ORACLE II (2014-2017), which included 1652 patients from 4 vascular centers (mean age, 64.61±12.67 years; men, 62.3 %).Results   Patients included into the ORACLE II study in 2014 were significantly older and the proportion of patients with diabetes mellitus was greater than in the ORACLE I study (14.7 and 22.6 %, respectively). After matching the groups by major clinical characteristics, it was found that introducing the invasive management tactics for ACS patients was associated with a reduced rate of all-cause death (from 8.2 to 6.1 % for one year), a tendency towards decreased number of coronary death cases (from 5.6 to 4.0 %), and a decrease in risk of recurrent coronary complications (from 17.4  to 7.7 %).Conclusion            Implementing the vascular program statistically significantly decreased the total death rate for at least one-year observation in comparable patient groups.

[Use of Statins, Anticoagulants, Antiaggregants and Antiarrhythmic Drugs in Patients With COVID-19. The Agreed Experts' Position of Russian Society of Cardiology, Eurasian Association of Therapists, National Society on Atherothrombosis, Societies of Experts in Urgent Cardiology, Eurasian Arrhythmology Association]

This article discusses relevant aspects in the treatment of patients with COVID-19. Up-to-date information about principles for administration of statins, antithrombotics, and antiarrhythmics is presented. The authors addressed in detail specific features of reversing heart rhythm disorders in patients with coronavirus infection and the interaction of antiarrhythmic and antiviral drugs. Recommendations are provided for outpatient and inpatient antithrombotic therapy for patients with COVID-19. Issues of antithrombotic and antiviral drug interaction are discussed.

[The effect of angiotensin receptors and neprilysin inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation]

AIM

To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation.

MATERIALS AND METHODS

We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation.

RESULTS

Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP.

CONCLUSION

The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.

[Full - transcriptome analysis of miRNA expression in mononuclear cells in patients with acute decompensation of chronic heart failure of various etiologies]

It is known that micro RNAs are an important regulatory element in the pathogenesis of many diseases, including cardiovascular diseases. Different levels of expression of these molecules in various pathologies makes miRNA a potential diagnostic and prognostic biomarker.

AIM

Analysis of miRNA expression levels in mononuclear blood cells (MBC) of patients with acute decompensation f chronic heart failure (CHF) of various etiologies and evaluation of the possibility of their use as a biological marker.

MATERIALS AND METHODS

7 male patients with acute decompensation of CHF with a reduced ejection fraction (EF), NYHA functional class II-IV (FC) according to NYHA [mean (M) EF 29.2%, standard deviation (SD) 13.27%] in age 38 to 65 years old [median (Me) 58 years]. In 3 patients, heart failure developed as a result of dilated cardiomyopathy (DCMP), in 4 patients - against the background of post - infarction cardiosclerosis of the ischemic nature [group of patients with coronary heart disease (CHD)]. The control group - 5 age - matched (from 41 to 57 years old, Me 49 years old) healthy male volunteers. A complete transcript analysis of miRNA expression in MNCs was performed for all patients and healthy volunteers.

RESULTS

Differentially expressed miRNAs were determined in patients with CHF (regardless of etiology) compared with healthy individuals: miR-182, miR-144, miR-183, miR-486-5p, miR-143 (log2FC >1, FDR p - value.

Early diagnosis of acute renal injury in patients with acute decompensation of chronic heart failure

AIM

To study the possibilities of previously diagnosing acute renal damage in patients with acute decompensation of chronic heart failure with reduced systolic function using biomarkers of acute renal injury.

MATERIALS AND METHODS

The study included 60 patients (62.0±11.1 years) with HADS (BNP &gt;500 pg/ml) and a reduced left ventricular ejection fraction (LV 27.05% [23.25; 32.75], c FC III-IV NYHA). The level of creatinine, urea, uric acid, albumin in serum was determined in all patients, as well as a number of biomarkers: lipocalin associated with neutrophil gelatinase (NGAL) and cystatin C (CysC) in serum; kidney damage molecule-1 (KIM-1) and angiotensinogen (AGT) in the urine.

RESULTS

AKI is determined based on changes in serum creatinine concentration or diuresis value. The results obtained indicate a high specificity and sensitivity of the use of biomarkers for the diagnosis of AKI in patients with ADHF. NGAL AUC - 0.833 (p&lt;0.001), Se - 82.8%, Sp - 4.2%. CysC AUC - 0.823 (p&lt;0.001), Se - 79.3%, Sp - 74.2%. KIM-1 AUC - 0.782 (p&lt;0.001), Se - 75.9%, Sp - 74.2%. AGT AUC - 0.829 (p&lt;0.001), Se - 82.8%, Sp - 77.4%. In a multifactorial regression analysis, it was found that with NGAL greater than 157.35 ng/ml, the risk of AKI increases 13.1 times (95% CI 1.365-126.431), with an increase in KIM-1, the risk of the development of AKI increases 20.6 times (95% CI 1.802-235.524), and with an increase in AGT more than 14.31 leng/ml, the risk of AKI increases 32.8 times (95% CI 2.752-390.110).

CONCLUSION

Acute kidney injury develops in 48.3% of patients hospitalized with acute decompensation of chronic heart failure. Patients with acute decompensation of chronic heart failure and AKI have significantly higher serum NGAL and CysC, KIM-1 and AGT values in the urine compared with patients without impairing renal function. These biomarkers can serve both for the early diagnosis of acute kidney damage and the prediction of AKI in patients with acute decompensation of chronic heart failure.

[Neutrophil gelatinase-associated lipocalin for early diagnosis of acute kidney injury in patients with acute decompensated heart failure]

BACKGROUND

the incidence of acute kidney injury (AKI) is high in patients with acute decompensated heart failure (ADHF) and is linked with increased morbidity and mortality rates. Predictive biomarkers of AKI could allow improve outcomes in AKI.

PURPOSE

to evaluate the value of serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations for early diagnosis of AKI in patients with ADHF with left ventricular (LV) systolic function.

METHODS

we enrolled 60 men (average age was 62.0±11.1 years) hospitalized with ADHF with reduced LV systolic function (LV ejection fraction (LVEF).

Possibilities and perspectives of using cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation

Heart failure is one of the main health care problems all over the world. Although, there are many drugs with proven effectiveness and hi-tech devices, there is a continuous process of searching new possibilities in heart failure prophylaxis going on because of huge economic burden and impact on life quality. Developing of atrial fibrillation in heart failure patients increases the risks of hospitalization and all-cause mortality. Appearance of new Optimizer Smart® system of cardiac contractility modulation is a perspective way of treatment in patients with heart failure and atrial fibrillation, who are not a candidate or have not got a good result from cardiac resynchronization therapy (CRT).

Multimarker Approach in Risk Stratification of Patients with Decompensated Heart Failure

PURPOSE

to study prognostic value of various biomarkers and their combinations in patients who survived decompensation of chronic heart failure.

MATERIALS AND METHODS

Patients (n=159) who were hospitalized with diagnosis of heart failure (HF) decompensation were included in a prospective single-center study. Examination on admission and the day of hospital discharge, included measurement of concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), copeptin, soluble suppression of tumorigenicity 2 (sST2), kopetin, neutrophil gelatinase-associated lipocalin (NGAL), and galectin-3. Te combined primary endpoint comprised cardiovascular (CV) death, frst hospitalization because of HF heart failure decompensation, episodes of HF deterioration which required additional i/v diuretics, and CV death with successful resuscitation.

RESULTS

During one-year follow-up 56 pts (35.2%) reached the combined primary endpoint. Tere were 78 (49.1%) cardiovascular events. During hospitalization, patients with the decompensation of heart failure experienced a decrease of sST2, NT-proBNP, galectin-3, kopetin, hsTnT and an insignifcant increase of NGAL. ROC analysis identifed signifcant relation between concentrations of NT-proBNP, sST2, copeptin and, to a lesser degree, hsTnT, determined at hospital discharge, and risk of combined primary endpoint during 1-year follow-up: area under the curve (AUC) was 0.733 [95% CI 0.645-0.820], p&lt;0.0001, 0.772 [95% CI 0.688-0.856], p&lt;0.0001, 0.735 [95% CI 0.640-0.830], p&lt;0.0001, and 0.659 [95% CI 0.553-0.764], p=0.005, respectively. Patients who during hospitalization did not achieve cut-off values of NT-proBNP ≤1696 rg/ml, sST2≤37.8 hg/ml, copeptin≤28.31 rmol/L and hsTnT≤28.37 rg/ml, had higher risk of reaching adverse events during 1 year; OR and 95% CI were 2.96 [1.61, 5.42] p&lt;0.0001, 4.31 [2.34, 7.93] p&lt;0.0001, 3.06 [1.59, 5.89] and 2.19 [2.12, 4.27]), respectively. According to Cox regression analysis, risk of the combined primary end point was the highest in patients with 3 or more elevated markers (OR = 6.6 [3.584, 12.158], p&lt;0.0001), average in patients with 2 elevated markers (OR = 1.123 [0.51, 2.48]), p=0.7), and the lowest in patients with no markers increase or increase of only one marker (OR = 0.11 [0.049, 0.241], p&lt;0.0001). In the Kaplan-Mayer survival analysis all three groups were statistically different. In order to identify the most prognostically strong model, a reclassifcation analysis was performed. According to this analysis, the combination of sST2 and NT-proBNP concentrations determined at hospital discharge, exceeded one NT-proBNP (reclassifcation = -8.1%). At the same time, predictive value of only sST2 just insignifcantly less than value of sST2 and NT-proBNP combination (reclassifcation = -1.9%).

CONCLUSION

Patients with three and more elevated markers at hospital discharge have high risk of adverse events. Te biggest prognostic value has combination of sST2 and NT-proBNP concentrations. In order to determine the long-term prognosis of a patient with HF decompensation, it is sufcient to measure concentrations of sST2 and NT-proBNP at hospital discharge. Alternatively, it is possible to limit to sST2 only, which is just insignifcantly inferior to the sST2 and NT-proBNP combination. Patients with concentrations of sST2 ≥37.8 hg/ml and NT-proBNP ≥1696 rg/ml at hospital discharge have maximal 1year risk of death due to recurrent HF decompensation.

Clinical significance of serial biomarkers activity determination after acute heart failure decompensation: sST2 NT-proBNP role during long-term follow-up

AIM

Monitoring of concentrations of modern biomarkers to evaluate the efficacy of long‑term treatment of patients after acute decompensated HF (ADHF).

MATERIALS AND METHODS

The study included 100 patients with severe decompensated FC II-IV CHF and LV EF &lt;40 % due to IHD, DCMP or AH. At discharge from the hospital, patients were divided into groups of low (NT‑proBNP&lt;1400 pg / ml) (control, n=30) and high (NT‑proBNP≥1400 pg / ml) risk (n=70). Patients at high risk were randomized to two treatment groups, a group of NT‑proBNP monitoring (NPM) (n=35) and a group of standard therapy (n=35). At the end of the study, noncompliant patients were isolated from these two groups into a separate group (n=10). The aim of the treatment was decreasing the NT‑proBNP concentration to less than 1000 pg / ml and / or ≥50 % of the baseline level. In addition to the soluble suppression of tumorigenicity 2 (sST2) receptor, concentrations of copeptin, neutrophil gelatinase associated lipocalin (NCAL), galectin 3, and high‑sensitivity troponin T were measured at discharge from the hospital (baseline) and at three and 6 months of treatment.

RESULTS

The strongest correlations were found between changes in concentrations (Δ%) of NT‑proBNP, copeptin, and sST2 and changes in CHF FC, 6‑min walk distance, CCS, quality of life, LV EF, and Е / Е' (р&lt;0.001). The incidence of cardiovascular events was directly related with the degree of decrease and / or increase in biomarker concentration. Patients of the NPM group had the lowest risk of adverse clinical outcome upon a decrease in NT‑proBNP &lt;988.5 pg / ml at 6 months of treatment or &gt; 50 % of the baseline level at discharge from the hospital. For these patients, the mean Δ% was 60.7±8.5 % for NT‑proBNP, 34.03±17.6 % for sST2, and 32.41±8.8 % for copeptin [OR at 95 % CI 0.08 (0.02-0.36), р &lt;0.0001]. A significant increase in the risk for cardiovascular events was observed only at a considerable increase in NT‑proBNP &gt;50 % [OR at 95 % CI 3.8 (1.13-13.0), р=0.03], and the highest incidence of cardiovascular events was observed in the group of noncompliant patients (110 %). Besides NT‑proBNP, to significantly decrease the risk of cardiovascular events, it was necessary to achieve a decrease in sST2 concentration to less than 30 ng / ml or by more than 24.9 % (Δ%) at the end of followup [ОR (95 % CI: 0.1 (0.02-0.5), р=0.004].

CONCLUSION

Among the modern biomarkers, changes in NT‑proBNP, sST2, and copeptin concentrations most accurately reflect changes in the clinical and functional status, quality of life, and EchoCG parameters in HF patients during long‑term monitoring. The lowest risk for adverse clinical outcomes was observed in post‑decompensation patients with a decrease in NT‑proBNP &lt;988.5 pg / ml after 6 months of treatment or ≥50 % of baseline upon discharge from the hospital. The sST2 concentration has to be reduced by more than 24.9 % of baseline and less than 30 ng / ml in the course of long‑term treatment after decompensated HF.

[Clinical and demographic characteristics of an outpatient Russian population with chronic heart failure at the time of enrollment in the QUALIFY registry for evaluating consistency with clinical guidelines on drug therapy]

BACKGROUND

Chronic heart failure is the most common condition in patients with cardiovascular diseases. Therefore, evaluating consistency of doctor's recommendations with guidelines on drug therapy is a relevant issue.

AIM

To evaluate consistency of doctor's recommendations with guidelines on drug therapy for CHF.

MATERIALS AND METHODS

The study presents enrollment visit data for the Russian part of the international prospective registry, QUALIFY. The study included 404 outpatient patients with CHF between February, 2013 through June, 2014. Consistency with guidelines for drug therapy was evaluated for 5 drug classes, including ACE inhibitors (ACEI), β-blockers (BB), angiotensin receptor antagonists (ARA), mineralocorticoid receptor antagonists (MRA), and ivabradine.

RESULTS

On the whole, the consistency was good in 64.9% of cases, moderate in 27.7% of cases, and poor in 7.4% of cases. Proportions of patients who received a target dose of a medicine and a dose ≥50% of the target dose were low, 21.5% and 62.3% for ACEI; 15% and 50.8% for BB; 20.3% and 39.8% for ARA; and 23.4% and 78.7% for ivabradine, respectively. These values, except for BB, were lower for patients with late hospitalization (hospitalization ≥6 months vs.

[Family History of Cardiovascular Disease in Patients With Early Development of Acute Coronary Syndrome]

The aim of the study was to analyze clinical features of patients with premature acute coronary syndrome (ACS) in relation to family history of cardiovascular disease (CVD) and familial hypercholesterolemia (FH).

MATERIALS AND METHODS

Of 2832 patients included in ORACUL 1 and ORACUL 2 multicenter observational trials 512 pts who developed premature ACS (≤55 years for men, ≤60 years for women) and had known family history and LDL level were selected for this study. Of these patients 297 had positive family history (51 with FH, 246 no FH), 215 had negative family history.

RESULTS

Among patients with positive family history there were more women (31 vs 20.9 %), while among patients with negative family history there were more men (79.1 vs 69 %). The fact of regular alcohol consumption was significantly more frequently observed among patients with positive family history but without FH, compared to patients with positive family history with FH (69.6 vs 47.1 %). Women with positive family history smoked more frequently than females with negative family history (51.1 vs 31.1 %). Among patients with negative family history compared with patients with positive family history there were more people who at admission had hyperglycemia exceeding 11.1 mmol / l (10.3 vs 4.4 %). Multiple vessel disease and coronary calcinosis were present in 73.2 and 24.7 %, respectively, of patients with positive family history, and in 56.9 and 9.8 %, respectively, of those with negative family history. Among patients with positive family history multivessel disease was more frequent in the subgroup with FH, while coronary calcinosis was more frequent in the subgroup without FH.

CONCLUSION

Thus, premature development of ACS might be associated not only with genetic factors but also with family history ("inheritance") of adverse habits. Herewith coronary calcinosis is more prevalent in patients with FH.

[Risk of Stroke After Exacerbation of Ischemic Heart Disease: Data of 3‑Years Follow-up]

PURPOSE

to analyze possible associations of clinical and genetic factors with development of ischemic stroke after exacerbation of ischemic heart disease (IHD).

MATERIALS AND METHODS

The Russian multicenter study aimed at assessment of risk of unfavorable outcomes after exacerbation of IHD "Exacerbation of IHD: logical probabilistic ways to course prognostication for optimization of treatment" (meaning of Cyrillic acronym - oracle) was conducted in 16 centers of 7 cities in Russia. We included into the study 1 208 patients with unstable angina and ST-elevation or non-ST-elevation myocardial infarction (MI). Data on outcomes were known for 1 193 patients, 15 patients were lost for follow-up.

RESULTS

Mean duration of follow-up was 644±14.45 (4-1 995) days. Shortest, longest, and mean time before development of stroke was 22, 1433 and 389±56.6 days after inclusion. Patients with strokes were older, more often had history of IHD prior to index hospitalization, arterial blood pressure level compatible with stage 3 arterial hypertension, less often were smokers, and more often had MI recurrences or repetitive episodes of severe ischemia during the index hospitalization. Patients also more often had documented atrial fibrillation during hospitalization, and lower level of glomerular filtration rate. Of studied genetic markers carriage of A allele of polymorphic marker G (-1082) A of interleukin-10 gene was significantly associated with risk of stroke development. Using linear regression analysis, we constructed a model of estimation of the stroke development risk. Comparison of diagnostic value of different scales for stroke risk assessment showed that area under the curve was 0.656, 0.686, and 0.756 for the GRACE, CHA2DS2‑VASc, and ORACLE scores, respectively.

[Chronic heart failure: New challenges and new perspectives]

Chronic heart failure is an important global public health problem. This is associated with extremely poor prognosis, high readmission rates, and substantial treatment costs in patients. The paper gives the main aspects of the setting-up of a specialized service to patients with heart failure.

[Translational medicine in Russian cardiology: a new stage or repetition of the past?]

The brief review gives the experience in using the concept of translational medicine in the practical activities of the Russian Cardiology Research and Production Complex in the past 25 years of its existence. It outlines the possible ways of developing this area in Russian medicine to solve crucial scientific and practical tasks.

[Therapy of High Risk Patients After Decompensation of Heart Failure Under NT-proBNP Control. Main Results]

AIM

to compare efficacy of treatment of high risk patients after acute decompensation (AD) of chronic heart failure (CHF) based on monitoring of NT-proBNP concentration and standard treatment.

MATERIAL AND METHODS

Patients (n=100) with class III-IV CHF and left ventricular ejection fraction (LV EF) <40% due to ischemic heart disease (IHD), dilated cardiomyopathy (DCMP), or arterial hypertension (AH) after compensation of HF before discharge were distributed into groups of low (NT-proBNP <1400 picog/ml, n=30) or high (NT-proBNP more or equal 1400 picog/ml, n=70) risk. High risk patients were randomized into 2 treatment groups: NT-proBNP based (group I, n=35) and standard (group II, n=35) therapy. At study closure we formed another group consisting of group I and II participants noncomplaint with study protocol (group NC, n=10). Groups practically did not differ by main clinical functional characteristics. Aim of treatment was lowering of NT-proBNP level below 1000 picog/ml or more or equal 50% from baseline. At discharge median NT-proBNP concentration was 3750.0 (2224.0; 6613.0), 2783.0 (2021.5; 4827.5), and 2162.0 (1684.5; 5750.0) picog/ml in groups I, II, and NC, respectively (=0.315).

RESULTS

At study entry all group I and II patients received combination of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, -adrenoblockers, antagonists of mineralocorticoid receptors. After 6 months changes of doses of neuro-hormonal modulators in group I were more pronounced than in group II. NT-proBNP concentration decreased by 53% down to 1585.5 (976,6; 2742,5) picog/ml, =0.001, and by 10.2% in groups I and II, respectively (between group =0.001). In group I compared with II we observed more pronounced improvement of clinical functional indicators, quality of life, and parameters of systolic and diastolic LV function (<0.05), fewer cardiovascular deaths (4 vs. 10, =0.033) and repeat decompensations and rehospitalizations because CHF (4 vs. 14, =0.007).

CONCLUSION

Compared with standard therapy long-term NT-proBNP guided treatment of high risk patients significantly significantly decreased rate of CV deaths and repeat decompensations and rehospitalizations because CHF, and more effectively influenced clinical and functional state, quality of life and main echocardiographical parameters of LV systolic and diastolic function.

[Trimetazidine in the Treatment of Chronic HeartFailure]

The review presents data on alterations of mitochondrial oxidative metabolism occuring due to heart failure, mechanisms of cytoprotective agent trimetazidine associated with a partial inhibition of the fatty acid oxidation and increased metabolism of pyruvate, reduction of cardiomyocyte apoptosis and oxidative stress are described. The results of clinical studies showing the effectiveness of trimetazidine therapy in ischemic heart decease are reported, as well as the latest data on the effects of prolonged use of trimetazidine on prognosis in patients with heart failure.

[The First Results of the Russian Register of Chronic Heart Failure]

We present in this paper first results of the Russian registry of chronic heart failure (CHF) as well as comparative analysis of available registries and a number of randomized controlled trials and meta-analyses on CHF.

[Mineralocorticoid receptor antagonists in the treatment of patients with chronic heart failure. Positions in 2015]

Mineralocorticoid receptor antagonists (MCRA) are part of standard medical therapy for heart failure (HF). The clinical efficacy of MCRA in patients with systolic HF has been proven by randomized clinical trials. The efficacy of this drug group in patients with chronic HF with preserved left ventricular systolic function and the advent and practical introductions of safer new-generation MCRA remain to be answered.