Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

AIM: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. MATERIAL AND METHODS: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. RESULTS: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. CONCLUSION: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

[Atrial Fibrillation After Coronary Artery Bypass Grafting].

PURPOSE: to identify the role of factors of inflammation and myocardial ischemia in the development of atrial fibrillation (AF) in the early postoperative period after coronary artery bypass grafting (CABG). METHODS: We enrolled in this study 96 patients with ischemic heart disease who had undergone CABG. Patients were divided into 2 groups: (1) without postoperative AF (n=67, 80.6% men, mean age 57.9+/-7.3 years), (2) with early new-onset AF after CABG (n=29, 86% men, mean age 64.0+/-8.4 years). RESULTS: AF occurred on average 4.9+/-3.8 days after surgery. Concentrations of interleukin-10, C-reactive protein, fibrinogen, troponin were not significantly different between two groups both before and after CABG. At multivariate analysis the following parameters were related to development of AF in postoperative period: left atrial dimension >41 mm (odds ratio [OR] 3.6 (95% confidence interval [CI] 1.2-5.8, p=0.0002), interleukin-6 level >68 pg/ml (OR 3.2, 95%CI 1.8-4.7, p=0.009), interleukin-8 level >9.5 pg/ml (OR 2.9, 95% CI 1.4-6.7, p=0.009). CONCLUSION: Our research shows significant increase of interleukin-6 and interleukin-8 in patients with AF after CABG what confirms the role of inflammation factors in development of this complication.

[Community acquired bacterial pneumonia and comorbidity in elderly patients].

We analyzed the clinical course of pneumonia in 67 elderly patients (39 females and 28 males, mean age 74,4±5,2 years) with chronic heart failure and chronic obstructive pulmonary disease (COPD). Patients were divided into 2 groups: 1st group - patients with COPD, 2nd group - patients without COPD. Pharmacological treatment was performed according to temperature, oxygen saturation, acute phase proteins and included ampicillin and sulbactam. The normalization of temperature and oxygen saturation was observed on 3-4 day in patients of the 1st group and on 2 day in patients of the 2nd group, normalization of leukocyte count and erythrocyte sedimentation rate - on 12-13 and 7-8 days, acute phase indicators (C-reactive protein, fibrinogen) on 7 and 5 days, correspondingly. Positive dynamics of chest X-ray was observed on 13 day in patients of the 1st group (the second control and the replacement of antibiotic for levofloxacin) and on 8 day in patients of the 2nd group (the first control).

[Factors associated with development atrial fibrillation after coronary artery bypass graft in elderly patients with coronary artery disease].

A total of 81 patients with coronary artery disease (CAD) who underwent coronary artery bypass graft (CABG) were enrolled in the study. Patients were divided into 2 groups: Group 1 - without postoperative atrial fibrillation (POAF) (59 patients, 74,6 % men, mean age 65,8±4 years), Group 2 - with early new-onset AF after CABG (22 patients, 90,9 % men, mean age of 67,7±5,4 years). Interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP), fibrinogen, superoxide dismutase (SOD), troponin I were studied. During the observation period AF occurred in 27,2 % cases, an average of 4,9±3,8 days after surgery. In the postoperative period were significantly higher in group 2 left atrium (LA) (43,9±3,4 vs. 37,6±3,9 mm, p<0,001), IL-6 (72,7±60,8 vs. 38,0±34,6 pg/ml, p=0,04), IL-8 (11,9±6,0 vs. 7,7±5,4 pg/ml, p=0,01), SOD (2 462,0±2 029,3 vs. 1 515,0±1 292,9 units/g, p=0,04) when compared with group 1. The multivariate analysis showed that the odds ratio for AF development in postoperative period for LA more than 39 mm was 2,1 (95 % CI 1,2-3,8, p=0,0004), IL-6 levels more than 65,18 pg/ml - 1,4 (95 % CI 1,1-2,7, p=0,009), IL-8 levels more than 9,67 pg/ml - 1,2 (95 % CI 1,1-3,7, p=0,009), SOD more than 2948 units/g -1,1 (95 % CI 1,01-2,9, p=0,04). Our study showed that left atrium dimension, high interleukin-6, interleukin-8 and superoxide dismutase levels play an important role in development of atrial fibrillation in early postoperative period after coronary bypass graft surgery.

[Volume of Coronary Artery Bypass Surgery and Risk of Postoperative Atrial Fibrillation].

PURPOSE: To identify prevalence of atrial fibrillation (AF) in dependence of volume of coronary artery bypass grafting (CABG) as assessed by the number of grafts. MATERIAL AND METHODS: The study included 431 patients with ischemic heart disease (IHD) who underwent CABG. Group 1 comprised patients with single-vessel bypass graft (n=47, 78.7% men, mean age 59.6+/-5.6 years), group 2 - with multivessel bypass grafts (n=384, 76.8% men, mean age 61.0+/-8,1 years). During the observation period postoperative AF developed in 3 patients (6.4%) with single vessel bypass graft and 69 patients (18.0%) with multivessel bypass grafts. At multivariate analysis predictive values were significant for the following parameters: aortic cross-clamping time >36 min - 1.7 (95% confidence interval [CI], 1.1-3.2, p=0.03), ischemia time >19 min - 2.0 (95% CI, 1.1-3.7, p=0.02), age >59 years - 2.4 (95% CI, 1.3-4.4, p=0.005), left atrial dimension >39 mm - 3.7 (95% CI, 2.1-6.6, p<0.0001), left ventricular ejection fraction <51% - 1.9 (95% CI, 1.3- 3.3, p=0.04). Predictive value of cardiopulmonary bypass time >56 min 1.2 (95% CI, 0.56-2.8) was not significant (p=0.5). CONCLUSION: In our study AF in the early postoperative period more often occurred in patients who underwent multivessel coronary bypass surgery. The most powerful predictor of AF in these patients was left atrial dimension exceeding 39 mm.

[Factors Associated With Development of Atrial Fibrillation After Coronary Artery Bypass Grafting].

PURPOSE: to identify factors associated with development of atrial fibrillation (AF) in the early postoperative period of coronary artery bypass grafting (CABG). METHODS: A total of 376 patients with ischemic heart disease who underwent CABG were enrolled in the study. RESULTS: During the observation period AF occurred in 74 patients (19.7%, 93% men, mean age 64.0+/-6.4 years), an average of 3.6+/-2 days after surgery. Multivariate regression analysis showed that odds ratio (OR) for AF in patients with age >59 years was 1.5 (95% confidence interval [CI], 1.1-3.5; p=0.04), aortic cross-clamping time >43 min - 2.4 (95% CI, 1.05-6.2; p=0.03), left atrial dimension (LAD) >39 mm - 5.0 (95% CI, 2.0-12.6; p=0.0006), left ventricular ejection fraction (LVEF) <51% - 3.6 (95% CI, 1.6-8.3, p=0.002). During ROC - analysis the high sensitivity was observed for LAD >39 mm (82%, =0.001), high specificity - for LVEF <51% (80%, =0.0009), highest positive likelihood ratio for LVEF <51% - 2.56 (=0.0009), greatest negative likelihood ratio for LAD >39 mm - 0.31 (=0.001). CONCLUSION: In our study, the risk of AF development in the early postoperative period of CABG depended on the patients age, left atrial size, left ventricular ejection fraction, and aortic cross-clamping time during CABG.