Поражение сердца при AL-амилоидозе. Состояние проблемы

AL cardiac amyloidosis is a relatively rare disorder that belongs to the group of infiltrative cardiomyopathies. Diagnosis of primary amyloidosis is challenging due to many unspecific symptoms and sings, which often leads to late diagnosis when treatment options are limited. Primary amyloidosis particularly needs to be excluded in patients with heart failure with preserved ejection fraction. Therapy in cardiac amyloidosis has to main vectors: 1) chemotherapy to eliminate amyloidogenic plasmatic cells 2) heart failure treatment. The main challenge for cardiologists is to support hemodynamics until response to chemotherapy occurs. In the article the issue of diagnostics, risk stratification and treatment of primary cardiac amyloidosis is addressed.Актуальность. AL-амилоидоз сердца относится к группе инфильтративных кардиомиопатий и является относительно редким заболеванием. Диагностика амилоидоза сердца представляет большие трудности ввиду множества неспецифичных симптомов системного характера, что зачастую приводит к поздней постановке диагноза, когда варианты лечения довольно ограничены. Диагноз амилоидоза обязательно должен быть исключен у пациентов с сердечной недостаточностью с сохранной фракцией выброса. Лечение пациентов с амилоидозом сердца включает два основных направления ― проведение химиотерапии с целью уничтожения амилоидогенных плазматических клеток и лечение сердечной недостаточности. Основной задачей кардиолога является поддержание гемодинамики до получения ответа на химиотерапию. В статье рассматриваются вопросы диагностики, стратификации риска и лечения больных с первичным амилоидозом сердца. Заключение. Использование современной химиотерапии демонстрирует значительное улучшение выживаемости

Review of novel clinical recommendations on diagnosis and treatment of atrial fibrillation (2016) of the European society of cardiology developed in collaboration with the European association for cardio-thoracic surgery

[No abstract available

Review of novel clinical recommendations on diagnosis and treatment of atrial fibrillation (2016) of the European society of cardiology developed in collaboration with the European association for cardio-thoracic surgery

[No abstract available

Prevalence of Advanced Chronic Kidney Disease in Patients with Nonvalvular Atrial Fibrillation Hospitalized in Cardiology Departments

Objective To estimate the prevalence of chronic kidney disease (CKD) 3b-5 stages and the newly diagnosed sustained reduction in glomerular filtration rate (GFR) <30 ml/min/1.73 m2 in patients with atrial fibrillation (AF) in real clinical practice, as well as the features of their anticoagulant therapy. Materials and Methods Retrospectively, data of all discharge epicrisis from cardiological departments of five Moscow hospitals from June 1, 2016 to May 31, 2017 were analyzed. Patients over 18 years old with AF were enrolled. At the next stage, patients with CKD 3 b-5 st and newly diagnosed sustained reduction in GFR <30 ml/min/1.73 m2 (at least 2 measurements during hospitalization) were selected. Results Data of 9725 patients were analyzed, AF was diagnosed in 2983 (31 %) cases, of which a decreased GFR <45 ml/min/1.73 m2 was detected in 27 % (n = 794) cases. Among them, 349 (44 %) were diagnosed with CKD 3b st, 123 (15 %) with CKD 4 st, 44 (6 %) with CKD 5 st, 278 (35 %) had a newly diagnosed sustained reduction in GFR. In 63 % of patients with AF and GFR <45 ml/min/1.73 m2, anemia was diagnosed, 39 % of them had moderate and severe one. 711 (89 %) patients were prescribed anticoagulants, 53 % were assigned direct oral anticoagulants (DOACs). Patients with CKD 3 b st. more often rivaroxaban 15 mg (29 %) was prescribed, with CKD 4 and CKD 5-warfarin (48 % and 25 %, respectively), in patients with newly diagnosed sustained reduction in GFR <30 ml/min/1.73 m2- A pixaban 10 mg/day (16.2 %). Conclusion A quarter of patients with AF revealed a decreased GFR <45 ml/min/1.73 m2, half of them were recommended DOACs. 42 % of patients with GFR <30 ml/min/1.72 m2 were prescribed DOACs, 27 %-warfarin. Patients with CKD 5 st DOACs were not assigned; in half of cases, none of the anticoagulants was recommended. Most often, the dose of the prescribed anticoagulant was not counted according to GFR in patients with newly diagnosed sustained reduction in GFR <30 ml/min/1.73 m2. © 2020 Rockefeller University Press. All rights reserved

Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р&lt;0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p&lt;0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD