Radionuclide Estimation of Left Vetricle Myocardial Contractility in Patients with Chronic Heart Failure and Post-Infarction Cardiosclerosis

Acute myocardial infarction (MI) is an important risk factor for the chronic heart failure (CHF). Twenty-five ischemic heart disease (IHD) male patients with post-infarction cardiosclerosis (PICS) aged 40 to 60 (at a mean age of 52,8±1,3 years) with MI duration from 6 months to 5 years were examined. Intensification of degree of CHF in IHD patients with PICS according to the findings of echocardiography and radioisotope ventriculography (RGV) was accompanied by a decreased myocardial contractility. RVG using sectoral analysis occurred to be an informative method in the evaluation of the myocardial contractility of the left ventricle, its reserve potentials in IHD patients with PICS complicated by CHF. It permits to optimize the diagnosis and treatment of CHF patients with PICS

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

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 spironolactone and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure

Aim. To study the effects  of spironolactone  and eplerenone on left ventricular diastolic function and neurohumoral factors in patients with heart failure (HF).Material and methods. We examined 131 patients  with coronary artery disease  and NYHA class  I-III HF. Patients  were randomized  into groups depending  on HF class: class I (n=31), class II (n=51) and class III (n=49).Results. The study revealed that the clinical course  of HF and LV diastolic dysfunction are associated with an increased  level of neurohormones  and are characterized by significantly high levels of aldosterone  and norepinephrine  in patients  with a restrictiveLV diastolic dysfunction. A correlation was found between  the level of neurohormones  (aldosterone  and norepinephrine)  and heart  remodeling parameters:  an inverse correlation with an ejection fraction (r=-0,68, r=-0,61,  respectively) and a direct correlation with LV  end-diastolic volume (r=0,58, r=0,66, respectively). Long-term treatment  with spironolactone  and eplerenone had a positive effect, reducing the level of mentioned neurohormones. In patients with class II HF, both drugs had a positive effect on the level of aldosterone  and norepinephrine, reducing them by 26,6% and 20,2% in the spironolactone  group and by 28,4% and  24,6% in the eplerenone group,  respectively.  In patients with class  III  HF, the decrease in aldosterone  level was more pronounced  in those taking eplerenone than spironolactone:  32,1% vs 20,2%, respectively.Conclusion. In patients  with HF, combination therapy with the inclusion of spironolactone  significantly reduced  the level of neurohormones mainly in patients with class II HF and, to a lesser extent, in those with class III HF. This suggests that combination therapy with spironolactone is less effective than with eplerenone in relation to neurohormones’  levels

COMPARISON OF LOSARTAN AND LISINOPRIL EFFECTIVENESS FOR GLOMERULAR AND TUBULAR MARKERS OF RENAL DYSFUNCTION IN CHRONIC HEART FAILURE

Aim. To compare the losartan and lisinopril influence on glomerular and tubular markers rates of renal dysfunction in I-III functional class (FC) chronic heart failure (CHF). Material and methods. Totally 92 patients studied with I-III FC CHF. First group (I) consisted of 47 patients taking losartan as addition to standard treatment for 6 months; second group (II) — 45 patients took lisinopril. All patients underwent glomerular filtration rate estimation (MDRD GFR) and enzymes levels in urine: alanine transaminase (ALT), aspartat transaminase (AST), alkaline phosphanase (AP). Results. The results showed that GFR <60 ml/min in I and II groups was found in 18 (38,3%) and 17 (37,8%) patients, resp. Baseline data analysis of urine enzymes that characterize functional condition of renal tubules, showed that in GFR <60 ml/min patients there is significant (p<0,05) increase of ALT, AST, AP in urine: for I group patients by 45,2%, 31,8%, 78,2%, resp., and for II group — 43,6%, 33,5%, 73,9%, resp., comparing to the patients with GFR >60 ml/min. Six month treatment with inclusion of losartan and lisinopril led to decrease of enzymes levels in urine to increase of GFR comparing to baseline. Conclusion. GFR and the level of fermenturia are the early predictors of tubular epitelium in kidneys, and can be treated as early predictors of renal dysfunction in CHF. Six month treatment with losartan and lisinopril increases GFR and significantly decreases fermenturia, hence improving the condition of tubular epithelium and showin nephroprotective effect

KIDNEY DYSFUNCTION EVALUATION IN CHRONIC HEART FAILURE PATIENTS

Aim. To study the signs of kidney dysfunction in chronic heart failure (CHF).Material and methods. We included 96 patients with postinfarction cardiosclerosis and CHF with the age of 40–60 years. Patients were divided into two groups by functional class (FC) of CHF according to NYHA. In all patients the levels of serum creatinine and MDRD glomerular filtration rate (GFR), urine alanine transferase, aspartat transferase, alkaline phosphatase and cholinaestherase by spectrophotometric method were measured.Results. In 33,3% of patients with II FC NYHA and in 66,67% with III FC NYHA we found GFR less than 60 ml/min/1,73 sq.m. Investigation of fermenturia levels in those according to renal functioning showed more prevalent increase of urine enzymes in lower GFR, in whom the patients with III FC NYHA consisted 66,67%. The level of ALT was 39% (p<0,01) higher and AP 35% (p<0,001) higher comparing to subjects without renal dysfunction.Conclusion. In patients with chronic heart failure as the diseases progresses there is kidney dysfunction developing with the decrease of GFR, increase of resdual nitrogen and enzimes in urine. Enzyme levels testing in urine of CHF patients can be a part of diagnostic approach to kidney dysfunction diagnostic at earlier stages

Relation of the heart remodeling and endothelial dysfunction in chronic heart failure patients

Aim. To study relation of the heart remodeling processes and endothelial dysfunction in patients with chronic heart failure (CHF).Material and methods. Totally, 103 patients studied with post infarction cardiosclerosis. All patients selected to 3 groups by functional class (FC): I group consisted of 28 patients with CHF I FC, II — 46 patients with II FC and III — 29 patients with III FC by NYHA. All patients underwent echocardiography, dopplerography of brachial artery.Results. Post infarction remodeling of the left ventricle (LV) led notonly to structural remodeling of LV, with chamber dilation, wallsthinning, contractility decrease, but to changes of LV geometry.Contractility decrease of LV myocardium followed by the disorderedendothelium-dependent vessel dilation, with increase of pulsative andresistive indexes, sensitivity decrease of brachial artery to the shifttension.Conclusion. In CHF patients the processes of heart remodeling followed by remodeling of vessels, showing functional and humoral parameters of endothelial dysfunction

ФУНКЦІОНАЛЬНІ ТА ГУМОРАЛЬНІ ПОКАЗНИКИ ДИСФУНКЦІЇ ЕНДОТЕЛІЮ У ХВОРИХ НА ХРОНІЧНУ СЕРЦЕВУ НЕДОСТАТНІСТЬ

103 male patients, aged 40 to 55 years with postinfarction cardiosclerosis (PICS), a complicated with chronic heart failure (CHF) have been surveyed. All patients were divided into three groups according to functional class (FC) CHF according to the New York Heart Classification (NYHA). Vasomotor endothelial function of the brachial artery (PA) was evaluated with dopplerographic method. VWF levels were determined using quantitative enzyme immunoassay method. Assessing the relationship between the severity of heart failure and the degree of endothelial dysfunction, we have determined that all patients with CHF suffered from endothelial dysfunction, and its severity increased with progression of CHF. The results of the research have shown that the level of vWF determined in the blood plasma of patients with CHF depends on the clinical course of the disease and its progression.Обследовано 103 пациента мужского пола, в возрасте от 40 до 55 лет с постинфарктным кардиосклерозом (ПИКС), осложненным хронической сердечной недостаточностью (ХСН). Все больные были распределены на три группы по функциональному классу (ФК) ХСН согласно Нью-йоркской классификации кардиологов (NYHA). Сосудодвигательную функцию эндотелия плечевой артерии (ПА) оценивали допплерографическим методом. Уровень ФФВ определяли с помощью количественного иммуноферментного метода. Оценивая взаимосвязь между тяжестью ХСН и степенью выраженности эндотелиальной дисфункции, мы установили, что у всех больных ХСН имела место эндотелиальная дисфункция, причем ее тяжесть увеличивалась при прогрессировании ХСН. Результаты исследования показали, что уровень ФФВ, определяемый в плазме крови у больных ХСН, зависит от клинического течения заболевания и прогрессирования его.Обстежено 103 хворих чоловічої статі, віком від 40 до 55 років з постінфарктним кардіосклерозом (ПІКС), ускладненим хронічною серцевою недостатністю (ХСН). Всі хворі були розподілені на три групи за функціональним класом (ФК) ХСН згідно Нью-йоркської класифікації кардіологів (NYHA). Судиннорухову функцію ендотелію плечової артерії (ПА) оцінювали за допплерографічним методом. Рівень ФФВ визначали за допомогою кількісного імуноферментного методу. Оцінюючи взаємозв'язок між тяжкістю ХСН і ступенем вираженості ендотеліальної дисфункції, ми встановили, що у всіх хворих ХСН мала місце ендотеліальна дисфункція, її тяжкість збільшувалася при прогресуванні ХСН. Результати дослідження показали, що рівень ФФВ, який визначається в плазмі крові у хворих на ХСН, залежить від клінічного перебігу захворювання та його прогресування

Features of cardiovascular remodeling, the level of neurohumoral factors depending on the degree of chronic heart failure and kidney dysfunction

Aim. To study the relationship between the level of the N-terminal prohormone of brain natriuretic peptide (NTproBNP) and aldosterone in serum, cardiovascular remodeling parameters with the degree of chronic heart failure (CHF) and kidney dysfunction (KD).Material and methods. Fifty two patients with coronary artery disease with CHF of I (19 patients), II (21) and III (12) functional classes (FC) were examined. All patients underwent echocardiography with assessment of systolic function and structural-geometric parameters of the left ventricle (LV), blood flow study at the level of the common carotid artery (CCA) with the determination of the thickness of the intim-media complex, velocity parameters of blood flow, resistance (RI) and pulsation (PI) indexes, estimated glomerular filtration rate (eGFR) by CKD-ЕРI method, the level of NTproBNP and aldosterone in serum. The patients were divided depending on the eGFR elvel: 30< eGFR ≤60 ml/min/1,73 m2 — 14 patients, eGFR >60 ml/min/1,73 m2 — 38 patients.Results. Patients with II FC CHF had the medium-high NTproBNP and aldosterone values. Subjects with FC III CHF had high levels of NTproBNP and aldosterone. A correlation relationship was found between the NTproBNP, aldosterone and ejection fraction (EF) levels (r=-0,70 and r=-0,72, respectively), between the NTproBNP, aldosterone and enddiastolic LV velocity (r=0,78 and r=0,70, respectively). There was a significant thickening of the carotid intima-media complex and a decrease in the blood flow velocity and an increase in vascular resistance with increasing CHF. We also noted a significant difference in the maximum end-diastolic velocity in patients with eGFR ≤60 ml/min/1,73 m2 compared with this indicator in patients with eGFR >60 ml/min/1,73 m2.Conclusion. In patients with CHF, a significant increase in NTproBNP and aldosterone levels is associated with FC of CHF, LV systolic dysfunction and KD. The interrelation of cardiovascular remodeling indicators with the degree of CHF and KD was revealed