Left Ventricular Function after Revascularization in Patients with Chronical Coronary Syndromes

Background: The purpose of this study was to determine the dynamics of morpho-functional and myocardial deformation characteristics of the left ventricle after revascularization in patients with chronic coronary syndromes (CCS). Methods and Results: The study included 136 CCS patients of both sexes with stable anginal symptoms [(i) clinical scenario] and asymptomatic coronary artery disease (CAD) at screening [(vi) clinical scenario]. Diagnosis of CCS was performed according to the 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. All patients underwent the following examinations: assessment of traditional risk factors, physical examination, general clinical and laboratory blood tests, 12-lead ECG, transthoracic echocardiography, two-dimensional speckle tracking echocardiography (STE), and coronary angiography (CAG). The SYNTAX score was calculated retrospectively according to the SYNTAX score algorithm. A total of 100 patients with CCS were enrolled in the main group (MG) and underwent revascularization by PCI with intracoronary stenting using drug-eluting stents. Among the main-group patients, one-vessel, two-vessel, and three-vessel CAD were detected in 36(26.5%), 34(25%), and 30(22.0%) cases, respectively. The comparison group (CG) included 36 CCS patients with hemodynamically non-significant coronary lesions (<50% stenosis). LVEF values were within the normal range in all groups, with the highest value in the CG, followed by the one-, two- and three-vessel lesion groups. LVEF obtained by the area-length method and modified biplane Simpson's method did not differ. The assessment of the contractile function of the LV myocardium was also obtained by assessing the global longitudinal strain (GLS) and global longitudinal strain rate (GLSR). The comparative analysis of the LV myocardial deformation properties in the studied groups showed that less negative GLS and GLSR were found in the three-vessel CAD, followed by the two-vessel and one-vessel CAD groups, and CG. CG demonstrated more negative GLS and GLSR than all MG subgroups. We analyzed the effect of revascularization on the GLS and found no statistically significant differences before and 48 hours after revascularization in all studied MG subgroups and CG. Thirty days after revascularization, GLS significantly showed more negative values in all MG subgroups: -18.12±0.63 versus -17.9±0.4 in one-vessel CAD, -16.13±0.71 versus -15.9±0.4 in two-vessel CAD and -13.91±1.25 versus -13.1±1.1 in three-vessel CAD. In CG with medical treatment only, GLS did not change statistically significantly but had more negative values than in the studied MG subgroups. Analysis of changes in LVEF after revascularization in the MG of patients with one-, two- and three-vessel CAD and in the CG after medical treatment did not reveal statistically significant dynamics. Conclusion: the results indicate the absence of statistically significant changes in myocardial deformation indicators and morpho-functional parameters of the left ventricle in CCS patients 48 hours after revascularization. Thirty days after revascularization, GLS significantly improves, while LVEF remains unchanged. GLS is superior to LVEF in visualizing improvement in LV function after revascularization in patients with CCS

Pulmonary hypertension syndrome in dilation cardiomyopathy patients: sildenafil application to common treatment of chronic heart failure

Aim. To assess clinical and hemodynamic efficacy of sildenafil at the background of basic therapy in patients with idiopathic and right ventricular (RV) dilated cardiomyopathy. Material and methods. Totally, 59 patients with idiopathic DCMP included. All patients were selected to 2 groups: I (n=28); M/F 15/13; 46,9 ±11,4 y.o., and II (n=31); M/F 17/14; 46,3±15,4 y.o. Number of patients with RV DCMP in each group was 10 (35,7%) and 13 (41,9%), resp. They underwent clinical status assessment by SCAHF, 6-minute walking test, standard ECG, echocardiography via transthoracic approach. Patients of the 1st group additionally to basic therapy of heart failure were prescribed sildenafil in individual dosage — mean 45,8±12,5 mg/day. Duration of the study was 6 months.Results. Women, consisting 45,7% in general, significantly predominated among patients with RV DCMP. By the results of the study there was regression of the mean points by SCAHF by 30,1% and 40,8%, increase of 6-minute distance by 50,1% and 45,8% in patients of I and II groups, respectively. At the background of sildenafil addition, there was significant decrease of systolic pressure in pulmonary artery in I group by 23,8% (p=0,031), that helped to decrease end-diastolic pressure in RV chamber and increased RV ejection fraction by 6,3%. In i group patients there was increase of diastolic reserve of RV due to improvement of active Ve by 29,1% (p=0,01) and Va by 54% (p=0,03), that led to a decrease of Ve/Va ratio by 38% (p&lt;0,05). The assessment of spirometry showed that combination therapy by sildenafil led to significant increase of Tiffeneau and Gaensler indexes by 23,4% and 12,3%, resp. (both p&lt;0,05).Conclusion. Pulmonary hypertension syndrome in most cases is present in patients with either idiopathic or RV DCMP. Additional prescription of sildenafil contributes to the decrease of heart failure and respiratory failure severity symptoms and to improvement of hemodynamical signs, leading to significant decrease of systolic pressure in pulmonary artery

Lung Function Parameters in Patients with Dilated Cardiomyopathy Complicated by Pulmonary Hypertension

Aim. To study clinical and morphofunctional indicators of respiratory function in patients with dilated cardiomyopathy (DCM) with and without pulmonary hypertension (PH).Material and methods. 91 patients with idiopathic DCM (34 women and 57 men; mean age of 46.4±13.7 years) were included into the study. 25 (27.4%) patients had right ventricular DCM (RV DCM). 6-minute walking test (6MWT), the standard 12-lead ECG, spirography, echocardiography were performed in all patients. PH occurred in 48 of DCM patients (Group I) and 43 DCM patients had no PH (Group II). A number of patients with RV DCM in Groups I and II was 11 (23%) and 14 (32.5%), respectively.Results. Pulmonary artery systolic pressure (PASP) in group I was 48.1±10.7 mmHg (in 71% of the patients – degree 1 of PH, and in 29% - degree 2). A significant decrease in the majority of speed indicators of respiratory functions was found in Group I. The inverse relationship between PASP and Tiffno index (p=0.03) and a positive correlation between forced vital capacity (53.17±9.21%) and 6MWT distance (206.7±80.3 m; p=0.017) were found in patients of Group I.Conclusion. PH syndrome often aggravates the DCM course. Forced expiratory volume in the first second, Tiffno index, and some speed indicators show disorders of respiratory function in DCM patients

SPIRAPRIL IN TREATMENT OF HEART FAILURE DUE TO DILATED CARDIOMYOPATHY

Spirapril in treatment of heart failure due to dilated cardiomyopathy

Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Aims: Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy. Methods: The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared. Results: Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p&lt;0.001), more frequent signs of heart failure (pulmonary rales in 70.7% and 55.4%, p=0.002), higher baseline LVEF (32.7% and 30.7%, p=0.005) and smaller left ventricular end diastolic diameter (57.4mm [±6.7] and 59.8mm [±8.1], p&lt;0.001). There were no differences in the frequencies of death from any cause, re-hospitalization for any cause, stroke, or thromboembolic events. Compared to women with PPCM-noHTN, women with PPCM-PE had a greater likelihood of left ventricular recovery (LVEF≥50%) (adjusted OR 2.08 95% CI 1.21-3.57) and an adverse neonatal outcome (composite of termination, miscarriage, low birth weight or neonatal death) (adjusted OR 2.84 95% CI 1.66-4.87). Conclusion: Differences exist in phenotype, recovery of cardiac function and neonatal outcomes according to hypertensive status in women with PPCM

Heart failure in Europe: Guideline-directed medical therapy use and decision making in chronic and acute, pre-existing and de novo, heart failure with reduced, mildly reduced, and preserved ejection fraction – the ESC EORP Heart Failure III Registry

Aims We analysed baseline characteristics and guideline-directed medical therapy (GDMT) use and decisions in theEuropean Society of Cardiology (ESC) Heart Failure (HF) III Registry. Methods and results Between1November 2018and31December 2020,10162 patients with acute HF (AHF, 39%, age 70 [62-79],36% women) or outpatient visit for HF (61%, age 66 [58-75], 33% women), with HF with reduced (HFrEF, 57%),mildly reduced (HFmrEF,17%) or preserved (HFpEF, 26%) ejection fraction were enrolled from 220 centres in 41European or ESC-affiliated countries. With AHF, 97% were hospitalized, 2.2% received intravenous treatment in theemergency department, and 0.9% received intravenous treatment in an outpatient clinic. AHF was seen by most bya general cardiologist (51%) and outpatient HF most by a HF specialist (48%). A majority had been hospitalized forHF before, but 26% of AHF and 6.1% of outpatient HF had de novo HF. Baseline use, initiation and discontinuation ofGDMT varied according to AHF versus outpatient HF, de novo versus pre-existing HF, and by ejection fraction. Afterthe AHF event or outpatient HF visit, use of any renin-angiotensin system inhibitor, angiotensin receptor-neprilysininhibitor, beta-blocker, mineralocorticoid receptor antagonist and loop diuretics was 89%, 29%, 92%, 78%, and 85%in HFrEF; 89%, 9.7%, 90%, 64%, and 81% in HFmrEF; and 77%, 3.1%, 80%, 48%, and 80% in HFpEF. ConclusionUse and initiation of GDMT was high in cardiology centres in Europe, compared to previous reports from cohortsand registries including more primary care and general medicine and regions more local or outside of Europe andESC-affiliated countries....................................