RESUMEN
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.
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Insuficiencia Cardíaca , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Estudios Prospectivos , Volumen Sistólico , Función Ventricular Izquierda , Método Doble CiegoRESUMEN
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 <50â% 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.
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Insuficiencia Cardíaca , Calidad de Vida , Enfermedad Crónica , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Fosfocreatina , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
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.
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Diuréticos , Insuficiencia Cardíaca , Enfermedad Crónica , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Federación de RusiaRESUMEN
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 77.8â%, the specificity was 82.4â%, the accuracy was 81.0â%; for the control group, 81.8â%, 70â%, and 76.2â%, respectively; for both groups together, 79.3â%, 80.0â%, and 79.8â%, respectively. In ROC-analysis of this prognostic model, the area under the ROC-curve (AUC) was 0.852 (95â% CI: 0.776-0.910; p<0.0001) for the calculation group; 0.818 (95â% CI: 0.669-0.920; p<0.0001) for the control group; and 0.855 (95â% 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.
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Insuficiencia Cardíaca , Complejos Prematuros Ventriculares , Ecocardiografía , Humanos , Persona de Mediana Edad , Curva ROC , Volumen SistólicoRESUMEN
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.
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Enfermedades Cardiovasculares , Isquemia Miocárdica , Aspirina , Enfermedades Cardiovasculares/prevención & control , Humanos , Inhibidores de Agregación Plaquetaria , Prevención PrimariaAsunto(s)
Fármacos Cardiovasculares/farmacología , Enfermedad de la Arteria Coronaria , Insuficiencia Cardíaca , Frecuencia Cardíaca/efectos de los fármacos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/tratamiento farmacológico , Enfermedad de la Arteria Coronaria/fisiopatología , Manejo de la Enfermedad , Quimioterapia Combinada , Necesidades y Demandas de Servicios de Salud , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/fisiopatología , Humanos , Grupo de Atención al Paciente/organización & administración , Federación de RusiaAsunto(s)
Antineoplásicos/efectos adversos , Cardiotónicos/uso terapéutico , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Neoplasias/complicaciones , Fosfocreatina/uso terapéutico , Enfermedades Cardiovasculares/inducido químicamente , Humanos , Neoplasias/tratamiento farmacológicoAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Isquemia Miocárdica/tratamiento farmacológico , Perindopril/uso terapéutico , Ramipril/uso terapéutico , Anciano , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Antihipertensivos/administración & dosificación , Angiografía Coronaria , Método Doble Ciego , Prueba de Esfuerzo , Femenino , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/prevención & control , Perindopril/administración & dosificación , Placebos , Pronóstico , Ramipril/administración & dosificación , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
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.
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Isquemia Miocárdica/tratamiento farmacológico , Trimetazidina/uso terapéutico , Vasodilatadores/uso terapéutico , Enfermedad Crónica , Estudios Transversales , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
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.
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Infarto del Miocardio/tratamiento farmacológico , Fosfocreatina/uso terapéutico , Estreptoquinasa/uso terapéutico , Terapia Trombolítica , Adulto , Anciano , Arritmias Cardíacas/etiología , Arritmias Cardíacas/prevención & control , Quimioterapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/complicaciones , Infarto del Miocardio/fisiopatología , Sístole , Disfunción Ventricular Izquierda/etiología , Disfunción Ventricular Izquierda/prevención & controlRESUMEN
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.
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Insuficiencia Cardíaca/diagnóstico , Caminata , Adulto , Anciano , Enfermedad Crónica , Prueba de Esfuerzo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
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.
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Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Metilhidrazinas/uso terapéutico , Calidad de Vida , Administración Oral , Adulto , Fármacos Cardiovasculares/administración & dosificación , Enfermedad Crónica , Femenino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/psicología , Humanos , Masculino , Metilhidrazinas/administración & dosificación , Persona de Mediana Edad , Isquemia Miocárdica/tratamiento farmacológico , Isquemia Miocárdica/fisiopatología , Isquemia Miocárdica/psicología , Satisfacción del Paciente , Volumen Sistólico/efectos de los fármacos , Resultado del TratamientoAsunto(s)
Fármacos Cardiovasculares/uso terapéutico , Insuficiencia Cardíaca/tratamiento farmacológico , Metilhidrazinas/uso terapéutico , Gasto Cardíaco/efectos de los fármacos , Diuréticos/uso terapéutico , Quimioterapia Combinada , Ecocardiografía , Tolerancia al Ejercicio/efectos de los fármacos , Estudios de Seguimiento , Insuficiencia Cardíaca/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Seguridad , Resultado del Tratamiento , Vasodilatadores/uso terapéuticoRESUMEN
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.
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Servicios de Salud/normas , Isquemia Miocárdica/rehabilitación , Calidad de la Atención de Salud , Cardiología/educación , Errores Diagnósticos , Hospitalización , Humanos , Competencia Profesional , Federación de RusiaRESUMEN
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.
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Angina de Pecho/terapia , Bloqueadores de los Canales de Calcio/uso terapéutico , Plasmaféresis/métodos , Vasodilatadores/uso terapéutico , Angina de Pecho/fisiopatología , Terapia Combinada , Electrocardiografía Ambulatoria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
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.
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Cardiotónicos/uso terapéutico , Insuficiencia Cardíaca/prevención & control , Infarto del Miocardio/complicaciones , Fosfocreatina/uso terapéutico , Adulto , Anciano , Cardiotónicos/administración & dosificación , Ecocardiografía , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/tratamiento farmacológico , Infarto del Miocardio/fisiopatología , Fosfocreatina/administración & dosificación , Pletismografía de Impedancia , Resultado del TratamientoRESUMEN
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.