[Model of Two-Years Forecasting of the Anti-Existent Patients With Acute Decompensation of Heart Failure on the Background of the Intermediate Fraction of Left Ventricle].

OBJECTIVE: Build a prognostic model using clinical, laboratory, and instrumental data to predict mortality in patients with midrange left ventricular ejection fraction (mrLVEF) within two years after hospitalization for acute decompensated heart failure (ADHF). MATERIALS AND METHODS: The study included 121 patients hospitalized for ADHF with mrLVEF ranging from 40% to 49.9% (91 males and 30 females, mean age 64.6±14.8 years). The independent sample used to validate the statistical model included 71 patients with ADHF and mrLVEF with a mean age of 65.59±12.12 years. Sex distribution of the independent sample was 51 males (70.8% of the independent sample), 20 females (27.8% of the total independent sample). In-hospital mortality of patients included in the study was 4.2%, and long-term mortality was 36.8%. We developed a tool to assess the risk of two-year mortality using classification trees. RESULTS: The root node is the red blood cell distribution width-coefficient of variation (RDW-CV); its diagnostic value in this model was 13.3%. The second-level nodes are glomerular filtration rate (GFR), with a cutoff level of 35 mL/min/1.73 m2, and chronic kidney disease (CKD). The third-level nodes are sex, the anterior-posterior dimension of the left atrium, with the cutoff level >47 mm, and low red blood cell count <4.22x1012/L. The estimated sensitivity of the model is 71.4%; estimated specificity is 85.7%. CONCLUSION: This model can be used to assess long-term mortality risk and identify groups of patients with mrLVEF who require closer monitoring.

[Prognostic value of the ultrasonic determination of the degree of interstitial edema in patients with intermediate ejection fraction of the left ventricle after treating acute decompensation of heart failure].

Aim To study ultrasonic characteristics of lung tissue in patients with heart failure with left ventricular (LV) mid-range ejection fraction (HFmEF) and predictive value of these characteristics after reversing acute decompensated heart failure (ADHF).Material and methods Ultrasonic characteristics of lung tissue were studied by prospective observation in 71 patients (mean age, 65.2±3.6 years; men, 64.3 %) with HFmEF (LVEF from 40 to 49 %) following ADHF reversal. Semiquantitative evaluation of B-lines was performed by the E. Picano (2016) method at 5+2 days after hospitalization and on discharge from the hospital. The distance between B-lines was 3 mm (В3 lines) and 7 mm (В7 lines). Patients' catamnesis was studied for determining the predictive value of lung tissue ultrasonic characteristics for two years since the index hospitalization. Statistical analysis was performed using the McNemar's χ2 test (for evaluation of linked samples and of changes in the presence/absence of B-lines as determined by lung ultrasound examination (USE)) and the Wilcoxon test (for evaluation of quantitative changes). Differences were considered significant at p<0.05.Results B7-lines characteristic of interstitial component of pulmonary parenchymal edema prevailed in patients with HFmEF. В3-lines characteristic of alveolar edema were found in a small amount. In the anterior-superior segment, B7-lines predominated over B3-lines (80 % vs. 20 %, p<0.01) on the right; however, on the lest, significant differences were not observed (64 % vs. 36 %, p>0.05). In the anterior-inferior segment, В7-lines prevailed over В3-lines on the right (75 % vs. 25 %, p<0.05); however, on the left, the difference was not significant (67 % vs. 33 %, p=0.05). In the lateral superior segment on the right, В7-lines predominated over В3-lines (75 % vs. 25 %, p<0.01); in contrast, on the left, there were no differences (67 % vs. 33 %, p>0.05). In lateral-basal segments on both sides, significant differences were present (73 % vs. 27 % on the right, p<0.05; 72 % vs. 28 % on the lest, p<0.05). The results of lung ultrasound were also used for evaluation of the B-line predictive value in patients with ADHF and mid-range EF on discharge from the hospital after reversal of X-ray and clinical symptoms of pulmonary congestion. In the next two years, 35 patients (49.2 % of sample) were rehospitalized with signs of ADHF (39 hospitalizations, 1.1 hospitalizations per patient). The rehospitalized patients were divided into two subgroups, with an increased number of B-lines and small congestion on discharge (6-15 В-lines) and without signs of congestion (<5 В-lines). For patients with a minimal (small) congestion on pulmonary ultrasound but regression of clinical and X-ray congestion, the number of rehospitalizations was 25 vs. 11 in patients with the number of B7-lines <5. In the ROC-analysis, the area under the curve was 0.706, which corresponded to the expert assessment as "good". The position sensitivity was 78.6 % and the specificity was 79.7 %.Conclusion "Ultrasonic pulmonary edema syndrome" in patients with LV mid-range ejection fraction after reversing ADHF was characterized by predomination of the interstitial component, despite the absence of X-ray congestion, correlated with the blood level of NT-proBNP measured at the same time, and was associated with rehospitalizations.

[Clinical case of thromboembolism of small branches of the pulmonary artery on the background of the single ventricle id type with the opening of the сava-caval collaterals].

A three-compartment heart - a severe congenital defect, can develop after genetic mutation or teratogenic influence on fetus at early stages of embryogenesis. According to the literary data, the survival of such patients without surgery is 6-7 %. This publication demonstrates clinical case of the patient who has single ventricle of the heart and lived up to 56 without surgery.

[Pharmacological prevention of cardiovascular diseases].

At present, cardiology makes use of a wide range of drugs belonging to various pharmacological classes for both preventing and treating cardiovascular diseases. Results of recent large clinical trials show the importance of carrying out preventive actions, but data of evidence based medicine suggest that only some of the methods of pharmacological prophylaxis have unequivocally demonstrated their ability to improve the forecast of life for patients with cardiovascular pathology. We have summarized data on the efficacy of some groups of drugs used in cardiology and assessed this information from the positions of proved validity of the prophylactic effect in particular groups of patients.

[Resistant hypercholesteremia in clinical practice: new insight into the causes and methods of treatment].

Coronary heart disease and other diseases caused by atherosclerosis, take first place among the causes of adult mortality. Leading role in the development of atherosclerosis belongs to violations of cholesterol metabolism. Reducing mortality from ischemic heart disease primarily associated with adequate correction of the lipid metabolism. The research of the possible causes and correction of resistant hypercholesterolemia is done. Determined that some patients with resistant to statins hypercholesteremia and normal or elevated levels of hormones T3 and T4 in the blood have isolated symptoms of hypothyroidism, which may be a manifestation of reducing tissue sensitivity to thyroid hormones. Adding to the statins levothyroxine in daily doses of 25-50 mkg have additional cholesterol reducing action, allowing to achieve target levels of lipoprotein in blood in patients. The use of levothyroxine in low doses in combination with statins is highly effective and economically justified.