Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure.

AIM: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF). MATERIAL AND METHODS: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death. RESULTS: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration. CONCLUSION: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

[Safety performance of rivaroxaban versus warfarin in patients with atrial fibrillation and advanced chro-nic kidney disease].

Aim To evaluate safety of using rivaroxaban in patients with stage 4 chronic kidney disease (CKD) or transient, stable decline of glomerular filtration rate (GFR) to 15-29 ml /min / 1.73 m2 in the presence of atrial fibrillation (AF).Material and methods This multicenter prospective, randomized study included patients admitted to cardiology departments from 2017 through 2019. Of 10 224 admitted patients 109 (3 %) patients with AF and stage 4 CKD or a stable decline of GFR to 15-29 ml /min / 1.73 m2 were randomized at 2:1 ratio to the rivaroxaban 15 mg /day (n=73) treatment group or to the warfarin treatment group (n=36). The primary endpoint was development of BARC and ISTH major, minor, and clinically relevant minor bleeding. Mean follow-up duration was 18 months.Results Patients receiving warfarin had a significantly higher incidence of BARC (n=26 (72.2 %) vs. n=31 (42.4 %), р<0.01) and ISTH (n=22 (61.1 %) vs. n=27 (36.9 %), p<0.01) minor bleeding and all ISTH clinically relevant (minor clinically relevant and major bleedings) n=10 (27.7 %) vs. n=8 (10.9 %), р=0.03]. The number of repeated hospitalizations was 65 (43% of patients) in the rivaroxaban treatment group and 27 (48% of patients) in the warfarin treatment group (р=0.57), including 24 (36.9 %) and 11 (40.7 %) emergency admissions in the rivaroxaban and warfarin treatment groups, respectively (р=0.96). Significant improvement of changes in creatinine clearance and GFR (by CKD-EPI and Cockroft-Gault) was observed in the rivaroxaban treatment group.Conclusion The study provided evidence for a more beneficial safety profile of rivaroxaban compared to warfarin in patients with AF and advanced CKD.

[Comparison of the efficacy and safety of electrical cardioversion and pharmacological cardioversion with nibentan in patients with persisting atrial fibrillation and flutter].

The aim of the study was to compare the efficacy and safety of pharmacological cardioversion (PC) by nibentan, a class III antiarrhythmic agent, and electrical cardioversion (EC) in patients with persisting atrial fibrillation (AFib) and atrial flutter (AFI) receiving basic antiarrhythmic therapy. Ninety-seven patients with persisting AFib and AFI were included in the trial (45 patients constituted PC group, and 52 constituted EC group). Both groups were comparable according to basic demographic and clinical parameters as well as antiarrhythmic therapy being applied. The results of the study showed that the efficacy of PC did not differ from that of EC (86.7% and 92.3% respectively, p = 0.282). the frequency of arrhythmogenic effect did not differ between the groups either (p = 0.46). One case of non-stable ventricular tachycardia was registered in the PC group. The most significant adverse effect was bradicardia, which was registered more often in the PC group than in EC group (26.7% and 3.8%, respectively, p = 0.001). In conclusion, the efficacy and safety of PC with nibentan in patients with persisting AFib/AFI is comparable with those of EC.

[Anginal States provoked by psychogenic stimuli. To the problem of psychosomatic reactions in patients with ischemic heart disease]. / Psikhogenno provotsirovannye anginoznye sostoianiia (k probleme psikhosomaticheskikh reaktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa).

Two types of vulnerability of coronary vessels damaged by atherosclerosis were proposed basing on results of a study of 94 patients with psychosomatic reactions accompanied with ischemia or myocardial infarction. First variant (35 patients) was characterized by stable course of the disease (high effort angina without coronary catastrophes, episodes of unstable angina, etc.) and selective sensitivity to definite key affect of high personal value. Second variant (49 patients) was distinguished by pronounced clinical manifestations (effort angina with progressive lowering of exercise tolerance). Cardiovascular system displays universal susceptibility to negative emotions of various intensity.

[Psychosomatic reactions comorbid with ischemic heart disease: psychogenically provoked infarctions and myocardial ischemia]. / Psikhosomaticheskie reaktsii, komorbidnye ishemicheskoi bolezni serdtsa: psikhogenno provotsirovannye infarkty i ishemii miokarda.

Ischemic heart disease (IHD) with psychogenic provoked myocardial infarctions (MI) and myocardial ischemic disease (MID) is considered as a psychosomatic disorder. Seventy patients, 17 female and 53 male, aged between 39-77 years, mean age 61.2 +/- 9.9 years, were observed. The presence of both somatic (prolonged atherosclerotic lesion of coronary arteries) and mental (personality disorders with symptoms of reactive lability under psychic trauma influence) predisposition is obligate for manifestation or exacerbation of this IHD type. It is suggested that atherosclerotic coronary vessels affection of heterogeneity may exist. Two types of vulnerability are described. In type 1 cardiovascular system exhibits selective sensitivity to the influence of obligate and of great personality significance cathatymic affect. A strict condition of its realization is amplification of negative emotions up to a level of pathological affective outbursts in the spectrum of paranoiac or explosive reactions. In these cases, IHD is characterized by a stable course (angina of high tensions, without instable anginal episodes etc). In type 2 cardiovascular system reveals vulnerability to negative emotions, the continuum of which is ended by polar pathological affects-cathatymic and anxiety. In contrast to cathatymic affect, a common feature of anxiety affect is a fast, like short-term emotional outburst, manifestation of instable, labile, dramatic external appearances (with tears, converse disorders etc). IHD symptom complex is distinguished by pronounced clinical manifestations (stenocardia of tension with progressive impairment of tolerability to loadings).