A breakthrough in the treatment of patients with heart failure with reduced ejection fraction: The clinical significance of the PARADIGM HF-trial

The implementation into clinical practice of new therapeutic strategies that Coll ld improve the prognosis of patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains relevant. Innovative approach is to restore imbalances of neurohumoral systems by inhibiting angiotensin II receptor and neprilysin. The review presents the role of the natriuretic peptides system in the HFrEF pathophysiology, historical approaches to neurohormonal modulation, clinical pharmacology of the first in the class of angiotensin receptor and neprilysin inhibitor sakubitril/valsartan. The results of the study PARADIGM-HF, in which sakubitril/valsartan therapy in patients with HFrEF compared with the recommended doses of enalapril was associated with the decrease of the of cardiovascular death and hospitalizations for HF by 20%, the risk of death from any cause by 16%, improvement of symptoms and exercise tolerance. Sakubitril/valsartan tolerated better than enalapril, rarely causes a Coll gh, hyperkalemia or renal dysfunction. There was no increase in the risk of angioedema. Based on the results of the study PARADIGM-HF sakubitril/valsartan was included in the national and international guidelines for HF

A breakthrough in the treatment of patients with heart failure with reduced ejection fraction: The clinical significance of the PARADIGM HF-trial

The implementation into clinical practice of new therapeutic strategies that Coll ld improve the prognosis of patients with heart failure (HF) with reduced ejection fraction (HFrEF) remains relevant. Innovative approach is to restore imbalances of neurohumoral systems by inhibiting angiotensin II receptor and neprilysin. The review presents the role of the natriuretic peptides system in the HFrEF pathophysiology, historical approaches to neurohormonal modulation, clinical pharmacology of the first in the class of angiotensin receptor and neprilysin inhibitor sakubitril/valsartan. The results of the study PARADIGM-HF, in which sakubitril/valsartan therapy in patients with HFrEF compared with the recommended doses of enalapril was associated with the decrease of the of cardiovascular death and hospitalizations for HF by 20%, the risk of death from any cause by 16%, improvement of symptoms and exercise tolerance. Sakubitril/valsartan tolerated better than enalapril, rarely causes a Coll gh, hyperkalemia or renal dysfunction. There was no increase in the risk of angioedema. Based on the results of the study PARADIGM-HF sakubitril/valsartan was included in the national and international guidelines for HF

Ventricular-arterial coupling parameters and its prognostic value in patients with decompensated heart failure

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 calcu-lated using the appropriate formulas. Differences were considered significant at p1,2 (predominantly patients with HF with reduced ejection fraction (HFrEF)-79%), 8% of patients had VAC 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 45 mmHg. © 2020, Silicea-Poligraf. All rights reserved

Effects of sacubitril/valsartan on the arterial stiffness and left ventricular-arterial coupling in patients with heart failure with reduced ejection fraction

Sacubitryl/valsartan in patients with heart failure with reduced ejection fraction (HFrEF) has shown an advantage over enalapril in reducing the risk of cardiovascular mortality and hospitalizations due to heart failure. Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC) and arterial stiffness in HFrEF patients. Material and methods. Arterial stiffness by applanation tonometry and LVAC - by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69±9 years, 89% male, arterial hypertension - 83%, diabetes - 39%, myocardial infarction - 89%, left ventricular ejection fraction 32±4%) initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance)/ Ees (left ventricular elastance) ratio. Differences were considered statistically significant at p < 0.05. Results. 72% of patients initially had elevated pulse wave velocity (PWV > 10 m/s). The decrease in PWV (from 11.5±2.9 to 10.2±2.9 m/s, p < 0.05), of the augmentation pressure (from 15.3±8.9 to 10.5±5.0 mm Hg, p=0.002), the increase in the reflected wave transit time (from 132±9 to 143±29 ms, p=0.02) and the subendocardial viability ratio (from 164±25 to 177±37%; p=0.009) were found after 12 months. Sacubitryl/valsartan- based therapy was associated with a decrease in central systolic blood pressure (from 116±19 to 106±10 mm Hg; p=0.001) and central pulse blood pressure (from 44±15 to 38±7 mm Hg; p < 0.05). Decrease in Ea (from 2.20±0.84 to 1.79±0.63 mm Hg/ml/m2; p=0.005) and Ea/Ees ratio (from 2.26±0.77 to 1.68±0.32; p=0.05) was found after 12 months. Ees did not change statistically significantly (1.00±0.34 vs 1.01±0.44 mm Hg/ml/m2). The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found. Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave. © 2018, Stolichnaya Izdatelskaya Kompaniya

EXPERIENCE OF HOSPITAL INITIATION OF SACUBITRIL/VALSARTAN IN A FEMALE PATIENT AFTER ACUTE DECOMPENSATED HEART FAILURE

The article discusses management of a female patient with chronic heart failure with reduced left ventricular ejection fraction after an episode of acute decompensation. Replacing an angiotensin-converting enzyme inhibitor with a representative of a new angiotensin receptor-neprilysin inhibitor class, sacubitril/valsartan, in the combination therapy allowed fast achievement and maintenance of the compensation state. The treatment was well tolerated and was not associated with clinically significant adverse effects

EXPERIENCE OF HOSPITAL INITIATION OF SACUBITRIL/VALSARTAN IN A FEMALE PATIENT AFTER ACUTE DECOMPENSATED HEART FAILURE

The article discusses management of a female patient with chronic heart failure with reduced left ventricular ejection fraction after an episode of acute decompensation. Replacing an angiotensin-converting enzyme inhibitor with a representative of a new angiotensin receptor-neprilysin inhibitor class, sacubitril/valsartan, in the combination therapy allowed fast achievement and maintenance of the compensation state. The treatment was well tolerated and was not associated with clinically significant adverse effects

Acute kidney injury in patients with prosthetic valve IE

Infective endocarditis (IE) is a serious disease with a high associated mortality rate, particularly when complicated by acute renal failure (ARF).In some cases, IE induces rapidly progressive glomerulonephritis and results in end-stage renal failure, which is associated with poor patient prognosis [1]. Patients with IE associated with ARF can be successfully treated with the proper use of antibiotics, surgery, renal replacement and ACEI/ARB therapies.Early detection of patients with impaired renal function may help to ensure more aggresive treatment and to improve clinical outcome. Serum creatinine is still gold standard of kidney injury, although it is well known as an insensitive and unreliable biomarker (for example, its concentration does not increase significantly until about half of the kidney function is lost). Considering these data, researches and clinicians are making great efforts in the past decade in order to discover and validate novel AKI biomarkers. Kidney injury molecule-1 (KIM-1), Neutrophil gelatinase-associated lipocalin (NGAL), Interleukin-18 (IL-18), Cystatin C (Cys-C) are some of new, promising markers of kidney damage which are currently in the focus ofpreclinical and clinical studies. Recent data suggest that some of these new biomarkers represent important parametars of acute tubular necrosis (ATN) and reliable predictors of development and prognosis of AKI. Beside that, monitoring of these markers could have significant importance for early d

Effects of sacubitril/valsartan on the arterial stiffness and left ventricular-arterial coupling in patients with heart failure with reduced ejection fraction

Sacubitryl/valsartan in patients with heart failure with reduced ejection fraction (HFrEF) has shown an advantage over enalapril in reducing the risk of cardiovascular mortality and hospitalizations due to heart failure. Aim. To study the effects of sacubitril/valsartan on left ventricular-arterial coupling (LVAC) and arterial stiffness in HFrEF patients. Material and methods. Arterial stiffness by applanation tonometry and LVAC - by two-dimensional echocardiography were evaluated in 18 patients with compensated HFrEF (age 69±9 years, 89% male, arterial hypertension - 83%, diabetes - 39%, myocardial infarction - 89%, left ventricular ejection fraction 32±4%) initially and after 6 and 12 months of therapy based on sacubitril/valsartan. LVAC was calculated as the Ea (arterial elastance)/ Ees (left ventricular elastance) ratio. Differences were considered statistically significant at p < 0.05. Results. 72% of patients initially had elevated pulse wave velocity (PWV > 10 m/s). The decrease in PWV (from 11.5±2.9 to 10.2±2.9 m/s, p < 0.05), of the augmentation pressure (from 15.3±8.9 to 10.5±5.0 mm Hg, p=0.002), the increase in the reflected wave transit time (from 132±9 to 143±29 ms, p=0.02) and the subendocardial viability ratio (from 164±25 to 177±37%; p=0.009) were found after 12 months. Sacubitryl/valsartan- based therapy was associated with a decrease in central systolic blood pressure (from 116±19 to 106±10 mm Hg; p=0.001) and central pulse blood pressure (from 44±15 to 38±7 mm Hg; p < 0.05). Decrease in Ea (from 2.20±0.84 to 1.79±0.63 mm Hg/ml/m2; p=0.005) and Ea/Ees ratio (from 2.26±0.77 to 1.68±0.32; p=0.05) was found after 12 months. Ees did not change statistically significantly (1.00±0.34 vs 1.01±0.44 mm Hg/ml/m2). The relationship between the decrease in PWV, Ea and the dynamics of blood pressure was not found. Conclusion. Sacubitryl/valsartan-based therapy in HFrEF patients results in a BP-independent improvement in LVAC due to a decrease in Ea, an improvement in the parameters of the central pulse wave. © 2018, Stolichnaya Izdatelskaya Kompaniya

Chronic heart failure: Clinical guidelines and real clinical practice

Aim. Expert assessment of real clinical practice compliance with national guidelines on management of patients with chronic heart failure (HF) before the opening of the Expert Center of HF treatment. Material and methods. All patients admitted to 2 city clinical hospitals of Moscow with HF were included into the register. Clinical, demographic, laboratory and instrumental characteristics and medical treatment before and during hospitalization were evaluated, as well as recommendations contained in the discharge summary. Results. 300 patients with HF were included into the register. The mean age was 75 years (39, 95); the proportion of men - 44%. 95% of patients had HF II- IV (NYHA), among them 24% - HF II, 61% - HF III, 15% - HF IV (NYHA). HF with reduced ejection fraction (HFrEF) was found in 45% of patients. 22% of the patients did not receive medical treatment before admission. 34% of patients with HFrEF received ACE inhibitors/angiotensin receptor blockers (ARBs), of which only 23% - in effective dose. β-blockers were prescribed in 41% of HFeEF patients, of which 22% - in the target dose. A third of patients needed in mineralocorticoid receptor antagonists (MRA) received spironolactone. During hospitalization 81% of HFrEF patients received ACEI therapy, 12% - ARBs, 91% - β-blockers, 90% - MRA, 81% - loop diuretics and 13% - thiazide diuretics. According to the discharge summary 5% of patients did not receive post-discharge blocker of the renin-angiotensin-aldosterone system without explanation in the medical documentation. β-blocker with proven efficacy was prescribed to 70% of HFrEF patients. Spironolactone was recommended after discharge in 89% of HFrEF patients. Conclusion. Implementation of register of hospitalized patients with HF gives an opportunity to identify shortcomings in the provision of medical care both in outpatient and inpatient stages

Chronic heart failure: Clinical guidelines and real clinical practice

Aim. Expert assessment of real clinical practice compliance with national guidelines on management of patients with chronic heart failure (HF) before the opening of the Expert Center of HF treatment. Material and methods. All patients admitted to 2 city clinical hospitals of Moscow with HF were included into the register. Clinical, demographic, laboratory and instrumental characteristics and medical treatment before and during hospitalization were evaluated, as well as recommendations contained in the discharge summary. Results. 300 patients with HF were included into the register. The mean age was 75 years (39, 95); the proportion of men - 44%. 95% of patients had HF II- IV (NYHA), among them 24% - HF II, 61% - HF III, 15% - HF IV (NYHA). HF with reduced ejection fraction (HFrEF) was found in 45% of patients. 22% of the patients did not receive medical treatment before admission. 34% of patients with HFrEF received ACE inhibitors/angiotensin receptor blockers (ARBs), of which only 23% - in effective dose. β-blockers were prescribed in 41% of HFeEF patients, of which 22% - in the target dose. A third of patients needed in mineralocorticoid receptor antagonists (MRA) received spironolactone. During hospitalization 81% of HFrEF patients received ACEI therapy, 12% - ARBs, 91% - β-blockers, 90% - MRA, 81% - loop diuretics and 13% - thiazide diuretics. According to the discharge summary 5% of patients did not receive post-discharge blocker of the renin-angiotensin-aldosterone system without explanation in the medical documentation. β-blocker with proven efficacy was prescribed to 70% of HFrEF patients. Spironolactone was recommended after discharge in 89% of HFrEF patients. Conclusion. Implementation of register of hospitalized patients with HF gives an opportunity to identify shortcomings in the provision of medical care both in outpatient and inpatient stages