[Creation of registers as one of the mechanisms for improving medical care for patients with chronic heart failure. Problem state].

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.

[Influence of Loading Dose Of Atorvastatin on the Risk of Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction].

Aim      This retrospective cohort study focused on evaluating the incidence of contrast-induced nephropathy (CIN) associated with administration of an atorvastatin loading dose (80 mg) prior to invasive coronary angiography (CAG) in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods  This retrospective cohort study included 386 patients with STEMI. The patients were divided into two groups: intervention group (n=118) and control group (n=268). Patients in the intervention group, at the stage of admission to the catheterization laboratory, were administered a loading dose of atorvastatin (80 mg, p.o.) immediately before access (introducer placement). The endpoints were development of CIN, which was determined by increased serum creatinine 48 h following the intervention by at least 25% (or 44 µmol/l) of baseline value. In addition, in-hospital mortality and incidence of CIN resolution were assessed. To adjust the groups for dissimilar characteristics, a "pseudorandomization" method was used by comparing propensity scores.Results The incidence of CIN was significantly lower in the intervention group than in the control group (10.5 % vs. 24.4 %; p=0.016) with the odds for the CIN development lower than in the control group (odds ratio (OR) 0.36; 95 % confidence interval (CI), 0.16-0.85). Creatinine concentrations returned to the baseline value in 7 days more frequently than in the control group (66.3 % vs. 50.6 %, respectively; OR, 1.92; 95 % CI, 1.04-3.56; p=0.037). In-hospital mortality was higher in the control group but did not differ significantly between the groups.Conclusion      ~Administration of atorvastatin 80 mg to STEMI patients immediately before CAG was associated with a reduced risk of CIN and a higher likelihood of serum creatinine returning to the values at admission by day 7.

[Prognostic value of acute cardiorenal syndrome in patients with acute cardiac pathology].

AIM: To assess the prevalence and prognostic value of AKI in patients with acute decompensation of chronic heart failure (ADCHF) with a reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) or acute coronary syndrome (ACS), to identify predictors of AKI. MATERIALS AND METHODS: In a prospective study included 863 patients, of which 141 with ADCHF, 446 - non-ST-elevation acute coronary syndromes (NSTE-ACS) and 276 - ST-segment elevation myocardial infarction (STEMI). AKI was diagnosed according to KDIGO recommendations. The end point was defined as death from cardiovascular causes. RESULT: During the follow-up from 1 to 37 months (median follow-up was 18 months) for patients with ADCHF in 24,8 % an endpoint was reported. For patients with ACS, the observation time ranged from 1 day to 14 months (median follow-up was 12 months), in 4,3 % - NSTE-ACS, 10,9 % - STEMI the end point was recorded. AKI developed in 14,8 % of patients with ADCHF HFpEF and 11,2 % ADCHF HFrEF, in 23,1 % - STEMI and 21,4 % - NSTE-ACS. AKI increases the risk of death from cardiovascular causes in patients with ADCHF HFrEF (OR 95 % 98,750 (11,158-873,976), р<0,001) and STEMI (OR 95 % 5,395 (2,451-11,878), p<0,001), but did not increase the risk of an endpoint occurrence in patients with ADCHF HFpEF (OR 95 % 1,875 (0,221-15,930), р=0,565) and NSTE-ACS (OR 95 % 1,199 (0,421-3,412), р=0,734). The multivariate analysis revealed risk factors for the development of AKI in patients with ADCHF HFrEF: high albuminuria (AU) from 30 mg / l (OR 95 % 5,763 (1,338-24,819), р=0,019), GFR<45 ml / min initially at admission to hospital (OR 95 % 76,593 (1,193-36,446), p=0,031), age>75 years (OR 15,933 (1,020-248,856), р=0,048). In patients with STEMI: age>75 years (OR 95 % 3,248 (1,476-7,146), p=0,003), female gender (OR 95 % 2,321 (1,190-4,526), p=0,013), acute heart failure (AHF) Killip IV (OR 95 % 10,334 (1,777-60,110), p=0,009). Risk factors for the development of AKI in patients with NSTE-ACS: age>75 years (OR 95 % 1,761 (1,051-2,949), р=0,032), PCI on RCA (OR 95 % 2,565 (1,193-5,517), р=0,016). CONCLUSION: In patients with ADCHF HFrEF and STEMI development AKI is associated with a poor prognosis, but does not affect the prognosis of patients with ADCHF HFpEF and NSTE-ACS. AKI in patients with ADCHF HFrEF can be predicted using predictors: GFR<45 ml / min, AU more than 30 mg / l and age>75 years. In patients with STEMI, the predictors of AKI were age>75 years, female gender, AHF Killip IV, and in patients with NSTE-ACS age>75 years, PCI on RCA.

[Contrast-Induced Acute R enal Injury After Percutaneous Coronary InterventionI in Patients With ST-Segment Elevation Myocardial Infarction].

AIM: To assess frequency and prognostic value of contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We included in this prospective observational study 233 patients with STEMI. Duration of follow-up was 6 months. During this period, we traced development of CI-AKI with subsequent analysis of relation of CI-AKI to STEMI outcomes. RESULTS: CI-AKI was registered in 29.6% of patients. Hospital mortality was 14.5 and 6.1% among patients with and without CI-AKI, respectively (p=0.037). Mortality from cardiovascular causes during the follow-up period was 17.4 and 7.3%, respectively (p=0.021). CI-AKI was associated with increase of risk of death during hospitalization (odds ratio 2.6, 95% confidence interval 1.033-6.592, p=0.042). The development of CI-AKI was associated with glomerular filtration rate.

[Predictors of acute heart failure in patients with ST-segment elevation myocardial infarction of the electrocardiogram after PCI].

BACKGROUND: Despite the PCI in patients with ST-segment elevation myocardial infarction (STEMI) the development of acute heart failure (AHF) Killip ≥II is associated with a poor prognosis. AIM: To identify predictors of the development of AHF and the prognostic value of AHF in patients with STEMI after PCI. MATERIALS AND METHODS: In a prospective study, which lasted 6 months, included 233 patients (average age of 62.1±10.89 years, 73.4% of men) admitted to the hospital due to the development of STEMI who underwent PCI. The endpoint was defined as the death from cardiovascular causes. Statistical processing of the results was carried out using the statistical packages of the programs "SPSS Statistics 17.0". RESULT: During the follow-up observation from 1 day to 6 months (median follow-up of 5.2 months), 25 patients (10.7%) reported the onset of the endpoint, including 20 cases during the index hospitalization. AHF Killip ≥II during indexed hospitalization developed in 25 patients (10.7%). Independent predictors of Killip ≥II were: GFR.

[Prognostic value of pathogenetic therapy-induced changes in NT-proBNP in patients with chronic heart failure].

AIM: To study the prognostic value of therapy-induced changes in plasma NT-proBNP levels in patients with left ventricular (LV) systolic dysfunction. SUBJECTS AND METHODS: The study covered 84 patients aged 23 to 70 years (mean 54 +/- 8.1 years) with LV systolic dysfunction (an ejection fraction of < 40%). Plasma NT-proBNP levels were determined in all the patients at baseline and 3 months later to evaluate the efficiency of therapy for heart failure (HF). The median follow-up was 18 months. The follow-up recorded the following outcomes (end points): death from decompensated HF and unplanned hospital admissions for progressive HF symptoms. RESULTS: The baseline and therapy high plasma levels of NT-proBNP (more than 3000 pg/ml) were associated with worsening prognosis. The therapy-induced decrease in NT-proBNP levels was associated with more favorable prognosis. CONCLUSION: Repeat dynamic determination of plasma NT-proBNP levels allows identification of patients at increased risk of poor outcomes for a more intensive observation and more aggressive pathogenetic therapy.