Тематичний Архів | Category Archives: Heart failure

L.G. Voronkov, V.V. Gorbachova, A.V. Lіashenko, T.I. Gavrilenko, L.S. Mkhitaryan, L.V. Yakushko, L.P. Parascheniuk Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction without anemia, depending on the presence of iron deficiency

The aim – to compare patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) without anemia depending on the presence of iron deficiency (ID) according to the main clinical, hemodynamic, laboratory parameters and prognosis indicators.

Material and methods. In January – February, 2018, 95 stable patients with CHF (83 of men and 12 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included during 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 found in 51 out of 95 patients without anemia. Patients with ID without anemia were reliably in higher functional class, had a lower body mass index, lower systolic blood pressure, glomerular filtration rate, worse 6-minute walking test and thigh quadriceps endurance and a lower quality of life by MLHFQ. They also had lower hemoglobin, MCV, MCH, hepcidin levels and higher NT-proBNP, interleukin 6, and citrulline levels. The presence of ID, even without concomitant anemia, increased both risk of death from any cause and the combined critical event risk (death or hospitalization) during 12 and 24 months. Conclusions. Among patients with CHF and reduced LVEF without anemia, ID was observed in 54 % of patients. Patients with ID were characterized by a greater proportion of patients in NYHA class III–IV and renal dysfunction, poorer functional capacity (6-minute walking test, thigh quadriceps endurance), poorer quality of life, lower body mass index, lower systolic blood pressure and lower hemoglobin and hepcidin levels along with higher circulating interleukin 6, citrulline and NT-proBNP levels. ID without concomitant anemia was associated with worse survival and more frequent hospitalizations.

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G.E. Dudnik, А.S. Solonovich, A.V. Liashenko Correction of renal dysfunction in patients with chronic heart failure and reduced left ventricular ejection fraction

The aim – to study the possibilities of correction of renal function parameters in patients with CHF and reduced LV EF on the background of treatment with a fixed combination of meldonium with gamma buterobetaine.

Material and methods. A total of 24 patients with stable CHF and reduced left ventricular ejection fraction (EF < 40 %), II–IV NYHA classes were examined. Among them, 17 people had CHD, 5 people – dilated cardiomyopathy. All patients underwent general clinical examination, determination of levels of creatinine, blood urea nitrogen, uric acid, microalbuminuria, GFR using the formula CKD-EPI. Ultrasound diagnosis of the vasodilating function of the brachial artery endothelium was performed using a test with reactive hyperemia. Against the background of standard treatment, patients received a fixed combination of meldonium with gamma-butyrobetaine (GBB) at a dose of 2 tablets 3 times a day (every 8 h) for 4 weeks. Results. Against the background of a 4-week intake of a combination of 360 mg of meldonium and 120 mg of GBB three times a day, patients had a statistically significant improvement in creatinine and GFR. Uric acid levels in the blood plasma of patients did not significantly change. There was no significant effect on the level of heart rate and systolic blood pressure. The levels of daily MAU significantly decreased, as well as blood urea nitrogen. There was a statistically significant improvement in vasodilator function of the endothelium. Conclusions. In stable patients with CHF and reduced LV EF, addition of meldonium 360 mg with GBB 120 mg to the standard pharmacotherapy is accompanied by improvement of renal function shown by significant reduction of blood creatinine, increase of GFR, decrease of blood urea nitrogen and daily MAU. This treatment improves vasodilator endothelial function.

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K.M. Amosova, K.I. Cherniaieva, Yu.V. Rudenko, O.I. Rokyta, Z.V. Lysak, E.I. Levenko Gender differences among patients with arterial hypertension and heart failure with preserved left ventricular ejection fraction

The aim – assessment of gender differences in the frequency of comorbidities, structural and functional state of the heart, arterial stiffness, pulse load and ventricular-arterial interaction in patients with hypertension and heart failure with preserved left ventricular ejection fraction.

Material and methods. 115 patients were diagnosed with HFpEF II A or II B stage, II or III NYHA FC, with LV EF ≥ 50 % and signs of LV diastolic dysfunction by TTE, and were divided into 2 groups by gender (group 1 – women with AH and HFpEF, and group 2 – men with hypertension and HFpEF). The control group consisted of 58 patients matched for age, gender composition, with AH 1–2 degrees, without heart failure; they were also divided into 2 groups (groups 3 and 4, respectively).

Results. The examined groups of patients did not statistically differ regarding age and, among patients with HF, men and women did not differ in frequency of II or III FC (NYHA); among men, earlier MI was noted more frequently than in women – 23 (37.1 %) vs 4 (7.5 %) (P<0.001). BMI among women with or without HF was higher (30.3±5.4 vs. 29.8±4.6 and 32.0±4.5 vs. 30.0±3.2, P<0.05), without differences in the frequency of obesity. In women, the average GFR was lower – 61.2±13.5 vs. 74.4±15.2 and 70.6±1.3 vs. 86.1±17.9 (by 13.3 % and 18 %, respectively, P<0.001) Among patients with HFpEF, the prevalence of anemia was higher in women (16 (30.2 %) vs. 7 (11.3 %), P<0.05). The distance of the 6-minute walk test was significantly less in the group of patients with HF of both genders compared with the control group (353.4±91.6 vs. 553.2±56.6 and 384.3±83.5 vs. 569.8±33.7, P<0.01), with a slightly worse result among women (by 8 %, P<0.01). In women with HF, compared with men, there were elevated rates of both arterial elastance Ea — 2.3±0.6 vs.1.9±0.4, P<0.05 (by 17.4 %), and end-systolic stiffness Ees – 3.3±1.3 vs. 3.0±1.1, P<0.05 (by 9.1 %). Despite similar values of brachial BP and central BP in women with HF, compared to men, larger PWWc-f was noted by 9.5 % (12.8±1.5 vs. 12.2±1.4, P<0.05) and AIx75 by 9.2 % (37.7±12 1 vs. 34.7±8.9, P<0.05). Conclusions. In the population of the examined patients with AH and HFpEF there is a tendency towards more pronounced diastolic LV dysfunction, severity of clinical manifestations of heart failure in women, in comparison with men, in the absence of gender differences. Women with HFpEF have a higher resistive and pulsative load on LV. Thus, in women with hypertension, there is an increased tendency to develop HFpEF compared to men.

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L.G. Voronkov, A.S. Solonovych, A.V. Liashenko, I.L. Revyenko, L.V. Yakushko, L.P. Paraschenyuk Cognitive function and adherence to treatment in patients with chronic heart failure and reduced left ventricular ejection fraction: relation and prognostic meaning

The aim – to investigate the relationship between cognitive function and adherence to treatment; to evaluate the predictive value of adherence to treatment questionnaires in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF).

Material and methods. 124 pts with stable CHF and reduced (< 40 %) LVEF NYHA II–IV not older than 75 years were examined. Besides routine clinical examination, standard neuropsychological tests (Mini Mental State Examination – MMSE, Schulte test, the HADS scale) were used. To assess adherence to the treatment, the Moriski – Green questionnaire and the disease-specific questionnaire of heart failure department were used. Cognitive dysfunction was defined as MMSE ≤ 26 points. Results. After distribution of pts to three groups depending on their adherence to treatment, it was found that they significantly differed in MMSE and Shulte test results. The number of points regarding adherence to treatment (Moriski – Green questionnaire and the questionnaire of heart failure department) directly correlated with MMSE (P=0.038 and P=0.023, respectively). The group of patients with high compliance had significantly better cognitive tests results (MMSE and Schultze) than the group of patients with moderate/low compliance – this was equally relevant to both questionnaires. The construction of survival curves showed that Moriski – Green questionnaire had no reliable prognostic significance both in relation to death and combined critical event (mortality/hospitalization) (P=0.113 and P=0.401, respectively); At the same time, the disease-specific questionnaire of heart failure department showed value regarding the prediction of long-term survival and the onset of a combined critical event (P=0.046 and P=0.024, respectively). Conclusion: More than half of pts with CHF and reduced LVEF have low and moderate adherence to treatment, which is associated with worse cognitive tests results (MMSE and Schulte). Evidence of relationship between adherence to treatment and cognitive function evaluated using our questionnaire were comparable to those obtained by Moriski – Green questionnaire. Using disease-specific questionnaire of heart failure department had a high value in predicting long-term survival and the onset of combined critical event (death or hospitalization) in patients with CHF and reduced LVEF, while the Moriski – Green questionnaire did not demonstrate the above-mentioned predictive value.

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V.V. Gorbachova, A.V. Lіashenko, T.I. Gavrilenko, L.S. Mkhitaryan, L.G. Voronkov Clinical and instrumental characteristics, clinical prognosis in patients with chronic heart failure and reduced left ventricular ejection fraction, depending on the presence and nature of the iron deficiency state

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.

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L.G. Voronkov, G.Ye. Dudnik, A.V. Liashenko Renal function in patients with chronic heart failure and reduced left ventricular ejection fraction depending on clinical and hemodynamic parameters

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.

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L.G. Voronkov, A.S. Solonovych, A.V. Liashenko The state of cognitive function in patients with chronic heart failure and reduced left ventricular ejection fraction depending on the main clinical, demographic and hemodynamic parameters

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.

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K.M. Amosova, O.V. Vasylenko, K.P. Lazareva, N.V. Shyshkina, Yu.О. Sychenko, I.I. Gorda, A.V. Sablin, N.V. Melnichenko, Yu.V. Rudenko, A.B. Bezrodnyi, K.I. Cherniaieva, I.I. Burlachenko The clinical characteristics of patients with arterial hypertension, symptoms of heart failure and preserved ejection fraction depending on E/e´ at rest and under physical exertion

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.

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L.G. Voronkov, V.V. Gorbachova, A.V. Lіashenko, T.I. Gavrilenko, L.S. Mkhitaryan Iron metabolism parameters in patients with chronic heart failure and reduced left ventricular ejection fraction depending on basic demographic, clinical and instrumental characteristics

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.

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L.G. Voronkov, O.L. Filatova, A.V. Lyashenko, N.A. Tkach, N.G. Lipkan Predictors of 24-month survival in patients with chronic heart failure and reduced left ventricular ejection fraction depending on gender

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.

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