Basic mechanisms of myocardial dysfunction: cellular pathophysiology of heart failure

36 MONTHS SURVIVABILITY AND ITS PREDICTORS IN PATIENTS WITH CHRONIC HEART FAILURE AND DECREASED FRACTION OF LEFT VENTRICULAR EJECTION DEPENDING ON SEX

Aim of the work: to compare survivability parameters during 36 months and their predictors among men and women with chronic heart failure and decreased fraction of left ventricular ejection. Materials and methods: the research included 356 patients with CHF (NYHA ІІ –ІV) with decreased LVEF<40 %, 18–75 years old. Using Kaplan-Meier method, there was analyzed the survivability in men and women during 36 months, then there were analyzed independent factors that influenced survivability terms depending on sex using the multiple logistic regression. Results. Our analysis of the survivability of patients with CHF with decreased LVEF demonstrated that the cumulative survival after 3 years of observation was 49 and 51 % for men and women, respectively. The curves of 36 months survivability didn’t reliably differ. At the analysis of factors, associated with the bad prognosis, there were observed differences between groups of men and women with CHF. Thus, in men the predictors of 36 month survival were: the thickness of the right ventricle wall, size of the right atrium, end-diastolic volume and end-systolic volume of LV, indices of EDV and ESV of LV, urinary acid level, value of LVEF. In women the predictors of survivability during 3 years were the following parameters: BMI, DM type 2 in an anamnesis, end-diastolic size of LV, end-systolic size of LV, blood glucose level, LVEF. Conclusion. The survivability of men and women with CHF with decreased LVEF during 36 months didn’t reliably differ and was 49 and 51 % respectively. But predictors of the lethal outcome in men and women essentially differed during 36 months, and their number is essentially higher in men.

Can hyperbaric oxygen be used as adjunctive heart failure therapy through the induction of endogenous heat shock proteins?

Heart failure (HF) is a chronic condition that is expected to increase in incidence along with increased life expectancy and an aging population. As the incidence of HF increases, the cost to national healthcare budgets is expected to run into the billions. The costs of lost productivity and increased social reliance on state support must also be considered. Recently, acute myocardial infarction (AMI) has come to be seen as the major contributing factor to HF. Although thrombolysis may restore coronary perfusion after an AMI, it may also introduce ischemic reperfusion injury (IRI). In an attempt to ameliorate sustained protein damage caused by IRI, endogenous chaperone proteins known as heat shock proteins (HSPs) are induced as a consequence of the stress of IRI. Recently, hyperbaric oxygen has been shown to induce the production of HSPs in noncardiac tissue, with a resultant protective effect. This current opinion review article suggests a possible role for hyperbaric oxygen, as a technologically modern drug, in augmenting the induction of endogenous HSPs to repair and improve the function of failing hearts that have been damaged by AMI and IRI. In addition, this simple, safe, noninvasive drug may prove useful in easing the economic burden of HF on already overextended health resources.