Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure.

AIM: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF). MATERIAL AND METHODS: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death. RESULTS: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration. CONCLUSION: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

[The prognostic value of the method for determining the estimated glomerular filtration rate in chronic heart failure with a preserved left ventricular ejection fraction: focus on cystatin C].

The aim of the present study is to determine the prognostic value of GFR reduction according to the CKD-EPI formula, taking into account blood creatinine and a formula that simultaneously takes into account creatinine and cystatin C in patients who were hospitalized for the first time due to decompensation of chronic heart failure with a preserved left ventricular ejection fraction (HFSA) observation within 24 months. MATERIALS AND METHODS: The study included 117 patients (women - 65.8%, mean age 71.6 ± 9.1 years) hospitalized due to debugging of CHF and having a preserved left ventricular ejection fraction according to echocardiography. The study was a prospective observation for 2 years after the inclusion of each patient. On the first day of hospitalization, all serum samples were taken to determine the level of cystatin C. The estimated glomerular filtration rate (eGFR) was determined using the CKD-EPI formula, taking into account blood creatinine and the combined formula, including creatinine and cystatin C. The combination was used as an end point death and re-hospitalization within two years of follow-up. To determine the effect of a decrease in eGFR on the forecast, the Kaplan-Maer method and the log-rank test were used. Differences were considered statistically significant at p<0.05. The study was approved by the local ethics committee. RESULTS: During the observation period, the mortality rate was almost 12%. At the same time, every third patient was repeatedly hospitalized within two years. In order to determine the effect of reducing GFR on reaching the end points, all patients were divided into groups with eGFR values of more or less than 45 ml/min/1.73 sq.m according to both formulas. When separating patients using the CKD-EPI formula, which includes only creatinine, the groups did not differ in terms of the frequency of reaching the combined end point, as well as its components: death and re-hospitalization. However, patients with eGFR values less than 45 ml/min/1.73 sq. M according to the combined formula data significantly more often reached the combined end point, mainly due to an increase in mortality. CONCLUSION: The data obtained suggest that adding cystatin C to the CKD-EPI formula and appropriately identifying patients with reduced eGFR has a high prognostic value for stratifying the risk of an unfavorable outcome after the first decompensation of HFSSFV.

[Prognostic value of biomarkers in chronic heart failure with preserved left ventricular ejection fraction]. / Prognosticheskoe znachenie biomarkerov pri khronicheskoi serdechnoi nedostatochnosti s sokhranennoi fraktsiei vybrosa levogo zheludochka.

The paper reviews major biomarkers for determining the prognosis in patients with chronic heart failure and preserved ejection fraction. It also considers cystatin C, one of the novel and probably the most practically important biomarkers.

[Nitrate assimilation activity of yellow lupine root nodules ?]. / Nitratassimiliruiushchaia funktsiia kluben'kov liupina zheltogo ?.

Low nitrate assimilation activity of the root nodules was demonstrated by assaying the nitrate reductase, glutamate synthase, glutamate dehydrogenase, and asparagine synthase activities, as well as the kinetics of 14C-labeled saccharose incorporation in the amino acids and amides of the cortex and the bacteroid-containing root nodule zones. Irrespective of the exogenous nitrogen concentration (0, 11.2, or 25 mM NO3-), nitrate concentration in the nodules was low as compared to the plant roots, leaves, and stems. This allowed us to propose the presence of structural and/or metabolic barriers in the nodules limiting nitrate accessibility and assimilation.

Experimental rabies in hibernator rodents.

Experiments carried out in different seasons with different strains of rabies virus have shown that hibernation prolonged the incubation period in sousliks (Citellus major Pall.). Mean survival of the animals infected during the active period was 32 days, while during hibernation it was 147.3 days (P less than 0.05), in some cases up to 251 days. The virus was isolated from and/or detected by fluorescent antibody test in 50% of cases in the brown fat and in some cases in the salivary glands and visceral organs. The brown fat biopsy allowed to detect the virus not earlier than 6 days before death. We propose to use heterothermal rodents for the study of mechanism of rabies virus persistence and suggest that these animals might represent a natural reservoir for rabies.