[Testosterone and congestive heart failure].

This article summarizes current information about the interrelation between testosterone concentrations and chronic heart failure (CHF). The authors described key publications that address the prevalence of testosterone deficiency in patients with CHF, the effect of endogenous and exogenous testosterone on the cardiovascular system, the relationship between testosterone levels and the severity and prognosis of CHF, and the efficacy of interventional treatments for CHF.

[Association of left bundle branch block definitions with response to cardiac resynchronisation therapy in patients with congestive heart failure].

Aim To compare diagnostic significance of different criteria for complete left bundle branch block (cLBBB) in prediction of reverse left ventricular (LV) remodeling associated with cardiac resynchronization therapy (CRT).Materials and methods This study included 93 patients (men, 81.7 %; mean age at the time of implantation, 56.6±9.3 years). Achievement of a maximum decrease in LV end-systolic volume (ESV) was recorded during the entire follow-up period for evaluation of LV reversibility by CRT. Based on the dynamics of LV ESV, patients were divided into two groups, non-responders (n=27) and responders (n=66). cLBBB was determined by 9 criteria (ESC 2006 and 2013, AHA 2009, Strauss, and MIRACLE, CARE-HF, MADIT-CRT, REVERSE, and RAFT used in large multicenter studies).Results Incidence of cLBBB was significantly higher in the group of responders as demonstrated by the AHA (p=0.001), ESC 2013 (p=0.014), Strauss (p=0.002), MADIT-CRT (p=0.014), REVERSE (p=0.013), and RAFT (p<0.001) criteria. The highest specificity was shown for the AHA and RAFT (92.6 %) criteria, and the highest sensitivity and overall accuracy were shown for the Strauss (80.3 % and 72.04 %, respectively) criterium. The criteria proposed in actual clinical guidelines (AHA and ESC 2013) demonstrated a strong consistency in detecting cLBBB (κ=0.818, 95 % CI, 0.7-0.936; p<0.001). However, the Strauss and ESC 2006 / AHA / ESC 2013 showed the least consistency in identifying cLBBB. For the criteria described in large multicenter studies, consistency in detecting cLBBB was minimal in most cases. However, criteria with moderate or strong consistency were used in the studies, which results have substantiated the use of cLBBB as a selection criterium (MADIT-CRT, REVERSE, and RAFT).Conclusion The reversibility of LV remodeling associated with CRT was different in patients with cLBBB determined by different criteria. All actual cLBBB criteria (AHA, ESC 2013, and Strauss) were significantly more frequently observed in the responder group. Nevertheless, these criteria differed in their sensitivity and specificity. A number of large multicenter studies have used criteria with minimal consistency in detecting cLBBB, which should be taken into account in interpreting results of these studies.

[Сhanges in quality of life in patients with congestive heart failure after cardiac resynchronization therapy].

PURPOSE: To assess the quality of life (QoL) changes in patients with congestive heart failure (CHF) one year after cardiac resynchronization therapy (CRT). METHODS: The study included 82 patients (68 males and 14 females) aged from 30 to 74 (mean age 55.8±9.2 years) who underwent implantation of a biventricular cardiac pacemaker for CRT. Depending on the echocardiographic response to CPT, the patients were divided into two groups: 56 people with a positive response (responders) and 26 people with insufficient response (non-responders). The SF-36 questionnaire was used to measure QoL. The results of the questionnaire were represented as scores over the eight subscales: physical functioning (PF), role-physical functioning (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health perceptions (MH). The QoL assessment was performed before and one year after CRT. RESULTS: Patients with CHF one year following CRT had significantly higher rates of improvement in PF QoL (before CRT 46.28±26.16; one year after CRT 53.05±27.65, p=0.023). The statistical tendency towards QoL improvement was revealed: VT QoL (before CRT 47.07±20.12, after CRT 51.83±20.07, p=0.081), SF (before СРТ 61.58±25.06, after CRT 67.07±24.57, p=0.088). Group of responders one year after CRT had significantly higher rates of improvement of QoL in PF (45.2±26.0 before CRT vs 57.1±26.4 after CRT, p=0.001); in VT (46.5±20.8 vs 54.4±19.7, p=0.010) and in SF (60.9±26.4 vs 70.8±20.8, p=0.012). The statistical tendency towards QoL improvement was revealed in BP (57.5±25.1 before CRT vs 64.8±23.8 after CRT, p=0.079), in GH (45.3±16.4 vs 49.1±18.0, p=0.079) and in MH (57.7±18.9 vs 62.5±17.7, p=0.081). In the group of nonresponders the statistical tendency towards decrease in QoL was detected during one year after CRT in RE (46.2±45.3 before CRT vs 26.9±41.1 after CRT, p=0.07). No significant differences were found in paired comparisons of other QoL indicators. CONCLUSION: We revealed significant increase in PF index in patients with CHF one year following CRT. The study showed that QoL was generally improving one year following CRT in responders while a tendency towards decrease in RE was detected in non-responders.

Impact of Depressive Symptoms on All-Cause Mortality in Patients with Congestive Heart Failure After Cardiac Resynchronization Therapy.

PURPOSE: to assess the association between depression and all-cause mortality in patients with congestive heart failure (CHF) after cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: We enrolled in this study 156 patients (mean age 55.3±9.6 years) with CHF and implanted devices for CRT. Mean duration of follow-up was 51.6±33.4 months. The Beck Depression Inventory (BDI) was used to evaluate depressive symptoms (DS); DS were considered absent for a score 0-9, mild to moderate - 10-18, severe - ≥19. For assessment of association of DS and mortality we used multivariate Cox proportional hazards regression model with estimation of hazard ratios (HR) with 95 % confidence intervals (95 %CI). RESULTS: Average Beck Depression Inventory score was 12.4±8.3. In 66 patients (42.3 %) there were no DS, 57 patients (36.5 %) had mild, and 33 (21.2 %) - severe DS. These groups did not differ by main clinical-functional and laboratory indicators. Among individuals without DS prevailed men (90.9 vs. 69.7 % among those with severe DS, p=0.007). Hypercholesterolemia was more frequent in patients with DS (63.3 vs. 43.9 % in patients without DS, p=0.02). During follow-up 33 patients died (21.2 %). Adjusted HR of death from all-causes for DS score as continuous parameter was 1.05, 95 % CI 1.01-1.09, p=0.02. Patients without DS were used as reference (HR=1.0) in analysis of categorical indicator. HR was 1.08, 95 % CI 0.46-2.54, p=0.9 in patients with mild, and 2.92, 95 % CI 1.17-7.32, p=0.02 - with severe DS. CONCLUSION: DS were associated with gender and hypercholesterolemia. Severe DS were independently associated with all-cause mortality in patients with CHF and implanted CRT devices.

[Does the lack of left ventricular reverse remodeling always mean non - response to cardiac resynchronization therapy?]

AIM: To evaluate clinical, morphological, functional features and mortality level in patients with different value of left ventricular reverse remodeling after cardiac resynchronization therapy (CRT). MATERIALS AND METHODS: The study enrolled 112 patients (mean age 54.6±9.9 years, 83.5% men) with left ventricular ejection fraction (LVEF) І35%, NYHA functional class II-IV. We enrolled patients with QRS width >120 ms or QRS.

Echocardiographic markers of dyssynchrony as predictors of super-response to cardiac resynchronisation therapy - a pilot study.

BACKGROUND: Some patients with congestive heart failure have greater improvement of cardiac remodelling after cardiac resynchronisation therapy (CRT) and they are identified as super-responders (SRs). It remains unclear if echocardiographic markers of dyssynchrony could accuratelly predict super-response to CRT. The aim of this study is to evaluate potential echocardiographic predictors associated with super-response to CRT. METHODS: Fifthy nine CRT patients (mean age 52.9 ± 9.0 years, 88% men) with congestive heart failure (54% ischaemic and 46% non-ischaemic aetiology) II-IV NYHA functional class were enrolled. To assess mechanical dyssynchrony we evaluated interventricular mechanical delay, the maximum delay between peak systolic velocities of the septal and posterior walls of left ventricle, duration of left ventricular pre-ejection period (LVPEP), left ventricular and interventricular dyssynchrony by tissue Doppler imaging and systolic dyssynchrony index by 3D echocardiography. After six months the patients were assessed for response and classified as SRs (reduction in left ventricular end-systolic volume (LVESV) ≥30%, n = 20) and non-SRs (reduction in LVESV < 30%, n = 39) and baseline data were analyzed to identify the predictors. RESULTS: Both groups demonstrated significant improvement in NYHA functional class, increase in left ventricular ejection fraction and reduction in LVESV. All parameters of mechanical dyssynchrony at baseline were significantly higher in SR group. Multiple logistic regression analysis showed that LVPEP (HR 1.031; 95% CI 1.007-1.055; p = 0.011) was an independent predictor for CRT super-response. In ROC curve analysis LVPEP with a cut-off value of 147 ms demonstrated 73.7% sensitivity and 75% specificity (AUC = 0.753; p = 0.002) for the prediction of super-response to CRT. CONCLUSION: Greater mechanical dyssynchrony is associated with super-response to CRT in patients with congestive heart failure. It is probable that an LVPEP > 147 ms can be used as independent predictor of super-response.

[Relationship between levels of sex hormones and response to cardiac resynchronisation therapy in men].

AIM: To study the relationship between levels of sex hormones and effectiveness of cardiac resynchronisation therapy (CRT) in men with chronic heart failure (CHF). MATERIALS AND METHODS: The best response to CRT (mean time, 38 [19,0;53,7] months) was identifed by a maximum decrease in left ventricular end-systolic volume (LVESV) in 58 men (mean age, 54.8±9.6) with CHF (61% IHD). Based on testosterone (TES) level, patients were divided into group 1 (n=28; 48%) - TES < median value (13.8 nmol/l) and group 2 (n=30; 52%) - TES > median value. Exercise tolerance (ET), echocardiography (EchoCG) parameters, plasma levels of NTproBNP, interleukin (IL) - 1ß, IL-6, IL-10, tumor necrosis factor α (TNF-α), С-reactive peptide (CRP), galectin-3 (Gal-3), matrix metalloprotease-9 (ММР-9), tissue inhibitors of metalloproteinases TIMP-1, TIMP-4, and the indexes MMP-9/TIMP-1 and MMP-9/TIMP-4 were evaluated in dynamics. Levels of TES, progesterone (PGN), dehydroepiandrosterone sulphate (DHEAS), and estradiol (Е2) were measured at baseline. Based on LVESV changes, non-responders (LVESV decrease by 15% but 30%) were identifed. RESULTS: In group 2, atrial fibrillation (р=0.064) and radiofrequency ablation of atrioventricular connection (р=0.014) were observed more frequently; incidence of diabetes mellitus was lower (р=0.017); QRS was smaller (р=0.001); ET was higher both at baseline (р=0.022) and in dynamics (р=0.018); numbers of responders and super-responders were greater (р=0.007); levels of PGN (р=0.028), Il-1ß (р=0.020), IL-10 (р=0.013), TNF- α (р=0.006) were higher; and Е2/TES was lower (р=0.004). While EchoCG parameters did not differ at baseline, group 2 showed a tendency towards greater changes in LVESV (р=0.069) and LV end systolic dimension (р=0.087), and a greater increase in LV ejection fraction (р=0.007). In dynamics: In group 1, a decrease in NT-proBNP was observed (р=0.015); in group 2, decreases in IL-1ß (р=0.001), IL-6 (р=0.015), IL-10 (р=0.001), TNF-α (р=0.001), TIMP-1 (р=0.046), and Gal-3 (р=0.051) were observed. Levels of sex hormones were correlated with EchoCG parameters, biomarkers of immune inflammation, fibrosis, and NTproBNP. The ROC analysis showed that a TES level not lower than 13.8 nmol/l was a predictor for a positive response to CRT with a sensitivity of 63.4% and specifcity of 76.5% (AUC=0.687; р=0.026). CONCLUSIONS: High levels of TES and PGN were associated with beter effectivity of CRT, higher ET, greater proportions of responders and super-responders, and reduced immune inflammation activity and fibrosis. A level of TES not lower than 13.8 nmol/l was a predictor for a positive response to CRT.

[Biomarkers of inflammation in patients with chronic heart failure and implanted devices for cardiac resynchronization therapy].

The aim of the study was to assess the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and inflammatory markers in patients with congestive heart failure (CHF) treated with cardiac resynchronization therapy (CRT). 97 patients (age 54.9+/-9.9 years; 87% men) with implanted CRT devices (median period after implantation 19.9+/-19.3 months) were enrolled. According to NT-proBNP level patients were divided into tertiles: first (n=36) - less than 848 pg/ml, second (n=29) - from 848 to 2936 pg/ml, and third (n=32) - more than 2936 pg/ml. We didnt find a relationship between inflammatory mediators, NT-probNP level and time after implantation. In the total group NT-proBNP significantly correlated with structural and functional parameters of the heart. In the first group in comparison with the third group levels of IL-6 were lower (pI-III=0.019) and levels of IL-l - higher (pI-III=0.006). IL-10, CRP, TNF- did not differ between groups. In the first group IL-l straightly correlated with IL-6, TNF- , IL-10 and left ventricular ejection fraction (LVEF), in the third group IL-6 straightly correlated with CRP, while correlation of IL-l with LVEF became negative. We suppose that in patients with mild HF IL-l can play an adaptive role. High levels of IL-6, CRP probably can be used as markers of CHF progression in patients treated with CRT.

[Antioxidant vitamins and age-related retinal dystrophy]. / Vitaminy antioksidantnogo deistviia i vozrastnaia distrofiia setchatki.

Importance of free radical oxidation in development of age-dependent dystrophy of retina was studied. The newly developed hypothesis of the disease pathogenesis suggests that an increase in the rate of photosensitized free radical oxidation occurred in retina tissue due to a deficiency in reduction equivalents in these patients as well as to a lack of exogenous antioxidants. Complexes of vitamins-antioxidants were advanced for treatment of the patients with sclerotic maculodystrophy.

[The seasonal dynamics of the indices of the oxidative-reductive processes in the erythrocytes of healthy subjects of different ages]. / Sezonnaia dinamika pokazatelei okislitel'no-vosstanovitel'nykh protsessov v éritrotsitakh zdorovykh liudei razlichnogo vozrasta.

A study is reported of the dynamics of the activity of enzymes markers of different metabolic ways--glycolysis, pentosophosphate cycle, gluconeogenesis--in erythrocytes of 157 practically healthy subjects in two age groups: from 20 to 35 years and from 35 to 60 years. It was shown that seasonal biorhythms of the above values that were definite in the young changed with age. These findings suggest the necessity of a chronobiological approach to research and clinico-laboratory investigations.

[Redox processes in the retina and tunic tissues of the rat eye in experimental alkalosis]. / Okislitel'no-vosstanovitel'nye protsessy v tkaniakh setchatki i sosudistoi obolochki glaza krys pri éksperimental'nom alkaloze.

It is shown in experiments is vivo that development of experimental metabolic alkalosis in rats is followed by changes in redox processes in the eye retina and tunic. For the first two months of the experiment the number of sulphydryl group decreases, while that of disulphide ones of water-soluble proteins and low-molecular compounds increases. The amount of oxidized metabolites of glycolysis and of a cycle of tricarboxylic acids (pyruvate, oxaloacetate, alpha-ketoglutarate) increases relative to the reduced ones (lactate, isocitrate, malate), as well as activities of hexokinase, pyruvate kinase, NAD-dependent malate dehydrogenase, while activities of fructose diphosphatase, glucoso-6-phosphate dehydrogenase, glutathione peroxidase and glutathione reductase fall. The content of malonic dialdehyde increases. 90 days later disorders of certain compensatory mechanisms of the metabolic system of alkalosis regulation probably occurred in the eye retina and tunic tissues: hexokinase and pyruvate kinase activity fell to the control values, while that of NAD-dependent malate dehydrogenase--below the control level; the content of lactate increased. Activity of glutathione-dependent enzymes remained low and the amount of malonic dialdehyde grew much more than in the previous terms.

[Visual work capacity with different sources of illumination]. / Zritel'naia rabotosposobnost' pri razlichnykh istochnikakh osveshcheniia.

The state of visual working capacity was comparatively investigated under conditions of natural light and artificial light using different sources of light (filament lamps, luminescent, sodium, mercury-arc lamps). It was found that sodium lamps were most adequate for high functional capacity of the visual analyzer.

[Retinal function under conditions of artificial illumination with varying spectral makeup in patients with sclerotic macular dystrophy]. / Funktsional'noe sostoianie setchatki u bol'nykh skleroticheskoi makulodistrofiei v usloviiakh iskusstvennogo osveshcheniia razlichnogo spektral'nogo sostava.

In conditions of a laboratory experiment using illumination of various light sources (by incandescent, luminescent, arc-mercury, natrium lamps), determination of visual acuity, visual field, color perception, restoration time of visual acuity after macular flash lighting (photostress test), Heidinger's phenomenon as well as visocontrastometry after V. V. Volkov, Weston's correction test were conducted in 46 patients (92 eyes) with macular dystrophy and 50 healthy persons in the dynamics of a working day. It was found that the spectral composition of the visible light has a remarkable influence on the function of color perception, contrast sensitivity, reaction of visual analyser on light load, visual ability to work. In patients with macular dystrophy, the dependence on the light medium was expressed much greater than in healthy persons. The highest functional state of the retina and visual ability to work in patients with macular dystrophy were provided by natrium lamps having a maximum radiation in the yellow part of the spectrum. The short-wave visible light of arc-mercury and luminescent lamps somewhat suppressed the functional state of the retina and reduced visual ability to work. The results obtained are important for selection of optimal conditions of work for patients with macular dystrophy.