Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region

AIM

To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.

MATERIAL AND METHODS

A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.

RESULTS

591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.

CONCLUSION

Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

Female and Male Phenotypes of Iron Deficiency in CHF. Additional analysis of the «The Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)» study

Aim    To evaluate the incidence of iron deficiency (ID) in men and women with chronic heart failure (CHF) and to compare clinical and functional indexes in patient with and without ID depending on the gender.Material and methods    An additional analysis of the study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)" was performed. The study included 498 (198 women, 300 men) patients with CHF, in whom, in addition to iron metabolism, the quality of life and exercise tolerance (ET) were studied. 97 % of patients were enrolled during their stay in a hospital. ID was defined in consistency with the European Society of Cardiology (ESC) Guidelines. Also, and additional analysis was performed according to ID criteria validated by the morphological picture of the bone marrow.Results    ID was detected in 174 (87.9 %) women and 239 (79.8 %) men (p=0.028) according to the ESC criteria, and in 154 (77.8 %) women and 217 (72.3 %) men (p=0.208) according to the criteria validated by the morphological picture of the bone marrow. Men with ID were older and had more severe CHF. They more frequently had HF functional class (FC) III and IV (63.4 % vs. 43.3 % in men without ID); higher concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP) and lower ET. HF FC III increased the probability of ID presence 3.4 times (p=0.02) and the probability of HF FC IV 13.7 times (p=0.003). This clinical picture was characteristic of men when either method of determining ID was used. In women, ID was not associated with more severe CHF.Conclusion    Based on the presented analysis, it is possible to characterize the male and female ID phenotypes. The male ID phenotype is associated with more severe CHF, low ET, and poor quality of life. In females of the study cohort, ID was not associated with either the severity of CHF or with ET.

Non-High Density Lipoprotein Cholesterol: A Modern Benchmark for Assessing Lipid Metabolism Disorders

Aim. To perform a population analysis of Non-High Density Lipoprotein Cholesterol level (non-HDL-c) in Russian population and to evaluate its association with cardiovascular events.

Material and Methods. The material consisted of results obtained from 11 regions of the ESSE-RF1 Study and from 4 regions of the ESSE-RF2 Study. Study protocols were identical. The studies were performed in 2012-2014 and 2017, respectively. Endpoints were assessed in 19041 people aged 35-64 years. The median follow-up was 6.5 years in ESSE RF (1) and 3.8 years in ESSE RF(2). Analysis was performed for three lipid variables: total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and non-HDLC in two samples: the general population sample and the same sample without individuals with coronary heart disease (CHD), myocardial infarction (MI) and/or stroke history and not taking statins (the population sample of "without a history of cardiovascular diseases [CVD]". The analysis of nonlinear associations was performed using the generalized additive Cox model. The combined cardiovascular endpoint was represented by cardiovascular death and nonfatal MI and stroke. Traditional and laboratory FRs, socio-demographic parameters were analyzed. The significance level for all tested hypotheses was set to be 0.05.

Results. The prevalence of elevated non-HDL-C level (>3.7 mmol/l) was found to be 74.6%. No gender differences were found: there was 74.6% for men and 74.5% for women. Both mean values and prevalence of elevated non-HDL-C were increased with age in women, and its level was slightly decreased in men after 55 years old. Almost all analyzed RFs were significantly associated with elevated non-HDL-C in these two population samples. In both samples elevated total CH and elevated LDL-C were associated with all-cause mortality after correction for all RFs. On the contrary, the non-HDL-C was associated with CVD combined end pints. It has been shown that the risk of these end points increases uniformly with increase in levels of non HDL cholesterol, no nonlinear associations were found.

Conclusion. The results of a population-based analysis of non-HDL-C performed in the Russian population for the first time confirmed that elevated non-HDL-C levels contribute significantly to determining the risk of cardiovascular events in the medium term. It can be assumed that the new risk scales (SCORE2 and SCORE OP) proposed by the European Society of Cardiology and the European Society of Preventive Cardiology, which include non-HDL C instead of TC, will allow adequate assessment of 10-year cardiovascular risk for Russians. However, continued monitoring of endpoints in order to obtain stable associations is required.

[Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study]

Aim    To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods    Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results    83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion    The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.

Cardioprotective Strategies for Doxorubicin-induced Cardiotoxicity: Present and Future

The improvement of drugs and protocols of chemotherapeutic treatment has led to improved outcomes and survival in patients with cancer. But along with this, at first glance a positive point, there was another interdisciplinary problem, which is the need for early detection and treatment of developing cardiotoxicity when taking chemotherapy drugs. The study of cardioprotective strategies has recently become increasingly relevant, due to the fact that many patients who have successfully undergone treatment for cancer have a high risk of developing or are at high risk of death from cardiovascular diseases. One of the main drugs for the treatment of a number of oncological diseases is an anthracycline – type antibiotic-doxorubicin. This review briefly examines the risk factors and pathophysiological mechanisms underlying anthracycline cardiotoxicity. The current possibilities of cardioprotection of anthracycline cardiotoxicity are considered in detail, and some promising targets and drugs for improving cardioprotective strategies are discussed.

Microrna: the role in the pathophysiology of atrial fibrillation and potential use as a biomarker

The aim of the study was to analyze medical literature on the role of microRNA in the pathophysiology of atrial fibrillation and the possibilities of using microRNAs as biomarkers.The analysis of modern medical literature was carried out using the PubMed – NCBI database.

Atrial fibrillation (AF) is a common and serious cardiovascular disease. The pathophysiological mechanisms underlying the development of atrial fibrillation are not entirely clear. In addition, there are no optimal biomarkers for early detection and assessment of the prognosis for patients with atrial fibrillation. Recently, the attention of researchers has been directed to the molecules of microRNA. There is a lot of evidence that they are involved in the pathogenesis of neurological, oncological, and cardiovascular diseases. This review examines the role of microRNAs in the pathophysiology of atrial fibrillation. The possibility of using microRNA as a biomarker for the diagnosis and prediction of atrial fibrillation is also discussed.MicroRNAs play a crucial role in the pathophysiology of atrial fibrillation, regulating the mechanisms of atrial remodeling, such as electrical remodeling, structural remodeling, remodeling of the autonomic nervous system, and impaired regulation of calcium levels. The stability of microRNAs and the possibility to study them in various biological fluids and tissues, including blood, make these molecules a promising diagnostic biomarker for various cardiovascular diseases. The presented data clearly indicate that AF is associated with changes in the expression level of various microRNAs, which can be quantified using a polymerase chain reaction. Further research is required to assess the role of microRNAs as biomarkers for atrial fibrillation, in particular to establish precise reference limits.

Arterial hypertension and antihypertensive therapy in older patients. The agreed opinion of experts from the Russian Association of Gerontologists and Geriatricians, the Antihypertensive League, the National Society for Preventive Cardiology

High blood pressure is a risk factor for cardiovascular morbidity and mortality, as well as cognitive decline and loss of autonomy in the elderly and old age. Randomized clinical trials (RCTs) in populations of older patients living at home with low comorbidity and preserved autonomy indicate the benefit of lowering elevated blood pressure in patients over 80 years of age. Older patients with senile asthenia, loss of autonomy and other geriatric problems were excluded from RCTs, and observational studies in these groups of patients indicate an increase in morbidity and mortality with lower blood pressure and antihypertensive therapy. Obviously, in very elderly patients, a universal strategy for the treatment of arterial hypertension cannot be applied due to the significant heterogeneity of their functional status. The geriatric approach to the management of arterial hypertension in older patients involves an assessment of the functional status, the presence of senile asthenia, and the degree of autonomy for the choice of antihypertensive therapy tactics.

Is the population level of anxiety and depression associated with mortality? Data from the ESSE-RF study

Aim. To study the associations of subclinical and clinical anxiety and depression, assesed by the Hospital Anxiety and Depression Scale (HADS), ≥8 points and ≥11 points, respectively, with all-cause mortality and cardiovascular mortality, as well as with the total number of nonfatal cardiovascular events (CVEs) in Russia.

Material and methods. The study included male and female population aged 25-64 years from the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study who signed an informed consent. The study included 16941 people (men, 6811 (40,2%)). To assess the anxiety and depression, HADS scale was used. The statistical analysis included individuals with subclinical/clinical (HADS ≥8) and clinical (HADS ≥11) anxiety and depression (HADS-A and HADS-D). The median of prospective follow-up was 5,5 years (from 2012 to 2019). The composite endpoint (CE) (cardiovascular death and nonfatal CVE occurred in 268 (4,2%) men and 203 (2,1%) women, while all-cause — in 220 (3,2%) men and 152 (1,5%) women.

Results. The results obtained showed that the survival rate of men and women with varying degrees of anxiety (HADS-A ≥8 and ≥11) was associated with all-cause mortality and CE in women. However, this relationship has not been confirmed in multivariate models. In the multivariate Cox proportional hazards model 1 (M1), a significant association of depression with all-cause mortality in women was revealed — HADS-D ≥8: relative risk (RR), 2,22; 95% confidence interval (CI): 1,56-3,15 and ≥11: RR, 2,43; 95% CI: 1,65-3,59 (p<0,005), as well as in men — HADS-D ≥8: RR, 1,51; 95% CI: 1,10-2,08 (p=0,01). In model 2 (M2), when added to M1 as a predictor of prior cardiovascular disease (≥3), depression was significantly associated with all-cause mortality only in women — HADS-D ≥8: RR, 2,23; 95% CI: 1,53-3,24 (p<0,005); HADS-D ≥11: RR, 2,61; 95% CI: 1,74-3,92 (p=0,01). In addition, only in women, subclinical/clinical depression (HADS-D ≥8) was significantly associated with fatal and non-fatal CVE — HADS-D ≥8: RR, 1,46; 95% CI: 1,08-1,98 (p=0,02).

Conclusion. Depression (HADS-D ≥8 and ≥11) in Russian women was significantly associated with all-cause mortality and CE (HADS-D ≥8). In men, depression (HADS-D ≥8) was significantly associated with allcause mortality when only conventional risk factors were included in the model, without taking into account prior cardiovascular disease. Anxiety in multivariate models was not associated with all-cause mortality and CE in both sex groups.

Contribution of hypertension and other risk factors to survival and mortality in the Russian population

Aim. To study the contribution of hypertension (HTN) to survival and mortality in the Russian population.

Material and methods. This prospective observational cohort included representative samples from 11 Russian regions (men and women aged 25-64 years, n=18251) examined in 2012-2014 as part of the Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation (ESSE-RF) study. The examination included a questionnaire (12 modules), anthropometric and blood pressure (BP) measurements, as well as biochemical blood tests. HTN was considered aa a systolic BP ≥140 mm Hg and/or diastolic BP ≥90 mm Hg, or when a subject receives antihypertensives. Treatment efficacy was considered as the proportion of persons (%) who achieved target BP among those taking antihypertensives. Depending on HTN status, all participants were divided into 4 groups: 1) those without HTN;

2)        those with HTN, taking antihypertensive agents and having systolic BP ≤140 mm H. and diastolic BP ≤90 mm Hg (effective therapy);

3)        those with HTN, taking medications, but not achieving target BP (ineffective therapy); 4) those with HTN, not taking antihypertensives. The life status of participants was updated every 2 years. Kaplan-Meier survival curves, as well as univariate and multivariate Cox proportional hazards models were created.

Results. The presence of HTN significantly reduced survival (p<0,001) in the cohort, which is significant when adjusted for age (men — relative risk (RR)=1,47, p<0,001, women — RR=1,17, p<0,001). In the multivariate model, the male sex (RR=2,3 p<0,001), age increase, smoking, tachycardia, and HTN are significant for all-cause mortality only for men, but not for women. However, for women, absence of higher education was significant. The presence of HTN significantly worsens cardiovascular survival in both sexes (p<0,0001). HTN increases the risk of a composite endpoint for both men and women (p<0,001). Analysis of Kaplan-Meier curves showed the worst survival rate in persons with HTN, taking antihypertensive drugs, but not reaching target BP levels.

Conclusion. The presence of HTN significantly worsens the survival rate of men and women. Special attention of medical community should be directed to increasing the proportion of effectively treated patients with HTN.

Thrombolytic Therapy in Treatment in Patients with Pulmonary Embolism not High-risk: SIRENA Registry Data

Aim. To study the features of the use of thrombolytic therapy (TLT) in normotensive patients with pulmonary embolism (PE) in real clinical practice in Russian hospitals.

Material and Methods. From 04/1 5/2018 to 04/15/2019 patients hospitalized with a diagnosis of PE consistently were included in the Russian multicenter observational prospective register "SIRENA” (RusSIan REgistry of pulmoNAry embolism).

Results. For 12 months in the registry was included 609 patients with a lifetime confirmed diagnosis of PE. TLT was performed in 152 patients with PE (25.0%), of which only 51 (33.8%) were indicated as "high risk" (shock or hypotension). In 101 not high risk patients, the indications for TLT were: severe shortness of breath/respiratory failure - 19 (18.8%), massive venous thrombosis - 7 (6.9%), signs of massive/submassive PE - 10 (9.9%), intermediate-high risk - 14 (13.9%), suspicion of acute coronary syndrome with ST segment elevation - 3 (2.9%), high pulmonary hypertension -2 (2.0%). The other 46 (45.5%) non-high-risk patients had no clear indication of the reasons for TLT in their medical history. To study the features of management of patients with not high-risk PE who received TLT (group 1), a selection of pairs of patients from the "SIRENA” registry, comparable in gender and age, in a ratio of 1:1 of patients with not high-risk PE who did not perform TLT (group 2). Hospital mortality was 4 (4%) patients in the TLT group and 6 (5.9%) patients in group 2 (р=0,748). Logistic regression analysis showed that floating blood clot in the veins of the lower extremities, syncopes in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis, and probability of completion TLT decreased in the presence of a history of bleeding, chronic kidney disease, surgery in the previous 12 months, increase in the size of the right atrium on EchoCG (statistical significance of the model x2=51.574; p<0.001). The development of bleeding during hospitalization was recorded only in 10 (9.9%) patients of group 1, including severe (3 stage on the BARC scale) in 2 patients. Patients without TLT more often developed an acute heart failure (25.9% vs. 8.5%, p=0.043).

Conclusion. In real clinical practice, there is a high frequency of TLT in patients with not high-risk PE. Floating blood clot in the veins of the lower extremities, syncope in the debut of PE, respiratory rate over 22 per minute were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis.

Value of comparative studies of "real clinical practice" in modern cardiology. Position paper based on the expert council discussion dated 12/18/2020

On December 18, 2020, an expert council was held with the participation of members of the Russian Society of Cardiology, the Eurasian Association of Ther-apists, the National Society for Atherothrombosis, the National Society for Evi-dence-Based Pharmacotherapy, and the Russian Heart Failure Society. The event was devoted to the discussion of the correct use of research data of "real clinical practice" in decision making.

Comorbidity in chronic obstructive pulmonary disease and cardiovascular disease

Comorbidity is one of the most significant problems of modern healthcare. Numerous studies have analyzed the possible pathogenetic mechanisms and relationships between a wide variety of diseases. Cardiovascular (CVD) and pulmonary diseases, in particular chronic obstructive pulmonary disease (COPD), have a number of the same risk factors and pathogenetic links, which aggravate each other's course. Moreover, CVD and COPD are among the most common diseases in the world. This review provides up-to-date information on the prevalence, risk factors and pathophysiological mechanisms underlying this unfavorable combination of diseases. Some problems of diagnosis and treatment of patients with COPD and CVD are also discussed.

[Expert consensus regarding treatment of iron deficiency in stable and decompensated patients with heart failure]

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of &lt; 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms.  It is, therefore, reasonable to screen for and treat ID in patients with HF.

High-sensitivity cardiac troponins: detection and central analytical characteristics

Recently, there have been some important changes in the laboratory diagnosis of patients with acute coronary syndrome, due to the introduction into routine practice of new high- and ultra-sensitive techniques for detection of myocardial damage biomarkers — cardiac troponins. Each method for cardiac troponins’ detection, among the existing wide variety of troponin immunoassays, has different analytical characteristics and allows the detection of different concentrations of troponins in the same patient. With an increasing number of companies developing high-sensitivity troponin immunoassays receiving regulatory approval, there is an urgent need for independent analytical and clinical evaluation of each method. This article discusses high- and ultrasensitive techniques for detection of cardiac troponins. The modern data on biochemical and metabolic characteristics of troponins, obtained using high- and ultra-sensitive techniques, are described: sex, age, circadian features and potential for detecting troponins in other biological fluids. Considerable attention is paid to the analytical characteristics of troponin immunoassays: limit of blank, limit of detection and limit of quantitation, coefficient of variation, as well as the 99th percentile and factors influencing it.

High-sensitivity cardiac troponins: circadian rhythms

High-sensitivity cardiac troponins (hs-cTnI and hs-cTnT) contribute to a progression in the diagnosis and treatment of cardiovascular diseases: acceleration of diagnosis of acute myocardial infarction (early diagnostic algorithms: 0-1 h, 0-3 h), and earlier initiation of optimal treatment, expansion of diagnostic and prognostic potential (earlier detection of myocardial damage during chemotherapy, endocarditis, myocarditis and other diseases). However, increased sensitivity slightly reduced the specificity and created the need for a more thorough interpretation of elevated levels of hs-cTnI and hs-cTnT in a number of pathologies that damage cardiomyocytes. In addition, there was a need to introduce reference levels of hs-cTnI and hs-cTnT (99 percentile), taking into account sex. Recently, there has also been information about circadian (diurnal) variations in hs-cTnT and hs-cTnI levels. We analyze in detail the results of clinical studies that found circadian changes in hs-cTnI and hs-cTnT. Possible mechanisms underlying these changes in hs-cTnT and hs-cTnI concentrations are discussed.

[The use of diuretics in chronic heart failure. Position paper of the Russian Heart Failure Society]

The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.

Thrombolytic Therapy in Normotensive Patients with Pulmonary Embolism (Data from the Retrospective Study)

Background. The thrombolytic therapy is absolutely recommended for patients in shock or hypotension because the benefits are clearly outweighing the risks. However, in hemodynamically stable patients, including those with acute right ventricular dysfunction and/or myocardial damage, thrombolysis has a significantly lower evidence level.

Aim. To study the criteria based on which doctors decide to conduct thrombolytic therapy in normotensive patients in real clinical practice according to the retrospective data.

Material and methods. A single-center retrospective cohort study analyzed medical records of patients hospitalized in 2006-2017 with a verified diagnosis of pulmonary embolism (PE) and who had a systolic blood pressure >90 mm Hg at the time of admission.

Results. The present study population included 299 patients with a verified diagnosis of PE from 2006 to 2017 years. Patients were divided into two groups: with thrombolysis (group 1) and without thrombolysis (group 2). Logistic regression analysis showed that age younger than 60 years, the presence of varicose veins of the lower extremities, skin cyanosis, syncope in the debut of PE were independent clinical factors that significantly influence the doctor's decision to perform thrombolysis. Increased troponin I, right ventricular dysfunction, and the severity of PE according to the PESI score showed no significant impact on this decision. In-hospital mortality in the group 2 was 1.9% (5 patients), while there were no deaths in the group 1. But the analysis of the association of thrombolysis with survival was difficult to perform due to the low incidence of deaths and the small number of patients in the group with thrombolysis (odds ratio 0.34; 95% confidence interval 0.03-8.18; р=0.856). No major bleeding was registered in any group.

Conclusion. We were not able to clearly identify independent clinical or instrumental factors that influence the decision to perform thrombolysis in patients with PE outside the framework of evidence-based medicine. Further research is needed.

Associations of Blood Pressure and Heart Rate and Their Contribution to the Development of Cardiovascular Complications and All-Cause Mortality in the Russian Population of 25-64 Years

Aim. To study the relationship of blood pressure (BP) and heart rate (HR) in a sample of men and women 25-64 years old and their predictive value for the development of fatal and non-fatal cardiovascular diseases (CVD) and mortality from all causes.

Material and methods. Prospective observation was for cohorts of the population aged 25-64 years from 11 regions of the Russian Federation. 18,251 people were included in the analysis. Each participant gave written informed consent. All surveyed persons were interviewed with a standard questionnaire. BP was measured on the right hand with an automatic tonometer. BP and HR were measured twice with an interval of 2-3 min with the calculation of the average value. The patients were divided into 4 groups: the first group with BP<140/90 ><140/90 mm Hg and HR≤80 beats/min; the second group – BP<140/><140/90 mm Hg and HR>80; the third group – BP≥140/90 mm Hg and HR≤80; the fourth group – BP≥140/90 mm Hg and HR>80 beats/min. Risk factors and cardiovascular history were analyzed as well. Deaths over 6 years of follow-up occurred in 393 people (141 – from CVD). Statistical analysis was performed using the open source R3.6.1 system.

Results. A HR>80 beats/min was found in 26.3% of people with BP≥140/90 mm Hg, regardless of medication. Analysis of the associations between HR and BP showed that for every increase in HR by 10 beats/min, systolic BP increases by 3 mm Hg. (p<0.0001). The group with HR>80 beats/min and BP≥140/90 mm Hg had the shortest life expectancy (p<0.001). Adding an increased HR to BP≥140/90 mm Hg significantly><0.001). Adding an increased HR to BP≥140/90 mm Hg significantly worsened the prognosis of patients. Similar results were obtained in the analysis of cardiovascular survival. Elevated BP and elevated HR had the same effect on outcomes, except for the combined endpoint, where the contribution of elevated BP was predominant. However, their combined effect was the largest and highly significant for the development of the studied outcomes, even after adjusting for other predictors. With an increase in HR by every 10 beats/min, the risk of mortality increased statistically significantly by 22%.

Conclusion. The prevalence of HR>80 beats/min in people with BP≥140 mm Hg amounted to 26.34%. Every 10 beats/min significantly increases the risk of mortality by 22%. Increased HR with elevated BP leads to increased adverse outcomes.

Cross-Sectional Study to Estimate the Prevalence of Familial Hypercholesterolemia in Selected Regions of the Russian Federation: Relevance, Design of the Study and Initial Characteristics of the Participants

Aim. To study the prevalence of familial hypercholesterolemia (FH), the characteristics of the clinical features and treatment of the disease in selected regions of the Russian Federation, this article describes the design and initial characteristics of patients included in the study.

Material and methods. The study participants were selected among those included in the study “Epidemiology of cardiovascular risk factors and diseases in the regions of the Russian Federation” (ESSE-RF) in different regions of the Russian Federation. The study included individuals with lowdensity lipoprotein cholesterol (LDL-C) levels >4.9 mmol/l or LDL-C levels >1.8 mmol/l, but ≤4.9 mmol/l during statin therapy, according to the data obtained in the ESSE-RF study. These persons are invited for examination and questioning by experts in the field of FH diagnostics. On the basis of the survey data and provided medical documentation, the following information is collected: age, sex, smoking status, presence of hypertension, history of coronary artery disease, stroke, atherosclerosis of cerebral and peripheral arteries, LDL-C level, type, volume and duration of lipid-lowering therapy throughout life, presence and dates of secondary causes of hyperlipidemia, information about the family history of development of early cardiovascular diseases and atherosclerotic diseases, increased levels of LDL-C in relatives of the 1st and 2nd degree of kinship. All patients are examined for the presence of tendon xanthomas (Achilles, metacarpal, elbow, knee tendons) and Corneal arcus. During the visit, blood is taken for subsequent biobanking, measurement of current blood lipid levels, elimination of secondary forms of hypercholesterolemia (for subsequent determination of liver enzymes, thyroid stimulating hormone) and genetic testing. The diagnosis of FH is based on Dutch Lipid Clinical Network Criteria (DLCN). Besides, all participants in the study are tested for compliance with the diagnosis of FH according to Simon Broome criteria. All patients with a definite or probable diagnosis of FH according to DLCN or Simon Broome criteria are subjected to ultrasound examination of carotid, femoral arteries and heart and molecular genetic testing for LDLR, APOB and PCSK9 gene variants.

Results. Out of 16 360 participants of the ESSE-RF study in 10 regions, 1787 people (10,9%) met the criteria for inclusion in this study. Among them, men accounted for 35.4%, of which 1150 (7%) patients had a LDL-C level >4.9 mmol/l and 637 (3,9%) had a LDL-C level from 1,81 mmol/l to 4.9 mmol/l during lipid-lowering therapy. When compared to the original cohorts of participants from the 10 regions as compared to 3 previously surveyed regions and selected sub-groups within these cohorts we observed significant differences in several parameters such as age, total cholesterol level, triglycerides, LDL-C, the frequency of cardiovascular diseases, that may indicate regional differences in FH prevalence.

Conclusion. The analysis of clinical data of the participants of the ESSE-RF study shows that more than 10% of individuals require an additional examination to verify the FH diagnosis, and regional differences in the FH prevalence are possible.

Coronary Heart Disease in HIV-Infected Patients

Currently, there are methods of drug exposure to the infection caused by the human immunodeficiency viruses (HIV), that allow to suppress the active replication of the virus in the patient's body. The era of antiretroviral therapy, which has allowed HIV-infected people to live longer, has begun. This led to an increase in their cardiovascular diseases, which occur at an earlier age and are more severe than in people without HIV. Specific or “nontraditional” risk factors damaging vascular wall occur in HIV patients along with traditional risk factors. These factors include: the negative impact of HIV on endothelium, an imbalance of inflammatory mediators, pathological immune activation, a decrease in the level of CD4 cells, a change in the number and function of platelets. The question of the effect of antiretroviral therapy on the occurrence of atherosclerotic vascular lesions remains debatable. Acute coronary syndrome (ACS) is one of the most frequent and most severe cardiovascular events in HIV-infected patients. The risk of myocardial infarction is highest in patients with a viral load of HIV-1 ribonucleic acid (RNA)≥500 copies/ml and a CD4 cell count of <200/ml. The most common form of ACS in HIV patients is ACS with ST segment elevation. Treatment of ACS in HIV patients has some difficulties: a high frequency of stent thrombosis, the frequent occurrence of thrombocytopenia, drug interactions with antiretroviral therapy. The high risk of developing cardiovascular diseases in HIV patients necessitates the introduction of active measures of primary and secondary prevention, taking into account the specific interaction of all drugs taken by the patient.

[Clinical and Diagnostic Value of Cardiac Markers in Human Biological Fluids]

The article is devoted to problems of clinical-diagnostic value of determination of cardio-specific troponins in human biological fluids. Improvement of laboratory instrumentation and emergence of high sensitivity methods of analysis have allowed to identify troponins in urine, dialysate, and oral fluid. In the review we present actual information related to measurement of troponins in blood serum, data on testing of cardio-specific troponins in urine, dialysate, and oral fluid. Special attention is paid to determination of some cardiomarkers in oral fluid with thorough analysis of diagnostic value and effectiveness of the conducted studies.

[Improvement of outcomes in patients with recent acute coronary syndrome: the place of PCSK9 inhibitors. The Resolution of National Advisory Board]

On April 9, 2018, the national advisory board "Improvement of outcomes in patients with recent ACS: the place of PCSK9 inhibitors" was held in Moscow. Leading Russian experts in the field of atherosclerosis and lipid-lowering treatment attended the board. The purpose of the Board was to determine the place of PCSK9 inhibitors in the improvement of outcomes in patients with recent (less than 1 year) acute coronary syndrome (ACS). During the Board, three major aspects of lipid-lowering treatment were discussed: 1) issues in reaching the target levels of LDL cholesterol in real clinical practice among patients with recent ACS; 2) the results of ODYSSEY OUTCOMES study and their role in the improvement of outcomes in patients with recent ACS; 3) treatment with PCSK9 inhibitors in the management of patients with recent (less than 1 year) ACS in everyday clinical practice, the role of lipid centers.

[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.

Prognostic Value of ECG in Patients with Pulmonary Embolism

Aim. To study the significance of electrocardiography (ECG) signs for determining the hospital prognosis in patients with pulmonary embolism (PE).

Material and methods. 472 consecutive patients (49.6% men; average age 58.06±14.28 years) with PE, hospitalized to our center from 23.04.2003 to 18.09.2014 were enrolled into the study. In all cases PE was confirmed by computed tomographic pulmonary angiography and rarely by pulmonary angiography, or by pathology. Patients management was in accordance with appropriate European guidelines. Data of patients' history, clinical symptoms, biochemical markers and instrumental methods (ECG, echocardiography) were analyzed by one-dimensional logistic regression. The end points were: death, shock and hypotension, right ventricular dysfunction and pulmonary hypertension, positive cardiac biomarkers.

pulmonary embolism, electrocardiography, prognosis, collapse, hypotension, dysfunction of the right ventricle. 443 patients (93.9%) without fatal outcome were the first group and 29 patients (6.1%) with a fatal outcome – the second group. SIQIII pattern (33 vs 55.2%; p=0.015), non-complete right bundle branch block (RBBB) (16.3 vs 37.9%; p=0.001), ST segment elevation in lead III (9.7 vs 20.7%, p=0.034), atrial fibrillation (12.9 vs 37.9%, p=0.048) were observed more frequently among patients of group 2. Multivariate analysis revealed that SIQIII pattern (odds ratio [OR] 2.26; 95% confidence interval [95%CI] 1.046-4.868; p=0.038) and RBBB (OR 2.84; 95%CI 1.272-6.327; p=0.011) were associated with worse prognosis. The SIQIII pattern was significantly associated with a fatal outcome with a sensitivity of 55% and a specificity of 33% (AUC=0.611) according to ROC-analysis. Risk of hypotension was related to the following ECG-signs: the p-pulmonale (OR 1.76; 95%CI 1.001-3.088; p=0.049), negative T-wave in lead III (OR 1.8; 95%CI 1.035-3.144; p=0.037). Inversion of the T wave in lead III was associated with the development of shock (OR 1.98; 95%CI 0.891-4.430; p=0.043).

ECG-signs were also associated with the development of right ventricular dysfunction and pulmonary hypertension: right axis deviation (OR 1.035; 95%CI 1.008-1.062; p=0.01), ST-segment elevation in the AVR lead (OR 3.769; 95%CI 1.018-13.955; p=0.047), negative T wave in leads III, V1-V3 (OR 1.015; 95%CI 1.008-1.023; p=0.001 and OR 1.014; 95%CI 1.005-1.022; p=0.001, respectively), RBBB (OR 1.013; 95%CI 1.003- 1.024; p=0.012), p-pulmonale (OR 1.015; 95%CI 1.007-1.023; p=0.001), deep S in leads V5-V6 (OR 1.015; 95%CI 1.006-1.024; p=0.001). However, there was no significant relationship between ECG signs and cardiac biomarkers (troponin I and BNP).

Conclusions. SIQIII pattern, RBBB and inversion of the T wave in lead III have prognostic value in unselected population of patients with PE. 

Availability and Affordability of Medicines for the Treatment of Cardiovascular Diseases in Pharmacies in Six Regions of the Russian Federation

Aim. To evaluate the availability and affordability of medicines used to treat of cardiovascular diseases (CVD) in several regions of the Russian Federation with different climatic, geographic, economic and demographic characteristics. Material and methods. The study was conducted in 6 regional capitals, chosen to differ in geographically, economically, and demographically. In each city, 5 pharmacies providing free medicines to certain categories of citizens (beneficiaries) and 5 private pharmacies serving anyone were selected at random. Medicine availability was assessed in all pharmacies, along with price only in the private pharmacies. Data were obtained for both original drug and appropriate generics. A list of 25 of the most frequently prescribed medicines for cardiovascular diseases was compiled. Results. Some general findings emerged. With the existence of a generic drug, the original drug was not available in the pharmacy supplying beneficiaries. Diuretics, as well as some ACE inhibitors, are not available in a number of pharmacies for beneficiaries. Enalapril in most licensed pharmacies is represented by generics, lisinopril in a number of cities is represented by both the original drug and generics. The presence of sartans was much lower than ACE inhibitors. Bisoprolol was most common beta-blocker. Calcium antagonists: if amlodipine was present in all licensed pharmacies, at list as generic, then nifedipine was not available in many licensed pharmacies. Among antiplatelet agents, aspirin was available in most pharmacies, and clopidogrel was mostly represented by generics. As for statins, only simvastatin could be found in almost all pharmacies. When analyzing the cost of drugs in licensed pharmacies, it was found that drugs containing furosemide are the cheapest among generics – about 17 rubles. The most expensive treatment with generics of rosuvastatin – about 4,374 rubles a month. The most expensive original medicine was also rosuvastatin – about 4,500 rubles for 30 tablets, the cheapest – the original drug of furosemide – about 35 rubles. On average, the cost of CVD treatment with major classes of drugs, including ACE inhibitor, beta-blocker, antiplatelet drug and statin, is 1,921.9 rubles per month. Conclusion. The basic cardiovascular medicines were characterized by a relatively high availability in 6 regions of the Russian Federation included in the analysis both by the criterion of the availability of drugs and by the criterion of the minimum price.

ST-Elevation Myocardial Infarction in Patients With Malignancies

Acute myocardial infarction (MI), the most severe complication of coronary artery disease, develops in 2-4% of patients with various malignancies.

PURPOSE

to explore the specific properties of ST-segment elevation myocardial infarction (STEMI) course in patients with cancer and its effect on short-term outcome.

MATERIALS AND METHODS

We included in this study 45 patients with STEMI and history of cancer hospitalized in the period from 01.01.2015 to 01.01.2017 (group I; 58% men, mean age 69.07±11.60 years). In the comparison group (group II) we selected 90 age and gender matched persons (58% men, mean age 68.16±11.75 years) from patients with STEMI without oncological diseases.

RESULTS

There were no differences between groups in main risk factors of cardiovascular diseases, except greater proportion of patients with damage of peripheral arteries in group 1 (22.2% compared with 5.6% in group 2, p=0.025). There were also no differences between groups in clinical characteristics at admission. However values of the following parameters were significantly lower in group I: concentration of hemoglobin (115.56±23.07 vs. 133.70±16.45 g/l in group 2, р&lt;0.001), red blood cell count (3.95±0.66x1012/l vs. 5.57±0.72x1012/l in group 2, р&lt;0.001), platelets (93±0.97x109/l vs 186±18.3x109/l in group 2, p&lt;0.001), total cholesterol (4.12±2.17 vs. 6.24±2.56 mmol/L in group 2, р&lt;0.001). There were differences in the frequency of use of antiplatelet drugs: at prehospital stage acetylsalicylic acid was given to 48.9% and 77.8% of patients in groups 1 and 2, respectively (p=0.044); clopidogrel and ticagrelor were also significantly more rarely used in group 1. There was no difference in use of thrombolysis and percutaneous coronary interventions (4.4 and 53.3% vs 5.6 and 56.6% in groups 1 and 2, respectively). In group 2 greater portion of patients was given statins (68.9 vs. 77.8%, p=0.021) and angiotensin-converting enzyme inhibitors (55.6 vs. 82.2%, p=0.008). Inhospital mortality was the same in both groups (4.4%). Occurrence of complications (bleeding, pulmonary edema, cardiogenic shock), and frequency of use of intra-aortic balloon counterpulsation, temporary cardiac pacing were similar. However in group 1 greater portion of patients had ventricular tachyarrhythmias (15.6 vs 2.2% in group 2, р=0.007); the presence of cancer was the only independent predictor of their emergence in multiple logistic regression (OR 8.11 [1.11-40.83], p=0.011).

CONCLUSIONS

Rates of application of myocardial reperfusion in STEMI patients with and without history of cancer were the same. Despite similar hospital mortality revealed peculiarities of STEMI course could affect long-term outcomes. Confirmation of this hypothesis requires planned prospective studies.

Predictive markers of atrial fibrillation in patients after acute ST-elevated myocardial infarction (the results of observational program “FAKEL”)

Aim. To assess probability of atrial fibrillation (AF) in patients after ST-elevated myocardial infarction (STEMI) with undergone primary percutaneous coronary intervention (PCI).

Material and methods. Prospective study in the period from December 2015 to November 2017 was carried out with consecutive inclusion of 107 patients at outpatient follow-up stage after STEMI who have undergone primary PCI. The mean age of patients was 69,5+7,8 years (40 (37,4%) women). Follow-up period was 18 months and included three visits (V): V1 — when included in the study, V2 — after 12 months, and V3 — after 18 months. The endpoints of the study were cases of first diagnosed AF, cardioembolic stroke and death. At all visits predictive markers (Willebrand factor, Cystatin C, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), galectin-3) in the blood plasma were determined.

Results. After 18 months of follow-up period in 19 (17,8%) patients were diagnosed AF, 5 of them (4,7%) had cardioembolic stroke, and 3 patients died. Median time of AF development from the onset of STEMI was 308 days. Cox multivariate analysis showed that the risk factors for first diagnosed AF were NT-proBNP — relative risk (RR): 1,05; 95% confidence interval (CI): 0,99-1,10 (p=0,038), cystatin C — RR: 1,44; 95% CI: 0,98-2,12 (p=0,043), galectin-3 — RR: 1,20; 95% CI: 1,03-1,40 (p=0,022).

Conclusion. There was a highly significant relationship between NT-proBNP of ≥400,0 pg/mL, cystatin С of ≥1,45 ng/mL and galectin-3 of ≥25 mg/mL in patients after STEMI who underwent primary PCI. These markers might serve as predictors of first diagnosed AF. Identification of these biomarkers may have potential therapeutic benefit in improving the prognosis of patients after STEMI who have undergone primary PCI and reduce mortality from cardioembolic stroke.

[Key Points of the 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope]

The article presents key points of published in March 2017, Guideline for the Evaluation and Management of Patients With Syncope (A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society). This document contains summary and analysis of evidence base and accumulated experience in this field and reflect further development of the problem of the management of adult and pediatric patients with suspected syncope. Traditionally, the basis of diagnostic algorithm of these patients has been primary examination, and in the present guideline one can find strengthening of the importance of anamnestic criteria, and supplementation of ECG criteria of arrhythmic syncope. At the same time, the diagnostic value of provocative tests has been revised, and the class of indications for these tests has been lowered. According to the guideline, along with diagnosis of the cause of fainting, risk stratifcation of short- and long-term adverse outcomes has a key value. The guideline summarizes latest achievements in the treatment of fainting in sarcoidosis, arrhythmogenic right ventricular dysplasia, primary arrhythmic heart diseases, orthostatic hypotension, and reflex-mediated syncope. Despite orientation on specifc properties of medical care in the USA, the guideline can be useful to practical physicians in choice of the best strategy of diagnosis and treatment of syncope in each individual case.

RELATION OF ANTHROPOMETRIC INDEXES AND CORONARY HEART DISEASE

An epidemics of obesity in the world during recent two decades, has already led to increased prevalence of diabetes, metabolic syndrome, oncological diseases, etc. Obesity is assessed with a variety of indexes, and recently the number of such tools was added with the two additional: visceral obesity index (VOI) and index of lipid products deposition (ILPD). The aim of the study — evaluation of the relation of anthropometric parameters with coronary heart disease. Materials of the study were representative selections from 13 regions of the ESSE-RF trial. In analysis of associations of body mass index (BMI), waist circumference (WC), relation of WC to height (WC/height x 100), VOI and IPLD with correction on the age and region, it was found that all studied parameters are significantly correlated with ischemic heart disease, however when the main risk factors were added, only two remained — odds ratio (95% confidence interval) for: WC/height×100 — 1,030 (1,019;1,040) (р<0,0001) and VOI — 1,053 (1,020;1,087) (р<0,0015) in males and WC/height×100 — 1,027 (1,021;1,033) (р<0,0001) and VOI — 1,052 (1,022;1,083) (р<0,0007) in females. It is important to note almost identical values of odds ratio for the indexes in both sexes. Reliability of the models obtained is confirmed by ROC analysis, where the area under curve for males was 0,68 and for females 0,67. The results witness on legitimacy of search for novel parameters of obesity that would have good reproducibility and are also simple and easy to use.

[Volume of Coronary Artery Bypass Surgery and Risk of Postoperative Atrial Fibrillation]

PURPOSE

To identify prevalence of atrial fibrillation (AF) in dependence of volume of coronary artery bypass grafting (CABG) as assessed by the number of grafts.

MATERIAL AND METHODS

The study included 431 patients with ischemic heart disease (IHD) who underwent CABG. Group 1 comprised patients with single-vessel bypass graft (n=47, 78.7% men, mean age 59.6+/-5.6 years), group 2 - with multivessel bypass grafts (n=384, 76.8% men, mean age 61.0+/-8,1 years). During the observation period postoperative AF developed in 3 patients (6.4%) with single vessel bypass graft and 69 patients (18.0%) with multivessel bypass grafts. At multivariate analysis predictive values were significant for the following parameters: aortic cross-clamping time >36 min - 1.7 (95% confidence interval [CI], 1.1-3.2, p=0.03), ischemia time >19 min - 2.0 (95% CI, 1.1-3.7, p=0.02), age >59 years - 2.4 (95% CI, 1.3-4.4, p=0.005), left atrial dimension >39 mm - 3.7 (95% CI, 2.1-6.6, p<0.0001), left ventricular ejection fraction <51% - 1.9 (95% CI, 1.3- 3.3, p=0.04). Predictive value of cardiopulmonary bypass time >56 min 1.2 (95% CI, 0.56-2.8) was not significant (p=0.5).

CONCLUSION

In our study AF in the early postoperative period more often occurred in patients who underwent multivessel coronary bypass surgery. The most powerful predictor of AF in these patients was left atrial dimension exceeding 39 mm.

[Factors Associated With Development of Atrial Fibrillation After Coronary Artery Bypass Grafting]

PURPOSE

to identify factors associated with development of atrial fibrillation (AF) in the early postoperative period of coronary artery bypass grafting (CABG).

METHODS

A total of 376 patients with ischemic heart disease who underwent CABG were enrolled in the study.

RESULTS

During the observation period AF occurred in 74 patients (19.7%, 93% men, mean age 64.0+/-6.4 years), an average of 3.6+/-2 days after surgery. Multivariate regression analysis showed that odds ratio (OR) for AF in patients with age >59 years was 1.5 (95% confidence interval [CI], 1.1-3.5; p=0.04), aortic cross-clamping time >43 min - 2.4 (95% CI, 1.05-6.2; p=0.03), left atrial dimension (LAD) >39 mm - 5.0 (95% CI, 2.0-12.6; p=0.0006), left ventricular ejection fraction (LVEF) <51% - 3.6 (95% CI, 1.6-8.3, p=0.002). During ROC - analysis the high sensitivity was observed for LAD >39 mm (82%, =0.001), high specificity - for LVEF <51% (80%, =0.0009), highest positive likelihood ratio for LVEF <51% - 2.56 (=0.0009), greatest negative likelihood ratio for LAD >39 mm - 0.31 (=0.001).

CONCLUSION

In our study, the risk of AF development in the early postoperative period of CABG depended on the patients age, left atrial size, left ventricular ejection fraction, and aortic cross-clamping time during CABG.

[Results of Russian Hospital Chronic Heart Failure Registry in Three Subjects of Russian Federation]

Aim of the RUssian hoSpital Heart Failure Registry (RUS-HFR) was to analyze clinical and epidemiological characteristics, application of modern drug and non-drug therapy among hospitalized patients with systolic chronic heart failure (CHF) in 3 subjects of Russian Federation.

MATERIAL AND METHODS

We conducted a prospective multicenter observational study in 3 cardiological centers (Petersburg, Orenburg, Samara) in which we recruited patients aged 18-75 years with left ventricular ejection fraction less or equal 40% without ongoing myocardial infarction or pulmonary thromboembolism.

RESULTS

Between October 2012 and June 2014 we included 524 patients (mean age 60 years, >79% men) mostly with NYHA class III CHF. Main etiological factors were ischemic heart disease and arterial hypertension, which was not corrected by the time of admission in 20-40.7% of patients. Portions of patients who had undergo the myocardial revascularization, surgery because of valvular heart defects, and implantation of permanent pacemaker including device for cardiac resynchronizing therapy were 11-41, 0-4, and 0-19.5%, respectively. In up to 25% of patients therapy with one of main medications or diuretic was initiated after hospitalization. At discharge 82.3-8.3, 76.3-95.8, 65.9-81.1, 80.7-94.6% of patients received ACEI/ARB, -adrenoblockers, MRA, diuretic therapy, respectively. Implantation of cardioverter ICD/CRT, ICD and heart transplantation were considered indicated in 0-21.2 and 0-6.6% of patients, respectively. Duration of hospitalization was 26+/-14, 15+/-10, and 13+/-5 bed-days in Petersburg, Orenburg, and Samara, respectively.

CONCLUSIONS

Compared with data obtained 10 years earlier portrait of a patient with in general remained unchanged. However portion of patients who had undergone cardio-surgical and electrophysiological interventions became tangible, and numbers of patients receiving therapy with ACEI/ARB, -adrenoblockers, and MRA became comparable with those in European registries. Significant deviations from guidelines on drug therapy were revealed at prehospital stage; and high-technology methods of therapy were insufficiently often recommended in participating hospitals. Portion of hospitalizations not related to acute decompensation was 5-37%, while duration of such hospitalizations as well as hospitalizations because of acute decompensation of CHF significantly exceeded this parameter in EU and USA. Absence of obligatory drug therapy prior to admission in a part of patients in RUS-HF raises questions on correction of patients compliance and on creation of a system of specialized ambulatory surveillance of CHF patients after discharge from hospital.

[The Antihypertensive Effect of the Fixed Combination of Amlodipine and Lisinopril in Patients With Coronary Heart Disease After Coronary Artery Bypass Grafting]

Literature data and results of our own register have indicate that hypertension is one of the most common risk factor in patients with ischemic heart disease (IHD) who have undergone coronary artery bypass grafting (CABG). But despite proven benefits of control of hypertension after CABG adherence of patients to corresponding recommendations remains low. Fixed combinations of antihypertensive drugs are associated with better compliance. In 30 IHD patients after CABG we studied effects of fixed lisinopril/amlodipine combination. This combination was safe and had high antihypertensive activity. Practically all patients responded to therapy and achieved target level of arterial pressure.

THE PREVALENCE OF NON-INFECTIOUS DISEASES RISK FACTORS IN RUSSIAN POPULATION IN 2012-2013 YEARS. THE RESULTS OF ECVD-RF

In the frame of Multicenter observational study ECVD-RF (Epidemiology of Cardiovascular Diseases and their Risk Factors in Regions of Russian Federation) by the unique protocol the investigation of representative selections of adult population at the age of 25-64 y.o. of 11 regions RF (n=18305, including males, n=6919 and females n=11386): Volgograd, Vologda, Voronezh, Ivanovo, Kemerovo, Orenburg, Samara, Tomsk, Tyumen, Saint-Petersburg and Northern Osetia-Alania. The prevalence of the following risk factors (RF) of cardiovascular diseases is evaluated: high blood pressure — 33,8%, obesity — 29,7%, high total cholesterol — 57,6%, high glucose level or diabetes — 4,6%, smoking (tobacco consumption) — 25,7%, insufficient (low) level of physical activity — 38,8%, excessive salt consumption — 49,9% and insufficient vegetables and fruits consumption — 41,9%. Gender differences and an increase with the age of the parameters mentioned are described.

The absence of a epidemiologic monitoring system at the Federal level leads to an impossibility of clear conclusions on the RF dynamics in Russian population. While comparing the ECVD-RF study with previous epidemiological studies we can just cautiously suppose the existence in 21st age of negative dynamics of one RF (obesity, dyslipidemia) and positive dynamics of the others (smoking).