Predictors of Unfavorable Prognosis in Patients with Heart Failure After Cardioverter-Defibrillator Implantation According to the Prospective Part of the Kuzbass Registry.

AIM: Identification of clinical and instrumental predictors for non-arrhythmic death in patients with heart failure (HF) and implantable cardioverter-defibrillator (ICD). MATERIAL AND METHODS: Through a telephone survey and examination of medical records from hospital and polyclinic databases, data were obtained on the alive/dead status and causes of death for 260 patients with heart failure (HF) and ICD included in the Kuzbass Registry of Patients with ICD. The follow-up period was 1.5 years. Clinical and instrumental parameters entered into the registry before the ICD implantation were included in a univariate and multivariate step-by-step analysis using the logistic (for qualitative variables) and linear (for quantitative variables) regression with calculation of regression coefficients and construction of a prognostic regression model. The quality of the created model was assessed using a ROC analysis. RESULTS: During the observation period, 54 (20.8%) patients died. In 21 (38.8%) patients, death occurred in the hospital and was caused by acute decompensated heart failure in 15 (71.4%) patients, myocardial infarction in 3 (14.3%) patients, stroke in 1 (4.7%) patient, and pneumonia in 2 (9.5%) patients. 33 (61.2%) patients died outside the hospital; the cause of death was stated as the underlying disease associated with acute decompensated heart failure: in 9 (27.2%) patients, dilated cardiomyopathy; in 1 (3.0%) patient, rheumatic mitral disease; and in 23 (69.7%) patients, ischemic cardiomyopathy. According to the univariate regression model, the risk of death in the long-term period was increased by the QT interval prolongation (U 2.41, p = 0.0161); elevated pulmonary artery systolic pressure (U 4.30, p=0.0000) and increased left atrial size according to echocardiography (U 2.98, p=0.0029); stage IIB HF (OR 2.41; 95% CI: 1.26-4.6), NYHA III-IV (OR 3.03; 95% CI: 1.58-5.81); chronic obstructive pulmonary disease (OR 5.24; 95% CI: 2.04-13.45); and lack of optimal drug therapy (ODT) for HF before ICD implantation (OR 2.41; 95% CI: 1.29-4.49). The multivariate analysis identified the most significant factors included in the prognostic regression model: pulmonary artery systolic pressure above 45 mm Hg, social status, chronic obstructive pulmonary disease, and lack of ODT for HF. CONCLUSION: To ensure a maximum benefit from ICD, the factors that increase the likelihood of non-arrhythmic death should be considered before making a decision on ICD implantation. Particular attention should be paid to mandatory ODT for HF as the main modifiable risk factor for unfavorable prognosis.

Long-term outcomes in patients with an implanted cardioverter-defibrillator according to the Kuzbass registry.

Aim    To analyze long-term outcomes by results of the prospective part of the Kuban registry of patients with an implantable cardioverter defibrillator (ICD).Material and methods    A prospective analysis of the incidence of hard endpoints and changes in the condition was performed for 260 patients with ICD successively added to the Registry of Patients with Implantable Cardioverter Defibrillator" from 2015 through 2019.Results    At the time of ICD implantation, all patients had chronic heart failure (CHF), mostly of ischemic etiology with a low left ventricular ejection fraction (LVEF); median LVEF was 30 (25; 36.5) %. 54 of 266 (21.9 %) patients died by 2021; 17 of them (31.5 %) died in the hospital; in 76.5 % of cases, death was caused by acute decompensated heart failure (HF). 139 (53.5%) patients were readmitted; 66 (25.4 %) hospitalizations were related with ICDs (lead revision or reimplantation); acute cardiovascular events developed in 38 (14.6 %) patients; 12 (4.6%) patients underwent percutaneous coronary interventions; orthotopic heart transplantation was performed for 4 patients. ICD shocks were recorded in 27 (10.4 %) patients. After the ICD implantation, median LVEF remained unchanged, 31 (25; 42) vs. 30 (25; 36.5) % (р>0.05). However, both objective and subjective HF symptoms worsened. Thus, the number of patients with IIB stage CHF increased from 29.6  to 88.8 % (р<0.01) and with NYHA III CHF from 24.2  to 34.5 % (p<0.05). 80 (30.8%) patients visited cardiologists on a regular basis. Only 7.3% of patients received an optimal drug therapy. During the observation period, the rate of beta-blocker treatment considerably decreased, from 90.6  to 64.3 % (р<0.01), and the rate of the mineralocorticoid receptor antagonist treatment decreased from 50.8  to 17.4 % (р<0.01). The rate of the diuretic treatment was inconsistent with the severity of patients' condition.Conclusion    Most of the problems the patients encountered after the ICD implantation were related with an inadequate treatment of the underlying disease. Since the majority of patients with ICD have a low LVEF, it is essential to focus on prescribing an optimal drug therapy and maintaining compliance with this therapy.

[Clinical and anamnestic characteristics of patients with an implanted cardioverter-defibrillator in real clinical practice (data from the Kuzbass register)].

Aim      To study the consistency of the practice of management, selection and routing of patients at high risk of sudden cardiac death (SCD) selected for cardioverter-defibrillator implantation (CDI) with current clinical guidelines and to evaluate the quality of subsequent outpatient follow-up and treatment based on a retrospective analysis of clinical amnestic data from the Kuzbass Registry of Patients with CDI.Material and methods  The study was based on the Registry of Patients with Implanted Cardioverter Defibrillator and included successive data of 28 patients hospitalized to the Kizbass Cardiological Center from 2015 through 2019. Social and clinical amnestic characteristics, indications for CVI, and concomitant drug therapy were analyzed retrospectively. Statistical analyses were performed with the Statistica 10.0 software (Statsoft, USA).Results Median age of patients was 59 (53; 66) years; 239 (83.6 %) men were included; 29 (10.1%) people were employed, CHI was performed in 182 (63.6 %) patients for prevention of SCC, and for secondary prevention in 104 (36.4 %) patients. 208 (72.7 %) patients were diagnosed with ischemic heart disease (IHD), and 145 (67.9 %) of them underwent myocardial revascularization. Noncoronarogenic diseases were found in 78 (27.3 %) patients, and most of them were diagnosed with dilated cardiomyopathy. All patients had chronic heart failure (CHF); half of them had stage IIA CHF. Median left ventricular ejection fraction was 30 (25; 36,5) % according to echocardiography using the Simpson method. Comorbidity was found in 151 (52.8 %) patients. 128 (44.8%) patients received a triple neurohormonal blockade for CHF treatment; titration to target doses was not performed in any of them. Antiarrhythmics were administered to 150 (52.4 %) patients.Conclusion      According to the data from the Kuzbass Registry of CVI, the main patient cohort consisted of men of pension age with IHD and CHF. Before CVI, more than a half of them had not received an optimum drug therapy and not all of them had received target lesion revascularization. Creating and analysis of Registries of CHI patients is an effective method for identifying existing problems in patient management before CVI and for optimizing their subsequent follow-up and treatment.

[Current understanding of the role of age-related hypogonadism in the development of cardiovascular diseases].

The literature review presents novel data on the prevalence of age-related hypogonadism and its relationship with aging, its impact on the circulatory system and cardiovascular diseases. This review summarizes the methods for diagnosing age-related hypogonadism, its association with traditional cardiovascular risk factors such as dyslipidemia, insulin resistance and diabetes mellitus, obesity, arterial hypertension. The mechanisms of the possible direct effect of testosterone on endothelium and vascular tone, the role of hormone replacement therapy as a way of preventing cardiovascular diseases are discussed.

[The dysplasia of myelopoiesis in patients with acute lymphoblastic leucosis].

Nowadays, the analysis of hematopoiesis in patients with acute lymphoblastic leucosis includes only quantitative characteristics of residue myeloid process of bone marrow. The evaluation of myelodysplasia is unexplored still. The analysis of myelopoiesis was carried on sampling of 108 patients with primary acute lymphoblastic leucosis (27 - T-acute lymphohlastic leucosis, 81 - B-acute Iymphoblastic leucosis). The characteristics of dysplasia of granulocytes, erythroid cells and megakaryocytes were based on the parameters of WHO classification of acute myeloid leucosis (2001). The monolinear dysplasia was established in 35 patients (32.4%). multilinear dysplasia--in 9 patients (8.3%). Under T- acute lymphoblastic leucosis the bilinear dysplasia was detected reliably more often and absence of dysplasia more rare than under B-acute lymphoblastic leucosis. The signs of dysplasia of various myeloid lines had no inter-correlation and had no dependencies from indicators of expression of early antigens (CCD34 and TdT) and myeloid antigens (CD13, CD33). The comparison of factual data with indicators of dysplasia under acute mteloid leucosis (181 patients) demonstrated that rates of uni- and multilinear dysplasia under T-acute Iymphoblastic leucosis and acute myeloid leucosis have no significant difference. The myelodysplasia is detected reliably (more often under B-acute lymphoblastic leucosis as compared with acute myeloid leucosis.

Reactivity of anti-macrophage monoclonal antibody D11 in human leukemia and malignant lymphoma.

We have studied the reactivity patterns of a previously described pan-macrophage monoclonal antibody (MAb) D11 in 324 cases of acute leukemia and malignant lymphoma (ML). Reaction of D11 in tissue sections was restricted to histiocytes and macrophages. In non-Hodgkin's ML, D11 helped to confirm or to establish the histiocytic nature in 8 of 96 cases, i.e., in 4 of 6 histiocytic MLs; 2 of 13 anaplastic large-cell lymphomas; 1 of 4 large-cell immunoblastic clear-cell MLs; and 1 of 2 histiocytosis X cases. Positive reaction of D11 in acute lymphoblastic leukaemia (ALL) was found in 9 of 86 cases (all belonging to early B-lineage leukemia), of which 4 were CD34-positive and 5 co-expressed 1 or more myeloid/monocytic antigens. MAb D11 did not react in 42 cases of acute-myeloblastic-leukemia (AML) FAB variants M0-M5, except 1 acute mixed-lineage leukemia M1/pre-pre-B. Comparative study of the MAb D11 and a standard CD68 MAb KP- 1 showed that the antigens belong to different epitopes of different molecules.

[The Technicon H-1 automatic blood analyzer in the hematology clinic]. / Avtomaticheskii analizator krovi "Tekhnikon H-1" v gematologicheskoi klinike.

Technicon H-1, an automated flow blood analyzer with determination of the leukocytic formula of cellular peroxidase activity for differentiated estimation, is used at the laboratory of N. N. Blokhin Cancer Research Center, Russian Academy of Medical Sciences. Analysis of the incidence of changes in the basic and additional characteristics recorded by the device in analyses of peripheral blood from 76 hematological patients, mainly with hemoblastosis variants, showed that if the number of blast cells were up to 45%, the analyzer recorded from 3 to 7 additional "alarm" signals, and a "blast+" signal in approximately 52% of these; if the count of blast cells were over 45%, the signal "blast+" was shown by the analyzer in 100% cases. A peroxidase channel helps detect the lymphoid or myeloid trend of leukemic cell differentiation.

[Use of a new antimacrophage monoclonal antibody D11 in diagnosis of hemoblastosis]. / Primenenie novogo antimakrofagal'nogo monoklonal'nogo antitela D11 v diagnostike gemoblastozov.

Expression of new Mab D11 on blood and bone marrow cells was investigated in 85 hemoblastosis patients. In normals, antigen D11 is expressed on some monocytes and all tissue macrophages. D11 was noted on lymphoblasts of 5 out of 10 cases with B-cell ALL and of 1 case in B-lymphoid blast crisis of chronic myeloid leukemia. In T-ALL, ANLL, non-Hodgkin's lymphomas in leukemization stage, hairy cell leukemia and chronic lymphoid leukemia the cells were nonresponsive to Mab D11. Unlike D11 which have round nuclei, lymphoblasts D11+ have folded nuclei and more pronounced cytoplasmic basophilia. There were both B and myeloid antigens on D11+ blasts. ALL D11+ patients had extramedullary foci, more suppressed granulocytic and thrombocytic components of hemopoiesis, shorter remissions than those with ALL D11-.

[Hairy-cell leukemia (a review of the literature and the authors' own data)]. / Volosatokletochnyi leikoz (obzor literatury i sobstvennye dannye).

Gene engineering interferon made in Russia (reaferon, realdiron) was given to 40 patients with hairy-cell leukemia. Complete and partial remissions were achieved in 56% and 28% of the patients, respectively. Minimum effect was reported in 3% of the cases. In 5 cases with primary resistance or recurrences the authors used pentostatin which produced complete remissions in all the five patients.

[Morphofunctional heterogeneity of leukemic cells in hairy cell leukemia]. / Morfofunktsional'naia geterogennost' leikemicheskikh kletok pri volosatokletochnom leikoze.

Bone marrow hairy cells were examined in 36 patients with hairy cell leukemia. Cytograms per 100 of hairy cells were assessed in all the patients. Leukemic cell size, cytoplasm profile, shape of the nucleus, and share of granular cells were under study. Cytochemical examination of hairy cells was carried out in 26 patients. Acid phosphatase and its tartrate inhibition, nonspecific alpha-naphthylacetate esterase, acid nonspecific esterase, and PAS reaction were investigated. In 15 patients hairy cells were immunologically examined using immunocytochemical APAAP method with IKO monoclonal antibodies 1, 91, 20, 124, 115, 92, 105, 30, 31, 86, 80, 87, GM-1. Morphologically two types of hairy cells were detectable: typical, with torn villose cytoplasm with numerous processes, and cells with clearly shaped scalloped cytoplasm. The two types did not differ by nuclear shape or size, presence of granules, but differed by their functions. Process hairy cells were characterized by features most typical of these cells: presence of tartrate-resistant acid phosphatase and CD22 (IKO91) B-cellular marker in the phenotype. In scalloped hairy cells cytochemical and immunological signs were less manifest.

[The morphoimmunological correlates in the leukemic degeneration of prolymphocytic lymphosarcoma]. / Morfoimmunologicheskie korreliatsii pri leikemizatsii prolimfotsitarnoi limfosarkomy.

Morphocytochemical and immunologic features of the bone marrow and peripheral blood lymphoid elements were studied in 40 patients with B-prolymphocytic lymphosarcoma in the stage of leukemic degeneration. Four types of pathologic lymphoid cells were distinguished: large prolymphocytes expressing pan-B CD19 and HLA-Dr antigens, medium-sized prolymphocytes with round nuclei, characterized by activation CD38 and CD45Ra antigens, prolymphocytes with split nuclei containing light and heavy immunoglobulin chains, and leukemic lymphocytes containing, besides pan-B antigens and immunoglobulins, antigens of the early hemopoietic (CD34) and early B-(CD10) precursors. The content of the RAS-positive substance in the prolymphocytes was inversely proportional to the parameters of activation antigens expression. Acid phosphatase activity correlated with the expression of CD22 and CD45Ra antigens.

[alpha-Naphthyl acetate esterase--a cytochemical marker of the T-helpers]. / al'fa-Naftilatsetatésteraza--tsitokhimicheskii marker T-khelperov.

The authors analyze the correlation between the frequency of detection of alpha-naphthylacetate esterase in peripheral blood lymphocytes and T helper/inductor ratio determined by immunological methods from CD-4 MCAB expression. The results indicate that the counts of esterase-positive lymphocytes cytochemically detected by alpha-naphthylacetate esterase activity reliably correlated with T helper counts assessed by immunoperoxidase method with Technicon H-1 flow analyzer.

[Use of automatic blood analyzer, Hemalog D, in cancer patients during radiotherapy and chemotherapy]. / Primenenie avtomaticheskogo analizatora krovi "gemalog D" u onkologicheskikh bol'nykh v protsesse luchevoi i khimioterapii.

The Hemalog D automatic cytochemical analyser was used to assess changes in the levels of neutrophil peroxidase and monocyte non-specific esterase in 194 cancer patients undergoing radiation and chemotherapy. Radiotherapy in the dose of 30-48 Gy did not affect functional activity of blood leukocytes. Combination chemotherapy induced moderate or severe leukopenia in 72.7% of cases. A decrease in the enzymatic activity of neutrophils and monocytes was observed in patients with normal and slightly decreased leukocyte counts. In patients with severe leukopenia, elevated levels of peroxidase and non-specific esterase in leukocytes were found.

[An analysis of the factor structure of the histochemical phenotype of normal muscle fiber and muscle fiber during a change in the functional load]. / Analiz faktornoi struktury gistokhimicheskogo fenotipa myshechnogo volokna v norme i pri izmenenii funktsionalnoi nagruzki.

Using dispersive and factor analyses of the serial sections of the skeletal muscle tissue it has been shown that the activity of myosin Ca-ATPase is the most essential parameter in the definition of the phenotype of skeletal muscle fiber according to its functional and metabolic characteristics. The stability of this parameter during different functional loadings permits to recommend it as the major one in the definition of the fiber phenotype.

[Features of the response of human striated muscle fibers to hypokinesia combined with physical loading]. / Osobennosti reaktsii ischerchennogo volokna skeletnoi myshtsy cheloveka pri gipokinezii v sochetanii s fizicheskoi nagruzkoi.

Antiorthostatic hypokinesia for 30 days produces in human beings certain atrophic changes and decreasing metabolic level in both types of the skeletal muscle fibers, the metabolic activity being more decreased in the fibers of the II type. The physical loading of speed-power character does not prevent atrophy phenomena, nevertheless produces an increase of the metabolic activity in both types of the fibers. Changes of adaptive character, resulted from the physical loading, do not ensure a complete compensation of the negative hypoxic effect, especially in relation to contractile structures of the fiber.