[Can a lipophilic statin improve the treatment of heart failure with preserved ejection fraction in patients with hypertension and obesity?]

AIM: To evaluate the effect of pleiotropic (anti-inflammatory and antifibrotic) effects of a lipophilic statin (atorvastatin) in the treatment of heart failure (HF) with preserved left ventricular (LV) ejection fraction (HFpEF)Material and methods. This observational study included 80 patients with HFpEF; 40 of them received atorvastatin 20-80 mg/day in addition to a standard treatment. 40 patient who refused of the statin treatment or had intolerance of the drug received only the standard treatment. The follow-up period was 12 months and included 5 visits. At the visits, the general condition of patients was evaluated; electrocardiography and echocardiography were performed at rest and during dosed physical exercise (PE); anthropometry was analyzed; and office blood pressure (BP), heart rate (HR) and parameters of systolic and diastolic LV function were recorded. RESULTS: Among the patients included into the study, women aged 60-70 years prevailed who had pronounced obesity (n=46; 57.5% with class II-II obesity), severe arterial hypertension (AH) (n=65; 81.2% with grade 3 hypertension), dyslipidemia, type 2 diabetes mellitus, and chronic kidney disease. The administration of atorvastatin in addition to standard therapy was associated with regression of HF symptoms and increased PE tolerance; these effects were more pronounced after 6 months of observation. Furthermore, during a 12-month follow-up, significant multidirectional changes in LV global longitudinal strain were noted; in the main group, the LV global longitudinal strain increased indicating an improvement in the LV systolic function while in the control group, it decreased reflecting early, preclinical manifestations of HF progression. A diastolic stress test in combination with a cardiopulmonary stress test was performed in 64 patients with HFpEF at enrollment and at 6 and 12 months of follow-up. When the load reached 50 W in the atorvastatin treatment group after 12 months, a significant increase in tissue Doppler velocity parameters was revealed, specifically in e' septal and e' lateral. This led to a significant decrease in the E / e' ratio while in the control group, no time-related changes in these parameters were noted. Similar changes were also detected at higher levels of PE. CONCLUSION: Long-term use of the lipophilic statin (atorvastatin) in addition to a standard therapy was associated with regression of clinical manifestations of HFpEF, provided preservation of the systolic function, and some improvement in the LV diastolic function both at rest and during dosed PE.

[Focus ultrasound for cardiology practice. Russian consensus document].

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.

[The use of diuretics in chronic heart failure. Position paper of the Russian Heart Failure Society].

The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.

[The role of diastolic transthoracic stress echocardiography with incremental workload in the evaluation of heart failure with preserved ejection fraction: indications, methodology, interpretation. Expert consensus developed under the auspices of the National Medical Research Center of Cardiology, Society of Experts in Heart Failure (SEHF), and Russian Association of Experts in Ultrasound Diagnosis in Medicine (REUDM)].

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.

[Clinical Capabilities and Limitations in the Use of Modern Technologies in Echocardiography].

Transthoracic echocardiography is the most frequently used method for detection of impaired contractility of the left ventricle. In most cases, assessment of contractility is carried out visually "by eye", what increases its subjectivity, is operator-dependent in nature and requires a high level of clinical training and experience of the researcher. Currently in the arsenal of a specialist in echocardiography for quantification of left ventricular contractility sometimes is used tissue Doppler echocardiography, however, this method requires special settings of the image (high frame rate, the allocation of zones of interest), depends on the scanning angle and on operator qualification, has high intra - and inter-operator variability, and significantly increases the duration of the study. Therefore, this method has not received wide clinical application. In the 2000s years an innovative technique of speckle tracking emerged, which, unlike tissue Doppler echocardiography is efficient, does not burden a researcher with time costs, has a low intra - and inter- operator variability, does not depend on scan angle. In recent years, this technology is actively implemented in clinical practice for detection of subclinical impairment of the functional state of the myocardium in different diseases and syndromes: arterial hypertension, ischemic heart disease, valvular defects, and congenital heart disease, heart failure, cardiomyopathy of different etiology.

[Position Paper. The role of iron deficiency in patients with chronic heart failure and current corrective approaches].

.

[Obesity in metabolic syndrome, as well as kidney dysfunction]. / Ozhirenie pri metabolicheskom sindrome i pochechnaia disfunktsiia.

The presence of metabolic syndrome (MS) in a patient allows him to be assigned to a group at high risk for atherosclerosis, cardiovascular events, coronary heart disease, and type 2 diabetes mellitus. In addition, MS negatively affects not only the heart and vessels, but also kidney function, which leads to chronic kidney disease (CKD). MS is pathogenetically associated with CKD and is an independent prognostic factor of the development of the latter, namely, the involvement of the kidney frequently determines prognosis and quality of life in these patients. The paper gives a modern view on the concept of MS and CKD and considers its main diagnostic criteria, etiology, and pathogenesis. The study of the relationships between MS and CKD may suggest that the high prevalence of kidney dysfunction in the general population is largely determined by metabolic nephropathies, including obesity-related nephropathy. The identification of risk factors and poor prognostic markers in this category of patients seems to be extremely important for the early diagnosis of the disease and their timely elimination is one of the main approaches to the comprehensive prevention of CKD in these patients.