RESUMEN
AIM: To evaluate the impact of a decrease in glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyze real clinical practice regarding the frequency of prescribing pathogenetic therapy for CHF, achieving target dosages depending on the gradation of GFR in patients included in the CHF Register of the Tyumen region. MATERIALS AND METHODS: The analysis included medical data of 4077 patients (1662 men and 2415 women) with NYHA class I-IV CHF who underwent examination and treatment in medical organizations of the Tyumen region for the period from January 2020 to May 2023. Criteria for inclusion in the register: proven heart failure. Chronic kidney disease (CKD) was assessed by GFR calculated using the CKD-EPI formula (ml/min/1.73 m2). The primary end point was defined as death from all causes. RESULTS: GFR<60 ml/min/1.73 m2 was recorded in 34.6% of patients, more common in women (40.2 and 26.6%, respectively; p<0.001). When dividing patients into phenotypes according to LVEF, no statistically significant differences were found in the distribution of patients according to GFR. In patients with HFrEF and HFpEF GFR<45 ml/min/1.73 m2 was associated with an increased risk of meeting the endpoint. Analysis of prescribed pathogenetic therapy showed that in patients with HFrEF, the frequency of prescription of ACE inhibitors, â-blockers and MRA decreased (p=0.023, 006 and 0.01, respectively), and ARNI, on the contrary, increased with a decrease in GFR (p=0.026). In patients with HFpEF, a similar trend towards a decrease in the frequency of prescription of ACEIs and MCBs with a decrease in GFR (p<0.001) remained, but it was compensated by an inversely proportional increase in the frequency of prescription of ARBs (p<0.001). 100% of the target dosage is achieved in more than 90% of patients taking MRA across the entire LVEF range. While for â-blockers and ARNI/ACE/ARB the percentage of patients receiving the full therapeutic dosage of drugs is significantly lower. When analyzing target dosages of pathogenetic drugs, gradations of achieved doses were distributed evenly throughout the entire range of GFR. CONCLUSION: GFR<60 ml/min/1.73 m2 occurs in every 3 patients with CHF across the entire range of LVEF. A decrease in GFR worsens the prognosis of patients with both HFrEF and HFpEF, increasing in direct proportion with the severity of the stage of CKD. Inclusion of patients in the monitoring program within the framework of the CHF service allows the treatment to be significantly brought closer to optimal drug therapy, at the same time, certain efforts are required to overcome difficulties with titration to target dosages.
Asunto(s)
Tasa de Filtración Glomerular , Insuficiencia Cardíaca , Insuficiencia Renal Crónica , Humanos , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Renal Crónica/fisiopatología , Insuficiencia Renal Crónica/epidemiología , Pronóstico , Persona de Mediana Edad , Anciano , Federación de Rusia/epidemiología , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/administración & dosificación , Sistema de Registros , Volumen Sistólico/fisiologíaRESUMEN
The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 26-29%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.
Asunto(s)
Insuficiencia Cardíaca , Hospitalización , Humanos , Enfermedad Crónica , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Federación de Rusia/epidemiologíaRESUMEN
Clinical and hemodynamic aggravation of heart failure with preserved ejection fraction (HFpEF) is largely due to progression of left ventricular (LV) diastolic dysfunction. The key role in the normal maintenance of diastolic function is played by a high level of activity of the intracellular signaling axis, cyclic guanosine-monophosphate-protein kinase G, the activity of which is significantly reduced in HFpEF. The activity of this axis can be increased by increasing the bioavailability of natriuretic peptides by blocking the enzyme neutral endopeptidase (neprilisin), which is responsible for the destruction of natriuretic peptides.This review presents experimental and clinical data on the use of neprilysin inhibitors in HFpEF and addresses prospects of this treatment.
Asunto(s)
Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Diástole , Insuficiencia Cardíaca/tratamiento farmacológico , Humanos , Neprilisina , Volumen Sistólico , Función Ventricular IzquierdaRESUMEN
BACKGROUND: The low efficiency of recommended therapy for reducing cardiovascular risk (CV) in patients with arterial hypertension even with an effective blood pressure decrease is often due to the persistence of high blood cholesterol and arterial stiffness. Among the effective ways to achieve the goal of therapy is considered the changing to a single-pill combinations (SPCs) of two antihypertensive drugs and statin. AIM: To assess influence of fixed combination consisted of amlodipine, lisinopril and rosuvastatin to the dynamic of lipid spectrum, blood pressure level and elastic properties of arteries in patients with arterial hypertension and high risk of cardio-vascular complications being transferred from their preceding antihypertensive therapy. MATERIALS AND METHODS: 113 patients with atherosclerosis of brachiocephalic arteries (BCA) receiving antihypertensive and partially taking statins therapy were assessed cholesterol, low-density lipoprotein cholesterol (LDL-C), peripheral and central blood pressure, carotid-femoral pulse wave velocity (PWV) initially and after 12 months of taking amlodipine + lisinopril + rosuvastatin (A+L+R) SPCs. RESULTS: The administration of A+L+R SPCs for 12 months was associated with an increasing of number of patients with the achieved target blood pressure.
Asunto(s)
Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares , Hipertensión , Presión Sanguínea , Humanos , Hipertensión/tratamiento farmacológico , Análisis de la Onda del Pulso , Factores de Riesgo , Rosuvastatina CálcicaRESUMEN
AIM: To study the impact of cold waves on disease course, hemodynamics, lipid and carbohydrate metabolisms, oxidative stress, and blood rheological properties in patients with cardiovascular diseases (CVD). SUBJECTS AND METHODS: 24 men and 36 women (their mean age was 62.9±9.7 years) were examined; coronary heart disease (CHD) and hypertension were present in 40 and 95% of the patients, respectively; selected therapy remained unchanged throughout the entire period. The investigators measured blood pressure and pulse wave velocity (PWV), carried out biochemical blood tests, estimated plasma oxidized low-density lipoproteins (oxLDL) and malondialdehyde (MDA) and erythrocyte superoxide dismutase (SOD) activity, calculated a MDA/SOD ratio, determined blood viscosity; as well as assessed quality of life using a visual analogue scale (VAS) and a specially developed questionnaire. RESULTS: Female sex, CHD, type 2 diabetes mellitus (DM-2) were independent predictors of cardiovascular events (CVEs) in the frost period. The persons who had experienced CVEs in frost had higher baseline PWV. CVEs, such as hypertensive crisis, emergency calls, cardiac arrhythmias, and the larger number of adverse reactions, were more commonly recorded in frost. There was an increase in blood glucose levels, a decrease in oxLDL, a rise in η2/η1, and a reduction in plasma viscosity during frost and elevated glycation end product levels at visit 2. Conclusion. The cold wave is associated with the larger number of CVEs in some patients with CVD during selected therapy. CHD, DM-2, female sex are independent predictors of CVE in patients with CVD during the winter period. In this period, there were increases in the levels of glucose, glycation end products, and erythrocyte aggregation, and a reduction in plasma viscosity.
Asunto(s)
Enfermedades Cardiovasculares , Frío/efectos adversos , Calidad de Vida , Anciano , Determinación de la Presión Sanguínea , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/psicología , Diabetes Mellitus Tipo 2/epidemiología , Femenino , Hemorreología , Humanos , Lipoproteínas LDL/sangre , Masculino , Malondialdehído/sangre , Persona de Mediana Edad , Estrés Oxidativo , Pronóstico , Análisis de la Onda del Pulso/métodos , Factores de Riesgo , Federación de Rusia/epidemiología , Estaciones del Año , Superóxido Dismutasa/sangre , Escala Visual AnalógicaRESUMEN
AIM: To study a relationship between thyroid function and the stiffness of great arteries in postmenopausal women with arterial hypertension (AH). SUBJECTS AND METHODS: The trial enrolled 76 postmenopausal patients with clinical hypothyroidism (CHT) (n = 24) or subclinical hypothyroidism (SCHT) (n = 52) and AH; a control group consisted of 40 postmenopausal women with euthyroidism. Body mass index (BMI), waist and hip circumferences, blood pressure (BP), thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, total cholesterol, triglycerides were determines; volumetric sphygmography was performed. Brachial-ankle pulse wave velocity (baPWV) was measured; cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were determined. RESULTS: The patients with CHT or SCHT and the controls were matched for age, BMI, BP, and heart rate. TSH levels in patients with SCHT (6.23 (5.27; 8.22) microU/ml) and in those with CHT (11.8 (9.09; 22.7) microU/ml) were statistically significantly higher than in the control group (2.25 (1.5; 2.72) microU/ml) (p < 0.05). BaPWV in the patients with SCHT (14.35 (12.5; 15.5) m/sec) and in those with CHT (13.75 (13.05; 15.25) m/sec) was also statistically significantly higher than in the control group (12.85 (12; 13.9) m/sec) (p < 0.05). Comparison of ABI and CAVI revealed no significant differences between the groups. Univariate analysis of the findings showed a significant impact on higher arterial stiffness in the SCHT and the CHT groups. Total cholesterol levels were significantly higher in the SCHT group than in the control one. CONCLUSION: The patients with AH and hypothyroidism versus their peers with AH and without thyroid function had significant rises in blood cholesterol levels and arterial stiffness. The rise in lipid levels was significantly marked only in the patients with SCHT; and baPWV equally increased in both the SCHT and the CHT groups.
Asunto(s)
Velocidad del Flujo Sanguíneo , Presión Sanguínea/fisiología , Hipertensión/fisiopatología , Hipotiroidismo/fisiopatología , Posmenopausia , Rigidez Vascular , Anciano , Índice Tobillo Braquial , Femenino , Estudios de Seguimiento , Humanos , Hipertensión/complicaciones , Hipotiroidismo/sangre , Hipotiroidismo/complicaciones , Persona de Mediana Edad , Factores de Riesgo , Tirotropina/sangreAsunto(s)
Monitoreo de Drogas , Insuficiencia Cardíaca , Hemodinámica/efectos de los fármacos , Hipotiroidismo , Tiroxina/administración & dosificación , Administración Oral , Anciano , Biomarcadores , Relación Dosis-Respuesta a Droga , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Terapia de Reemplazo de Hormonas , Humanos , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Hipotiroidismo/metabolismo , Masculino , Persona de Mediana Edad , Péptido Natriurético Encefálico/metabolismo , Fragmentos de Péptidos/metabolismo , Calidad de Vida , Tiroxina/sangre , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas , Mixoma , Ecocardiografía , Electrocardiografía , Atrios Cardíacos/fisiopatología , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/fisiopatología , Neoplasias Cardíacas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Mixoma/diagnóstico , Mixoma/fisiopatología , Mixoma/cirugía , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
AIM: to evaluate of the effectiveness of switching from beta-adrenoblockers (BAB) non-included into the guidelines for the management of chronic heart failure (CHF) to nebivolol and bisoprolol for outpatients. SUBJECTS AND METHODS: The study included 67 patients with stable Functional Classes (FC) II and II CHF who received the standard therapy and BAB non-included into the guidelines for the management of CHF. The patients were randomized to the groups taking bisoprolol (n = 35) or nebivolol (n = 32) in doses of 1.25 to 10 mg/day. Before and 6 months after therapy, the investigators assessed the patient's clinical status and quality of life (QL), performed a six-minute walk test and echography, and determined the blood level of the N-terminal fragment of brain natriuretic peptide prohormone (NT-proBNP). RESULTS: The switching to bisoprolol and nebivolol was followed by a significant clinical improvement, a larger covered distance, and better QL. Left ventricular ejection fraction was increased along with a reduction in mean FC CHF. There were no significant changes in NT-proBNP in the total patient group, but it was significantly decreased in the subgroup of those with the baseline high level of the peptide. CONCLUSION: The switching of patients with stable CHF from therapy with BAB not included into the guidelines for the management of CHF to nebivolol or bisoprolol yields positive results and improves left ventricular systolic function (which is attended by the reduction in NT-proBNP levels) and may be recommended for treatment in the outpatient setting.