Risk of heart failure depending on the state of renal filtration function in patients with uncomplicated hypertension

Aim. To assess the risk of heart failure (HF) depending on the state of renal filtration function in patients with uncomplicated hypertension (HTN) without kidney dysfunction.Material and methods. This cross-sectional screening clinical trial consecutively included 176 outpatients with uncomplicated HTN and without chronic kidney disease (CKD). To assess the HF risk, the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. To assess the renal filtration function, the blood serum concentration of creatinine and cystatin C was determined, followed by glomerular filtration rate (GFR) estimation using the CKDEPI equation with both parameters. Echocardiography was performed to assess the cardiac structural and functional state.Results. Correlation analysis revealed a moderate direct relationship between NT-proBNP and blood cystatin C concentration (r=0,370; p<0,005), as well as a moderate inverse relationship with GFR (CKD-EPIcre) and GFR (CKD-EPIcys) (r= -0,321; p<0,05 and r=-0,360; p<0,005, respectively). ROC curve for all available values of blood cystatin C revealed the most optimal cut-off threshold of 1016 ng/ml (AUC=0,726, p<0,001), which ensures the sensitivity of 72,2% (p<0,001) and specificity of 62,0% (p<0,001). ROC curve for all available GFR values (CKD-EPIcys) revealed a cut-off threshold of 74 ml/min/1,73 m2 (AUC=0,702, p=0,002) with a sensitivity and specificity of 55,6% and 74,7%, respectively (p=0,001 and p=0,001, respectively). Taking into account the cut-off points for cystatin C and GFRcys, the first group consisted of 73 (41,48%) patients with cystatin C ≥1016 ng/ml and GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2, while the second one — 103 (58,52%) patients with cystatin C <1016 pg/ml and GFR (CKDEPIcys) >74 ml/min/1,73 m2. The presence of impaired glucose tolerance, left ventricular diastolic dysfunction (LV DD), LV hypertrophy and left atrial enlargement leads to an additional increase in HF risk in patients with uncomplicated HNT without CKD.Conclusion. The ROC analysis showed that cystatin C and cystatin C-based GFR (CKD-EPIcys) can be used as markers of HF risk in patients with uncomplicated HTN without CKD. With an increase in cystatin C ≥1016 ng/ml, the relative risk of HF is 2,99, while with a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2 — 1,26. The presence of impaired glucose tolerance, LV DD, LV hypertrophy and left atrial enlargement in patients with uncomplicated HTN without CKD with a cystatin C increase ≥1016 ng/ml and a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2 and below further increases the risk of developing CHF

Masked hypertension risk as condition of arterial stiffness in cardiovascular risk patients: a pilot single-stage screening observational study

Background. Masked arterial hypertension (MAH) is associated with asymptomatic injury of both heart and kidneys. Links between MAH and arterial stiffness are unclear, with debates ongoing on their mutual causative relation. Research into the arterial stiffness contribution to MAH development is a perspective area of cardiology.Objectives. The MAH risk assessment as a condition of arterial stiffness in patients at cardiovascular risk (CVR) without a verified cardiovascular disease (CVD).Methods. A single-stage screening observational study included a total of 92 CVR patients without a verified cardiovascular disease. The trial conducted general clinical examination, daily blood pressure monitoring (DBPM), volumetric sphygmoplethysmography with reading cardio-ankle vascular index (CAVI1), aortic and carotid artery pulse wave velocity (PWV), carotid-femoral PWV (CFV) and augmentation index.Results. Patients were assigned in two cohorts by MAH presence, the primary MAH (58; 63.0%) and normal BP in DBPM (34; 37.0% patients) cohorts. The cohorts did not discord by age, major CVR factors, comorbidity or clinical profile. Men prevailed over women in the MAH cohort (p = 0.028). The cohorts had similar CFV, aortic PWV and augmentation index. Carotid PWV was higher in the MAH cohort both in mean values and elevation rate (p = 0.002 and p = 0.035, respectively). OR and HR were 3.29 and 2.35 (95% CI for OR 1.08–10.49, HR 1.05– 6.02), respectively. MAH was associated with increased CAVI1 for mean values and CAVI1 > 8 incidence rate (p = 0.010 and 0.049, respectively); OR 3.29 (95% CI 1.00–11.41), HR 2.46 (95% CI 1.00–7.10). Correlation analysis revealed a moderate direct dependence between the MAH presence and elevation rate of C-PWV (Q = 0.53) and CAVI1 > 8 (Q = 0.53).Conclusion. The risk of MAH development in CVR patients is both gender and arterial stiffness-dependent. MAH development is associated with increased CAVI1 and carotid PWV

Risk factors and diagnostic value of urinary N-terminal pro-brain natriuretic peptide for verification of heart failure in human immunodeficiency virus-infected patients

Aim. To determine the risk factors and diagnostic value of urinary N-terminal probrain natriuretic peptide (NT-proBNP) for verification of heart failure in human immunodeficiency virus (HIV)-infected patientsMaterial and methods. This cross-sectional screening clinical trial included 115 HIV-infected patients who were hospitalized during 24 months. The patients were divided into 2 groups, depending on the data suggestive of HF and the blood and urinary NT-proBNP concentration. So, group 1 included 69 HIV-infected patients with HF symptoms and increased blood and urinary NTproBNP, while group 2 — 46 HIV-infected patients not meeting HF criteria. NTproBNP concentration was determined on Immulite 1000 Immunoassay System (DPC, USA) in blood plasma and frozen urine using Vector Best reagents (Russia).Results. Correlation analysis revealed a significant direct moderate correlation between blood and urinary NT-proBNP in the entire cohort of studied patients (r=0,367; p<0,05). Urinary NT-proBNP ≥8,6 pg/ml ml is diagnostic for HF verification in HIV-infected patients. Significant differences between the groups were obtained in the incidence of ventricular arrhythmias, viral hepatitis B and C, liver cirrhosis, infective endocarditis, other inflammatory diseases, thrombocytopenia, left ventricular (LV) diastolic dysfunction and its severity. In addition, there were differences in LV mass index, left atrial volume index, incidence of LV hypertrophy and left atrial enlargement, concentration of hemoglobin and CD4 cells <200 in 1 µl. The preserved LV ejection fraction was detected significantly more often (p<0,001). Conclusion. In HIV-infected patients, blood plasma and urinary NT-proBNP concentration correlates with each other. Urinary NT-proBNP ≥8,6 pg/ml is diagnostic for HF verification in HIV-infected patients. Risk factors and features of developing HF, estimated by NT-proBNP concentration in frozen urine in HIV-infected patients, are comparable to data obtained from blood plasma NTproBNP

Contribution of inflammation to heart failure development in human immunodeficiency virus-infected patients

Aim. To determine the peculiarities of heart failure (HF) development in human immunodeficiency virus (HIV)-infected patients, depending on the blood concentration of C-reactive protein (CRP).Material and methods. This cross-sectional screening clinical trial included 100 patients hospitalized with HIV infection and a history of HF for 28 months. The patients were divided into 2 groups depending on blood CRP concentration. The cut-off point was CRP of 15 mg/l. The first group included 37 HIV-infected patients with HF and blood CRP <15 mg/l, while the second group — 63 HIV-infected patients with HF and CRP concentration ≥15 mg/l. The inclusion criteria were HIV infection and prior HF, stable medical state, taking into account the underlying disease that required hospitalization. The study did not include patients with acute cardiovascular diseases within prior 3 months, acute decompensated and acute heart failure, cancer, infectious diseases, conditions that required surgical intervention. N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined in all patients.Results. Correlation analysis revealed a strong inverse relationship between the blood concentrations of NT-proBNP and CRP (r=-0,639; p<0,005). A ROC curve revealed the most optimal cut-off threshold of 9,8 mg/l (AUC=0,796, p<0,05), which ensures sensitivity of 92,9% (p<0,05) and specificity of 57,6% (p<0,05). The odds ratio (OR) of an increase in NT-proBNP >450 pg/ml, and hence the risk of acute decompensated HF in the presence of a CRP concentration of 1-9,8 mg/l in HIV-infected patients with HF was 44,73 (95% CI=8,62;311,10), while relative risk (RR) — 18,73 (95% CI=4,94;112,94). In the presence of in hospital inflammatory diseases and CRP ≥15 mg/l in HIV-infected patients and prior HF, the RR of acute decompensated HF is reduced by 88% (RR=0,12, 95% CI=0,03-0,33).Conclusion. CRP values from 1 to 9,8 mg/l in HIV-infected patients with HF are predictors of its severity, characterized by a higher incidence of HF with reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy without significant differences with patients who have CRP >9,8 mg/l. CRP concentration >9,8 mg/l in HIV-infected patients and prior HF indicates the development of an inflammatory process, and not a worsening of the HF course

Target organ remodelling in hypertensive pregnant women in relation with the type of hypertension

Relevance: Currently, the incidence of chronic and pregnancy-associated hypertension is continuously increasing. The characteristics of target organs impairment and of its impact on the adverse prognosis in hypertensive pregnant women represent a disputable and insufficiently explored medical problem. The aim of the study: To assess the impairment of target organs in pregnant women with hypertensive disorders in relation with the type of hypertension. Materials and methods: Four hundred and thirteen (413) pregnant women were included in the study. Among them, 63 pregnant women with hypertensive disorders were selected. Thirty one (31) pregnant women had chronic hypertension (CH), 32 women suffered from pregnancy-associated (“gestational") hypertension (GH). Thirty two (32) pregnant women with normal blood pressure represented a control arm. Women with secondary or unclassified hypertension were excluded from the study. Results: Left ventricle (LV) remodelling in 24-26-week pregnant women with hypertensive disorders was more significant in patients with chronic hypertension vs. those with GH and distinguished by predominant and more severe LV dysfunction. During the first trimester of pregnancy, hypertensive women demonstrated increased cystatin С blood level as an early indicator of renal filtration impairment. This increase was more significant in patients with pregnancy-associated hypertension. Remodelling of the arterial wall and kidney structure included increased collagen production, present in the suppression of blood MMP-9 and MMP-2 levels in patients with chronic hypertension and of MMP-9 only - in women with gestational hypertension, without associated CIMT changes.Conclusions: The impairment of target organs in pregnant women with hypertensive disorders depended on the type of hypertension. In women with chronic hypertension, LV remodelling in the form of diastolic dysfunction was predominant, while the women with pregnancy-associated hypertension demonstrated renal filtration abnormalities as early as in the first pregnancy trimester, present in the cystatin С blood level variations. Reduced MMP-9 blood level during the first trimester of pregnancy was an early integral indicator of remodelling of the intercellular matrix of arterial wall and kidneys both in chronic and gestational hypertension.Актуальность. В последние годы наметилась тенденция увеличения частоты встречаемости не только хронической, но и гестационной АГ у женщин на фоне беременности. Известно, что оба варианта гипертензивных расстройств способствуют у беременных трансформации их в преэклампсию/эклампсию, служат важным фактором риска развития осложнений беременности как со стороны матери, так и со стороны плода и приводят к развитию ассоциированных с АГ сердечно-сосудистых клинических состояний, таких как инсульты, острое повреждение почки, злокачественная ретинопатия, а также к развитию преждевременных родов, задержке внутриутробного развития плода, низкому весу ребенка при рождении. Целью исследования явилась оценка особенности течения гипертензивного синдрома у беременных и поражение органов-мишеней при хронической и гестационной артериальной гипертензии. Материалы и методы. В исследование были включены 223 беременные женщины. Среди них были выделены 63 беременные с гипертензивным синдромом. У 31 беременной была выявлена хроническая артериальная гипертензия (ХАГ), у 32 - гестационная АГ (ГАГ). В исследование не включались женщины с вторичной и неклассифицируемой АГ. Результаты. В работе было продемонстрировано, что течение гипертензивного синдрома при беременности зависит от формы АГ. Хроническая АГ, в отличие от гестационной, характеризуется преобладанием повышения САД как по частоте регистрации, так и по продолжительности в течение суток в сочетании с более низкой среднесуточной и дневной его вариабельностью. Гестационная АГ отличается преимущественно более выраженными изменениями ДАД, характеризующимися значимым его повышением в утренние часы и ночное время, длительной ночной диастолической гипертензией более 65% времени в сочетании с низкой вариабельностью ДАД в дневные и ночные часы. Ремоделирование ЛЖ на 24-26-й неделе беременности у женщин с гипертензивным синдром более выражено у больных с хронической АГ и характеризуется более частой и более тяжелой диастолической дисфункцией ЛЖ. Важным является вывод о том, что более ранним маркером нарушения фильтрационной функции почек в I триместре у беременных с гипертензивным синдромом является увеличение концентрации цистатина С в крови, более выраженное при гестационной АГ. Также установлено, что ранним маркером структурной перестройки артериальной стенки и почек, характеризующейся повышенным коллагенообразованием, при отсутствии изменений ТКИМ у беременных с АГ следует считать снижение концентрации в крови ММП-9 и ММП-2 для больных с хронической АГ и только ММП-9 для больных с гестационной. Выводы. Поражение органов-мишеней у беременных с гипертензивным синдромом зависит от его формы: при хронической АГ чаще регистрируется ремоделирование ЛЖ, представленное его диастолической дисфункций, при гестационной - чаще встречается снижение фильтрационной функции почек уже в I триместре беременности, оцененной по уровню цистатина в крови. Уменьшение в крови концентрации ММП-9 в I триместр беременности является ранним интегральным маркером перестройки артериальной стенки и межклеточного матрикса почек как при хронической, так и гестационной АГ

The prevalence and course of hypertensive disorders of pregnancy in women of Perm

This study aimed to evaluate the risk factors of complications of hypertensive pregnancy disorders (HPD), particularly preeclampsia, dependent on their type (chronic or gestational hypertension), in parallel with the assessment of mother and child outcomes in various types of HPD.Целью исследования явилось оценка факторов риска осложнений ГРБ, в частности, преэклампсии, в зависимости от ее формы (ХАГ или ГАГ), а также оценки исходов беременности у матери и у плода при разных формах ГРБ

Pharmacoepidemiological analysis of routine management of heart failure patients in the Russian Federation. Part II

Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia

2020 Clinical practice guidelines for Hypertrophic cardiomyopathy

Russian Society of Cardiology (RSC)With the participation: Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation Task Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V