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Aim To study the effectiveness of a treatment based on monitoring the soluble ST2 receptor (sST2) concentration in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) after acute decompensated heart failure (ADHF).Material and methods The study included 37 patients hospitalized for ADHF with LVEF ≤40% and sST2 concentration ≥37.8 ng/ml at the time of discharge from the hospital. Patients were randomized into two groups: a sST2 monitoring (sST2M) group (19 patients) and a standard therapy (ST) group (18 patients). The follow-up period was 12 months. At baseline, the groups practically did not differ by clinical, functional, laboratory, and instrumental characteristics. For the sST2M group, the goal was reducing the sST2 concentration by >30% of baseline or to <30 ng/ml.Results Therapy in both groups was comparable both in doses and in frequency of administration of basic drugs. However, the diuretic therapy was more frequently adjusted in the sST2M group (3.0 [1.0; 4.0] vs. 1.0 [0; 3.0] adjustments per patient, p = 0.047), which required more visits to the clinic (7.0 [6.0; 9.0] vs. 6.0 [6.0; 6.0] visits per patient, p=0.024). In the sST2M group at 6 months, the sST2 concentration was decreased by 43.3% (p=0.001), and 13 patients (72.2%) achieved the goal. In the ST group, the sST2 concentration was decreased by 38.5% (p=0.001), and 11 patients (68.8%) reached the target values. After 12 months, the downward trend continued in both groups. In both groups, the NT-proBNP concentration decreased: in the sST2M group by 27.7% (p=0.014), and in the ST group by 31.9% (p = 0.006). By the 12th month, the decrease remained only in the sST2M group. Only the sST2M group had an increase in LVEF (+28.5%, p=0.003), a decrease in left ventricular end-systolic volume (LVESV) (-12.0%, p=0.017), and a decrease in left atrial volume (-13.4%, p=0.045); at 12 months, LVEF remained increased (26%, p=0.006), and LA volume remained decreased (-14.3%, p=0.028). Quality of life and results of 6-minute walk test (6MWT) improved in both groups. For 6 months of treatment, the sST2M group had a significantly lower incidence of composite endpoints (CEP, cardiovascular death and decompensation/hospitalization due to HF), 26.3% (5 events) of the sST2M group compared to the ST group, 83.3% (15 events) (p=0.029), primarily due to a lower incidence of decompensated HF. For 12 months of follow-up, the incidence of CEP in the ST group was 122.2% (22 events), and 47.4% (9 events) in the sST2M group (p=0.035).Conclusions The tactics of sST2 monitoring used in the treatment of "high-risk" HFrEF patients (with high sST2 concentrations) is associated with increased LVEF, improved functional status of patients, a beneficial effect on LV remodeling, and decreased incidence of CEP.
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Insuficiencia Cardíaca , Disfunción Ventricular Izquierda , Humanos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Volumen Sistólico , Función Ventricular Izquierda/fisiología , Proteína 1 Similar al Receptor de Interleucina-1 , Pronóstico , Biomarcadores , Calidad de Vida , Pacientes Ambulatorios , Péptido Natriurético EncefálicoRESUMEN
The authors report the clinical case of secondary Takotsubo syndrome developed after transcatheter aortic valve replacement that was performed in compassionate manner in female patient with combination of congenital ventricular septal defect and acquired severe aortic stenosis. In the teams view, Takotsubo syndrome was triggered with profound changes of intracardial hemodynamics subsequent to iatrogenic impairment of preexisting interventricular shunt.
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Estenosis de la Válvula Aórtica , Defectos del Tabique Interventricular , Cardiomiopatía de Takotsubo , Reemplazo de la Válvula Aórtica Transcatéter , Femenino , Humanos , Cardiomiopatía de Takotsubo/diagnóstico , Cardiomiopatía de Takotsubo/etiología , Cardiomiopatía de Takotsubo/terapia , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/cirugía , Defectos del Tabique Interventricular/diagnóstico , Defectos del Tabique Interventricular/etiología , Defectos del Tabique Interventricular/cirugía , Aorta , Resultado del TratamientoRESUMEN
Coronary no-reflow phenomenon (CNR) is a complication of primary percutaneous coronary intervention (PCI). According to different reports, CNR occurs in 10 to 60â% of cases. Despite the long history of studying this phenomenon many issues remain unsolved. This article presents a clinical case of electrocardiographically confirmed ST-segment elevation myocardial infarction. In this case, the CNR phenomenon occurred during PCI and was associated with heart rhythm disorders, left ventricular (LV) cavity dilatation with a decrease in LV contractility, and formation of intracavitary thrombus. The patient asked for medical care late, which could influence the development of CNR. This case demonstrates the clinical significance, diagnostic characteristics, and successful drug correction of the no-reflow phenomenon.
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Fenómeno de no Reflujo , Trombosis , Angiografía Coronaria , Humanos , Intervención Coronaria Percutánea , Infarto del Miocardio con Elevación del STRESUMEN
The review aims to appraise the value of determining the concentrations of the new biomarker sST2 for assessing prognosis and monitoring treatment effectiveness of patients with decompensated heart failure during an episode of decompensation and during long-term follow-up after discharge from the hospital. The article analyses in detail the expedience of sST2 measurement in a patient with ADHF on admission and discharge from the hospital and the changes in the biomarker level during the period of active treatment for risk-stratification in patients, presents the optimal threshold values of sST2, which should be oriented when selecting patients with high and very high risk. The importance of subsequent monitoring of the marker concentration during long-term observation in emphasized to predict the risk of death, HF re-decompensation / HF rehospitalization. The potential benefits of choosing sST2 as the optimal marker for serial measurement during long-term follow-up, as well as evaluating the treatment effectiveness in patients with HF, compared to the "classical" variant - natriuretic peptides are shown.
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Insuficiencia Cardíaca , Biomarcadores , Humanos , Péptido Natriurético Encefálico , Fragmentos de Péptidos , Pronóstico , Resultado del TratamientoRESUMEN
AIM: Monitoring of concentrations of modern biomarkers to evaluate the efficacy of longterm treatment of patients after acute decompensated HF (ADHF). MATERIALS AND METHODS: The study included 100 patients with severe decompensated FC II-IV CHF and LV EF <40 % due to IHD, DCMP or AH. At discharge from the hospital, patients were divided into groups of low (NTproBNP<1400 pg / ml) (control, n=30) and high (NTproBNP≥1400 pg / ml) risk (n=70). Patients at high risk were randomized to two treatment groups, a group of NTproBNP monitoring (NPM) (n=35) and a group of standard therapy (n=35). At the end of the study, noncompliant patients were isolated from these two groups into a separate group (n=10). The aim of the treatment was decreasing the NTproBNP concentration to less than 1000 pg / ml and / or ≥50 % of the baseline level. In addition to the soluble suppression of tumorigenicity 2 (sST2) receptor, concentrations of copeptin, neutrophil gelatinase associated lipocalin (NCAL), galectin 3, and highsensitivity troponin T were measured at discharge from the hospital (baseline) and at three and 6 months of treatment. RESULTS: The strongest correlations were found between changes in concentrations (Δ%) of NTproBNP, copeptin, and sST2 and changes in CHF FC, 6min walk distance, CCS, quality of life, LV EF, and Ð / Ð' (Ñ<0.001). The incidence of cardiovascular events was directly related with the degree of decrease and / or increase in biomarker concentration. Patients of the NPM group had the lowest risk of adverse clinical outcome upon a decrease in NTproBNP <988.5 pg / ml at 6 months of treatment or > 50 % of the baseline level at discharge from the hospital. For these patients, the mean Δ% was 60.7±8.5 % for NTproBNP, 34.03±17.6 % for sST2, and 32.41±8.8 % for copeptin [OR at 95 % CI 0.08 (0.02-0.36), Ñ <0.0001]. A significant increase in the risk for cardiovascular events was observed only at a considerable increase in NTproBNP >50 % [OR at 95 % CI 3.8 (1.13-13.0), Ñ=0.03], and the highest incidence of cardiovascular events was observed in the group of noncompliant patients (110 %). Besides NTproBNP, to significantly decrease the risk of cardiovascular events, it was necessary to achieve a decrease in sST2 concentration to less than 30 ng / ml or by more than 24.9 % (Δ%) at the end of followup [ÐR (95 % CI: 0.1 (0.02-0.5), Ñ=0.004]. CONCLUSION: Among the modern biomarkers, changes in NTproBNP, sST2, and copeptin concentrations most accurately reflect changes in the clinical and functional status, quality of life, and EchoCG parameters in HF patients during longterm monitoring. The lowest risk for adverse clinical outcomes was observed in postdecompensation patients with a decrease in NTproBNP <988.5 pg / ml after 6 months of treatment or ≥50 % of baseline upon discharge from the hospital. The sST2 concentration has to be reduced by more than 24.9 % of baseline and less than 30 ng / ml in the course of longterm treatment after decompensated HF.
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Insuficiencia Cardíaca , Péptido Natriurético Encefálico/uso terapéutico , Fragmentos de Péptidos/uso terapéutico , Calidad de Vida , Biomarcadores , Estudios de Seguimiento , Insuficiencia Cardíaca/tratamiento farmacológico , HumanosRESUMEN
Takotsubo cardiomyopathy (TCM) is a well-known complication of many conditions associated with emotional or physical stress. Abnormal catecholamine release has been hypothesized to be the main cause of TCM. Myocardial infarction (MI) is associated with release of large amounts of catecholamines. We present here two cases in which patients simultaneously suffered from acute MI and TCM. In these elderly women without prior history of severe somatic diseases we have not revealed any external stressing factor responsible for the initiation of the disease. Therefore, we have considered primary coronary event (acute MI) to be a triggering factor of TCM manifestation.