[Bone Metabolism and Mineral Density in Chronic Heart Failure].

PURPOSE: to assess the state of bone metabolism and mineral density in outpatients with chronic heart failure (CHF). MATERIAL AND METHODS: We examined 70 outpatients (30 men, 40 women, aged 56-88 years) with CHF and 40 outpatients without CHF (10 men, 30 women, aged 57-88 years). Examination included laboratory assessment, echocardiography, study of bone mineral density (BMD) in the lumbar spine and femoral neck using dual-energy X-ray absorptiometry. RESULTS: Osteoporosis was recorded in 61.4 and 32.4%, osteopenia - in 20 and 42.5%, normal BMD - in 18.6 and 25% of patients with and without CHF, respectively. A total of 24.3 and 7.5% of patients with and without CHF, respectively, experienced various bone fractures during mean follow up of 26.5 months. Significant correlation was established between osteoporosis and patient's age (r=0.36; p=0.002), CHF duration (r=0.26; p=0.039), falls (r=0.29; p=0.015), fractures (r=0.42; <0.001), chronic kidney disease - CKD (r=0.24; =0.048), N-proBNP (r=0.52; =0.007), GFR (r=-0.37; =0.010). In unifactorial analysis osteoporosis was associated with CKD (odds ratio [R] 3.1, 95% confidence interval [CI] 1.1-8.8, p=0.032 , N-proBNP (R 9.8, 95% CI 1.1-8.9, =0.043) and frequent alls (R 4.0, 95% CI 1.3-12.7; =0.019). CONCLUSIONS: Association of high N-proBNP level and abnormal renal function with lowered BMD allows to suggest that low BMD is an independent marker of CHF severity, and patients with CHF are at high risk of osteoporosis and related fractures.

[POSSIBILITIES FOR COMPREHENSIVE LABORATORY EXAMINATION OF WOMEN WITH OSTEOPOROSIS ON AN OUTPATIENT BASIS].

The current possibilities for comprehensive laboratory examination of women with osteoporosis on an outpatient basis are discussed with reference to the use of different specific biomarkers of bone metabolism are discussed. The use of biochemical markers of bone metabolism and osteoporosis together with the determination of bone mineral tissue density as an additional factor for the prediction of bone density reduction and risk of fractures is considered. Such approach is believed to be instrumental for the correct choice and improvement of antiresorption therapy.

[Hronic heart failure and concomitant diseases in elderly patients: anemia and cardio-renal anemic syndrome].

AIM: to assess impact of anemia on chronic heart failure (CHF) course in elderly patients in primary care setting. Methods. We examined 164 outpatients (n=164) aged 60-85 years with clinically stable CHF due to ischemic heart disease and arterial hypertension. All patients underwent clinical, laboratorial evaluation, ECG, EchoCG measurements, 6 min walk test. Patients were categorized according to the presence of anemia, as defined by the WHO criteria (hemoglobin levels <13 g/dl in men and <12 g/dl in women). Median duration of follow up was 1.85 (1.0-4.75) years. Results. Anemia was found in 32.9%, cardio-renal anemic syndrome (CRAS) in 23.2% of patients. In all patients anemia was mild (Hb>9 g/dl). It was associated with diabetes mellitus (odds ratio [R] 2.2, 95% CI 1.03-4.69, =0.041), high creatinine level (R 2.76, 95% CI 1.25-6.12, =0.012) and chronic kidney disease (R 5.66, 95% CI 2.51-12.77, <0.001). During follow-up mortality rate was similar among anemic and non-anemic patients (27.8 vs 30%, =0.768). Patients with CRAS had worse survival compared with patients of the same age without anemia and preserved kidney function (=0.004). Age >75 years (R 3.58, 95% CI 1.59-7.99, =0.002), diabetes (R 2.68, 95% CI 1.19-6.04, =0.018), history of myocardial infarction (R 2.7, 95% CI 1.24-6.04, =0.013), systolic blood pressure <110 mm Hg (OR 2.49, 95% CI 1.09-5.71, =0.030), complete left bundle branch block (LBBB) (OR 2.79, 95% CI 1.26-8.22, =0.012), creatinine >130 mmol/l (OR 3.53, 95% CI 1.51-8.22, =0.004) were predictors of mortality of elderly patients with CRAS. Conclusions. CHF patients with and without anemia had similar survival but survival of those with CRAS was worse compared with patients without anemia and preserved kidney function. Age >75 years, diabetes mellitus, history of myocardial infarction, low systolic blood pressure, complete LBBB, high creatinine level were predictors of mortality in patients with CRAS.

[Chronic heart failure and osteoporosis].

Osteoporosis (OP) and chronic heart failure (CHF) are chronic noninfection diseases which are characterized not only by high prevalence but also by development of severe complications such as fractures in OP and decompensation in CHF. These complications lead to loss of functional, social activity and independent way of life, worsening of quality of life, hospitalizations, and premature death of a patient. During many years OP and CHF have been looked upon as independent diseases but according to recent data risk factors of their development and progression are common. In this article we pay special attention to mechanisms of development of CHF and OP, their risk factors, instrumental and laboratory diagnosis of OP, and problems of its treatment.