[Risk Assessment of Development of the Major Adverse Cardiac Events in Patients with Chronic Heart Failure with a Preserved and Intermediate Ejection Fraction in the Presence of a Bendopnea Symptom].

Aim To evaluate the risk of major cardiovascular complications (CVC) in patients with chronic heart failure (CHF) with intermediate and preserved ejection fraction (EF) depending on the presence of bendopnea symptom.Material and methods The study included 104 patients with stage II CHF and left ventricular EF ≥40 %. Mean age of the patients was 72.8±10.6 years. A test for detection of bendopnea symptom was performed for all patients. Two groups were formed: group 1, 69 patients with the bendopnea symptom and group 2, 35 patients with a negative test. Follow-up duration was 24 months. The composite endpoint (CEP) was death and hospitalization for any CVC.Results Mean time to the bendopnea symptom was 17.3±6.61 s. At two years of follow-up, the CEP was observed in 36 (34.6 %) patients, including 30 (43.5 %) patients in group 1 and 6 (17.1 %) patients in group 2. 12 patients died, and 9 of them had the bendopnea symptom. 21 patients of group 1 were hospitalized for CVC. Risk of CEP was significantly 1.7 times higher for men (relative risk, RR 1.7 [1.1; 2.6]) than for women. The presence of bendopnea symptom increased the risk of CEP 1.4 times (ОР 1.4 [1.1;1.9]) for women and 2.3 times (RR 2.3 [1.4; 3.6]) for men.Conclusion Results of the study demonstrated an unfavorable effect of bendopnea symptom on risk of CEP during the two-year follow-up of CHF patients with preserved and intermediate EF.

[Quality of life in patients with heart failure with preserved ejection fraction and the bendopnea symptom].

PURPOSE: The study of quality of life (QOL) in patients with CHF with preserved LVEF (left ventricular ejection fraction) and a symptom of bendopnea with different levels of salt intake. Materials and methods. The study included 66 patients. The main symptoms of CHF were edema in 54.5% of cases, dyspnea in 77% of cases, ascites was detected in only 2 patients, an enlarged liver in 7 patients. Abdominal obesity was detected in 53 patients. Quality of life was assessed by the SF­36 questionnaire, the level of salt intake was assessed by the Charlton: SaltScreener questionnaire. Results. On average, the time of occurrence of the bendopnea was 22.5±9.3 seconds, the minimum was 5 seconds. The absence of the effect of abdominal obesity on the risk of bendopnea (relative risk 1.18 [0.76; 1.83]) was revealed. According to the SF­36 questionnaire, a decrease in physical health indicators (median 31.3 points [20.7; 42.3]) and psychological health (average score 43.2±21.7) was found. In patients with bendopnea, QOL was reduced due to both physical and mental health, unlike patients without bendopnea: physical functioning (Physical Functioning - PF) 24.8±16.1 against 47±28.9 points, p=0.001 ; role­based functioning due to physical condition (Role­Physical Functioning - RP), 0 [0; 25] vs. 37.5 [0; 100] points, p=0.008; general health (General Health - GH) 29.9±15.8 against 50±14.2 points, p=0.0005, social functioning (Social Functioning - SF) 56 ± 38 against 78.9 ± 17.8 points ; p = 0.004. Multidimensional regression analysis revealed the relationship between the time of occurrence of the symptom bendopnea and the level of salt intake, physical and psychological activity (r2=0.25; p<0.009). The time of onset of the symptom of bendopnea in patients with CHF decompensation was significantly longer (18.9±8.7 vs. 26.2±8.5 seconds, p=0.003). The presence of diseases such as hypertension, COPD, IHD, atrial fibrillation, cerebrovascular disease did not significantly affect QOL (p> 0.05), while the presence of bronchial asthma or chronic kidney disease significantly reduced QOL of patients (p<0.05). Conclusion. The presence of the symptom bendopnea significantly reduces the quality of life of patients with CHF with preserved LVEF (left ventricular ejection fraction).

[Correlations of IL-18 and IL-6 with sodium consumption in patients with arterial hypertension and diabetes mellitus].

AIM: To determine correlations of AH-associated interleukins (IL-18, IL-6) with sodium consumption in AH patients with and without DM. MATERIALS AND METHODS: The study included AH patients with and without DM (n=63) who were managed at the Municipal Clinic #64, Moscow Department of Health Care, Branch 1. Plasma levels of IL-6 and IL-18 were measured using ELISA kits (Bender Med-Systems). Salt consumption was determined using a Charlton: SaltScreener questionnaire. Statistical analyses were performed using the Statistica 10.0 software. RESULTS: Four groups were formed: Group 1, grade 2 AH and DM (n=19); Group 2, grade 2 AH and no DM (n=4); Group 3, grade 3 AH and no DM (n=28); and Group 4, grade 3 AH and DM (n=12). Group 2 was small and was excluded from further analysis due to impossibility of statistical treatment. All patients consumed more than 6 g of salt per day (approximately 10 g). Analysis of intergroup differences in selected parameters showed differences between groups in levels of cholesterol, triglycerides, LDL, and GFR. The following correlations were identified in the groups: Group 1, positive correlation of IL-18 with sodium consumption (r=0.65) and CRP level (r=0.52) and of IL-6 with LDL level (r=0.48); Group 3, positive correlation of IL-18 with IL-6 (r=0.66) and of IL-6 with CRP (r=0.52); Group 4, positive correlation of IL-18 with GFR (r=0.82) and of IL-6 with waist circumference (WC) (r=0.84) and IL-6 (r=0.73). CONCLUSION: Patients consuming more than 6 g of salt daily (approximately 10 g) with AH and DM had more pronounced inflammation, which promoted progression of kidney disease.

[The effect of the level of total sodium deposited in the myocardium on its stiffness]. / Vliianie urovnia obshchego natriia, deponirovannogo v miokarde, na ego zhestkost'.

AIM: To determine a relationship between the level of total sodium in the myocardium to its stiffness. SUBJECTS AND METHODS: The investigation enrolled 18 hypertensive patients who had suddenly died; their mean age was 40±10 years; mean waist circumference, 102±12.5 cm; height, 170±7.7 cm; myocardial mass, 319±53 g. RESULTS: The variation in the myocardial level of total sodium averaged 211.7±37.5 (min, 71.5; max, 226.17) mmol/l. The sodium level was ascertained to be affected to the greatest extent by myocardial mass (SS=3615.56; p=0.00029) and age at death (SS=1965.568; p=0.0029), whereas gender and smoking had a considerably lower impact (SS=778.584; p=0.03). A univariate regression analysis showed that there was a relationship between myocardial sodium levels and the thickness of the anterior wall of the left ventricle (ß=0.94; p=0.000001; r2=0.88), that of the anterior wall of the right ventricle (ß=0.82; p=0.000021; r2=0.66), and that of the interventricular septum (ß=0.94; p=0.000001; r2=0.89). The wall thickness of the myocardium was established to depend on its sodium level (SS=21813.89; p=0.000001; r2=0.88): the higher sodium amount in the myocardium, the thicker its walls. The average velocity of acoustic wave propagation was 6.24±0.51 m/sec. A significant correlation was observed between sodium concentrations in the myocardium and its stiffness (ß=0.72; p=0.00062; r2=0.49). CONCLUSION: The level of sodium deposited in the myocardium, which is directly related to dietary sodium intake, is significantly correlated with myocardial stiffness. It can be assumed that the elevated level of sodium deposited in the myocardium is an independent factor that changes the stiffness of the myocardium and appears to influence the development of its diastolic dysfunction.

[Factors associated with levels of interleukins -18, -8, and -6 in hypertensive patients at high and very high cardiovascular risk].

AIM: To identify the most significant factor influencing blood levels of cytokines in patients at high and very high cardiovascular risk. MATERIALS AND METHODS: A patient base from the "Management of chronic patients with multiple diseases" project was analyzed. 523 patients (mean age, 87±17.8) were included. Plasma samples were analyzed for concentrations of sodium, creatinine, IL-1, IL-2, IL-4, IL-6, IL-8, IL-10, IL-18, and NT-proBNP. GFR was calculated using the CKD-EPI formula. Time-related CHF progression was assessed in one year; the time-related progression was considered an increase in CHF stage. Salt consumption was determined using the Charlton: SaltScreener questionnaire at the baseline visit and at one year. Low-salt diet containing 5 g of salt per day was recommended to all patients; 3.5 g of salt per day was recommended to patients with a documented diagnosis of CHF. Statistical analysis was performed using the Statistica 10.0 software. RESULTS: 52.2 % of included patients consumed 6-10 g of salt per day; 43.4 % of patients consumed 10 g of salt or more per day; and only 4.4 % of patients consumed 5 g of salt or less per day. 21 % of included patients were at high risk of cardiovascular complications whereas for the vast majority of patients (79 %), the risk was stratified as very high. Two clusters of patients were formed based on the grade of hypertension, one-year CHF progression, and plasma levels of IL-6, -8, and -18. The one-year progression of CHF most significantly influenced the levels of IL-18, -8, and -6. The IL-6 level was correlated with the NT-proBNP level; an approximately similar degree of correlation was found for NT-proBNP and BP. CONCLUSION: Therefore, the performed statistical analysis determined correlations between the following factors: IL-6 level, NTproBNP level, and one-year CHF progression.

[Impact of the dosing of basic drugs on the risk of rehospitalization in patients with chronic heart failure].

AIM: To investigate the impact of doses of the drugs, which have been achieved during adjustment and account for less or more than 50% of the maximal therapeutic ones on the risk of rehospitalization. SUBJECTS AND METHODS: The data of the Pavlov Register were used to assess the treatment of patients with chronic heart failure. To assess the risk of rehospitalization in relation of the dose of a drug, all the doses were represented in percentage terms depending on the maximum therapeutic one. RESULTS: The risk of hospitalization during 6 months in the patients receiving angiotensin-converting enzyme inhibitors at a dose of 25% or less of the therapeutic one was 21.18% (odds ratio (OR), 1.41; 95% confidence interval (CI), 1.13-1.76), that at doses of 50 and 100% of the therapeutic one was 16% (OR, 0.71; 95% CI, 0.56-0.88) and 34% (OR, 0.51; 95% CI, 0.43-0.60), respectively. The risk of rehospitalization in the patients taking ß-blockers at doses of 25, 50, and 100% of the therapeutic one was 26% (OR, 1.05; 95% CI, 0.94-1.17), 23% (OR, 0.902; 95% CI, 0.75-1.07), and 6.25% (OR, 0.19; 95% CI, 0.07-0.56), respectively. The combined analysis of the dose and use frequency of diuretics showed that the highest risk of rehospitalization turned was noted in the patients using a single dose of 100 mg of furosemide (4.2% of cases) once weekly and was as high as 39% (OR, 0.45; 95% CI, 1.04-1.98). CONCLUSION: The risk of rehospitalization is largely determined by the dosing factor in outpatient settings. Increasing the doses during adjustment reduces the risk of rehospitalization.

[First Open Study of Syndrome of Acute Decompensation of Heart Failure and Concomitant diseases in Russian Federation: Independent Registry ORAKUL].

Aim of the study was to assess mortality and rate of repetitive hospital admissions on days 30, 90, 180, 360, of observation as well as prevalence of concomitant diseases in patients with congestive heart failure (CHF). The register was formed in 41 centers of 20 cities of Russian Federation. Number of included patients with signs of chronic heart failure (CHF) was 2498. Data on 2404 was available for final analysis. Rehospitalization rate was 31, 11, 11, and 9.5% during 30 days, and during periods 31-90, 91-180, 181-360 days after discharge from hospital, respectively. Hospital mortality was 9%, 30 days and 1 year total mortality was 13 and 43%, respectively. Risk of death was most strongly affected by pneumonia, liver cirrhosis, and chronic kidney disease (mortality 49.5, 45.7, and 47.2%, respectively). Prognostic value of factors was ranked in the following order (descending): age, body mass index < 19 kg/m2, systolic blood pressure < 100 mm Hg, heart rate (HR) > 70 bpm, body temperature < 36.5 C. Each predictor was assigned weight of 1 point. Score 5 meant that risk of death with a high degree of probability approached 100%. Patients included into ORAKUL compared with those included in Euro HF register were more severely ill: in ORAKUL ejection fraction < 40% was observed 1.89 times more often, and more patients had "wet-cold" profile. Patients in ORAKUL had greater HR, smaller ejection fraction, lower glomerular filtration rate, and worse compliance to scientifically based treatment.

[First Open Study of Syndrome of Acute Decompensation of Heart Failure and Concomitant Diseases in Russian Federation: Independent Registry ORAKUL].

Aim of the study was to assess mortality and rate of repetitive hospital admissions on days 30, 90, 180, 360 of observation as well as prevalence of concomitant diseases in patients with congestive heart failure (CHF). The register was formed in 41 centers of 20 cities.

[Effect of loop diuretics with different elimination half-lives on natriuresis changes and indicators characterizing the state of renal tubulointerstitial tissue].

AIM: To investigate the effect of loop diuretics with different elimination half-lives on natriuresis (NU) changes in patients with hypertensive disease (HD) and chronic heart failure (CHF). SUBJECTS AND METHODS: Fifty-six patients who had signs of progressive CHF and needed diuretic therapy were selected from a group of the patients who had participated in our previous study of the types of natriuretic curves. They all received torasemide SR or torasemide IR. RESULTS: It has been shown that the type of a natriuretic curve may be variable in the patients. In the toracemide IR group, NU worsens more frequently and earlier than in the toracemide SR group (p < 0.05). The type of the curve is associated with elevated Tamm-Horsfall protein (THP) levels, its transition from one to another type, and the duration of HD to the greatest degree. It has been found that the longer history of HD is, the higher effect of angiotensin II is. The probability of transition of the natriuretic curve from type 3 to 2 is 83.93% (odds ratio 11.667) from type 2 to 1 is 92.86% (odds ratio 120.00). CONCLUSION: With time and altered NU, there is a significant deterioration of sodium excretion, and an increase in THP excretion, which is a marker for progressive tubulointerstitial fibrosis, and angiotensin II activity increases, which gives proof to the necessity of monitoring NU.