Polianthes venustuliflora (Asparagaceae, Agavoideae), una especie nueva endémica de Michoacán, México

Background and Aims: Polianthes is an endemic genus from Mexico, which consists of 19 species, including the one described here. As part of a systematic review of the genus, a botanical exploration was carried out throughout its geographical range where several new species were discovered. Some of these have already been described and published. We here will describe and illustrate P. venustuliflora, endemic to the state of Michoacán, which differs morphologically from P. montana and P. platyphylla.Methods: As part of the research process we have reviewed specimens of Polianthes collected in the north of the state of Michoacán, from different national herbarium collections and two foreign herbaria. These individuals have morphological characteristics that differ from those of the species already described. In addition, a botanical exploration was carried out in the area to prepare herbarium specimens in which vegetative and reproductive characteristics were also evaluated, allowing to morphologically separate Polianthes venustuliflora from similar species. The risk category was evaluated according to the method proposed by the International Union for Conservation of Nature.Key results: Polianthes venustuliflora is described and illustrated as a new species from the state of Michoacán, Mexico. This new species is morphologically related to P. montana and P. platyphylla, differing from these by presenting 3 to 7 leaves in the rosette, occasionally 9, leaves from 12 to 35, rarely 40 cm in length, with papillose to regularly denticulated margin; length of the inflorescence from 24 to 68 cm and number of floral nodes from 3 to 7. It is assigned the category of risk in Critically Endangered (CR).Conclusions: Polianthes venustuliflora is endemic to the north of Michoacán. According to criterion B of the IUCN, it is considered a Critically Endangered species (CR).Antecedentes y Objetivos: Polianthes es un género endémico de México conformado por 19 especies, incluida la que aquí se describe. Durante la revisión sistemática del género se efectuó una exploración botánica por toda su área de distribución geográfica conocida, descubriéndose varias especies nuevas, algunas ya fueron descritas y publicadas. Aquí se describe e ilustra P. venustuliflora, endémica del estado de Michoacán, la cual se diferencia de P. montana y P. platyphylla.Métodos: Se revisaron especímenes de Polianthes recolectados en el norte de Michoacán, provenientes de diferentes herbarios nacionales y dos extranjeros, con características morfológicas diferentes a las especies ya descritas. Asimismo, se realizó una exploración botánica por la zona indicada, para preparar ejemplares de herbario, en los cuales se evaluaron caracteres vegetativos y reproductivos que permitieron separar a Polianthes venustuliflora de especies morfológicamente similares. La categoría de riesgo se evaluó con base en el método propuesto por la Unión Internacional para la Conservación de la Naturaleza.Resultados clave: Se describe e ilustra Polianthes venustuliflora, una especie nueva del estado de Michoacán, México, la cual se relaciona morfológicamente con P. montana y P. platyphylla, y difiere de éstas por presentar 3 a 7 hojas en la roseta, a veces 9, hojas de 12 a 35, rara vez 40 cm de largo, con margen papiloso a regularmente denticulado; largo de la inflorescencia de 24 a 68 cm y número de nudos florales de 3 a 7. Se le asigna la categoría de riesgo en Peligro Crítico (CR).Conclusiones: Polianthes venustuliflora es endémica del norte de Michoacán. De acuerdo con el criterio B de la IUCN se considera una especie en Peligro Crítico (CR)

CARDIORENAL INTERACTION IN DECOMPENSATED CHRONIC HEART FAILURE

Aim. To investigate the prevalence of cardiorenal interactions, predictors of development, variants of clinical course, and outcomes of acute kidney injury (AKI) in patients with acute decompensation of chronic heart failure (ADCHF).Material and methods. Patients (n=278) with clinical manifestations of ADCHF were included into the study. All patients underwent clinical, laboratory and instrumental investigation. Renal function was assessed using the CKD-EPI formula to calculate glomerular filtration rate (GFR). Hydration was assessed using the bioimpedance analyzer ABC-01 "Medass" (Russia). Chronic kidney disease (CKD) and AKI were diagnosed according to the criteria of the latest Russian and international guidelines. Six phenotypes of AKI were identified: outpatient and hospital acquired, transient and persistent, de novo, and on the background of CKD.Results. CKD was detected in 125 (45%) patients. AKI developed in 121 (43.5%) patients, and in 52.9% of cases was nosocomial, in 53.7% transient and in 52.1% of cases occurred in patients without history of CKD. The risk of in-hospital mortality compared with patients without AKI significantly increased only in patients with nosocomial AKI (14.1 and 3.8%, p<0.05), AKI de novo (14.3 and 3.85%, p <0.05) and persistent (25 and 3.8%, p<0.001). Patients with these variants of AKI as compared to patients without AKI had more pronounced hydration, as well as less frequent prescription of loop diuretics and beta-blockers during outpatient treatment.Conclusion. The high rate (67.6%) of cardiorenal interactions was found out in patients admitted to hospital with ADCHF. Unfavorable prognostic phenotypes of AKI were hospital acquired, persistent AKI and AKI de novo. Patients with these phenotypes had a more pronounced hydration and inadequate outpatient therapy

ПРОЯВЛЕНИЯ СИНДРОМА СТАРЧЕСКОЙ АСТЕНИИ У ПАЦИЕНТОВ СТАРЧЕСКОГО ВОЗРАСТА И ДОЛГОЖИТЕЛЕЙ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ

Background. Frailty is a high-priority issue in cardiovascular medicine because of the aging of patients. It reflects the complex functional disorders and is associated with high morbidity and adverse outcomes. The aim of the study was to examination prevalence of frailty, its associations with mortality and hemorrhagic risk in elderly patients with ACS. Materials and methods. In 130 patients ≥ 75 years (82,7 ± 4,7 years, arterial hypertension (AH) 91,5%, previous myocardial infarction (MI) 32,3%, atrial fibrillation 32,3%, diabetes 26,9%, admitted with MI 75,4% or unstable angina 24,6%, frailty (national validated questionnaire), nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination) were assessed. Results. Mean score on a national validated questionnaire was 2,9 ± 1,4 points. Only 8.5% of patients responded negatively to all questionnaire questions. None of the patients had 7 points. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% patients had 1, 2, 3, 4, 5 and 6 points. 8,5% of the patients were non-frail, 25,4% pre-frail and 66,1% frail. Patients with frailty were more likely women, had higher incidence of AH, MI in this hospitalization, GFR 2. Conclusion. Frailty occured in 66,1% of elderly patients with ACS, was associated with increased prevalence of cardiovascular diseases.Наряду с увеличением выживаемости пациентов 75 лет и старше с сердечно-сосудистыми заболеваниями становится актуальным синдром старческой астении (ССА) в данной популяции. ССА ассоциируется с высокой частотой осложнений и неблагоприятным прогнозом и отражает комплекс функциональных изменений. Цель: оценка распространенности и ассоциации ССА при использовании валидированного скринингового опросника «Возраст не помеха». Материалы и методы. У 130 пациентов ≥ 75 лет, госпитализированных с ОКС (67,7% женщин, средний возраст 82,7 ± 4,7 лет, артериальная гипертония (АГ) 91,5%, инфаркт миокарда (ИМ) в анамнезе 32,3%, фибрилляция предсердий 32,3%, сахарный диабет 26,9%, ИМ в настоящую госпитализацию 75,4%, нестабильная стенокардия 24,6%) ССА оценен по скрининговому опроснику «Возраст не помеха». Оценивали когнитивные функции (Mini-Mental State Examination), питание (Mini Nutritional Assessment). Результаты. Средний балл по опроснику «Возраст не помеха» составил 2,9 ± 1,4 балла. На все вопросы ответили отрицательно только 8,5% пациентов. Ни один из пациентов не ответил положительно на все вопросы. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% пациентов имели 1, 2, 3, 4, 5 и 6 баллов. У 66,1% пациентов диагностировали ССА, у 25,4% - предастеническое состояние, у 8,5% нарушений не было выявлено. Пациенты с ССА по сравнению с пациентами без ССА характеризовались большей частотой АГ и ИМ, диагностированного в настоящую госпитализацию, меньшей скоростью клубочковой фильтрациии (СКФ). Вывод: ССА встречается у 66,1% пациентов с ОКС старческого возраста и долгожителей, ассоциируется с большей частотой сердечно-сосудистых заболеваний

EFFECT OF SACUBITRIL/VALSARTAN ON NATRIURESIS, DIURESIS AND BLOOD PRESSURE IN HYPERTENSIVE PATIENTS

Aim. To study the effect of sacubitril/valsartan compared with valsartan on natriuresis, diuresis, blood pressure (BP) and the level of biomarkers in hypertensive patients.Material and methods. Hypertensive patients (n=16) received sacubitril/valsartan 400 mg QD or valsartan 320 mg QD for 7 days in a double-blind,-randomized, cross-over study. The change in 24-hour diuresis and natriuresis, fractional urinary sodium excretion, and BP level have been studied, as-well as soluble biomarkers: cyclic guanosine monophosphate (cGMP), plasma brain natriuretic peptide (BNP), mid-regional precursor of the atrial natriuretic-peptide (MR-proANP) and the N-terminal precursor of the brain natriuretic peptide (NT-proBNP).Results. The trend toward higher levels of 24-hour natriuresis on Day 1 (21%, p=0.068) was found in the sacubitril/valsartan group compared to-valsartan one. Fractional sodium excretion was significantly higher in the sacubitril/valsartan group on Day 1 after 6 hours (50%, p=0.004) and subsequent-samples up to 12 hours; the maximum effect was achieved 2-4 hours after taking the medication (mean value 2.08, p=0.005). Sacubitril/valsartan-therapy compared with valsartan therapy was associated with a significant increase in 24-hour diuresis on Day 1 (41%, p<0.05), but not on Day 7-(15%, p=0.134). Sacubitril/valsartan therapy, in contrast to valsartan therapy demonstrated a significant increase in 24 h cGMP urinary excretion-on Day 1 (95%, p<0.001) and Day 7 (83%, p=0.001). Sacubitril/valsartan lowered BP more effectively than valsartan [on Day 7, 12 hours after-taking the drug, the differences were13.6 mm Hg (p=0.004) for systolic and6.7 mm Hg (p=0.03) for diastolic BP. The decrease in the level of-NT-proBNP and MR-proANP in plasma and the transient increase in the level of BNP were found in the sacubitril/valsartan group. Both sacubitril/valsartan and valsartan therapies were well tolerated and safe.Conclusion. Sacubitril/valsartan therapy in hypertensive patients compared with valsartan therapy was associated with transient increase in natriuresis and diuresis, more pronounced decrease in BP and changes in biomarker levels reflecting persistent inhibition of neprilysin and decrease in myocardial wall tension

COMPARATIVE RESEARCH OF ENALAPRIL AND ATENOLOL ANTIHYPERTENSIVE EFFICACY IN HIGH RISK PATIENTS

Aim. To evaluate the effecacy of enalapril (Enam, Dr.Reddy’s, India) and atenolol (Tenormin, AstraZeneca, UK) and their influence on processes of cardiovascular system remodeling in comparative research in patients with arterial hypertension. Material and methods. 38 patients with arterial hypertension stage II were examined. 21 patients were treated with enalapril (10-40 mg\d) and 17 – with atenolol (50-100 mg\d). Duration of therapy was 24 weeks.  A daily monitoring of blood pressure and echocardiography were made before and after the treatment. Spontaneous erythrocyte aggregation and deformability, spontaneous platelet aggregation and adhesive property of neutrophils were also estimated. A number of leucocytes carrying activation markers and expressing adhesive molecules was calculated. The plasma concentration of adhesive molecules (ICAM-1) and von Willebrand protein as well as serum concentration of N-terminal peptide of procollagen type III was also estimated. Results. Enalapril versus atenolol improved blood rheology, reduced functional leucocytes activity, plasma concentration of von Willebrand protein and intercellular adhesive molecules. The reduction in collagen III synthesis activity in enalapril therapy was proved. A significant regress of left ventricle hypertrophy due to enalapril treatment was related with favorable non-hemodynamic effects. Conclusion. The research revealed that the blockage of tissue rennin-angiotensin system is very important in prevention of cardiovascular complications especially in high risk patients

MANIFESTATIONS OF FRAILTY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME

Background. Frailty is a high-priority issue in cardiovascular medicine because of the aging of patients. It reflects the complex functional disorders and is associated with high morbidity and adverse outcomes. The aim of the study was to examination prevalence of frailty, its associations with mortality and hemorrhagic risk in elderly patients with ACS. Materials and methods. In 130 patients ≥ 75 years (82,7 ± 4,7 years, arterial hypertension (AH) 91,5%, previous myocardial infarction (MI) 32,3%, atrial fibrillation 32,3%, diabetes 26,9%, admitted with MI 75,4% or unstable angina 24,6%, frailty (national validated questionnaire), nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination) were assessed. Results. Mean score on a national validated questionnaire was 2,9 ± 1,4 points. Only 8.5% of patients responded negatively to all questionnaire questions. None of the patients had 7 points. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% patients had 1, 2, 3, 4, 5 and 6 points. 8,5% of the patients were non-frail, 25,4% pre-frail and 66,1% frail. Patients with frailty were more likely women, had higher incidence of AH, MI in this hospitalization, GFR < 60 ml/min/1,73 m2. Conclusion. Frailty occured in 66,1% of elderly patients with ACS, was associated with increased prevalence of cardiovascular diseases

Значение микроальбуминурии в стратификации риска больных неосложненной артериальной гипертонией

Microalbuminuria (MAU) and a reduction in glomerular filtration rate are independent predictors of cardiovascular morbidity and mortality. Aim was to assess the role of MAU in risk stratification of non-diabetic hypertensive patients. The subgroup of patients with MAU was much more likely to show the other signs of subclinical organ damage as compared to patients with left ventricular hypertrophy, carotid abnormalities or increased pulse wave velocity. Thus, MAU is the integral marker of subclinical organ damage.Категория сердечно-сосудистого риска определяет сроки начала медикаментозной антигипертензивной терапии и целевой уровень АД. Важнейшая роль в стратификации риска принадлежит выявлению субклинического поражения органов-мишеней. Изучали роль микроальбуминурии (МАУ) в стратификации риска больных неосложненной артериальной гипертонией. Выявлено, что МАУ значительно превосходит скорость распространения пульсовой волны между сонной и бедренной артерией > 12 м/с, гипертрофию левого желудочка, толщину комплекса интима-медиа сонных артерий > 0,9 мм по предсказывающей способности в отношении наличия других субклинических органных изменений. Результаты исследования свидетельствуют о значении МАУ как интегрального маркера субклинического поражения органов-мишеней

Effect of dapagliflozin therapy on achieving cardiovascular mortality target indicators in patients with heart failure

Aim. To assess the effect of therapy with sodium glucose co-transporter type 2 inhibitor dapagliflozin in patients with heart failure with reduced ejection fraction (CHrEF) on the state cardiovascular mortality target indicators.Material and methods. All adult Russian patients with NYHA class II-IV HFrEF (left ventricular ejection fraction ≤40%) were considered as the target population. The characteristics of patients in the study corresponded to those in the Russian Hospital HF Registry (RUS-HFR). The study suggests that the use of dapagliflozin in addition to standard therapy will be expanded by 10% of the patient population annually in 2022-24. Cardiovascular mortality modeling was performed based on the extrapolation of DAPA-HF study result. The number of deaths that can be prevented was calculated when using dapagliflozin in addition to standard therapy. Further, the contribution of prevented deaths with dapagliflozin therapy to the achievement of federal and regional cardiovascular mortality target indicators (1, 2 and 3 years) was calculated.Results. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF with the expansion of dapagliflozin therapy by 10% of the patient population annually will additionally prevent 1729 cardiovascular death in the first year. This will ensure the implementation of cardiovascular mortality target indicators in Russia in 2022 by 11,8%. In the second year, 3769 cardiovascular deaths will be prevented, which will ensure the implementation of target indicators in 2023 by 17,2%. In the third year, 5465 cardiovascular deaths prevented, which will ensure the implementation of implementation of target indicators in 2024 by 18,7%.Conclusion. The use of dapagliflozin in addition to standard therapy for patients with NYHA class II-IV CHrEF will ensure the implementation of implementation of target indicators in 2024 by 18,7%

Types of hemodynamic response to orthostasis according to continuous blood pressure monitoring: a case series of heart failure with reduced ejection fraction

Heart failure (HF) is associated with unfavorable outcomes and high health care costs. Determination of the hemodynamic response to orthostasis can be an additional tool in assessing the stability and compensation of HF patients. Active orthostatic test (AOT) with blood pressure monitoring serves as a simple and available screening method. However, a complete characteristic of the hemodynamic response, especially during the first minute of orthostasis, can be obtained only with continuous blood pressure monitoring. The presented case series demonstrate the types of hemodynamic response in patients with heart failure with reduced ejection fraction in AOT with continuous blood pressure monitoring, available data on the mechanisms of its development, clinical and prognostic role, and also presents the advantages and limitations of AOT

Frequency of hemodynamic response to orthostatic stress in heart failure with reduced ejection fraction, associations with clinical blood pressure

Aim. To assess hemodynamic response to active standing test (AST) with beat-to-beat blood pressure (BP) monitoring, their association with office BP and symptoms of orthostatic intolerance in patients with heart failure (HF).Material and methods. Outpatient HF patients with documented  left ventricular ejection  fraction &lt;40%, followed   up in a HF center  and receiving optimal medical therapy, underwent AST with beat-to-beat  non-invasive BP monitoring.Hemodynamic response was assessed according to the European Federation of Autonomic Societies criteria.Results. The study included 87 patients (mean age, 57±10 years; men, 76%). Normal hemodynamic response to orthostatic stress was observed  in 36 (41,4%) patients. Pathological response prevailed during the first minute of orthostatic stress — initial orthostatic hypotension (OH) (n=29, 33,3%) and delayed BP recovery (n=18, 20,7%).  Classical OH was detected  in 4 (4,6%)  patients. There was no orthostatic hypertension, defined as an increase in systolic BP (SBP) ≥20 mm Hg. According to office BP, hypotension was observed in 19 (21,8%) patients (SBP &lt;90 mm Hg in 4 patients and 90-100 mm Hg in 15), hypertension (SBP &gt;140 mm Hg) in 11 (12,6%) patients. Pathological response to orthostatic stress were more often observed  in office  SBP &gt;140 mm Hg compared  to SBP ≤140 mmHg (90,9% and 53,9%, p=0,020).Orthostatic intolerance was noted in 43 (49,4%) patients and were not associated with the level of office SBP (p=0,398) or pathological responses to orthostatic stress (p=0,758 for initial OH and p=0,248  for delayed  BP recovery).Conclusion. The pathological hemodynamic response in AST with beat-to-beat BP monitoring in ambulatory patients with HF is most often represented  by initial OH and delayed BP recovery associated  with office SBP &gt;140 mmHg. The frequency of symptoms of orthostatic intolerance did not differ between groups depending on the presence of an inadequate response to orthostatic stress