[Prognostic value of periprocedural dynamics of left ventricular ejection fraction and subclinical pulmonary congestion in patients with myocardial infarction].

AIM: To assess the joint prognostic value of periprocedural dynamics of the left ventricular ejection fraction (PPD of LVEF) and subclinical pulmonary congestion during lung stress ultrasound in patients with first acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI) in relation to the development of heart failure (HF) in the postinfarction period. MATERIALS AND METHODS: Our prospective, single-centre, observational study included 105 patients with a first MI with no HF in the anamnesis and successful PCI. All patients underwent standard clinical and laboratory tests, NT-proBNP level assessment, echocardiography, lung stress ultrasound with a 6-minute walk test. All patients had no clinical signs of heart failure at admission and at discharge. Criteria for PPD of LV EF: improvement in LV EF≥50%; ∆LV EF more than 5%, but LV EF<50%. According to the results of lung stress ultrasound, pulmonary congestion was diagnosed: mild (2-4 B-lines), moderate (5-9 B-lines) and severe (≥10 B-lines). The end point was hospitalization for HF for 2.5 years. RESULTS: Upon admission, LV EF of 50% or more was registered in 45 patients (42.9%). Positive PPD was registered in 31 (29.5%) patients. After stress ultrasound of the lungs, 20 (19%) patients had mild subclinical pulmonary congestion, 38 (36%) moderate and 47 (45%) severe according to the criteria presented. During the observation period, patients with no PPD of LVEF were significantly more likely to be hospitalized for the development of HF (in 44.4% of cases) compared with patients with positive PPD (in 15.2% of cases) and with initial LV EF≥50% (in 13.4% of cases; p=0.005). When performing logistic regression analysis, the best predictive ability was found in the combination of the absence of PPD of LV EF and the sum of B-lines ≥10 on exercise (relative risk 7.45; 95% confidence interval 2.55-21.79; p<0.000). CONCLUSION: Evaluation of the combination of PPD of LV EF and the results of stress lung ultrasound at discharge in patients with first AMI and successful PCI with no HF in anamnesis allows us to identify a high-risk group for the development of HF in the postinfarction period.

[Prognostic Value of Right Ventricular Dysfunction in Patients With Decompensated Chronic Heart Failure].

Aim      To determine the incidence rate and the practical significance of right ventricular dysfunction (RVD) in the development of cardiovascular complications in patients with decompensated chronic heart failure (DCHF).Material and methods  This prospective, single-site observational study included 171 patients older than 18 years with NYHA functional class (FC) II-IV chronic heart failure (CHF) who were hospitalized for DCHF. Standard and extended 2D and 3D echocardiography (EchoCG) was performed for all patients on admission. Additionally, functional characteristics of the right ventricle (RV) were evaluated in the 3D mode followed by autonomic 3D processing with a EchoPac station (USA). RVD was taken as a disorder of two or more RV functional parameters according to results of 2D EchoCG, or a reduced RV free wall strain according to results of 2D speckle-tracking EchoCG, or a reduced RV ejection fraction (EF) according to results of 3D EchoCG. Statistical analysis was performed with a SPSS Statistics v. 26.0 software.Results The incidence rate of RVD in general population of patients with DCHF was 75.4 % (n=129). A higher prevalence of RVD was observed in patients with CHF with a low left ventricular (LV) EF (90.1 %). Patients with RVD had a more severe clinical status (significantly higher FC and higher Clinical Condition Scale (CCS) scores), more frequent atrial fibrillation (AF), and higher concentrations of uric acid and total bilirubin. RVD significantly correlated with male sex (odds ratio (OR), 2.05; 95 % confidence interval (CI), 1.01-4.19; р=0.046) and AF (OR, 3.52; 95 % CI, 1.71-7.26; р<0.001). Patients with RVD had lower values of both LV and RV function. Lower LV EF and AF increased the probability of RVD by 1.06 times (95 % CI, 0.90-0.98; р=0.001) and by 2.63 times (95 % CI, 1.08-6.40; р=0.001), respectively. Evaluation of the predictive significance of RV parameters measured by 2D and 3D EchoCG showed only effects of RV EF (2D) and RV global longitudinal strain (GLS) (3D) on all-cause hospitalization. RVD as evaluated by accepted criteria did not influence adverse outcomes.Conclusion      The determined incidence, correlations, and the predictive value of RVD in patients with DCHF indicated the appropriateness of assessing the RV function to optimize the management of patients regardless of the CHF phenotype.

[Risk Assessment of Adverse Outcomes in Symptomatic Patients With Arterial Hypertension and Chronic Heart Failure With Preserved Ejection Fraction Using THE HFA-PEFF Algorithm].

Aim      To study the incidence of heart failure (HF) in patients with arterial hypertension (AH), symptoms of HF, and left ventricular ejection fraction (LV EF) ≥50 % using a novel, modified HFA-PEFF diagnostic algorithm and to evaluate the liver hydration status and density depending on the established HF profiles and the prognostic significance of this algorithm.Material and methods  This study included 180 patients (median age, 72 years) with AH, symptoms of HF, and LV EF ≥50 %. The incidence of chronic HF with preserved ejection fraction (CHFpEF) was studied with the stepwise, modified HFA-PEFF diagnostic algorithm, and long-term outcomes were assessed at 3, 6, and 12 months of follow-up. The hydration status was determined by a bioimpedance vector analysis, and the liver density was measured by indirect fibroelastometry. The following tests were performed for all patients: standard, general clinical and laboratory examination with evaluation of CH symptoms (including N-terminal pro-brain natriuretic peptide test); extended echocardiography with assessment of structural and functional parameters of the heart; a KCCQ questionnaire was used for evaluation of patients' condition and quality of life (QoL). Long-term outcomes were studied by phone calls at 3, 6, and 12 months following discharge from the hospital/visit (worsened QoL, repeated hospitalization for cardiovascular causes, cardiovascular death or all-cause death).Results The following profiles were determined by the HFA-PEFF algorithm: with CHFpEF, with intermediate probability of HF, and without HF (58.9, 31.1, and 10 %, respectively). The study showed that patients with CHFpEF compared to patients of the intermediate group and without HF, had higher levels of brain natriuretic peptide, more pronounced signs of congestion according to results of the bioimpedance vector analysis and a higher liver density according to results of indirect fibroelastometry of the liver, which allowed identification of a group of patients with a high probability of CHFpEF. The diagnosis of HF by HFA-PEFF had an adverse prognostic significance with respect of worsened QoL according to the KCCQ questionnaire, and of repeated admission for HF during a year.Conclusion      In AH patients with symptoms of HF and LV EF ≥50 %, CHFpEF was detected with the HFA-PEFF algorithm in 58.9 % of cases. Patients with AH and verified CHFpEF had a high incidence of hyperhydration and increased liver density. A diagnosis of CHFpEF by the HFA-PEFF algorithm had an adverse prognostic significance with respect of long-term outcomes.

Prognostic Value of Subclinical Pulmonary Congestion With Stress Ultrasound of the Lungs in the Development of Heart Failure in Patients With Primary Myocardial Infarction and Percutaneous Coronary Intervention.

Aim      To determine the clinical and prognostic significance of subclinical pulmonary congestion, as evaluated by stress ultrasound (stress-US) examination of the lungs, in the development of heart failure (HF) during the postinfarction period after acute myocardial infarction (AMI) and percutaneous coronary intervention (PCI).Material and methods  This prospective observational study included 103 patients with no history of HF and with the first AMI and successful PCI. Standard laboratory tests, including the measurement of NT-proBNP, echocardiography, stress-US of the lungs with a 6-min walk test (6MWT), were performed for all patients. Pulmonary congestion was diagnosed with the total number of B lines ≥2 during stress: mild (2-4 B lines), moderate (5-9 B lines), and severe (≥10 В lines). Subclinical pulmonary congestion implied the absence of clinical signs of congestion in the presence of ultrasonic signs of pulmonary congestion (>2 В lines) during stress. The phenomenon of "wet" lung was identified when the total number of B lines was <2 at rest ("dry" lung) and ≥2 after stress. When the total number of B lines was >2 at rest ("wet" lung at rest) and ≥2 after stress, the phenotype was identified as "very wet" lung. The endpoint was hospitalization for HF during 1.5 years.Results The study showed a high incidence of subclinical pulmonary congestion as determined by the results of stress-US test of the lungs, mild (18.4 %), moderate (37.9 %) and severe (42.7 %), and of "wet" and "very wet" lung phenotypes (65 %). The "wet/very wet" lung phenotypes correlated with the body weight index (R=0.236; p=0.016), troponin concentration upon admission and at 6-12 h (R=0.231; p=0019 and R=0.212; p=0.033, respectively), NT-proBNP concentration (R=0.276; p=0.035), Е peak (R=0.241; p=0.019), global longitudinal strain (GLS) (R=-0.208; p=0.034), and left ventricular end-diastolic dimension (R=0.351; p=0.0004). The higher probability of hospitalization for HF during 1.5 years after the discharge from the hospital correlated with a LV EF ≤48 % (OR, 4.04; 95 % CI: 1.49-10.9; р=0.006), a post-stress total number of B lines ≥10 (OR, 3.10; 95 % CI: 1.06-9.52; р=0.038), a pulmonary artery systolic pressure >27 mm Hg (OR, 3.7; 95 % CI: 1.42-9.61; р=0.007).Conclusion      Stress-US of the lungs with evaluation of the total number of B lines should be performed for patients after the first AMI and PCI and with no clinical signs of congestion, for stratification of the risk for HF in the postinfarction period.

[Focus ultrasound for cardiology practice. Russian consensus document].

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.

[Pulmonary congestion by lung ultrasound in decompensated heart failure: associations, in-hospital changes, prognostic value].

BACKGROUND: Recently lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for assessment of pulmonary congestion (PC) in patients with decompensated heart failure (DHF). OBJECTIVE: to assess the incidence, in-hospital changes and prognostic significance of PC assessed by LUS in DHF patients. MATERIALS AND METHODS: Routine clinical assessment and eight-zone LUS were performed in 162 patients with DHF (men 66%, mean age 68±12 years, hypertension 97%, history of myocardial infarction 44%, atrial fibrillation 60%, ejection fraction [EF] 40±14%, EF<40% 46%, baseline NT-proBNP 4 246 [1741; 6 837] pg/ml). Sum of B-lines ≤5 was considered as normal, 6-15, 16-30 and >30 - as mild, moderate and severe PC, respectively. RESULTS: Using LUS on admission PC was diagnosed in all patients (moderate and severe in 31.5 and 67.3%, respectively). At discharge normal LUS profile was observed in 48.2% of patients. In 33.3, 14.8 and 3.7% of patients PC was mild, moderate, and severe, respectively. According to multivariable Cox regression analysis including age, sex, EF, NYHA functional class, and jugular venous distension sum of B-lines >5 at discharge was associated with higher probability of 12-month all-cause death (hazard ratio [HR] 2.86, 95% confidence interval [CI] 1.15-7.13, p=0.024), sum of B-lines >15 - with higher probability of HF readmission (HR 2.83, 95%CI 1.41-5.67, p=0.003). CONCLUSION: During hospital stay the incidence of PC as assessed by LUS decreased from 100 to 52% of patients. Sum of B-lines >5 at discharge was independently associated with higher risk of 12-month all-cause death, >15 - with higher risk of 12-month HF readmission.

[The Value of Right Ventricular Dysfunction and Right Ventricular-Pulmonary Artery Coupling in Chronic Heart Failure: The Role of Echocardiography].

In this review article we discuss the clinical and prognostic value of echocardiographic evaluation methods of the right ventricular function and right ventricular - pulmonary artery coupling, advantages and disadvantages of echocardiography in comparison with other instrumental methods of investigation in patients with chronic heart failure.

Infective Endocarditis in Moscow General Hospital: Clinical Characteristics and Outcomes (Single-Center 7 Years' Experience).

AIM: to investigate clinical properties of course and outcomes of infective endocarditis (IE) depending on source of infection, to find predictors of mortality in a Moscow general hospital. MATERIALS AND METHODS: We included in this study 176 patients with definite and possible infective endocarditis (the Duke criteria), admitted in our hospital in 2010-2017. Patients were divided in three groups according to source of infection. All patients underwent standard clinical and laboratory assessment, echocardiography, blood culture test combined with blood PCR with sequencing. Inhospital and 1-year outcome were evaluated. RESULTS: Among 176 patients with IE 65.3 % were men (median age 57 [35-72] years), most patients (n=149, 84.7 %) had native valve IE. Etiological factor was identified in 127 (72.2 %) cases. Gram-positive infective agents prevailed (54 %). Surgery in active phase of the disease was performed in 30 (17 %) patients. Among patients with healthcare-associated IE (n=76, 43.9 %) prevailed those older than 60 years, with high Charlson comorbidity index, with culture-negative IE, and complicated clinical course (mainly progressing heart failure). Patients with intravenous drug use associated IE (n=50, 28.4 %) had low Charlson index, association with hepatitis C viral infection, involvement of tricuspid valve with big vegetations, high frequency of embolic complications, and low inhospital mortality. Group of patients with community acquired IE (n=50, 28.4 %) more often had uncommon causative microorganisms, and had better long-term outcome. In-hospital mortality was 30.1 % (n=53) mostly due to sepsis with multi-organ failure, and heart failure. Risk factors of inhospital death were history of cardiovascular diseases, old age, kidney damage, methicillin-resistant Staphylococcus aureus (MRSA) infection, uncontrolled infection, and embolic events. Risk factors of 1-year mortality were history of stroke, and heart failure as IE complication. Independent predictors of in-hospital death were MRSA infection (odds ratio [OR] 50.32, 95 % confidence interval [CI] 1.66-213.92; p=0.002), persistent infection (OR 18.6, 95 %CI 5.37-64.40; p=0.001), duration of fever >7 days after initiation of antibacterial therapy (OR 13.41, 95 %CI 3.51-51.24; p=0.001); and of death during first year - history of cerebral infarction (OR 4.39, 95 %CI 1.32-14.70; p=0.016)), and heart failure as IE complication (OR 8.1, 95 %CI 1.97-67.09; p=0.016). Among patients subjected to surgery there were no fatal outcomes during 1 year after hospital discharge, while among conservatively treated patients were 21 (14.4 %) deaths (p<0.009). CONCLUSION: Main clinical features of IE course in patients urgently admitted to a general hospital was dominance of healthcare-associated  IE among patients, who were older than 60 years with severe comorbidities. These patients had more complications and worse outcome. Modeling of prognosis identified uncontrolled infection as key factor of unfavorable outcome. Surgery significantly reduced long-term mortality.

[Modern conceptions of cardiac amyloidosis].

Cardiac amyloidosis is accumulation in the heart of a pathologic fibrillar protein amyloid. It represents a heterogeneous group of states from clinically insignificant amyloid accumulation in isolated atrial amyloidosis to severe involvement of the heart in primary amyloidosis when mean duration of life equals to 6 months. Insufficient awareness of physicians of this pathology leads to erroneous and belated diagnosis of cardiac amyloidosis. This paper contains contemporary data of pathophysiology, clinical manifestation, diagnosis, treatment, and prognosis of various variants of cardiac amyloidosis.

[The state of carotid arteries in young men with arterial hypertension].

PURPOSE: To study elastic properties of carotid arteries in young men with arterial hypertension (AH). MATERIAL AND METHODS: We examined men aged 18-25 years (mean 21.1+/-0.14 years): 36 with normal blood pressure (BP), 123 with stable and 51 with unstable AH. Parameters studied comprised intima-media thickness (IMT) of carotid arteries, their M-mode measured maximal systolic and minimal diastolic diameters (Ds and Dd), stiffness of common carotid artery (CCA) wall determined on the basis of analysis of elasticity and distensibility coefficients (CC and DC), Peterson's and Young's modules of elasticity (Ep and E), and index of flow deformation (CS). RESULTS: Compared with young men with normal BP and unstable AH patients with stable AH had abnormal elastic properties of CCA and increased IMT. CONCLUSIONS: Stable AH in young men is associated with signs of remodeling of CCA walls and increase of their rigidity.

[Echocardiographic assessment of myocardial fibrosis in young men with arterial hypertension and different types of left ventricular remodeling].

In order to study structural functional characteristics of myocardium including parameters of myocardial fibrosis according echocardiography data in men with various levels of arterial pressure (AP) we examined 215 men aged 18-25 (mean 21.1+/-0,1) years with history of elevated AP at casual measurement. AP phenotype (normotension, stable arterial hypertension [AH], unstable AH) was determined on the basis of multiple measurements of clinical AP and 24 hour AP monitoring. At echocardiography we assessed presence of left ventricular (LV) hypertrophy (LVH), type of LV geometry, proportionality of LV myocardial mass (LVMM), diastolic function. Myocardial fibrosis was assessed by pixel density distribution range (PDDR) with the use of analysis of reflected signal. There were no manifestations of LV remodeling in subjects with normal AP. Concentric LV remodeling was found in 27.5 and 60.5% of patients with unstable and stable AH, respectively. Concentric LVH was found only in patients with stable AH (4.8%). Disproportionally high LVMM was found in 16.1% of subjects with stable AH. In a combined group with concentric LV remodeling and LVH rate of disproportionally high LVMM was 20.8%. We noted significant (p<0.001) increase of PDDR in stable AH (181.4+/-2.2) compared with PDDR in normal AP (164.6+/-4.6) and unstable AH (160.1+/-2.7). In stable I degree AH PDDR (177.3+/-2.2) was insignificantly lower than in II degree AH (185.7+/-3.9). PDDR in concentric LV remodeling was 180.5+/-2.3, in concentric LVH- 166.8+/-13.2, in normal LV geometry - 168.4+/-2.5. PDDR in disproportionally high LVMM was higher than in proportional LVMM. Independent interrelationship was found between PDDR and body mass index (r=0.17; p=0.03), duration of AH (r=0.17; p=0.03), isovolumic relaxation time (r= 0.15; p=0.04). In young men LV remodeling can be detected at the stage of unstable AH. In stable AH degree of myocardial fibrosis was associated with higher AP level, concentric LV geometry, disproportionally high LVMM, lowering of diastolic function.

[Disproportionately high left ventricular myocardial mass in patients with arterial hypertension].

BACKGROUND: Increase of myocardial mass of left ventricle (MMLV) to a greater extent than required by hemodynamic load by elevated arterial pressure (AP) is reflected in concepts of " disproportionately " high (DH) MMLV and resistant to antihypertensive treatment LV hypertrophy (LVH). AIM: To study in patients with arterial hypertension (AH) frequency of DH MMLV and factors associated with it. MATERIAL AND METHODS: Patients (n=170, 70 men, age 57.6+/-5.9 years) with previously untreated or irregularly treated uncontrollable AH. Proportionality of MMLV was assessed by coefficient of disproportionality (CD) defined as ratio of actual to expected MMLV. RESULTS: DH MMLV was found in 140 patients (82.4%). Frequency of ECHOCG LVH among patients with DH MMLV was 49.3%. There were no cases of LVH among patients with proportional MMLV. Frequency of LVH depended on severity of disproportionality of MMLV elevation and was 18.9% at CD 128-155.9% and 82.2% at CD 184%. Patients with DH MMLV were characterized by greater body mass index, higher rate of disturbances of carbohydrate and lipid metabolism. Patients with DH MMLV without compared with those with LVH were characterized by significantly higher rate of concentric variant of LV geometry (66.2 vs 40.6%, p<0.05) and diastolic dysfunction (57.7 vs 36.2%, p<0.05), lower values of parameters of systolic LV function and higher rate of combination of concentric remodelling and diastolic LV dysfunction. CONCLUSION: DH MMLV is frequent among patients with previously untreated or irregularly treated uncontrollable AH. Calculation of disproportionality of MMLV allows to give additional characteristic of morphofunctional state of the myocardium in patients with AH. DH MMLV is associated with complex of subclinical structurally-functional disturbances of the myocardium and unfavourable changes of carbohydrate and lipid metabolism.