Clinical Features and the NT-proBNP Marker in Patients with Chronic Heart Failure in the Setting of Atrial Fibrillation and Chronic Obstructive Pulmonary Disease

Aim: To determine the clinical features and analyse the concentration of the heart failure (HF) marker in patients with atrial fi brillation (AF) and chronic obstructive pulmonary disease (COPD).Materials and methods: 120 patients were divided into the following groups: 1) experimental group including patients with chronic heart failure (CHF), AF and COPD (n = 29); 2) comparison group 1 including patients with COPD, but without cardiovascular diseases (CVD) (n = 28); 3) comparison group 2 consisting of patients with CHF and COPD, but without AF (n = 30); 4) comparison group 3 comprising patients with CHF and AF, but without COPD (n = 33). Clinical symptoms and tolerance to physical load were assessed for all patients with CHF using the clinical condition scale (CCS) and the 6 Minute Walk Test (6MWT), respectively. The severity of dyspnoea was assessed (mMRC scale) in the groups of patients with COPD. The concentration of NT-proBNP was analysed using a Biomedica NT-proBNP reagent pack (SK-1204).Results: A comparative analysis of the CHF clinical manifestations (according to CCS) in the study groups showed higher median values in the group of patients with CHF, AF and COPD, as compared to the same indicator in patients with CHF and AF, but without COPD (p < 0.001). An intergroup analysis of the dyspnoea symptom using the mMRC scale showed the lowest degree of dyspnoea in the group with COPD and without CVD, which signifi cantly differed from the same indicator in patients with CHF and COPD, but without AF (p = 0.015). The 6MWT results did not reveal signifi cant differences between the groups (p = 0.017). In assessing the level of the HF marker, higher concentrations of NT-proBNP were found in the group of patients with CHF, AF and COPD, which exceeded its concentration in patients with CHF and COPD, but without AF (p = 0.0003), as well as in patients with CHF and AF, but without COPD (p = 0.01).Conclusion: 1. Due to the presence of chronic bronchial obstructive syndrome, higher severity of clinical HF symptoms was established in patients with CHF, AF and COPD – as compared to the group including patients with CHF and AF, but without COPD. 2. A statistically signifi cant higher level of NT-proBNP was determined in patients with CHF, AF and COPD, which is associated with the presence of hemodynamic load on both ventricles of the heart under the mutual infl uence of AF and chronic bronchial obstruction on the hemodynamics of the pulmonary circulation

STUDY OF THE PARAMETERS OF TOLERABILITY AND ADHERENCE TO THERAPY IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND ARTERIAL HYPERTENSION ON THE BACKGROUND OF TREATMENT WITH FIXED COMBINATION OF RAMIPRIL AND AMLODIPINE (ACCORDING TO THE RESULTS OF OBSERVATIONAL STUDY "GRANAT-2")

Working group of the “GRANAT-2” study: Tula - Trubitsyn G.I., Ivanov Yu.V., Mirenkova O.K., Eskova R.A., Simonova R.P., Milon M.E., Telegina E.V., Kuznetsov A.M., Zhukova N.A., Zainullina I.K.; Rostov-on-Don - Budanov O.V., London E.M., Minosyan L.V., Nedashkovskaya N.G., Ter-Ananyants Ye.A.; Tomsk - Proskokova I.Yu., Permyakova O.V., Politova L.V., Maneeva I.D., Ivanova S.Yu.; Nizhny Novgorod - Larina O.V., Pokrovskaya I.N., Patselt E.A.; Moscow - Sladkova T.A., Zelenova Т.V. Aim. To study the tolerability and adherence to antihypertensive therapy in patients with hypertension and chronic obstructive pulmonary disease (COPD) using the fixed combination of ramipril and amlodipine in the observational program for patients with arterial hypertension and COPD (GRANAT-2). Material and methods. Patients with hypertension and COPD (n=52) with all inclusion criteria and without exclusion criteria who signed informed consent to participate in the GRANAT-2 program were included into the study. The use of a fixed combination of ramipril and amlodipine was recommended in all patients. The doses were determined by the treating physicians in accordance with the official drug instruction. The patients had 4 visits, and the duration of the study was 5 months. The Morisky-Green test was used to assess an adherence of patients to treatment. Assessments of blood pressure, adverse events were performed at all visits. Results. 50 of 52 patients completed the study: 45 patients used the studied fixed combination in the recommended doses, and 5 patients used other antihypertensive drugs, 2 patients withdrew from the study. Systolic blood pressure after 1 month of treatment decreased by an average of 20 mm Hg from the baseline, and diastolic blood pressure – by 10 mmHg. These rates after 5 months of therapy were 29 mm Hg and 15 mm Hg, respectively. Target blood pressure level was achieved in all patients. Increase in adherence of patients to treatment (according to the Morisky-Green test from 21.1% to 65.1%) was found. 2 cases of adverse events (dry cough) were registered. The discrepancy in adherence assessment was revealed between the results from the Morisky-Green test and the data from program case report forms. Conclusion. Regular patient visits to the doctor and the rapid achievement of an antihypertensive effect with good tolerability of a fixed combination of ramipril and amlodipine contributed to the increase in adherence of patients to treatment. Undesirable effects of the drug therapy are significant, but not leading factors that have a negative impact on the patient adherence to treatment

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio

Clinical features of post-COVID-19 period. Results of the international register “Dynamic analysis of comorbidities in SARS-CoV-2 survivors (AKTIV SARS-CoV-2)”. Data from 6-month follow-up

Aim. To study the clinical course specifics of coronavirus disease 2019 (COVID-19) and comorbid conditions in COVID-19 survivors 3, 6, 12 months after recovery in the Eurasian region according to the AKTIV register. Material and methods.The AKTIV register was created at the initiative of the Eurasian Association of Therapists. The AKTIV register is divided into 2 parts: AKTIV 1 and AKTIV 2. The AKTIV 1 register currently includes 6300 patients, while in AKTIV 2 — 2770. Patients diagnosed with COVID-19 receiving in- and outpatient treatment have been anonymously included on the registry. The following 7 countries participated in the register: Russian Federation, Republic of Armenia, Republic of Belarus, Republic of Kazakhstan, Kyrgyz Republic, Republic of Moldova, Republic of Uzbekistan. This closed multicenter register with two nonoverlapping branches (in- and outpatient branch) provides 6 visits: 3 in-person visits during the acute period and 3 telephone calls after 3, 6, 12 months. Subject recruitment lasted from June 29, 2020 to October 29, 2020. Register will end on October 29, 2022. A total of 9 fragmentary analyzes of the registry data are planned. This fragment of the study presents the results of the post-hospitalization period in COVID-19 survivors after 3 and 6 months. Results. According to the AKTIV register, patients after COVID-19 are characterized by long-term persistent symptoms and frequent seeking for unscheduled medical care, including rehospitalizations. The most common causes of unplanned medical care are uncontrolled hypertension (HTN) and chronic coronary artery disease (CAD) and/or decompensated type 2 diabetes (T2D). During 3- and 6-month follow-up after hospitalization, 5,6% and 6,4% of patients were diagnosed with other diseases, which were more often presented by HTN, T2D, and CAD. The mortality rate of patients in the post-hospitalization period was 1,9% in the first 3 months and 0,2% for 4-6 months. The highest mortality rate was observed in the first 3 months in the group of patients with class II-IV heart failure, as well as in patients with cardiovascular diseases and cancer. In the pattern of death causes in the post-hospitalization period, following cardiovascular causes prevailed (31,8%): acute coronary syndrome, stroke, acute heart failure. Conclusion. According to the AKTIV register, the health status of patients after COVID-19 in a serious challenge for healthcare system, which requires planning adequate health system capacity to provide care to patients with COVID-19 in both acute and post-hospitalization period

Effects of chronic airway obstruction and atrial fibrillation on the cardiac structure and function in patients with heart failure

Aim. To study the cardiac remodeling in heart failure (HF) patients with atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD).Material and methods. The study included 120 patients who were divided into 4 groups: the experimental group — patients with HF, AF and COPD (n=29), group 1 — patients with COPD, without cardiovascular disease (n=28), group 2 — patients with HF and COPD, without AF (n=30), group 3 — patients with HF and AF, without COPD (n=33). All patients underwent echocardiography using the MyLab70 Ultrasound System (Esaote, Italy).Results. In comparison with patients of group 3, patients of the experimental group had lower left and right atrial volumes (p=0,001 and p=0,004, respectively), higher right ventricular (RV) wall thickness (p<0,001), lower RV end-diastolic area index (p=0,007) and fractional area change (FAC) (p=0б011), which indicates the effect of chronic airway obstruction on cardiac remodeling in patients with combination of these pathologies. In comparison with patients of group 2, patients of the experimental group had significantly larger RV dimension (p=0,012) and higher RV endsystolic area index (p<0,001), as well as lower systolic RV function (ejection fraction (p=0,002), FAC (p<0,001), tricuspid annular plane systolic excursion (p=0,012)) and higher pressure in the pulmonary circulation (p=0,001). This is due to high hemodynamic load on the RV related to AF and chronic airway obstruction.Conclusion. The results of the study revealed features of cardiac remodeling pathogenesis in HF patients with AF and COPD. Comparative analysis of the results made it possible to indicate different mechanisms underlying AF, to assess the effects of both AF and chronic airway obstruction on the cardiac structure and function in patients with HF and combination of these pathologies

STUDY OF PATIENTS ADHERENCE TO TREATMENT IN METABOLIC SYNDROME, WITH THE NOVEL COMBINATION ANTIHYPERTENSION COMPOUND OF RAMIPRIL AND AMLODIPINE BY THE DATA OF OBSERVATIONAL STUDY GRANAT-1

Aim.  To  study  some   aspects  of  antihypertension   therapy  (AHT) adherence in patients  with arterial hypertension  (AH) and  metabolic syndrome  (MS) by an  example  of fixed combination  of ramipril and amlodipine,  under  the  framework  of GRANAT-1  trial (Observational Program   for  Patients   with  Arterial  Hypertension   and   Metabolic Syndrome).Material  and  methods. Totally,  101  patient  included,  having  had confirmed AH and MS. All participants completed the study. All patients consented to participate, had been recommended the combination drug AHT — fixed  combination of ramipril and amlodipine (Egipres) in various dosages selected  by clinician in routine assessment. Every patient was invited to clinic for 4 visits during 5 months with interval 1-2-2 months (visits 1-4).  For  assessment of  the  general  adherence  to  clinician recommendations (CR) during the first and final visits, all patients filled the Moriskos-Green test (MG) including 4 questions. In all visits, patients were assessed BP level, heart  rate,  and  during visits 2-4  there  was adverse events evaluation (AE). Also, the real adherence was evaluated by  the  intake  of Egipres,  and  activeness   of clinicians towards  the achievement of target BP levels in participants.Results. The recommended AHT started taking 95 patients, by the end Egipres was being taken by 92 participants, 9 of them took other AHT. 90 patients achieved target BP (81 taking Egipres). Effect of the prescribed at visit 1 AHT in most patients appeared by 1 month (visit 2): in every third patient the target BP was reached,  and mean systolic BP decreased by 17,2 mmHg and diastolic BP by 7,7 mmHg (visit 2), and 31,0 mmHg and 16,1  mmHg,  resp.  — by visit 4.  Totally, 3  AE  registered,   probably amlodipine-related.  A significant improvement of total adherence was found: if at the beginning of study, by MG test only 22 (21,8%) adhered, by the end — 70 (69%) of patients.  In three  cases  there  was lack of clinician activity to help achieve target BP.Conclusion. Single-time usage  of the fixed combination of amlodipine and ramipril, its high efficacy and safety with regular visiting of physician help to increase general adherence of patients to treatment