The aim – to compare patients with chronic heart failure and reduced left ventricular ejection fraction (LVEF) with absolute and functional iron deficiency (ID) state according to the main clinical, hemodynamic, laboratory parameters and clinical prognosis indicators.
Material and methods. In January – February, 2018, 128 stable patients with chronic heart failure (111 of men and 17 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included in a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test.
Results. ID was observed in 61 % of patients, 65 % had absolute ID. Patients with both types of ID were in higher functional class, had a poorer quality of life and worse clinical and laboratory indices than patients without ID. Regardless of the difference in the functional and absolute ID formation mechanisms, no significant distinctions in the clinical and functional parameters, quality of life, as well as the parameters of intracardiac hemodynamics were found. Contrary to expectations, elevated levels of hepcidin were not detected in patients with functional ID compared to the absolute ID group. The reliable differences in survival/hospitalization rate between patients without ID and both groups of patients with ID allow us to recommend the screening of iron deficiency in all patients with chronic heart failure and reduced LVEF.
Conclusions. ID is found in 61 % patients. Functional ID was found in 27 patients (21 %), absolute ID – in 51 patients (39.6 %). There were no differences between groups of patients with absolute and functional ID by age, functional class, LVEF, percentage of aneamic patients, 6-minute walking distance, thigh quadriceps endurance, quality of life, physical activity index, NT-proBNP, citrulline and hepcidin levels. Compared to patients with absolute ID, patients with functional ID had higher levels of hemoglobin, MCV, MCH, interleukin-6. Presence of both ID types was associated with worse survival and more frequent hospitalization.
The aim – to examine the relationship between parameters of the renal function and main characteristics in patients with chronic heart failure and reduced left ventricular ejection fraction during their clinical and instrumental examination.
Material and methods. The present analysis includes 134 patients and reduced left ventricular ejection fraction with II–IV New York Heart Association (NYHA) classes. All patients were in stable clinical condition. Baseline measurements included height, weight, blood preasure, heart rate, NYHA classification. All patients were examined by routine ECG, echocardiography. Glomerular filtration rate (GFR) was estimated using the CKD-EPI equation. Daily microalbuminuria and urinary albumine/creatinine ratio were determined. Definitions of levels of blood urea nitrogen, uric acid, interleukin-6, NT-proBNP and citrulin were performed. All patients received standard treatment.
Results. The performed study demonstrated the role of GFR as indicator most closely related to the clinical characteristics of the examined patients (NYHA class, age, hypertension, diabetes, anemia) and levels of interleukin-6 and citrulline. Microalbuminuria level and albumin/creatitine ratio in urine did not show a similar relation, except for the NYHA class. Blood urea nitrogen was higher in patients with higher NYHA class and with concomitant diabetes and anemia. All studied parameters of the renal function revealed a reliable association with uric acid level. There were no significant (P<0.05) relationships between renal function parameters and systolic blood pressure, heart rate, left ventricular ejection fraction and flow-dependent vasodilator response of the brachial artery, as well as the level of NT-proBNP in plasma.
Conclusions. Among stable patients with chronic heart failure and reduced left ventricular ejection fraction, there were significantly lower levels of GFR in patients with III–IV NYHA classes, in older women (≥ 63 years) and in patients with hypertension, diabetes and anemia. The level of GFR was directly related to the level of circulating biomarkers, such as uric acid, interleukin-6 and citrulline. The levels of microalbuminuria, urinary albumine/creatinine ratio, blood urea nitrogen were significantly higher in patients with ІІІ–ІV NYHA classes.
The aim – to investigate clinical and other factors associated with cognitive dysfunction in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction.
Material and methods. 124 patients with stable CHF and reduced left ventricular ejection fraction (< 40 %), NYHA II–IV not older than 75 years were examined. Vital signs, routine laboratory tests, glomerular filtration rate by CKD-EPI, electrocardiography and ehocardiography parameters were studied. Cognitive function was evaluated by standard neuropsychological tests – MMSE (Mini Mental State Examination), Shulte and HADS. Cognitive dysfunction was defined as MMSE ≤ 26 points. Apart from routine examination, quality of life evaluation by The Minnesota Living with Heart Failure Questionnaire (The MLHFQ); evaluation of functional capacity by Duke Activity Status Index, endothelium-dependent vasodilation test were performed.
Results. Cognitive dysfunction (abnormal MMSE) was observed in 85 (68.6 %) patients. There was no significant differences of MMSE and Schulte test results in men and women, groups of patients with atrial fibrillation (AF) and sinus rhythm. Instead, a significantly worse MMSE and Schulte tests were observed in groups of patients with higher NYHA class (Р<0.001 for both tests), arterial hypertension (P=0.04 and P=0.012, respectively), coronary heart disease (Р<0.001 for both tests) and after myocardial infarction (Р<0.001 and P=0.002, respectively). The group of elderly patients had significantly worse MMSE and Schulte scores (Р<0.001 for both tests). Levels of systolic blood pressure, heart rate and left ventricular ejection fraction did not significantly affect cognitive function, while lower glomerular filtration rate was associated with presence of the cognitive dysfunction.
There was a significantly higher prevalence of cognitive dysfunction in patients with diabetes (P=0.049). At the same time, MMSE and Schulte tests were significantly worse in patients with anemia (P=0.02 and Р<0.001, respectively) and renal dysfunction (GFR < 60 ml/(min · 1,73 m2)) (P=0.003 and Р<0.001, respectively).
Conclusion. Cognitive dysfunction was observed in 68.6 % of stable CHF patients. There was no significant influence of heart rate, systolic blood pressure, left ventricular ejection fraction, atrial fibrillation and COPD on cognitive tests. Cognitive dysfunction in patients with CHF is associated with older age, coronary heart disease, history of hypertension and myocardial infarction, anemia and renal dysfunction.
The aim – to study clinical characteristics of patients with arterial hypertension, symptoms of heart failure and preserved left ventricular (LV) ejection fraction (EF) depending on the value of E/e´ at rest and after submaximal exercise testing (SET).
Material and methods. A prospective study involved 103 patients, average age 65.4±10.8 years, with clinical signs of heart failure, LV EF ≥ 50 % and signs of LV diastolic dysfunction. Echocardiography with tissue Doppler, SET, applanational tonometry were conducted. The level of NT-proBNP was studied. According to E/e´, patients were divided into 3 groups: E/e´ > 13 at rest (group І), E/e´ > 13 after SET (group ІІ), E/e´ < 13 after the SET (group ІІІ).
Results. Group І included 64 (62.1 %), group ІІ – 24 (23.3 %), group ІІІ – 15 (14.5 %) patients. Patients were comparable regarding age, gender, frequency of earlier myocardial infarction and the average level of systolic blood pressure. Patients of group І, compared to those in groups ІІ and ІІІ, more often had atrial fibrillation, chronic kidney disease and anemia (all Р<0.01). Frequencies of diabetes mellitus and obesity in group ІІ were larger than in group ІІІ: 12 (50 %) and 4 (26.6 %); Р<0.05) and 15 (62.5 %) and 3 (20 %); Р<0.01), respectively. Severity of heart failure by NYHA was greatest in group І, less – in group ІІ and the smallest – in group ІІІ (all Р<0.01). Group ІІ, compared to group ІІІ, had worse exercise tolerance based on submaximal exercise test duration (7.2±1.7 and 8.6±1.9 minutes, Р<0.01) and power (50.0±19.9 and 68.3±22.0 W, Р<0.02), higher left atrial volume index (LAVI) 38.7±1.2 and 35.3±1.2 ml/m2 Р<0.05, left ventricular myocardial mass index (LVMI) 138.7±13.7 and 128.0±35.1 mg/m2 Р<0.05 and levels of NT-proBNP 422.8±93.8 and 134.3±53.5 pg/ml.
Conclusions. Patients with E/e´ > 13 at rest differ from those with E/e´ increase after SET, by decrease of exercise tolerance and higher frequency of comorbidities. In patients with arterial hypertension, heart failure II–III classes NYHA and unchanged E/e´ at rest, its increase more than 13 after SET was noted in 61.5 % patients, and was associated less exercise load, greater frequency of obesity and type 2 diabetes, greater LVMI and LAVI and higher levels of NT-proBNP.
The aim – to study the iron metabolism parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (rLVEF) depending on main clinical characteristics of patients obtained during the instrumental study.
Material and methods. During period from January 2016 till February 2018, 134 stable patients with CHF (113 (84.3 %) of men and 21 (15.7 %) of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included at a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test (6MWT) and a standardized lower limb extension test.
Results and discussion. Iron deficiency was found in 83 (62 %) of 134 patients with CHF and rLVEF. There were no significant differences of iron metabolism in regard to CHF etiology and most co-morbidities. The presence of anemia was associated with lower ferritin, transferrin saturation (TSAT) and serum iron levels, and the presence of renal dysfunction – with the latter two. Patients in NYHA III–IV class had significantly lower TSAT and serum iron levels. The ferritin level was significantly higher only in group of patients with better muscular endurance, while TSAT and serum iron levels were also significantly higher in patients with greater 6-minutes walking distance, better hip muscles endurance, greater physical activity index and fewer scores by the Minnesota quality of life scale. Ferritin has shown a significant correlation with serum iron levels and hemoglobin. TSAT level correlated with a serum iron level, hemoglobin, limb muscles endurance, 6-minute walking test result, physical activity index and MLHFQ score.
Conclusions. Iron deficiency has been revealed in 62 % of patients with CHF and rLVEF. The plasma ferritin level is lower in patients with anemia and with worse muscle endurance. TSAT and serum iron levels are lower in patients with NYHA III–IV class, anemia, renal dysfunction, worse physical tolerance indicators and poorer quality of life. Both ferritin and TSAT demonstrate a relation to hemoglobin and iron plasma level, additionally TSAT – with physical activity index, 6-minutes walking test distance (6MWT), quadriceps femoris muscle endurance and MLHFQ quality of life.
The aim – to compare survival rates and predictors of the onset of lethal outcome in men and women with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) during 24-months follow-up.
Material and methods. 356 patients with ischemic CHF (NYHA II–ІV) and LVEF < 40 % were examined. Cumulative survival was calculated by Kaplan – Meier method. Comparison of survival in groups was performed by Mantel – Cox test. Predictors of survival were determined by multiple logistic regression. Cut-off values of clinical variables associated with non – survival during 24 months of follow-up were determined.
Results. Analysis of survival in patients with CHF and reduced LVEF showed that cumulative survival at the end of 24 manth of follow-up was not significantly different (P=0.092), 68 % in men and 72 % in women. Factors associated with poor prognosis varied significantly depending on gender. We determined indicators associated with poor survival by cluster analysis. In men these were: left ventricle free wall thickness < 0,75 сm, ureic acid > 627 mkmol/L, LVESV index > 110 cm/m2, LVEF < 25 %, LVEDV > 340 mL (ОR 6.8–5.7). In women, these were glucose level > 11,4 l/L, LVESV > 287 mL, LVEDV > 302 mL, LVESD > 6,5 cm, IVS thickness less than 0,7 cm, LVEDV index > 176 cm/m2 (ОR 16.2–11.2).
Conclusion. Survival of men and women with CHF and reduced LVEF during 24-month of follow-up not significantly different, while predictors of lethal outcome are different.
The aim – to compare 12-months survival and its predictors in men and women with chronic heart failure (CHF) and reduce left ventricular ejection fraction (LVEF).
Material and methods. 356 CHF patients with LVEF were examined. The 12-months survival by Kaplan – Meier method was calculated. Predictors of survival were calculated by Cox regression (univariate) model.
Results. Cumulative survival among men and women for 12 month were 91 % and 92 %, respectively (H=0,59). Predictors of survival in men were: the presence of angina pectoris, right ventricular wall thickness, LVEF, left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), LVEDV index, LVESV index, stroke volume, pulmonary artery average pressure, creatinine level, total cholesterol, estimated glomerular filtration rate. Predictors of 12-months survival in women were: LVEF, LVEDV, LVESV, and total bilirubin level.
Conclusions. Twelve-months survival in men and women with CHF and LVEF were similar. Predictors of 12-months survival in men and women are considerably different, the number of predictors being substantially more in men.
The aim – to сonduct a comparative evaluation of the effectiveness of different treatment strategies for «wet and warm» patients with acute decompensated heart failure (ADHF) with сhronic kidney disease (CKD).
Material and methods. A prospective study involved 141 patients with ADHF aged 38 to 85 years (mean age 66.4±2.2), who were hospitalized sequentially in the cardiology departments during 2012–2014. Among all patients with CKD, glomerular filtration rate < 60 ml/(hr · 1.73 m2) was revealed in 95 patients (67.3 %). Diuretic-central (DC) strategy was chosen in 57, nitrate-central (NC) – in 38 patients.
Results. At admission patients DC and NC groups were comparable regarding the level of NT-proBNP, which was significantly decreased in both groups on day 3 (Р<0.05) and in the NC group compared to DC, this decrease was significantly greater than both day 3 and day of the discharge (P<0.05). Glomerular filtration rate was significantly higher already at day 3 in the NC group (35.7±2.8 ml/min versus 30.4±2.7 ml/min, Р<0.05) and was maintained higher at the discharge (63.2±3.7 ml/min versus 48.1±3.8 ml/min, Р<0.01).
Conclusion. In patients with ADHF with CKD, the nitrate-central strategy, in comparison with diuretic-central, is associated with more pronounced clinical decongestion and less pronounced influence on kidney function.
The aim – to determine the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with systolic chronic heart failure (CHF) depending on quality of life (QoL) parameters by MHFLQ and SF-36 questionnaires.
Material and methods. There were examined 113 patients aged 60.20±0.74 years with systolic CHF of ischemic and hypertensive etiology. Depending on QoL indicators (total score by MHFLQ, physical (PH) and mental (MH) component of SF-36 questionnaire) the patients were divided into groups with relatively low (RL), relatively satisfactory (RS) and relatively high (RH) levels of QoL. The serum level of NT-proBNP was determined by ELISA.
Results. Levels of NT-proBNP ranged from 904 to 3836 pg/ml (in average – 1977.5±88.8 pg/ml). Analysis of the level of NT-proBNP depending on QoL by MHFLQ showed that in the group of RL (total score ≥ 61) QoL the level of biomarker and the number of patients with high level (> 2130 pg/ml) of NT-proBNP are higher than in groups with relatively satisfactory (60-41 points) and relatively high (≤ 40 points) QoL (2552 pg/ml versus 1880 and 1650 pg/ml, respectively, Р<0.009 and 51.6 % against 22.6 % and 25.8 %, respectively, Р<0,04). Similarly the level of NT-proBNP was related to QoL by SF-36 questionnaire.
Conclusions. It was shown that in patients with systolic HF II-III NYHA class of ischemic and hypertensive etiology level of NT-proBNP was, to some extent, associated with QoL by MHFLQ, PH and MH by SF-36 questionnaire.
The aim – to study diagnostic and prognostic possibilities of cardiotropic autoantibodies in the elderly patients with ischemic heart disease and different myocardial contractile function.
Material and methods. 130 patients with ischemic heart disease and stable angina pectoris II–III functional classes, at the age range 60–74 years (average age 69.5±0.9 years) were included. Among them, 70 patients with chronic heart failure IIA stage, II–III functional classes NYHA, with decreased left ventricular contractile fiunction (left ventricular ejection fraction (LVEF) < 45 %) and 60 patients with preserved LVEF (> 45 %). 10 normal subjects aged 60–75 years were examined as controls. The follow-up period was 3 years. At an initial stage, a comprehensive medical history was collected for all patients, as well as data of current clinical, instrumental and laboratory tests (ECG, echocardiography, blood, urine samples), HRV. Cardiotropic autoantibodies levels were assessed using imunoenzyme method.
Results. Patients with LV dysfunction had significant differences regarding incidence of increased titer of cardiotropic autoantibodies, characterizing status of different myocardial structures: β1-adrenergic receptors (β1-AR), membranes of cardiomyocytes (Com-02), cytoplasm of cardiomyocytes (Cos-05), cardiomyosin (L-myosin). It has been noted that in patients with left ventricular systolic dysfunction an increased autoantibodies titer was observed 2–3 times more frequently than in patients with unchanged LVEF. The results of a correlation analysis revealed the presence of a probable inverse correlation between the level of autoantibodies to β1-AR (r=0.81; P<0.05), Com-02 (r=0.62; P<0.05), Cos-05 (r=0.58; P<0.05) and LVEF. The titer of autoantibodies to β1-AR was found to have the best predictive value for stratifying patients in the group with chronic heart failure. At higher levels of autoantibodies, the risk of having this type of systolic dysfunction was increased by 6.42 times. An increased titer of other autoantibodies had rather a low diagnostic value for L-myosin (OR 3.49; 95 % CI 1.49–8.29); Com-02 (OR 3.38; 95 % CI 1.34–8.68). In the presence of an elevated titer of autoantibodies to β1-AR, Cos-05 and L-myosin OR distribution of patients into groups by criteria of presence of systolic dysfunction was 12.0 (95 % CI 7.5–25.4). In case of combination of β1-AR, Com-02 and L-myosin, this indicator was 6.1 (95 % CI 1.21–10.4). In case of a simultaneous increase in the titer of autoantibodies to β1-AR and L-myosin OR was 5.27 (95 % CI 1.17–12.2). These data suggest the diagnostic value of an increased titer of cardiotropic autoantibodies to β1-AR to assess the presence of chronic heart failure in elderly patients with IHD.
Conclusions. An increased titer of autoantibodies to β1-AR, Cos-05 and L-myosin has a predictive value for the development of chronic heart failure.