PREDICTORS OF ATRIAL FIBRILLATION RECURRENCE AFTER RADIOFREQUENCY ABLATION IN PATIENTS WITH CHRONIC HEART FAILURE.

OBJECTIVE: The aim: To study the predictive power of demographic, hemodynamic and electrocardiographic factors for atrial fibrillation recurrence after radiofrequency ablation (RFA) in patients with chronic heart failure. PATIENTS AND METHODS: Materials and methods: Study included 120 patients, aged 59,80±10,08 years old with chronic heart failure with preserved left ventricular ejection fraction who were undergo RFA due to atrial fibrillation (AF). A standard 12-lead electrocardiogram (ECG) was registered. Before the procedure the standard echocardiographic parameters were obtained. After 12 months, patients were divided into 2 groups: non-recurrence group and recurrence group. RESULTS: Results: As a result of prospective follow-up within 12 months AF recurrences were observed in 32 patients (27%), 88 patients remained non-recurrent (73%). The left atrium (LA) diameter and aortic root diameter were lager in the recurrence group (4,59±0,45 vs. 4,08±0,61 cm, p<0,001; 3,37±0,60 vs. 2,80±0,67 cm, p<0,001). The AF recurrence group before RFA had a significantly longer QTc interval than the non-recurrence group (387,23±2,31 vs. 341,22±8,91 ms, p<0,010). ROC curve analysis revealed LA diameter the most sensitive factor for AF recurrence after RFA. CONCLUSION: Conclusions: QTc duration before radiofrequency ablation and its prolongation after intervention are independent predictors of atrial fibrillation recurrence; left atrium diameter before ablation is a highly sensitive predictor in patients with chronic heart failure with preserved left ventricular ejection fraction.

MORPHOLOGICAL AND STRUCTURAL CHANGES IN MYOCARDIUM, LIPID AND СARBOHYDRATE METABOLISM DURING DIFFERENT OUTCOMES OF CHRONIC HEART FAILURE IN PATIENTS WITH ISCHEMIC HEART DISEASE AND DIABETES MELLITUS TYPE II.

OBJECTIVE: The aim: To establish features of structural and functional changes in myocardium, carbohydrate and lipid metabolism, in patients with different outcomes of chronic heart failure (CHF), caused by IHD and DM type II. PATIENTS AND METHODS: Materials and methods: Examination of 100 patients who have CHF with IHF and DM type II was performed. Patients were divided in two groups, according to outcome: group I (n = 66) - patients with favorable outcome, mean age 60,0 [55,8; 63,3] years, group II (n = 34) - unfavorable outcome of CHF, mean age 58,0 [55,0;60,3] years. We analysed complaints, cardiologycal anamnesis, cardiovascular risk factors, physical examination data. Transthoracic echocardiography (TTE), carbohydrate and lipid panel were assessed to find out early specific signs of myocardial injury. RESULTS: Results: We find out statistically significant associations between TTE results, lipid panel and CHF progression in study population. CONCLUSION: Conclusions: Comparative analysis showed that degree of CHF in patients with IHD and DM type II that have preserved LV EF is associated with: duration of DM and CHF, arterial hypertension (AH) level and degree of carbohydrate and lipid metabolism disturbances. Early TTE signs of unfavorable outcome are: increase of transmitral deceleration time (Dt), increase of mean PA pressure (PA MP) even in range lower the 20mmHg.

The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial: baseline characteristics.

BACKGROUND: The Dapagliflozin and Prevention of Adverse outcomes in Chronic Kidney Disease (DAPA-CKD; NCT03036150) trial was designed to assess the effect of the sodium-glucose co-transporter 2 (SGLT2) inhibitor dapagliflozin on kidney and cardiovascular events in participants with CKD with and without type 2 diabetes (T2D). This analysis reports the baseline characteristics of those recruited, comparing them with those enrolled in other trials. METHODS: In DAPA-CKD, 4304 participants with a urinary albumin:creatinine ratio (UACR) ≥200 mg/g and estimated glomerular filtration rate (eGFR) between 25 and 75 mL/min/1.73 m2 were randomized to dapagliflozin 10 mg once daily or placebo. Mean eGFR was 43.1 mL/min/1.73 m2 and median UACR was 949 mg/g (108 mg/mmol). RESULTS: Overall, 2906 participants (68%) had a diagnosis of T2D and of these, 396 had CKD ascribed to a cause other than diabetes. The most common causes of CKD after diabetes (n = 2510) were ischaemic/hypertensive nephropathy (n = 687) and chronic glomerulonephritis (n = 695), of which immunoglobulin A nephropathy (n = 270) was the most common. A total of 4174 participants (97%) were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 1882 (43.7%) diuretics, 229 (5.3%) mineralocorticoid receptor antagonists and 122 (2.8%) glucagon-like peptide 1 receptor agonists. In contrast to the Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), the DAPA-CKD trial enrolled participants with CKD due to diabetes and to causes other than diabetes. The mean eGFR of participants in the DAPA-CKD trial was 13.1 mL/min/1.73 m2 lower than in CREDENCE, similar to that in the Finerenone in Reducing Kidney Failure and Disease Progression in DKD (FIDELIO-DKD) trial and the Study Of diabetic Nephropathy with AtRasentan (SONAR). CONCLUSIONS: Participants with a wide range of underlying kidney diseases receiving renin-angiotensin system blocking therapy have been enrolled in the DAPA-CKD trial. The trial will examine the efficacy and safety of dapagliflozin in participants with CKD Stages 2-4 and increased albuminuria, with and without T2D.