In Search of Optimal Criteria for Iron Deficiency in CHF Patients. Post-hoc Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)".

AIM: Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 µmol/l. MATERIAL AND METHODS: An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 µg/l or ferritin from 100 to 299 µg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 µmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 µmol/l criteria, and by both were analyzed. RESULTS: ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 µmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 µmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 µmol/l vs. 19.4 µmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml). CONCLUSION: Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 µg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

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)¼ 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.

[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.

[The role of compensatory mechanisms in pathogenesis of coronary heart disease].

The multilevel system regulating cardiac activity during coronary heart disease is considered.

[Methods for the correction of dysregulated erythropoesis in coronary heart disease].

AIM--to develop pathogenetic methods for the correction of dysregulated erythropoesis in coronary heart disease (CHD). 20 patients with myocardial Q-infarction and 52 ones with chronic CHD. 26 patients of the CHD group suffered anemia. Ten volunteers without signs of cardiovascular pathology served as controls. Characteristics of peripheral blood and iron metabolism, serum levels of inflammation markers and erythropoietin (EPO) were measured. In most CHD patients elevated levels of TNF-alpha inhibited hepatic synthesis of EPO. Low hepcidin production was associated with increased EPO levels and low iron content in blood. Anemia developing in CHD patients may cause not only inflammation but also depletion of iron reserves. Correction of dysregulated erythropoesis in coronary heart in CHD must be performed with due regard for the above mechanisms on an individual basis.

[Erythropoietin in patients with chronic heart failure].

The aim of this work was to elucidate the relationship between the serum erythropoietin level, the degree of heart involvement in patients with chronic cardiac failure (CCF), characteristics of peripheral red blood cells and iron metabolism. A total of 77 patients with ischemic CCF were enrolled in the study. The control group comprised 13 subjects free from cardiovascular disorders. The analyses encompassed peripheral blood, serum iron, iron-binding capacity of serum, creatinine clearance, erythropoietin and TNF-alpha levels, echoCG data. The patients with CCF were divided into three groups based on the level of erythropoietin. Statistical analysis revealed the relationship between anemia, structural-functional changes in myocardium and erythropoietin production. Anemia appeared to be an additional stimulus for biosynthesis of erythropoietin in these patients.

[Characteristics of left ventricular hypertrophy in patients with different forms of arterial hypertension based on echocardiographic data]. / Kharakteristika gipertrofii levogo zheludka u bol'nykh s razlichnymi formami arterial'noi gipertonii po dannym ékhokardiografii.

Echocardiographic investigation of 110 patients with different forms of stable arterial hypertension demonstrated a moderately close correlation between left-ventricular myocardial weight, and systolic and diastolic arterial blood pressure in patients with essential hypertension and chronic diffuse glomerulonephritis, and a weak correlation between left-ventricular myocardial weight and systolic pressure in patients with renovascular hypertension and chronic unilateral or predominantly unilateral pyelonephritis. Inadequate left-ventricular hypertrophy has similar incidence (15-20%) in patients with different forms of arterial hypertension, whereas excessive hypertrophy only occurs in patients with essential hypertension. The frequency of asymmetrical hypertrophy differs in the two groups.

[Lipid peroxidation in osteoarthrosis patients during sanatorium-health resort treatment]. / Sostoianie perekisnogo okisleniia lipidov u bol'nykh osteoartrozom v protsesse sanatorno-kurortnogo lecheniia.

It is suggested that a rise in plasma level of LPO products may be involved in osteoarthrosis pathogenesis. A direct correlation exists between elevated levels of diene conjugates, compensatory activity of antioxidant system and osteoarthritis form, history and season of the year. The highest LPO activity was observed in multiple articular lesions versus mono-osteoarthrosis. Compensatory potential of antioxidant system exhausted with the disease duration and is minimal in spring. The disease responded best to sulfurated hydrogen baths combined with laser treatment of the affected joints.

[Correlation of structurally-functional cardiac condition and levels of erythropoietin, tumour necrosis factor-alpha in blood in heart failure].

Structurally-functional myocardium parameters and their interconnection with erythropoietin and tumour necrosis factor-alpha levels in blood plasma of patients with heart failure were analysed. Prevalence of erythropoietin over tumour necrosis factor-alpha in blood had positive effect on myocardium-contraction ability under acute heart failure. Improvement of pumped cardiac function was not registered under prevalence of erythropoietin over tumour necrosis faetor-a in blood of patients with chronic heart failure.

[On erythropoietin level formation in the blood under conditions of acute disturbance of cardiac function].

The erythropoietin levels in the blood of 50 patients with myocardial infarction were studied. The control group consisted of 33 patients with gastroenterologic diseases. Increased erythropoietin production in patients with myocardial infarction was caused by blood hypoxia under conditions of keeping kidney erythropoietin function. No dependence was found between manifestation of heaviness of acute heart failure caused by acute myocardial ischemic and hormone production in patients without anemia.

[About erythropoietin production in humans from different age groups].

Erythropoietin level was studied in blood plasma of humans from different age groups and in patients with chronic hearts failure of ishemic genesis. It was determined that there was no statistically significant difference of erythropoietin level among the age groups. Erythropoietin level in patients with chronic heart failure was 16-fold greater (102.86 +/- 29.04 mU/ml) than in the studied elder aged groups (6.38 +/- 1.82 mU/ml). The data obtained indicate that elderly (60 to 85 years) persons' organisms retain the ability of response to hypoxia by intensive erythropoietin production.