Bendopnea: Association With Echocardiographic Features and Clinical Outcomes in Elderly Patients With Chronic Heart Failure.

AIM: to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of follow-up in ambulatory elderly patients with chronic heart failure (CHF). MATERIALS AND METHODS: We conducted an open, prospective, non-randomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II-IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean follow-up was 26.6±11.0 months. RESULTS: Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea.  Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04-34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score)  (OR 1.78, 95 % CI 1.29-2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07-1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34-21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2-46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69-65.9, p=0.002), increased indexed LV end-systolic diameter (OR 8.2, 95 % CI 1.9-34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4-12.5, p=0.008), indexed LV end-systolic volume (OR 1.32, 95 % CI 1.07-1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03-1.45, p=0.002), high levels of NT-proBNP (OR 1.0, 95 % CI 1.0-1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02-1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002-1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04-28.4, p=0.003), and patient's mortality (OR 5.63, 95 % CI 1.94-16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04-2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75-21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04-2.80, p=0.050). During follow-up 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85-9.9, p<0.001). CONCLUSION: Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

Clinical observation of a patient with arterial hypertension and obstructive sleep apnea syndrome.

The clinical observation of a postmenopausal patient with the syndrome of obstructive sleep apnea in the outpatient health care stage.

[Risk of Cardiovascular Complications and Geriatric Syndromes Among Elderly Women].

AIM: to assess the prevalence of some geriatric syndromes and their association with high risk of cardiovascular complications (RCVC) among elderly women. MATERIAL AND METHODS: We examined 72 women aged 69-77 years with cardiovascular diseases. Examination included laboratory and echocardiography assessment, dual-energy X-ray absorptiometry, 6-min walk test, assessment of psycho-emotional status using Mini-mental State Examination (MMSE) questionnaire. Frailty was defined as three or more of the following: weight loss, low physical activity levels, MMSE less or equal 23 points, weakness (chair stand test>10 sec), history of multiple falls. Follow up was 7.3 (5.5-7.8) months. RESULTS: High CVR was found in 70.8% women: in 59.1% women aged 65-74 years and in 89.3% - aged more or equal 75 years, =0.006. Osteoporosis (OP) was found in 51.3% women aged 65-74 and in 90.5% - aged more or equal 75 years, =0.024; MMSE was 27 (24-28) vs 24 (20-26) points, respectively, =0.008. The geriatric syndrome of frailty was found in 13.6% women aged 65-74 and in 64.3% - aged more or equal 75 years. Frailty was associated with high CVR (odds ratio [R] 7.2, 95% confidence interval [CI] 1.5-34.2, =0.013), chronic kidney disease (CKD, R 18.9, 95%CI 5.2-20.2, <0.001), P (R 4.5, 95%CI 1.3-15.8, =0.019), history of myocardial infarction (MI, R 6.8, 95%CI 2.2-20.8, =0.001), greater age (R 6.0, 95%CI 2.1-17.5, =0.001). CONCLUSION: High CVR was prevalent among greater age women what could be explained by prevalence of chronic heart failure, atrial fibrillation, CKD. Prevalence of frailty was 13.6 and 64.3% among women aged 65-74 and more or equal 75years, respectively. It was significantly associated with high CVR, OP, PMI, CKD.

[High Serum Concentrations of Uric Acid: Clinical and Prognostic Significance in Chronic Heart Failure].

The article is devoted to the value of asymptomatic hyperuricemia in patients with chronic heart failure (CHF). The review summarizes results of a number of epidemiological reports that have increasingly linked elevated serum uric acid with an increased risk of incident CHF and adverse outcomes in CHF patients. Pharmacological and non-pharmacological approaches to influencing disturbances of uric acid metabolism are discussed.