Current approaches to risk assessment of chronic heart failure after myocardial infarction

In the last decade, there has been an increase in the number of survivors of myocardial infarction (MI). However, the risk of developing chronic heart failure (CHF) remains high in this category of patients. Population aging and comorbidity further contribute to adverse outcomes. Optimization of approaches to identify predictors of postinfarction CHF is an important clinical task of modern medicine. The aim of the investigation is to develop a method to assess the risk of CHF development after MI. Material and Methods. The present analysis included 186 patients who underwent MI from January 2019 to January 2020: 86 patients with signs of CHF above functional class (FC) 2 (NYHA) (mean age 64.3 years) and 100 patients without signs of CHF or with CHF 1 (NYHA) (mean age 62.6 years) by day 30 of MI. A mathematical model of CHF risk after MI was built by factor and correlation analysis methods. Results. A method for assessing CHF risk after a previous MI was developed. The proposed formula is programmed in Excel table processor and includes 5 indicators: presence of atrial fibrillation, Killip class of acute heart failure, triglycerides level, ST-segment elevation of electrocardiogram, left ventricular ejection fraction less than 45 %. The authors’ approach allows long-term personalized monitoring, taking into account the ranked contribution of each factor in a particular patient; it is characterized by high sensitivity, specificity, and accuracy. Conclusion. The present study investigated the factors of formation of postinfarct chronic heart failure syndrome. An original mathematical formula for CHF risk estimation, including routine indices of MI patients, has been proposed. The approach allows personalized management of selected cohorts of patients – with increased and standard risk of postinfarction CHF

Evolution of chronic heart failure syndrome in a patient with myocardial infarction and complex rhythm disturbances

Abstract: today the problem of chronic heart failure as a complication of myocardial infarction and other cardiovascular diseases continues to be relevant, due to the increase in the prevalence of heart failure, especially the severe stage of heart disease and the main causes of deaths of this cohort of patients. The article presents a clinical case of chronic heart failure syndrome with complex rhythm disturbances in the patient against the background of the transferred transmural myocardial infarction and hypertension. The authors demonstrated that after a thorough assessment of the risk and benefit of various treatment methods, the therapeutic and surgical tactics of management of the patient in this clinical situation were correctly chosen, which allowed not only to prolong life, but also to improve the quality of life of the patient. Thus, in this clinical case, we show the importance of personalized therapy in the progression of chronic heart failure syndrome in patients with combined cardiovascular disease.На сегодняшний день проблема хронической сердечной недостаточности, как осложнение инфаркта миокарда и другой сердечно-сосудистой патологии продолжает оставаться актуальной, связно это с увеличением распространенности сердечной недостаточности, особенно тяжелой стадии поражения сердца и основными причинами летальных исходов данной когорты пациентов. В статье представлен клинический случай синдрома хронической сердечной недостаточности со сложными нарушениями ритма у пациента на фоне перенесенного трансмурального инфаркта миокарда и гипертонической болезни. Авторами продемонстрировано, как после тщательной оценки риска и пользы различных методов лечения была правильно подобрана терапевтическая и хирургическая тактика ведения больного в данной клинической ситуации, что позволило не только продлить жизнь, но и улучшить качество жизни пациента. Таким образом, данным клиническим случаем мы показываем важность персонифицированной терапии при прогрессировании синдрома хронической сердечной недостаточности у пациентов с сочетанной сердечно-сосудистой патологией

Genetic predictors of five-year outcomes of acute coronary syndrome

Aim. To determine the genetic predictors of five-year outcomes in patients with acute coronary syndrome (ACS).Material and methods. The study included patients admitted to the City clinical hospital № 1 (CCH №1) in Novosibirsk with a diagnosis of ACS in the period 2010-3 2011 (n=280). All patients were examined in accordance with clinical guidelines and standards of care, genetic markers were assessed. Genotyping included determination of single nucleotide polymorphisms (SNPs), confirming its association with the development of the ACS according to the results of an international genomeassociated studies: rs1376251, rs4804611, rs 1333049, rs619203, rs10757278, rs2549513, rs499818, rs17465637. All patients are kept in touch from the moment of initial contact to the present time, with the help of available means of communication and annual examinations in order to assess the end points. “End points” included: repeated nonfatal myocardial infarction (MI), hospitalization for myocardial ischemia, re-revascularization or chronic heart failure (CHF), nonfatal acute cerebrovascular accident (NACA), cardiovascular death.Results. We revealed SNPs, which play a role in predicting long-term outcomes of ACS: rs10757278, rs 4804611, rs 1333049, rs 2549513. The genotype of rs2549513 as 2,9-fold (95% CI 1,06-8,03; p=0,041) increases the risk of unfavorable long-term prognosis in the subgroup of men older than 55 years. The AA genotype rs10757278 and GG genotype rs1333049 are associated with a favorable long-term prognosis (OR=0,47, 95% CI 0,23-0,96; p=0,042 and OR=0,41, 95% CI 0,22-0,78; p=0,049, respectively) in the group of patients older than 55 years. For the GG genotype rs1333049 association was characteristic only for women. The AA genotype rs4804611 is associated with a favorable outcome of ACS at the age of 55 years (OR=0,036, 95% CI 0,14-0,96; p=0,053), significant differences were obtained in the group of men (p=0,36).Conclusion. The use of identified genetic predictors to assess the risk of five-year outcomes will strengthen a personalized approach to patients and, together with conventional prevention measures, will reduce cardiovascular mortality