[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.

[Features of the hemodynamics of myocardial infarct patients undergoing the most widely used rehabilitation programs]. / Osobennosti gemodinamiki u bol'nykh infarktom miokarda pri ispol'zovanii naibolee rasprostranennykh programm reabilitatsii.

Integrated body rheography, radiocardiography and radionuclide ventriculography were used to investigate hemodynamic changes in 101 myocardial infarction patients during the hospital stage of the disease. Changes in major hemodynamic parameters were demonstrated by the end of the 1st week and when walking was resumed. At the resumed-walking stage, the mechanism of declining stroke and cardiac indices was shown to depend on physical activation rates. Hemodynamic response is mostly conditioned by myocardial insufficiency when walking is resumed rapidly during the 2nd week, and by smaller venous return due to hypovolemia where it is resumed slowly during the 4th week. Expanding motion regimens at slow rates results in persistent hemodynamic disturbances in myocardial infarction patients.

[Oxygen supply of the body in myocardial infarction]. / Kislorodnoe obespechenie organizma pri infarkte miokarda.

Oxygen transport and demand were examined in 71 patients with myocardial infarction within the first 5 weeks of the disease. The volume of blood-transported oxygen was shown to be determined mainly by the blood circulatory minute volume. Lower arterial blood oxygen is an additional factor of diminished oxygen transport in hypodynamic central hemodynamics. Within the first 5-10 days of myocardial infarction, there was a progressive reduction in oxygen transport, but by days of 28-35, there was its gradual increase. These changes are the most prominent in patients with a hyperdynamic type and negligible in those with a hypodynamic type within the first 24 hours of myocardial infarction. The important of oxygen transport decrease compensation is its increased tissue extraction from arterial blood, thereby providing the stable oxygen demand in the wide range of its supply fluctuations.

[Phosphocreatine in the treatment of patients with myocardial infarct: effects on hemodynamics and oxygen supply]. / Fosfokreatin v lechenii bol'nykh infarktom miokarda: vliianie na gemodinamiku i kislorodnoe obespechenie organizma.

Changes in the major parameters of central and intracardiac hemodynamics and body's oxygen supply were examined in 93 patients with massive myocardial infarction in the in-hospital period of the disease. Traditional therapy was given to 71 patients; in addition, phosphocreatine infusions (a course dose being 30 g) were used in 22 patients in acute myocardial infarction. Phosphocreatine therapy failed to substantially affect cardiac pump function, but prevented left ventricular dilation and development of congestive heart failure. The patients receiving phosphocreatine showed an increase in body's oxygen consumption due to its elevated tissue extraction. No adverse effects of phosphocreatine were found.

[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.

[Changes in stroke volume in ventricular asystole]. / Izmeneniia udarnogo ob"ema krovi pri zheludochkovoi ékstrasistolii.

Change in the stroke volume in ventricular extrasystoles was studied in 27 patients. In patients with cardiac insufficiency a decrease in the extrasystolic stroke volume was more noticeable than in patients without cardiac insufficiency. "Hemodynamic debts" for extrasystolic and postextrasystolic contractions in patients with the presence and absence of cardiac insufficiency were undistinguished. In interpolated extrasystoles "hemodynamic debts" were less than in non-interpolated.

[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.

[Systemic thrombolytic therapy in acute myocardial infarct: its effect on left ventricular function, body oxygen consumption and disease prognosis]. / Sistemnaia tromboliticheskaia terapiia pri ostrom infarkte miokarda: vliianie na funktsiiu levogo zheludochka, kislorodnoe obespechenie organizma i prognoz zabolevaniia.

Echocardiography, integral rheography of the body, Holter monitoring, assessment of oxygen consumption and blood gases were used in examination of 93 patients with macrofocal myocardial infarction (MI). 48 patients received thrombolytic therapy (TT) within 6 hours of MI which in 27 patients implied standard drugs (streptodecase, celiase, avelysin) and new medicine APSAC (21 patients). 45 patients received no TT. It was found that in acute MI period systemic TT prevented a fall in left ventricular performance, promoted advanced oxygen supply due to intensified oxygen extraction by tissues. This fact is attributed to transient changes in blood rheology. Application of APSAC prevented inhibition of myocardial contractility and development of congestive heart failure in subacute MI period. TT patients demonstrated ventricular arrhythmia on MI day 1 more often though by the number of the main arrhythmia types the groups differed insignificantly. Within 1-year postmyocardial infarction period TT patients had less repeat MI and were less frequently diagnosed to develop congestive heart failure.

[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.

[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.

[Neoton (exogenic phosphocreatinine) in combined therapy of chronic cardiac failure]. / Primenenie neotona (eksogennogo fosfokreatinina) v kompleksnoi terapii khronicheskoi serdechnoi nedostatochnosti.

To evaluate clinicohemodynamic effect of neoton (exogenic phosphocreatine) given in an intravenous course, the drug was added to standard scheme in 53 patients with chronic cardiac failure (6.0 g/day i.v. drip for 5 days or 3.0 g/day for 10 days). 20 control patients received standard therapy alone. A course neoton produced an increase in the ejection fraction, a reduction in end-diastolic and end-systolic left ventricular volumes. It is recommended to include neoton in the scheme of chronic cardiac failure treatment in the dose 3.0 g/day for 10 days.

[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.

[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.

[Exogenous phosphocreatine in the prevention and treatment of cardiac insufficiency in patients with myocardial infarction]. / Profilaktika i lechenie serdechnoi nedostatochnosti u bolnykh infarktom miokarda s pomoshchíu ékzogennogo fosfokreatina.

Central, intracardiac hemodynamics and myocardial contractility were assessed in 97 inpatients with macrofocal myocardial infarction. Of them, 71 received conventional chemotherapy versus 26 patients given additionally intravenous phosphocreatine (neoton). The total dose of neoton 30 g was injected during the course of 6 days following the disease onset. With minimal changes in central hemodynamics, phosphocreatine was found to prevent left-ventricular dilatation and development of congestive heart failure by decreasing preload, to maintain myocardial contractility without reduction.