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.
The aim – to assess polymorphic variants of T−786→C gene of endothelial NO-synthase depending on presence of insulin resistance (IR) in patients with systolic chronic heart failure (CHF).
Material and methods. We have examined 107 patients (pts) with CHF of II–IV NYHA class with left ventricular systolic dysfunction without diabetes, with coronary heart disease or dilated cardiomyopathy. The pts have undergone general clinical studies, echocardiography, flow-mediated vasodilatory response (FMD) of arteria brachialis. Insulin was determined by the automatic enzyme immunoassay method. Index HOMA ≥ 2.77 was taken into account as a criterion for IR. To determine plasma level of TNF-α we have used enzyme immunoassay test system. The molecular genetic study of polymorphism T−786→C gene of endothelial NO-synthase based on method of the polymerase chain reaction determined polymorphic variants of T−786→C eNOS gene according to modified procedures.
Results. IR phenomenon has been found in 45 pts (42 %) with chronic heart failure. About a third of pts (33 of 107) had the HOMA index value between 3.0 or higher. The main clinic-demographic, hemodynamic, echo parameters have not shown a statistically significant difference between pts with CHF with or without IR. However, pts with CHF and IR had significantly lower FMD (5.40 (4.63; 7.95) %) of arteria brachialis than pts without IR, where correspondingly (7.99 (5.21; 11.50) %; Р=0.033). Among 104 examined pts with CHF (three patients refused genetic testing for religious reasons) the promoter polymorphism genotype TT T–786→C eNOS gene has been observed in 43.2 % (n=19) pts with IR, and in 31.7 % (n=19) without IR; there have been 45.5 % of TC heterozygotes (n=20) with IR, and 55.0 % (n=33) without IR; the so-called rare genotype CC has been observed in both groups almost equally.
Conclusions. Insulin resistance has been detected in 42 % patients with CHF and left ventricular systolic dysfunction. Among examined pts with systolic CHF frequency of genotypes TT, TC, CC T−786→C gene of endothelial NO-synthase has not differed significantly in the groups with and without IR. Poor flow-mediated vasodilatory response of arteria brachialis in pts with CHF and the presence of phenomenon of IR has been associated with higher levels of TNF-α and uric acid in the blood serum.
The aim – to determine changes of cardiovascular system and neurohumoral regulation at early stages of chronic heart failure (CHF) in children and adolescents with different myocardial pathologies.
Material and methods. There have been examined 208 adolescents at the age of 12–18 years with different myocardium pathologies: 54 after myocarditis and 154 with dysplastic cardiopathies. Control group consisted of 68 apparently healthy peers. Morphofunctional, general haemodynamics parameters, diurnal urinary excretion of catecholamines, plasma renin activity, angiotensin-II and aldosterone, IL-1β and IL-6 cytokines, TNF-α and apoptosis factor СD95/Fas levels in blood serum have been studied.
Results. It has been established that adolescents with myocardial inflammatory and noninflammatory pathology manifested heart contractility disorders in both ventricles, in some cases detected with exercise testing only. Such manifestations have been accompanied by highly increased activation of neurohumoral systems (sympathoadrenal and renin-angiotensin-aldosterone), increase of antiinflammatory cytokines level and СD95/Fas frequency.
Conclusion. Obtained data provide pathogenetic basis for usage of neurohumoral activation blockers in adolescents with subclinical manifestations of heart failure.
The aim – to create cardiovascular risk score based on analysis of circulating biomarkers of CHF.
Material and methods. We studied prospectively the incidence of fatal and non-fatal cardiovascular events, as well as the frequency of death from any cause in cohort of 388 patients with chronic heart failure during 3 years of observation. Circulating levels of NT-pro brain natriuretic peptide (NT-proBNP), galectin-3, high-sensitivity C-reactive protein (hs-CRP), osteoprotegerin and its soluble receptor sRANKL, osteopontin, osteonectin, adiponectin, endothelial apoptotic microparticles (EAM) and endothelial progenitor cells (EPC) were measured at baseline.
Results. Median follow-up of patients included in the study was 2.76 years (range 1.8–3.4 years). There were 285 cardiovascular events registered, including 43 deaths and 242 readmissions. Independent predictors of clinical outcomes in patients with CHF were NT-proBNP, galectin-3, hs-CRP, osteoprotegerin, sRANKL/osteoprotegerin ratio, CD14+CD309+Tie2+ EPС, EAM and EAM/CD14+CD309+ EPС ratio. Index of cardiovascular risk was calculated by mathematical summation of all ranks of independent predictors, which occurred in the patients included in the study. The average value of the index of cardiovascular risk in patients with CHF was 3.17 units (95 % CI 1.65–5.10 units.). Kaplan – Meier analysis showed that patients with CHF and the magnitude of the risk of less than 4 units have advantage in survival compared to patients with higher values of cardiovascular risk score.
Conclusion. Assessment of biomarker risk score of fatal and non-fatal cardiovascular events, based on measurement of circulating NT-proBNP, galectin-3, hs-CRP, osteoprotegerin, EAM and the ratio of the EAM/CD14 + CD309 + EPС, allows to predict the probability of survival of patients with CHF, regardless of age, gender, contractile function of the left ventricular myocardium and the number of comorbidities.
The aim – to study adipose tissue hormones and humoral systemic inflammatory response (TNF-α), lipid status depending on the presence of insulin resistance (IR) in patients (pts) with chronic systolic heart failure (CHF).
Material and methods. We examined 107 pts with CHF II–IV NYHA class without diabetes with left ventricular systolic dysfunction. Insulin and adipokines were determined an automatic enzyme immunoassay analyzer IEMS LabSystems (Finland) using specific reagent kits: insulin (DRG Diagnostics, Germany), leptin (DRG Diagnostic, Germany), adiponectin (Assaypro, USA). Glucose, lipid and uric acid levels in the blood plasma were determined by automatic biochemical analyzer «A-25» (BioSystems, Spain). For the determination of TNF-α in plasma we used enzyme immunoassay test system «Proteins circuit» (Russia). IR was based on the value of the index HOMA ≥ 2.77. All of these studies were conducted on patients achieving euvolemic state. Statistical analysis was performed using the software package SPSS Statistics.
Results. IR was found in 45 patients (42 %) with chronic heart failure. About a third of pts (33 of 107) had a HOMA index value between 3.0 or more. Accordingly IR-pts had higher levels of fasting glucose (5.39±0.59 vs 4.98±0.62 mmol/l, Р=0.001). Also, the insulin level in blood plasma of IR-pts was significantly higher Me=15.34 [12.97; 24.27] compared to the group of non-IR-pts Me=7.87 [4.87; 10.39] mU/ml (Р<0.001) and control group Ме=9.07 [6.47; 12.39] mkU/ml (Р<0,001). On the basic demographic and clinical hemodynamic parameters significant difference was not found between patients with CHF with and without IR. However, patients with CHF and IR had significantly higher values of leptin (Me=8.30 [3.69; 22.01] ng/ml vs 5.53 [1.36; 16.97] ng/ml (Р=0.044), higher values of TNF-α (Me=3.4 [1.35; 19.25] pg/ml vs. Me=2.8 [1.82; 5.38] pg/ml, P=0.041) and uric acid (549.37±155.23 umol/l vs. 463.55±131.15 umol/l, P=0.003) in blood plasma compared with a group non-IR pts with CHF.
Conclusions. Patients with CHF, regardless of the IR phenomenon, have higher levels of leptin and adiponectin. In patients with CHF and IR we observed significantly higher levels of leptin in the blood plasma compared to patients with CHF without IR, with no significant differences in levels of adiponectin and relation leptin/adiponectin. In IR-pts with CHF there are signs of humoral autoimmune response with higher levels of circulating tumor necrosis factor-alpha compared to non-IR pts and control subjects. The level of uric acid in the blood plasma was significantly higher in IR-pts with CHF compared to non-IR pts with CHF.
The aim – to study the features of rotational motion of left ventricular walls in patients with dilated cardiomyopathy.
Material and methods. 70 patients with dilated cardiomyopathy and 35 patients without cardiac pathology have been involved into the study. General clinical examination and echocardiography, including speckle tracking echocardiography, have been carried out. Patients with dilated cardiomyopathy have been subdivided into 2 groups according to absence or presence of complete left bundle branch block.
Results. Normal left ventricular basal and apical rotation constituted –4.3±1.3 °, and 10.5±0.6 °, respectively. Decrease of both basal rotation by 37 % and apical rotation by 64 %, in comparison with normal rates, have been observed in patients with dilated cardiomyopathy and without total left bundle-branch block (Group I). Basal and apical rotation were in the opposite directions. Moderate decrease of basal rotation, constituting 2.6±1.7 °, which is 40 % lower the normal rates, have been observed in patients with dilated cardiomyopathy and with complete left bundle branch block (Group II). At the same time the apical rotation was in the same direction as the basal one, with angle of rotation of –2.±1.5 °, which is significantly lower than normal rates by 122 %.
Conclusions. Normal left ventricular basal and apical rotation is in the opposite directions, i.e., basal rotation is clockwise and apical rotation is counter-clockwise. In dilated cardiomyopathy the rotational capacity of left ventricular myocardium is sharply decreased, and, additionally, in occurrence of total left bundle-branch block the direction of apical rotation is changed. The significant decrease of apical rotation and change of its direction in patients with dilated cardiomyopathy with total left bundle-branch block leads to increase of heart failure.
The aim – to study diagnostic value of NT-pro-BNP plasma level to establish severity of chronic heart failure due to ischemic heart disease depending on concomitant type 2 diabetes mellitus. Eighty two patients with ischemic chronic heart failure have been included into the study. It was shown that circulating level of NT-pro-BNP reflects heart failure severity at excess of cut-off point value 1272.45 fmol/ml (sensitivity 88.6 %, specificity 72.3 %, the positive likelihood ratio 6.15; the negative likelihood ratio 0.16) in patients with chronic heart failure and type 2 diabetes mellitus. At lower concentrations NT-pro-BNP may reflect presence of other reasons potentially modulating exaggerated cardiovascular risk, such as: type 2 diabetes mellitus, proinflammatory activation, atherosclerotic lesions of coronary arteries, hyperlipidemia and regional left ventricular dysfunction.