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Russian Journal of Cardiology 2020, 25 (1)

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CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russian Journal of Cardiology. 2020;25(1):8

ORIGINAL ARTICLES

THE RISK OF VENOUS THROMBOEMBOLISM IN PATIENTS WITH HEART FAILURE

Vereina N. K., Agasyan D. G., Chulkov V. S.

Abstract

Aim. To quantify the risk of venous thromboembolism (VTE) in hospitalized patients, depending on the severity of heart failure (HF).

Material and methods. Current cross-sectional study included 132 patients hospitalized in the cardiology department in 2019. All participants were divided into 2 groups: group 1 (n=48) — patients with class I-II HF; group 2 (n=84) — patients with class III-IV HF. A total quantitative assessment of the VTE risk was carried out according to the Caprini risk scoring method.

Results. All patients hospitalized in the cardiology department, regardless of HF class, had a moderate and high risk of VTE and required prophylactic anticoagulation. High VTE risk had 85% of patients with class I-II HF; 97,6% — patients with a class III-IV HF. Mean score of ≥10 was observed in every fifth patient. Atrial fibrillation requiring long-term anticoagulant therapy was observed in 51,5% of patients. There were no absolute contraindications for parenteral prophylactic anticoagulation at the time of hospitalization in the study population.

Conclusion. All patients admitted to the cardiology department had a moderate and high according to the Caprini risk score, regardless of HF class. More than half of the patients had indications for long-term anticoagulant therapy. The remaining patients required the parenteral prophylactic anticoagulation.

Key words: heart failure, venous thromboembolism, prevention.

Relationships and Activities: not.

South Ural State Medical University, Chelyabinsk, Russia.

Vereina N. K. ORCID: 0000-0003-0678-4224, Agasyan D. G. ORCID: 0000-0003-4729-6606, Chulkov V. S. ORCID: 0000-0002-0952-6856.

Received: 22.12.2019

Revision Received: 31.12.2019

Accepted: 04.01.2020

For citation: Vereina N. K., Agasyan D. G., Chulkov V. S. The risk of venous thromboembolism in patients with heart failure. Russian Journal of Cardiology. 2020;25(1):3678 doi:10.15829/1560-4071-2020-1-3678

LONG-TERM MORTALITY RISK IN HOSPITALIZED PATIENTS WITH HEART FAILURE AFTER MYOCARDIAL INFARCTION

Galyavich A. S.1, Mingalimova I. M.2, Galeeva Z. M.1, Baleeva L. V.1

Abstract

Aim. Comparative assessment of laboratory and instrumental parameters of patients with heart failure (HF) after myocardial infarction at admission and discharge from the hospital to determine the long-term mortality risk.

Material and methods. The clinical outcomes of 117 patients with stage II-III (Strazhesko-Vasilenko Classification) heart failure (64 men and 53 women) were studied. All patients admitted to the hospital underwent laboratory and instrumental examination. The average follow-up for patients after discharge from the hospital was 3 years (12 to 44 months). The long-term mortality risks of HF patients were compared according to the examination data upon admission and discharge from the hospital.

Results. The long-term mortality risk factors of HF patients at admission are the levels of pro-brain natriuretic peptide (proBNP) (risk 1,08, p=0,001), D-dimer (risk 1,062, p=0,018), urea (risk 1,048, p=0,016), creatinine (risk 1,006, p=0,016), alanine transaminase (risk 1,002, p=0,009). The long-term mortality risk factors of HF patients at discharge are urea (risk 1,141, p=0,001), N-terminal proBNP (risk 1,101, p=0,002), and the number of neutrophils (risk 1,064, p=0,002).

Conclusion. There is a difference in risk factors for long-term mortality risk of HF patients at admission and discharge from the hospital.

Key words: heart failure, long-term risk.

Relationships and Activities: not.

1Kazan State Medical University, Kazan; 2Interregional Clinical and Diagnostic Center, Kazan, Russia.

Galyavich A. S. ORCID: 0000-0002-4510-6197, Mingalimova I. M. ORCID: 0000-0002-7081-6211, Galeeva Z. M. ORCID: 0000-00029580-3695, Baleeva L. V. ORCID: 0000-0002-7974-5894.

Received: 20.12.2019

Revision Received: 29.12.2019

Accepted: 08.01.2020

For citation: Galyavich A. S., Mingalimova I. M., Galeeva Z. M., Baleeva L. V. Longterm mortality risk in hospitalized patients with heart failure after myocardial infarction. Russian Journal of Cardiology. 2020;25(1):3671 doi:10.15829/1560-4071-2020-1-3671

BETA-ADRENERGIC REACTIVITY OF ERYTHROCYTES AND THE PROGRESSION OF HEART FAILURE IN PATIENTS AFTER MYOCARDIAL INFARCTION

Garganeeva A. A., Aleksandrenko V. A., Kuzheleva E. A., Rebrova T. Yu.

Abstract

Aim. To identify the associations between beta-adrenergic reactivity of erythrocytes and the progression of heart failure (HF) in patients after myocardial infarction (MI).

Material and methods. The study included 50 patients with HF and history of MI 6 months ago. To determine the level of sympathoadrenal system activity, we analyzed beta-adrenergic reactivity by changing the osmotic resistance of erythrocytes by use of adrenoceptor blocking agent.

Results. The frequency of HF progression after index MI was 26% (n=13). All patients were divided into 2 groups depending on the presence/absence of HF progression in the postinfarction period. When determining beta-adrenergic reactivity, it was found that patients with HF progression compared with patients without it had the higher level of beta-adrenergic reactivity of membrane (β-ARM) of erythrocytes: 58,8 (50,9; 78,0) CU and 46,8 (38,0; 66,3) CU, p=0,025). A ROC analysis made it possible to establish the β-ARM level ≥49,53 CU a cut-off point, which can be considered as a marker of HF progression in patients after MI (sensitivity 92,3%, specificity 62,2%). This level of β-ARM is associated with a more than five-fold increase of HF progression risk in patients after MI (OR 5,48; 95% CI 1,28-23,37; p=0,024).

Conclusion. In patients with HF and MI history, there is a decrease in the adrenergic reactivity of erythrocyte cell membrane, which is reflected by an increase of β-ARM above normal range of 20 CU. At the same time, β-ARM in patients with HF progression compared with patients without it is significantly increased. Established cut-off point of β-ARM (≥49,53 CU) allows predicting the HF progression with high sensitivity and specificity.

Key words: adrenergic reactivity, heart failure, myocardial infarction, sympathoadrenal system.

Relationships and Activities: not.

Cardiology Research Institute, Tomsk National Research Medical Center, Tomsk, Russia.

Garganeeva A. A. ORCID: 0000-0002-9488-6900, Aleksandrenko V. A. ORCID: 0000-0002-6717-5898, Kuzheleva E. A. ORCID: 0000-0002-8070-2234, Rebrova T. Yu. ORCID: 0000-0003-3667-9599.

Received: 16.12.2019

Revision Received: 21.12.2019

Accepted: 25.12.2019

For citation: Garganeeva A. A., Aleksandrenko V. A., Kuzheleva E. A., Rebrova T. Yu. Beta-adrenergic reactivity of erythrocytes and the progression of heart failure in patients after myocardial infarction. Russian Journal of Cardiology. 2020;25(1):3407 doi:10.15829/1560-4071-2020-1-3407

HEART FAILURE IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS

Goryacheva O. G., Koziolova N. A.

Abstract

Aim. To determine the features of heart failure (HF) development in patients with human immunodeficiency virus (HIV) infection.

Material and methods. In a general hospital, 160 patients were examined during the year. All of them were divided into 2 groups: group 1 (n=100) — HIV-infected patients with specific clinical picture of HF; group 2 (n=60) — patients without HIV infection and with HF verified by echocardiography and concentration of N-terminal prohormone of brain natriuretic peptide (NT-proBNP).

Results. In comparison with group 2, HIV-infected patients had the following statistically significant differences: lower left ventricular ejection fraction (LVEF), lower prevalence and severity of left ventricle diastolic dysfunction, higher LV mass index

(LVMI), and lower NT-proBNP. HIV-infected patients had statistically significant moderate inverse relationship of LVEF (r=-0,43; p=0,015), E/e’ (r=-0,32; p=0,045), LVMI (r=-0,46; p=0,002) and strong relationship of NT-proBNP (r=-0,54; p<0,001) with CD4 T-lymphocyte count in 1 mm3 in the presence of HF symptoms and signs and an increase in NT-proBNP over 125 pg/ml. In group 1, there was a significantly higher prevalence of smoking, chronic alcoholism, drug use, chronic hepatitis C and cirrhosis (especially manifested by hepatomegaly and splenomegaly in combination with ascites and hepatic cytolysis), chronic pancreatitis, pneumonia and inflammatory diseases accompanied by higher erythrocyte sedimentation rate and C-reactive protein concentration, and lower hemoglobin level. HIV-infected patients were statistically less likely to use all groups of drugs for HF treatment, with the exception of spironolactone, and more likely to use drugs for multimorbidity treatment.

Conclusion. The HF prevalence in hospitalized HIV-infected patients, estimated on the basis of symptoms and NT-proBNP increase >125 pg/ml, was 54%; on the basis of LVEF decrease <50% — 32%. The clinical picture of HIV-infected patients is characterized by various symptoms, including those typical for HF with normal NT-proBNP level, due to the high prevalence of comorbidities and concurrent medication.

Key words: heart failure, human immunodeficiency virus.

Relationships and Activities: not.

E. A. Wagner Perm State Medical University, Perm, Russia.

Goryacheva O. G. ORCID: 0000-0002-3336-228X, Koziolova N. A. ORCID: 0000-0001-7003-5186.

Received: 09.01.2020

Revision Received: 19.01.2020

Accepted: 19.01.2020

For citation: Goryacheva O. G., Koziolova N. A. Heart failure in human immunodeficiency virus-infected patients. Russian Journal of Cardiology. 2020;25(1):3706 doi:10.15829/1560-4071-2020-1-3706

THE RELATIONSHIP OF THE PROLONGED PR INTERVAL WITH THE LONG-TERM SURVIVAL IN PATIENTS WITH HEART FAILURE UNDERGOING CARDIAC RESYNCHRONIZATION THERAPY

Soldatova A. M., Kuznetsov V. A., Gizatulina T. P., Malishevsky L. M., Dyachkov S. M.

Abstract

Aim. To assess the relationship between the prolonged PR interval (≥200 ms) and the long-term survival of patients undergoing cardiac resynchronization therapy (CRT).

Material and methods. A total of 85 patients (mean age — 55,1±9,9 years; men — 81,2%) with NYHA class II-IV heart failure (HF) were examined. The mean follow-up was 34,0±21,2 months. Patients with PR<200 ms (n=52) made up group I, with PR≥200 ms (n=33) — group II. Then the patients were divided into subgroups depending on the QRS duration: ≥150 ms (n=33 in group I and n=14 in group II, respectively) <150 ms (n=19 in group I and n=19 in group II, respectively).

Results. In patients of group II, a history of myocardial infarction (MI) was more often registered (p=0,005), left ventricular ejection fraction (LVEF) was lower (p=0,032). In a multivariate analysis, MI (OR 3,217; CI 95% 1,188-8,712; p=0,022) and LVEF value (OR 0,869; CI 95% 0,780-0,968; p=0,011) had a significant relationship with the PR interval prolongation (≥200 ms). The survival of patients of group I was 59,6%, group II — 18,2% (Log-rank test p<0,001). According to Cox regression model, the initial left ventricle end-systolic volume (OR 1,012; 95% CI 1,006-1,017; p<0,001), inferior wall MI (OR 1,690; 95% CI 1,131-2,527; p=0,011) and PR interval ≥200 ms (OR 2,179; 95% CI 1,213–3,915; p=0,009) were associated with long-term mortality. In patients with PR≥200 ms, survival rate was low, regardless of the QRS duration (21,4% in patients with QRS≥150 ms, 15,8% in patients with QRS<150 ms; Log-rank test p=0,698) In patients with PR<200 ms, the survival rate of patients with QRS≥150 ms was 72,7%, and for patients with QRS<150 ms — 36,8% (Log-rank test p=0,031).

Conclusion. In HF patients, PR interval prolongation (≥200 ms) is associated with long-term mortality increase. The highest survival rates were observed in patients with PR<200 ms and QRS≥150 ms. In patients with QRS≥150 ms, the presence of PR≥200 ms should be considered as an additional criterion for CRT.

Key words: cardiac resynchronization therapy, heart failure, first-degree AV block.

Relationships and Activities: not.

Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Tomsk, Russia.

Soldatova A. M. ORCID: 0000-0001-5389-0973, Kuznetsov V. A. ORCID: 0000-0002-0246-9131, Gizatulina T. P. ORCID: 0000-0003-4472-8821, Malishevsky L. M. ORCID: 0000-0002-1025-3728, Dyachkov S. M. ORCID 0000-0002-3238-3259.

Received: 23.05.2019

Revision Received: 05.07.2019

Accepted: 22.08.2019

For citation: Soldatova A. M., Kuznetsov V. A., Gizatulina T. P., Malishevsky L. M., Dyachkov S. M. The relationship of the prolonged PR interval with the long-term survival in patients with heart failure undergoing cardiac resynchronization therapy.

Russian Journal of Cardiology. 2020;25(1):3348 doi:10.15829/1560-4071-2020-1-3348

VENTRICULAR-ARTERIAL COUPLING PARAMETERS AND ITS PROGNOSTIC VALUE IN PATIENTS WITH DECOMPENSATED HEART FAILURE

Kobalava Zh. D.1, Lukina O. I.1,2, Meray I.1,2, Villevalde S. V.3

Abstract

Aim. To assess ventricular-arterial coupling (VAC) parameters and their prognostic value in patients with decompensated heart failure (HF).

Material and methods. VAC parameters were evaluated upon admission using two-dimensional echocardiography in 355 patients hospitalized with decompensated HF. VAC was expressed as the ratio between arterial elastance (Ea) and end-systolic LV elastance (Ees). The optimal VAC range was considered 0,6-1,2. Parameters of left ventricular (LV) efficacy were calculated using the appropriate formulas. Differences were considered significant at p<0,05.

Results. The median values of Ea, Ees and VAC were 2,2 (1,7;2,9) mmHg/ml, 1,8 (1,0;3,0) mmHg/ml and 1,32 (0,75;2,21) respectively. In 63% of patients, VAC disorders were detected: 55% of patients had VAC >1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC <0,6 (all patients with HF with preserved ejection fraction (HFpEF)). Normal VAC was observed in 78%, 42%, and 1% of patients with HFpEF, HF with mid-range EF and HFrEF, respectively. There was significant correlation between Ea/Ees ratio and levels of NTproBNP (R=0,35), hematocrit (R=-0,29), hemoglobin (R=-0,26), pulmonary artery systolic pressure (PAPs) (R=0,18), dimensions of left atrium (R=0,32) and right ventricle (RV) (R=0,32). After 6 months, rehospitalization with decompensated HF was recorded in 72 (20,3%) patients, 42 (11,8%) patients died. Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg increased the risk of rehospitalization with decompensated HF and all-cause mortality 2,5 and 3,7 times, respectively.

Conclusion. Impaired VAC was diagnosed in 63% of patients with decompensated HF. However, the increased risk of all-cause mortality and rehospitalization with decompensated HF over the 6 months was associated with Ea decrease <2,2 mmHg/ml and PAPs increase >45 mmHg.

Key words: ventricular-arterial coupling, arterial elastance, ventricular elastance, heart failure.

Relationships and Activities: the study was supported by PFUR Program “5-100”.

1Peoples’ Friendship University of Russia, Moscow; 2V. V. Vinogradov City Clinical Hospital, Moscow; 3Almazov National Medical Research Center, St. Petersburg, Russia.

Kobalava Zh. D. ORCID: 0000-0003-1126-4282, eLibrary SPIN: 9828-5409, Lukina O. I. ORCID: 0000-0002-8930-9252, Meray I. ORCID: 0000-0001-6818-8845, Villevalde S. V. ORCID: 0000-0001-7652-2962.

Received: 2712.2019

Revision Received: 02.01.2020

Accepted: 09.01.2020

For citation: Kobalava Zh. D., Lukina O. I., Meray I., Villevalde S. V. Ventriculararterial coupling parameters and its prognostic value in patients with decompensated heart failure. Russian Journal of Cardiology. 2020;25(1):3695 doi:10.15829/1560-4071-2020-1-3695

DIAGNOSTIC VALUE OF N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDE IN HEMODIALYSIS PATIENTS

Sedov D. S.1, Fedotov E. A.2, Rebrov A. P.1

Abstract

Aim. To assess the diagnostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in hemodialysis (HD) patients.

Material and methods. A total of 80 patients over the age of 18 with an end-stage renal disease (ESRD) on HD were included in this study. NT-proBNP serum levels were measured for all patients in addition to traditional clinical and biochemical studies. Transthoracic echocardiography and bioimpedance spectroscopy using the Body Composition Monitor (BCM) device (Fresenius, Germany) were performed for all patients on HD. Patients were divided into two groups depending on the hydration status determined by BCM. Patients were also divided into three groups depending on the ejection fraction (EF) of the left ventricle: HF with reduced EF (less than 40%) (HFrEF), mid-range EF (from 40% to 49%) (HFmrEF), and HF with preserved EF (50% or more) (HFpEF). Three groups of patients were identified according to quartile level of NT-proBNP (<1095 pg/ml (n=20); 1095-4016 pg/ml (n=40); >4016 pg/ml (n=20).

Results. The median of the NT-proBNP serum level was 2114,6 [1095; 4016] pg/ml. A significant increase in the NT-proBNP levels was found in HD patients with hyperhydration (p<0,05). Statistically significant differences were generally found between the concentration of NT-proBNP depending on the LVEF (n=80). However, in pairwise comparisons, significant differences were found only between the groups of patients with HFpEF and HFmrEF (p=0,02); a tendency to differences was revealed when comparing the groups of HFpEF and HFrEF (p=0,07). A proportional increase in the concentration of prohormone to the increase in systolic dysfunction was found while analyzing the median NT-proBNP, both among all patients and after separation into groups depending on the hydration status. A tendency to increase the frequency of new cardiovascular events, systolic and diastolic myocardial dysfunction in group of patients with prohormone increase was revealed.

Conclusion. NT-proBNP serum levels in HD patients are significantly higher than the average population levels. A significant increase in the NT-proBNP levels was found in hemodialysis patients with hyperhydration. NT-proBNP should be used as an additional method for the diagnosis of heart failure on HD, including clarifying of the phenotype of heart failure depending on left ventricle EF. NT-proBNP high levels in patients on HD may be associated with a risk of developing cardiovascular events, systolic and diastolic myocardial dysfunction. It is necessary to use an examination algorithm for the differential diagnosis of heart failure and hyperhydration syndrome during dialysis: clinical examination, bioimpedansometry, transthoracic echocardiography, determination of serum NT-proBNP level.

Key words: chronic kidney disease, hemodialysis, NT-proBNP, heart failure, cardiovascular diseases.

Relationships and Activities: not.

1V. I. Razumovsky Saratov State Medical University, Saratov, Russia; 2Saratov Regional Blood Center, Saratov, Russia.

Sedov D. P. ORCID: 0000-0003-2260-0958, Fedotov E. A. ORCID: 0000-0003-3563-5535, Rebrov A. P. ORCID: 0000-0002-3463-7734.

Received: 22.11.2019

Revision Received: 26.12.2019

Accepted: 30.12.2019

For citation: Sedov D. P., Fedotov E. A., Rebrov A. P. Diagnostic value of N-terminal pro-B-type natriuretic peptide in hemodialysis patients. Russian Journal of Cardiology. 2020;25(1):3621 doi:10.15829/1560-4071-2020-1-3621

CLINIC AND PHARMACOTHERAPY

THE EFFECT OF IVABRADINE AS PART OF STANDARD THERAPY ON VASCULAR ENDOTHELIAL FUNCTION AND CARDIAC ELECTRICAL INSTABILITY IN PATIENTS WITH POST-INFARCTION CARDIOSCLEROSIS AND HEART FAILURE

Abdullaev A. A., Mammaev S. N., Anatova A. A., Islamova U. A., Makhacheva A. M.

Abstract

Aim. To reveal the equivalence of nebivolol replacement with ivabradine in the prevention of endothelial dysfunction and cardiac electrical instability in patients with heart failure with reduced ejection fraction (HFrEF).

Material and methods. In current observational study, 126 patients with HFrEF in the postinfarction period were randomized into two groups for six-month treatment: group 1 (n=62) — standard therapy (acetylsalicylic acid 0,1 g/day, clopidogrel 75 mg/day, veroshpiron 50 mg/day, nebivolol 5 mg/day, perindopril 5 mg/day and rosuvastatin 20 mg/day; group 2 (n=66) — the same therapy with nebivolol replacement with ivabradine 10 mg/day. Initially and after 6 months, 24-hour Holter monitoring was performed, heart rate variability was determined. We also investigated endothelial dysfunction using the photoplethysmographic technique with post-occlusive reactive hyperemia (PORH) test.

Results. The heart rate, the number of episodes and the duration of symptomatic and silent myocardial ischemia, total myocardial ischemia were significantly decreased in both groups (p<0,001). The decrease of supraventricular extrasystole frequency in both groups had not statistical significance (p>0,05). In both groups, after therapy, parameters of heart rate variability were improved with the parasympathetic predominance (p<0,01). In both groups, the PORH test revealed the increase of brachial artery diameter (group 1 — 5,90±3,15% and group 2 — 5,88±1,82%) and pulse wave amplitude (group 1 — 1,81±0,78 and group 2 — 1,73±0,90 times), which indicates a trend towards an improvement in endothelial function. Intergroup comparisons did not reveal significant differences.

Conclusion. Ivabradine is equivalent to nebivolol in preventing ventricular extrasystole and reducing heart rate, number of episodes of symptomatic and silent ischemia and the duration of total myocardial ischemia in patients with HFrEF. Ivabradine equivalently to nebivolol improves endothelial function and heart rate variability with reducing the sympathetic activity.

Key words: heart failure, postinfarction period, endothelial dysfunction, heart rate variability, 24-hour Holter monitoring, ivabradine, nebivolol.

Relationships and Activities: not.

Dagestan State Medical University, Makhachkala, Russia.

Abdullaev A. A. ORCID: 0000-0001-5287-5827, Mammaev S. N. ORCID: 0000-0001-8898-8831, Anatova A. A. ORCID: 0000-0002-8682-8137, Islamova U. A. ORCID: 0000-0002-1280-1505, Makhacheva A. M. ORCID: 0000-0002-5065-4577.

Received: 02.11.2019

Revision Received: 13.11.2019

Accepted: 20.11.2019

For citation: Abdullaev A. A., Mammaev S. N., Anatova A. A., Islamova U. A., Makhacheva A. M. The effect of ivabradine as part of standard therapy on vascular endothelial function and cardiac electrical instability in patients with post-infarction cardiosclerosis and heart failure. Russian Journal of Cardiology. 2020;25(1):3592 doi:10.15829/1560-4071-2020-1-3592

CHRONIC HEART FAILURE AND THE FREQUENCY OF TAKING NONSTEROIDAL ANTI-INFLAMMATORY DRUGS: A REGISTER-BASED STUDY ON THE POSSIBLE RISKS

Tarlovskaya E. I., Mikhailova Yu. V.

Abstract

Aim. To study the frequency of taking nonsteroidal anti-inflammatory drugs (NSAIDs) and possible adverse events in patients with cardiovascular diseases and heart failure (HF) hospitalized in the Heart Failure Therapy Center (Nizhny Novgorod).

Material and methods. According to the local register, the study included 336 patients (men — 156 and women — 180, average age — 71 (63; 80)), hospitalized in Heart Failure Therapy Center in Nizhny Novgorod from February 1 to November 1,2019. Examination and treatment of patients was performed based on current clinical practice guidelines and standards. According to the results of echocardiography, HF with preserved ejection fraction was diagnosed in 70% of patients, HF with mid-range ejection fraction — in 20%, and HF with reduced ejection fraction — in 10%. Based on data on the outpatient NSAIDs taking, all participants were divided into 2 groups: NSAID+ (n=63) and NSAID- (n=273).

Results. Among hospitalized patients, 18,7% of patients took NSAIDs on an outpatient basis, without a doctor’s prescription, more often non-selective, mainly by mouth, for stopping arthralgia. The frequency of emergency hospitalizations due to acute HF decompensation depending on the NSAIDs taking did not significantly differ. In the NSAID+ group, acute kidney injury was diagnosed 3 times more often and 10 times more often when NSAIDs were taken ≥1 times a week. Anemia was diagnosed more often in the NSAID+ group, when taking NSAIDs ≥1 times a week. In the NSAID+ group, grade 2-4 anemia was significantly more often diagnosed.

Conclusion. None of the patients took the recommended NSAIDs with a low cardiovascular risk. Patients taking NSAIDs were more likely to have a history of atrial fibrillation and acute cerebrovascular accident. Patients from the NSAID+ group had the higher incidence of acute kidney injury and anemia.

Key words: heart failure, nonsteroidal anti-inflammatory drugs, left ventricular hypertrophy, acute kidney injury, anemia.

Relationships and Activities: not.

Privolzhsky Research Medical University, Nizhny Novgorod. Russia.

Tarlovskaya E. I. ORCID: 0000-0002-9659-7010, Mikhailova Yu. V. ORCID: 0000-0002-0942-6070.

Received: 21.12.2019

Revision Received: 31.12.2019

Accepted: 04.01.2020

For citation: Tarlovskaya E. I., Mikhailova Yu. V. Chronic heart failure and the frequency of taking nonsteroidal anti-inflammatory drugs: a register-based study on the possible risks. Russian Journal of Cardiology. 2020;25(1):3677 doi:10.15829/1560-4071-2020-1-3677

COMPARATIVE PHARMACOECONOMIC ANALYSIS OF MEDICATION FOR PATIENTS AFTER ACUTE DECOMPENSATED HEART FAILURE

Zyryanov S. K., Ushkalova E. A.

Abstract

Aim. Pharmacoeconomic comparison of medication management strategies (valsartan+sacubitril) for patients with heart failure (HF), stabilized after an episode of acute decompensated heart failure (ADHF).

Material and methods. “Cost — effectiveness analysis” and “Budget impact analysis” were used. The study is conducted in terms of the interests of Russian Federation health care system and budgets of individual regions.

Results. The use of valsartan+sacubitril combination will require an increase in direct medical costs for 1 year by 38,5% compared with enalapril. The cost of one life year gained when using the valsartan+sacubitril combination was 307,294 rubles. When estimating data for the target ADHF population (n=200,769), valsartan+sacubitril will require additional 4,4 billion rubles per year. At the same time, this will save almost 17 thousand lives and prevent 126 thousand ambulance calls and 33,9 thousand rehospitalizations, including more than 6,5 thousand in the intensive care unit.

Conclusion. The use of valsartan+sacubitril combination in HF patients hospitalized with ADHF is cost-effective management strategy that significantly improves the prognosis in this category of patients.

Key words: heart failure, cost-effectiveness analysis, alsartan+sacubitril, life years gained, budget impact analysis.

Relationships and Activities. The article was published by order and financial support of Novartis Pharma LLC in accordance with the internal policies of Novartis Pharma LLC and the current legislation of the Russian Federation. The opinion of Novartis Pharma LLC may differ from the opinion of the authors. ID 1291248/HEOR/A4/7000/12.19

Peoples’ Friendship University of Russia, Moscow, Russia.

Zyryanov S. K. ORCID: 0000-0002-6348-6867, Ushkalova E. A. ORCID: 0000-0003-4165-1726.

Received: 26.12.2019

Revision Received: 07.01.2020

Accepted: 08.01.2020

For citation: Zyryanov S. K., Ushkalova E. A. Comparative pharmacoeconomic analysis of medication for patients after acute decompensated heart failure. Russian Journal of Cardiology. 2020;25(1):3690 doi:10.15829/1560-4071-2020-1-3690

GENETICS IN CARDIOLOGY

EVALUATION OF ST2 AS AN EARLY MARKER OF HEART FAILURE WITH A PRESERVED LEFT VENTRICULAR EJECTION FRACTION IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION

Polyanskaya E. A., Koziolova N. A., Mironova S. V.

Abstract

Aim. To assess the diagnostic value of soluble ST2 (sST2) for early detection of heart failure with a preserved ejection fraction (HFpEF) in patients with persistent atrial fibrillation (AF).

Material and methods. A total of 165 patients hospitalized with AF paroxysm were examined. The inclusion criteria were the persistent AF and LVEF >50% according to echocardiography. A cohort of 60 patients with persistent AF and preserved LVEF

was formed. Patients were divided into 2 equal groups of 30 people depending on the HF presence, assessed on the basis of LV diastolic dysfunction with or without left atrial enlargement >34 ml/m2 or left ventricular mass index >110 g/m2 in men and 95 g/m2 in women, as well as an increase in the N-terminal prohormone of brain natriuretic peptide (NT-proBNP) >125 pg/ml. LVEF was calculated using the Simpson method; assessment of LV diastolic function was carried out with determination of transmitral flow velocity characteristics and visualization of mitral annulus motion. The NT-proBNP concentration was determined in blood serum using the Biomedica Group reagent (Austria), sST2 — using Presage ST2 (Critical Diagnostics, USA) by enzyme-linked immunosorbent assay on an Immulite 1000 analyzer (DPC, USA).

Results. In patients with HFpEF and persistent AF, the correlation analysis showed a direct strong relationship between NT-proBNP and sST2 (r=0,726; p<0,05). To assess sST2 as a diagnostic criterion for HF, ROC curve was constructed. It was shown that with sST2 ≥16 ng/ml (AUC=0,89), the sensitivity of the method was 80%, the specificity — 83%.

Conclusion. In patients with a persistent AF, serum sST2 concentration ≥16 ng/ml can be used as an alternative to the NT-proBNP criterion for early diagnosis of HFpEF.

Key words: persistent atrial fibrillation, heart failure.

Relationships and Activities: not.

E. A. Wagner Perm State Medical University, Perm, Russia.

Polyanskaya E. A. ORCID: 0000-0002-3694-3647, Koziolova N. A. ORCID: 0000-0001-7003-5186, Mironova S. V. ORCID 0000-0002-1788-4282.

Received: 09.01.2020

Revision Received: 19.01.2020

Accepted: 19.01.2020

For citation: Polyanskaya E. A., Koziolova N. A., Mironova S. V. Evaluation of ST2 as an early marker of heart failure with a preserved left ventricular ejection fraction in patients with persistent atrial fibrillation. Russian Journal of Cardiology. 2020;25(1):3705 doi:10.15829/1560-4071-2020-1-3705

CLINICAL AND RESEARCH MEDICINE

RATIONALE AND DESIGN OF MULTICENTER PROSPECTIVE OBSERVATIONAL STUDY OF TYPES, GRADE, VARIABILITY, ASSOCIATIONS AND PROGNOSIS OF ORTHOSTATIC RESPONSES IN HEART FAILURE (GRAVITY-HF)

Shlyakhto E. V.1, Villevalde S. V.1, Soloveva A. E.1, Zvartau N. E.1, Sitnikova M. Yu.1, Fedorova D. N.1, Vinogradova N. G.2,3, Fomin I. V.2

Abstract

Heart failure (HF) is one of the leading causes of adult mortality. Increased risk of death determines need for better understanding of the pathophysiological mechanisms, predictive risk stratification models and applicable methods to improve prognosis. One of the unfavorable prognostic factors may be an inadequate hemodynamic response to orthostatic stress. Orthostatic hypotension (OH) is known to be an independent predictor of many cardiovascular diseases, particularly HF, and death. Single-center study of HF population revealed that systolic blood pressure within 3-5 minutes after standing up may be a predictor of long-term unfavorable outcomes. Nevertheless, data about OH in patients with HF are limited and inconsistent due to heterogeneity of populations and different methodology in published studies. In this regard, a population-based study of the orthostatic response in patients with HF (stable and decompensated) is needed. The article describes the rationale and design of a multicenter prospective observational study aimed to assess the clinical and prognostic significance of orthostatic responses in HF patients.

Key words: orthostatic hypotension, heart failure, blood pressure.

Relationships and Activities: not.

1Almazov National Medical Research Center, St. Petersburg; 2Privolzhsky Research Medical University, Nizhny Novgorod; 3Heart Failure Therapy Center, City Clinical Hospital № 38, Nizhny Novgorod, Russia.

Shlyakhto E. V. ORCID: 0000-0003-2929-0980, Villevalde S. V. ORCID: 0000-0001-7652-2962, Soloveva A. E. ORCID: 0000-0002-0013-0660, Zvartau N. E. ORCID: 0000-0001-6533-5950, Sitnikova M. Yu. ORCID: 0000-0002-0139-5177, Fedorova D. N. ORCID: 0000-0001-8392-7386, Vinogradova N. G. ORCID: 0000-0002-3391-7937, Fomin I. V. ORCID: 0000-0003-0258-5279.

Received: 16.12.2019

Revision Received: 21.12.2019

Accepted: 25.12.2019

For citation: Shlyakhto E. V., Villevalde S. V., Soloveva A. E., Zvartau N. E., Sitnikova M. Yu., Fedorova D. N., Vinogradova N. G., Fomin I. V. Rationale and design of multicenter prospective observational study of types, GRAde, VariabilITY, associations

and prognosis of orthostatic responses in Heart Failure (GRAVITY-HF). Russian Journal of Cardiology. 2020;25(1):3662

doi:10.15829/1560-4071-2020-1-3662

VALIDITY AND RELIABILITY OF THE RUSSIAN-LANGUAGE VERSION OF THE SELF-CARE OF HEART FAILURE INDEX IN PATIENTS WITH HEART FAILURE

Kartamysheva E. D.1,2, Lopatin Yu. M.1,2

Abstract

Aim. To assess the validity and reliability of the Russian-language version of The Self-Care of Heart Failure Index (SCHFI, version 6.2) in patients with heart failure (HF).

Material and methods. The translation of the SCHFI (version 6.2) into Russian was performed according to the Brislin’s model. The Russian version of the SCHFI was tested in 128 patients with NYHA class II-IV HF (mean age 63,6±8,8 years, 70,3% men). The Cronbach’s alpha, test-retest reliability, construct (confirmatory factor analysis) and concurrent (comparison of the SCHFI and European Heart Failure Self-Care Behavior Scale (EHFScBS_9) results) validities were determined.

Results. The Cronbach’s alpha for the SCHFI scale was 0,74 and characterized sufficient level of test reliability. The test-retest reliability (estimated after 3 months of observation) was 0,81 (p<0,01), which also indicates a sufficient level of reliability. The baseline level of selfcare ability in HF patients according to SCHFI was 136,8±40,6 points. The factor analysis confirmed the expediency of dividing the SCHFI into 3 sections: A — self-care maintenance, B — self-care management, C — self-care confidence. Analysis of the concurrent validity of the SCHFI and EHFScBS_9 revealed an inverse correlation between both scales.

Conclusion. The Russian-language version of The Self-Care of Heart Failure Index (version 6.2) is a simple and effective tool for assessing self-care ability in HF patients, and can be used both in clinical trials and in actual clinical practice.

Key words: heart failure, self-care ability, self-care ability scales, reliability, validity.

Relationships and Activities: not.

1Volgograd State Medical University, Volgograd; 2Volgograd Regional Clinical Cardiology Center, Volgograd, Russia.

Kartamysheva E. D. ORCID: 0000-0002-9873-9254, Lopatin Yu. M. ORCID: 0000-0003-1943-1137, ResearcherID: B-2804-2017.

Received: 24.11.2019

Revision Received: 02.01.2020

Accepted: 21.01.2020

For citation: Kartamysheva E. D., Lopatin Yu. M. Validity and reliability of the Russian-language version of the Self-Care of Heart Failure Index in patients with heart failure. Russian Journal of Cardiology. 2020;25(1):3639 doi:10.15829/1560-4071-2020-1-3639

CLINICAL CASES

COMPLICATED UPPER EXTREMITY DEEP VEIN THROMBOSIS (PAGET-SCHROETTER DISEASE): A CASE REPORT

Syromyatnikova L. I.1,2, Aliev E. Kh.1, Lapin O. M.2, Mekhryakov S. A.2

Abstract

We report the case of the development of pulmonary embolism in a patient with Paget-Schroetter disease.

Key words: Paget-Schroetter disease, upper extremity deep vein thrombosis, pulmonary embolism.

Relationships and Activities: not.

1E. A. Wagner Perm State Medical University, Perm; 2City Clinical Hospital № 4, Perm, Russia.

Syromyatnikova L. I. ORCID: 0000-0002-8305-1115, Aliev E. Kh. ORCID: 0000-0002-4313-6317, Lapin O. M. ORCID: 0000-0002-1288-4478, Mekhryakov S. A. ORCID: 0000-0001-5679-4100.

Received: 16.06.2019

Revision Received: 31.07.2019

Accepted: 17.08.2019

For citation: Syromyatnikova L. I., Aliev E. Kh., Lapin O. M., Mekhryakov S. A. Complicated upper extremity deep vein thrombosis (Paget-Schroetter disease): a case report. Russian Journal of Cardiology. 2020;25(1):3379 doi:10.15829/1560-4071-2020-1-3379

ASYMPTOMATIC UNRUPTURED ANEURYSM OF THE LEFT SINUS OF VALSALVA: A CASE HISTORY REPORT

Sadykova G. K.1,2, Ivanov D. O.1, Lepekhina A. S.2, Ryazanov V. V.1

Key words: Valsalva sinus, aneurysm, aorta, computed tomography, aortography.

Relationships and Activities: not.

1St. Petersburg State Pediatric Medical University, St. Petersburg; 2Almazov National Medical Research Center, St. Petersburg, Russia.

Sadykova G. K. ORCID: 0000-0002-6791-518X, Ivanov D. O. ORCID: 0000-0002-0060-4168, Lepekhina A. S. ORCID: 0000-0002-3805-8430, Ryazanov V. V. ORCID: 0000-0002-0037-2854.

Received: 05.11.2019

Revision Received: 16.12.2019

Accepted: 23.12.2019

For citation: Sadykova G. K., Ivanov D. O., Lepekhina A. S., Ryazanov V. V. Asymptomatic unruptured aneurysm of the left sinus of Valsalva: a case history report. Russian Journal of Cardiology. 2020;25(1):3602 doi:10.15829/1560-4071-2020-1-3602

LITERATURE REVIEWS

LUNG ULTRASOUND IN OPTIMIZING MANAGEMENT OF PATIENTS WITH HEART FAILURE: CURRENT STATUS AND FUTURE PROSPECTS

Kobalava Zh. D.1, Safarova A. F.1,2, Kokhan E. V.1, Islamova M. R.1,2

Abstract

The review discusses the prognostic value and contribution to therapy optimization of lung ultrasound for heart failure patients.

Key words: lung ultrasound, B-lines, congestion, heart failure, dyspnea.

Relationships and Activities: not.

1Peoples’ Friendship University of Russia, Moscow; 2V. V. Vinogradov City Clinical Hospital, Moscow, Russia.

Kobalava Zh. D. ORCID: 0000-0003-1126-4282, eLibrary SPIN: 9828-5409, Safarova A. F. ORCID: 0000-0003-2412-5986, eLibrary SPIN: 2661-6501, Kokhan E. V. ORCID: 0000-0002-5556-7106, eLibrary SPIN: 1307-6750, Islamova M. R. ORCID:

0000-0002-1951-0890.

Received: 18.12.2019

Revision Received: 31.12.2019

Accepted: 04.01.2020

For citation: Kobalava Zh. D., Safarova A. F., Kokhan E. V., Islamova M. R. Lung ultrasound in optimizing management of patients with heart failure: current status and future prospects. Russian Journal of Cardiology. 2020;25(1):3666 doi:10.15829/1560-4071-2020-1-3666

CLINICAL AND MORPHOLOGICAL FEATURES OF MALFORMATIONS OF THE MITRAL VALVE COMPLEX

Trisvetova E. L., Yudina O. A.

Abstract

The mitral valve complex is a multicomponent anatomically and functionally coordinated formation, ensuring the activity of the left ventricle and, in general, the heart. Congenital disorders of the structure, quantity, and form of the mitral complex components can be asymptomatic or cause hemodynamic changes that require surgery. Often, clinical signs of mitral complex abnormalities are manifested as mitral stenosis, regurgitation or its combination and contribute to misdiagnosis. To identify the morphological features of abnormalities by echocardiography, it is necessary to know the possible structure aberrations. The article describes the normal anatomy of the mitral valve complex and abnormalities of the fibrous ring, valve leaflets, papillary muscles and chordae tendineae.

Key words: mitral valve complex, abnormalities, diagnosis, clinical features, morphological features.

Relationships and Activities: not.

Belarusian State Medical University, Minsk, Republic of Belarus.

Trisvetova E. L. ORCID: 0000-0003-4168-7219, Yudina O. A. ORCID: 0000-0001-7623-0601.

Received: 28.05.2019

Revision Received: 05.07.2019

Accepted: 18.09.2019

For citation: Trisvetova E. L., Yudina O. A. Clinical and morphological features of malformations of the mitral valve complex. Russian Journal of Cardiology. 2020;25(1):3357 doi:10.15829/1560-4071-2020-1-3357

11 февраля 2020 г.

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