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

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 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

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

Prevalence of professional burnout among practicing cardiologists in the constituent entities of the Russian Federation

The burnout syndrome among healthcare professionals is a headline problem in the world, as it leads to poor health of medical workers, affects patient satisfaction with health care and the healthcare system as a whole. At the same time, existing preventive measures can improve the well-being of staff.Aim. To study the prevalence of professional burnout syndrome among practicing cardiologists in the Russian Federation (RF).Material and methods. This cross-sectional study was carried out using the method of online anonymous surveying. The inclusion criterion was the current practical activity in the RF. The study involved 452 cardiologists from 8 federal districts (women; n=377, 83,4%), 48,2% of which worked in a hospital. Occupational burnout was assessed using the Maslach Burnout Inventory (MBI) questionnaire in the Russian language adaptation for healthcare workers by N. E. Vodopyanova and E. S. Starchenkova. The score was calculated on three subscales (emotional exhaustion, depersonalization, personal accomplishment), the maximum score for the subscales was 54, 30 and 48, respectively. The personal accomplishment subscale is the opposite as follows: the higher the score, the less the symptom severity. Additionally, demographic parameters, working conditions, the desire to change job and field of activity were taken into account. Regression analysis was used to establish associations of burnout with factors.Results. The median score of the emotional exhaustion subscale was 29,5 (23,0; 35,0) points, depersonalization — 12,0 (8,0; 16,0) and personal accomplishment — 32,0 (28,0; 37,0). Men had higher depersonalization score than women as follows: 15,0 (10,0; 18,0) vs 11,0 (8,0; 15,0), p=0,001. High degrees of emotional exhaustion and depersonalization (burnout) were found in 235 (52%) cardiologists, while all three symptoms simultaneously — in 132 (29,2%) doctors. There were no symptoms of burnout in 84 (18,6%) cardiologists. A high degree of burnout was associated with a desire to change job (p&lt;0,001).Conclusion. A high prevalence of professional burnout among practicing cardiologists in the RF was revealed, which, in turn, is associated with the desire to change job or occupation

СУТОЧНЫЕ ПАРАМЕТРЫ ПЕРИФЕРИЧЕСКОГО И ЦЕНТРАЛЬНОГО АРТЕРИАЛЬНОГО ДАВЛЕНИЯ У ПАЦИЕНТОВ С РАЗЛИЧНОЙ ЭТИОЛОГИЕЙ ТЕРМИНАЛЬНОЙ ПОЧЕЧНОЙ НЕДОСТАТОЧНОСТИ

Aim. To study peripheral and central ambulatory hemodynamics during the 44-hour interdialytic period in patients with different etiology of end-stage renal disease (ESRD)Methods. 68 patients with ESRD receiving renal replacement therapy underwent 44-hour interdialytic ambulatory measurement of aortic and brachial artery blood pressure using a validated oscillometric technology Vasotens BPLab (OOO “Petr Telegin”,Nizhny Novgorod). The obtained results were estimated using the Mann-Whitney test depending on the etiology of ESRD (i.e. as a result of primary kidney disease or arterial hypertension (AH) and/or diabetes mellitus (DM). p&lt;0.05 wasconsideredstatistically significant.Results. Elevated levels of clinical systolic BP (SBP) before (156 [143; 168] and 146 [136; 155] mm Hg) and after the initiation of hemodialysis (154 [140; 169] and 146 [137; 155] mm Hg; p&lt;0.05) were commonly found in patients with ESRD secondary to AH and/or DM compared with those patients with ESRD caused by primary kidney disease. This group of patients demonstrated elevated 44-hour peripheral SBP (149 [138; 160] and 139 [132; 147] mm Hg), pulse BP (PBP) (65 [56; 74] and 60 [54; 66] mm Hg), central nocturnal SBP (132 [122; 143] and 125 [116; 133] mm Hg); p&lt;0.05. Peripheral (152 [141; 163] and 147 [136; 158] mm Hg) and central SBP (137 [125; 148] and 131 [121; 141] mm Hg) were higher in the group of patients with ESRD due to AH and/or DM on day 2 after hemodialysis initiation compared to those on day 1; p&lt;0.05. Peripheral and central daily and nocturnal SBP and pulse BP were also elevated. Patients with primary kidney disease had elevated nocturnal central SBP on day 2 after hemodialysis initiation compared to those on day 1 (131 [121; 142] and 126 [116; 135] mm Hg, p&lt;0.05).Conclusion. Patients with ESRD secondary to AH and/or DM had higher levels of clinical SBP before and after hemodialysis initiation, as well as ambulatory peripheral and central SBP and pulse BP during both, the 44-hour interdialytic period and on interdialytic days 1-2, compared with patients with primary kidney diseases. In addition, patients in this group demonstrated elevated peripheral and сentral SBP and PBP on day 2 after hemodialysis initiation compared with those on day 1. Цель. Изучить параметры периферической и центральной гемодинамики в течение 44 ч. междиализного интервала у пациентов с различной этиологией терминальной почечной недостаточности (ТПН).Материалы и методы. У 68 пациентов с ТПН, получающих заместительную почечную терапию программным гемодиализом (ГД), выполнено 44 ч. параллельное амбулаторное мониторирование артериального давления (АД) в плечевой артерии и аорте в междиализный период при помощи валидированного осциллометрического прибора BPLab Vasotens (ООО «Петр Телегин», Нижний Новгород). Результаты оценены с использованием метода Манна-Уитни в зависимости от этиологии ТПН: вследствие первичной патологии почки и в исходе артериальной гипертонии (АГ) и/или сахарного диабета (СД). Различия считали значимыми при p&lt;0,05.Результаты.. У пациентов с ТПН вследствие АГ и/или СД по сравнению с ТПН в исходе первичных почечных заболеваний выявлены более высокие уровни клинического систолического АД (САД) перед (156 [143;168] и 146 [136;155] мм рт. ст.) и после сеанса ГД (154 [140;169] и 146 [137;155] мм рт.ст.); p&lt;0,05. В этой же группе пациентов обнаружены более высокие значения периферического 44 ч. САД (149 [138;160] и 139 [132;147] мм рт.ст.), пульсового АД (ПАД) (65 [56;74] и 60 [54;66] мм рт.ст.), центрального ночного САД (132 [122;143] и 125 [116;133] мм рт. ст.); p&lt;0,05. Только в группе пациентов с ТПН вследствие АГ и/или СД уровень периферического (152 [141;163] и 147 [136;158] мм рт. ст.) и центрального САД (137 [125;148] и 131 [121;141] мм рт. ст.) во 2-й междиализный день был выше, чем в 1-й; p&lt;0,05, также выше были уровни периферического и центрального дневного и ночного САД, ПАД. В группе пациентов с ТПН в исходе первичных почечных заболеваний уровень центрального САД в ночные часы был выше во 2-й междиализный день по сравнению с 1-м (131 [121;142] и 126 [116; 135] мм рт. ст., p&lt;0,05).Заключение. Пациенты с ТПН вследствие АГ и/или СД по сравнению с пациентами ТПН в исходе первичных почечных заболеваний характеризуются более высокими уровнями клинического систолического АД до и после сеанса гемодиализа, а также показателей амбулаторного периферического и центрального САД и ПАД как за весь 44 ч. междиализный период, так и отдельно в 1-й и 2-й междиализные дни. Кроме того, в этой группе пациентов уровни периферического и центрального САД и ПАД во 2-й междиализный день были выше, чем в 1-й.