[Results of 3 years work of the Russian hospital register of chronic heart failure (RUssian hoSpital Heart Failure Registry - RUS-HFR): relationship between management and outcomes in patients with chronic heart failure].

AIM: To analyze management and outcomes in patients with CHF managed by specialists in heart failure (HF) or general cardiologists/physicians in real-life clinical practice. MATERIALS AND METHODS: Survival rate, rehospitalization rate, general health condition, and the administered therapy were evaluated for HF patients with reduced LV ejection fraction at three years of discharge from cardiological hospitals. These patients had been included in a prospective, multicenter, observational study, "The Russian Hospital HF Registry" (RUS-HFR). The first group consisted of patients who were managed at a specialized HF department of the Federal Center and followed up at the outpatient stage by a cardiologist specializing in HF (Group 1, St.­Petersburg; n =74). The other two groups (Group 2 and Group 3) included patients who were managed at other cardiological departments of the Federal Center (n=186) or the Regional Center (n=130) and subsequently followed up at the place of residence. RESULTS: After the discharge from the hospital, 58-95 and 12-19% of RUS-HFR patients were followed up by a cardiologist or a physician, respectively, on an outpatient basis while 5-23% of patients did not visit a doctor at all. In three years, the survival rate of Group 1, 2, and 3 patients was 80 vs. 78 (р>0.05) vs. 52% (р0.05) vs. 100% (p1,2.

[Calculator "Available prognosis": Method of evaluation for predicting survival of patients with chronic heart failure and reduced left ventricular ejection fraction].

BACKGROUND: A method for predicting one-year survival of patients with heart failure and reduced ejection fraction (HFrEF) is required to choose a management tactics and determine indications for high-tech care at the outpatient stage. AIM: To develop a method for proper prediction of survival of patients with HFrEF in outpatient clinics. MATERIALS AND METHODS: This was a prospective study of 212 patients with functional class II-IV CHF of non-valvular origin and LV EF (Simpson) ≤35 % aged 18-70, including 176 (83 %) men and 36 (17 %) women who had given an informed consent to participate in the study. STUDY DESIGN: hospitalization to a specialized department for treatment of heart failure; best titration of tolerated doses and stabilization of the patient's condition; evaluation of status; laboratory and instrumental tests; outpatient follow-up by an HF specialist (visits, telephone contacts, therapy adjustment, and admission to a specialized HF department in case of decompensation); 200­item database population; recording the composite endpoint (cardiovascular death, or implantation of a mechanical circulatory assist (MCA) device, or heart transplantation (HT) within 12 months). RESULTS: For 12 months, 135 (64 %) patients survived; a MCA device was implanted to 5 (2 %) patients; HT was performed for 21 (10 %) patients; and a fatal outcome was observed in 51 (24 %) patients. Therefore, 77 patients had the composite endpoint. A method for predicting survival was developed using a multiple logistic regression analysis. The developed proper method for survival prediction included the following parameters: age of HFrEF onset; frequency of respiratory movements; systolic blood pressure measured at 3-5 min of orthostasis; lymphocyte count, and red cell distribution width. An identified patient with a predicted survival less than one year should be as soon as possible forwarded to a selection panel for considering HT or MCA implantation as a «bridge¼ to HT. A predicted survival longer than one year is an indication for further outpatient management and considering cardioverter defibrillator implantation. CONCLUSION: The method for proper outpatient evaluation of survival prognosis for patients with HFrEF allows to predict the one-year survival using routine indexes, such as results of objective examination, case history, and blood count, without additional expenses.

[Transthyretin amyloidosis in a cohort of old and very old patients with chronic heart failure].

BACKGROUND: Life-time diagnostics of wild type transthyretin amyloidosis (ATTR(wt)-amyloidosis) is virtually absent, even though ATTR(wt)-amyloidosis is an underestimated cause for morbidity and mortality, particularly in the older age group. AIM: To study incidence, demographic characteristics, and morpho-functional features of ATTR(wt)-amyloidosis in patients with FC IV CHF and LV hypertrophy > 15 mm according to autopsy data. MATERIALS AND METHODS: Postmortem reports were retrospectively analyzed for patients (n=141; 19 % males, 81 % females) of cardiology departments aged ≥69 with the underlying CHF syndrome. From all formalin-fixed fragments of the myocardium embedded in paraffin were prepared 5-7 mkm cuts, which were stained with Congo red (Sigma, USA) and viewed under normal and polarized light. Immunohistochemical analysis was also performed using antibodies to AA-amyloid, transthyretin, kappa and lambda-light chains of immunoglobulins. RESULTS: deposits were found in both old and very old persons aged 91.25±9.67, mostly in women due to shorter life span of men. In different FCs associated with LV hypertrophy, according to autopsy data amyloid deposits were observed in virtually every fifth deceased (21 % of cases). The amount of myocardial amyloid deposits was generally small (56 % of cases had (+) and 27 % had (++) amyloid deposits); 17 % of cases had considerable amyloid deposits (7 % had (+++) and 10 % had (++++)). The presence of amyloid deposits did not influence indexes of myocardial hypertrophy, such as ventricular septum thickness, LV posterior wall thickness, and heart mass. In the presented cases we observed focal amyloid deposition in the myocardium typical for old age-related amyloidosis; in 97 % cases, amyloid was located in the interstitium, around cardiomyocytes and in 3 % of cases - exclusively around blood vessels. CONCLUSION: ATTR (wt)-amyloidosis was detected in every fifth patient in the old and very old cohort, primarily in women (83 %), and was not diagnosed during the life time. Characteristic morphological manifestations of ATTR(wt)-amyloidosis were focal amyloid deposits mostly in the myocardial interstitium.

[Response predictors for physical training HFrEF patients].

PURPOSE: To identify different types and possible predictors of physical rehabilitation (PR) response in reduced ejection fraction heart failure (HFrEF) patients, selected on the basis of achievement the lactate threshold during cardiopulmonary exercising test (CPET). METHODS: 64 patients, chronic heart failure (CHF) NYHA II-III functional class were included in our study. Mean age 54±12,5 years, body mass index (BMI) 26,5±6,4 kg/m2, ejection fraction (EF) 26,4±1,4 %, NYHA II: III (67 %: 33 % patients). The original estimated results of physical examination, laboratory parameters, CPET, quality of life (QOL), exercise tolerance (ET) and echocardiography (EchoCG). Physical rehabilitation (PR) efficiency was estimated on the basis of peak oxygen uptake (VO2peak), QOL and ET dynamics after 1,3 and 6 months; EF dynamics was estimated after 6 months. Data were statistically processed using software package "Statistika, 9.0". RESULTS: After 6 months PR EF increased by 7,5±0,5 %, QOL - 17.5±8 points, ET - 9.5±1 points and VO2 peak - 4.4 ml/min/kg, end-diastolic volume decreased by 6±2.0 ml from baseline (p1,2,3,4, respectively). Echocardiography, CPET, QOL and ET improvement revealed a significant number of patients (EF - 48 %, VO2 peak - 64 %, QOL - 64 %, ET - 67 % of patients, respectively). Revealed a strong positive correlation between the initial values of VO2 peak and EF (rEF=0,4, p), and between baseline levels of sodium, haemoglobin and the of PR efficiency (rNa= 0,41, p,0,05; rHb = 0,45, p.