[Prospects for use of Vericiguat in HFrEF: Implications of VICTORIA Trial Results. Advisory Board Summary].

In September 2021, an online meeting of the Council of Experts was held. The proposed focus of discussion was publishing the results of an international prospective, randomized, double-blind, placebo-controlled study VICTORIA. The objective of the VICTORIA study was evaluation of the efficacy and safety of supplementing a standard therapy with vericiguat at a target dose of 10 mg twice a day as compared to placebo for prevention of cardiovascular death and hospitalization for heart failure (HF) in patients with clinical manifestations of chronic HF and left ventricular ejection fraction <45% who have recently had an episode of decompensated HF. The aim of the meeting was interpretation of the VICTORIA study results on efficacy and safety of vericiguat for a potential use in a Russian population of patients after a recent episode of decompensated chronic HF with reduced ejection fraction.

Interim Results of the BYHEART Observational Study: Exogenous Phosphocreatine Effect on the Quality of life of Patients with Chronic Heart Failure.

Aim      Improvement of quality of life is one of the most important goals for the treatment of patients with chronic heart failure (CHF). This study searched for ways to increase the efficiency of CHF treatment based on parameters of quality of life in CHF patients during and after the treatment with exogenous phosphocreatine (EP).Material and methods  The effect of a single course of EP treatment on quality of life of patients with functional class (FC) II-IV CHF with reduced or mid-range left ventricular ejection fraction was studied as a part of the all-Russia prospective observational study BYHEART. The presence of FC II-IV CHF and a left ventricular ejection fraction <50 % were confirmed by results of 6-min walk test (6MWT) and findings of echocardiography after stabilization of the background therapy.Results An interim data analysis showed that the course of EP treatment was associated with a significant improvement of quality-of-life indexes as determined by the Minnesota Living with Heart Failure Questionnaire (LHFQ) total score. These indexes significantly increased and remained at a satisfactory level for 6 mos. following completion of the treatment course. Also, the treatment significantly beneficially influenced the clinical condition of patients (heart failure severity scale), results of 6MWT, and the increase in left ventricular ejection fraction.Conclusion      The conclusions based on results of the interim analysis should be confirmed by results of the completed study. Complete results are planned to be published in 2022.

[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.

[The method for prediction of high-grade premature ventricular contractions in patients with heart failure and preserved ejection fraction].

Aim To develop a method for prediction of high-grade ventricular extrasystole (VE) in patients with chronic heart failure with preserved ejection fraction (CHF-PEF) based on results of an echocardiography (EchoCG) study.Material and methods At the first step, the study included 121 patients of the Cardiology Department, Municipal Clinical Hospital #31, St. Petersburg (calculation group) with symptoms and clinical signs of CHF-PEF (median age, 62 years). For testing accuracy of the developed formula, a control group was formed, which consisted of 42 patients with CHF-PEF (median age, 59 years). EchoCG at rest and ECG Holter monitoring were performed for all patient. The VE classification according to B. Lown and M. Wolf (1971) in the M. Ryan (1975) modification was used. Results of the evaluation were determined by the most significant recorded grade. Grade III or higher VE were considered as high-grade VE.Results Using logistic regression analysis of data for patients of the calculation group, a statistical model was constructed and a respective formula was developed to predict a probability of high-grade VE in CHF-PEF patients depending on the presence of risk factors (EchoCG criteria). According to the obtained data the following factors primarily contributed to the model: interventricular septal (IVS) thickness (p=0.007; Wald=7.44), end-diastolic volume index (EDVI) (p=0.044; Wald=4.13), and the degree of diastolic dysfunction (DD) (p<0.0001; Wald=19.90). For testing the formula accuracy, the analysis was performed in the control group. Based on data of both stages, the following values were obtained: for the calculation group, the method sensitivity was 77.8 %, the specificity was 82.4 %, the accuracy was 81.0 %; for the control group, 81.8 %, 70 %, and 76.2 %, respectively; for both groups together, 79.3 %, 80.0 %, and 79.8 %, respectively. In ROC-analysis of this prognostic model, the area under the ROC-curve (AUC) was 0.852 (95 % CI: 0.776-0.910; p<0.0001) for the calculation group; 0.818 (95 % CI: 0.669-0.920; p<0.0001) for the control group; and 0.855 (95 % CI: 0.792-0.905; p<0.0001) for both groups together, which indicated a good quality of the prognostic model.Conclusion The EchoCG predictors of high-grade VE in patients with CHF-PEF included degree of DD, EDVI, and IVS thickness. The developed method with the constructed formula for prediction of high-grade VE in CHF-PEF patients showed high sensitivity, specificity and accuracy.

[Antiaggregants in Primary Prevention of Cardiovascular Diseases and Prevention of Atherothrombosis in Patients With Stable Ischemic Heart Disease: Aspects of Efficacy and Safety].

This review is devoted to the use of antiaggregants. We consider here pathogenesis of intraarterial thrombosis, mechanism of action of antiaggregants, and recommendations on the use of drugs of this class for primary prevention of cardiovascular diseases and prevention of atherothrombotic complications of stable ischemic heart disease. Information on mechanisms of development and causes of resistance to antiaggregants is also presented. Finally we discuss the problem of safety of therapy with antiaggregants, methods of lowering the risk of bleeding, and prevention of aspirin induced gastropathy.

[Trimetazidine in correction of chronic heart failure in patients with ischemic heart disease]. / Trimetazidin v korrektsii khronicheskoi serdechnoi nedostatochnosti u bol'nykh ishemicheskoi bolezn'iu serdtsa.

Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.

[Neoton and thrombolytic therapy of myocardial infarction]. / Neoton i tromboliticheskaia terapiia pri infarkte miokarda.

AIM: To evaluate neoton therapy effects in acute myocardial infarction (MI) on systolic function of the left ventricle, arrhythmia and clinical symptoms in patients on thrombolytic therapy (TLT). MATERIAL AND METHODS: 106 males with Q-MI entered the study. 47 received treatment without TLT and neoton, 30 patients received TLT with streptokinase preparations, 29 patients were given streptokinase preparations and neoton. Left ventricular systolic function was measured by echocardiography on day 1, 3, 7, 14, 21 and 28; arrhythmia was analysed at Holter monitoring in day 1 and 2 of MI. RESULTS: TLT failed to arrest progression of left ventricular dilation by the end of the hospital stay. Patients given neoton in acute period of MI had no increase in the end systolic and diastolic volumes of the left ventricle in the course of the first months after MI onset. Antiarrhythmic action of neoton manifested on MI day 2. CONCLUSION: Neoton given to MI patients receiving TLT prevents progression of left ventricular systolic dysfunction and establishment of predictors of unfavourable outcome.

[Six-minute walking test for the evaluation of the status of patients with chronic cardiac failure]. / Primenenie proby s 6-minutnoi khod'boi dlia otsenki sostoianiia bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu.

The paper presents the results of application of the modified 6-minute walking test for assessment of exercise tolerance in follow-up of patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF). At admission and after 3-4 weeks of treatment 52 IHD patients underwent the walking test and described subjective effects according to modified Borg's questionnaire. The repeated test registered increased walking distance and subjective response. The results of the study confirm validity of using 6-minute walk test in combination with modified Borg questionnaire in routine hospital and outpatient practice as a simple, safe and informative method of control over IHD patients' condition and assessment of their treatment efficacy.

[Effect of mildronate on life quality of patients with chronic heart failure]. / Kachestvo zhizni bol'nykh s khronicheskoi serdechnoi nedostatochnost'iu. Effekt lecheniia mildronatom.

AIM: To study quality of life (QL) of patients with chronic heart failure (CHF) and QL changes resultant from mildronate therapy. MATERIALS AND METHODS: QL was studied in 30 IHD patients with CHF of NYHA class II-IV, ejection fraction > 45%; 40 IHD patients without CHF and 30 healthy subjects. CHF patients were treated for 30 days with oral mildronate (250 mg 4 times a day). QL was assessed according to the method SF-36 Health Status Survey. RESULTS: QL in CHF patients is much lower than that of the controls. Objective severity of the disease and subjective satisfaction with life do not always coincide. Mildronate in a dose 1 g/day per os may be beneficial for LQ of CHF patients. CONCLUSION: It is thought desirable to include QL in analysis of efficiency of managing patients with CHF. SF-36 is a tool able to follow up changes in QL of CHF patients within a short-term treatment period.

[Evaluation of medical services provided to patients with heart ischemia at medical institutions of various professional levels]. / Analiz kachestva meditsinskoi pomoshchi bol'nym ishemicheskoi bolezn'iu serdtsa v meditsinskikh uchrezhdeniiakh raznogo kvalifikatsionnogo urovnia.

The quality of medical care for patients with ischemic heart disease was assessed for a specialized cardiological clinic and cardiological department of a district hospital. Doctor's errors were most numerous in unstable angina pectoris. However, the number and importance of these errors depended primarily on qualification of the cardiologist. The errors in the specialized clinic were less connected with the errors of previous stages of diagnosis and treatment. The results of the trial allowed design of different educating programs oriented on cardiologists of the clinic and hospital.

[Effectiveness of drug therapy alone or its combination with plasmapheresis in patients with severe angina pectoris]. / Effektivnost' medikamentoznoí terapii i ee kombinatsii s kursom lechebnogo plazmafereza u bol'nykh stenokardieí tiazhelogo techeniia.

92 patients with ischemic heart disease and severe angina pectoris received either nitro drugs and calcium antagonists (n = 24) or their combination with plasmapheresis (n = 68). The efficacy of the treatment was assessed by the number of anginal episodes, doses of nitro drugs, pre- and posttreatment dynamic ECG readings. It is shown that 75% of the patients benefited from the addition of plasmapheresis to the treatment scheme. According to dynamic ECG, positive effect of plasmapheresis occurred also in painless ischemia.

[Prophylactic use of Neoton in cardiac failure in patients with myocardial infarction]. / Primenenie Neotona dlia profilaktiki serdechnoí nedostatochnosti u bol'nykh infarktom miokarda.

Echocardiography and integral body rheography were made in 174 patients with macrofocal myocardial infarction (MI) to study hemodynamics at six stages of hospital rehabilitation (MI day 1-28). 97 patients received neoton (4 different scheme) in the acute period of MI. Neoton administration was found to prevent progressive left ventricular dilation and emergence of cardiac insufficiency in subacute period of MI, to reduce the risk of cardiac aneurism, recurrence and postinfarction angina. The response to neoton rises with an increase of its dose on the first day of the disease and lessening of the time span from first symptoms of MI and first neoton injection. An optimal scheme of neoton use is proposed.

[Structure and negative sequelae of medical errors in care for angina pectoris]. / Struktura i negativnye sledstviia vrachebnykh oshibok pri okazanii meditsinskoí pomoshchi bol'nym stenokardieí.

12 cardiologists trained as experts in assessment of medical care quality (MCQ) made a computer-assisted expertise of the care rendered to 110 anginal patients. Of these 68 patients had angina of effort (AE) and 42 had unstable angina (UA). This made up 10% of annual number of anginal patients treated in the cardiological clinic in 1996. Medical errors were of the same type in both the groups. Inadequate collection of information, erroneous diagnosis, treatment, continuity occurred in 50, 30, 15 and 5% of all the errors, respectively. Negative effects of the errors were mild (less seriously suffered AE patients), but led to waste of health service resources.