Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.

AIM: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program. MATERIAL AND METHODS: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system. RESULTS: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death. CONCLUSION: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

[Age aspects of arterial stiffness in patients with hypertension].

To study age aspects of arterial stiffness we examined 130 patients with hypertension who signed protocol of informed consent to participate in research, mean age 61,7±14,3 years. All the patients underwent ambulatory blood pressure monitoring by the standard method and were divided into four groups: 1st group - patients of young age (n=17), 2nd group - patients of middle age (n=36), 3rd - senior patients (n=52), 4th - elderly patients (n=25). In senior and elderly patients with hypertension arterial stiffness significantly increases comparing with younger patients resulting in an increase of the index of arterial stiffness and augmentation index.

[Factors associated with thrombosis of the left atrial appendage in patients with chronic atrial fibrillation].

This study was designed to elucidate hemostatic and genetic characteristics associated with thrombosis of the left atrial appendage (LAA) in patients with chronic atrial fibrillation (AF). It included 91 patients (mean age 62 ± 7.6 years) with coronary heart disease (CHD) and chronic AF. Group I was comprised of 63 patients without LAA thrombosis, group 2 contained 28 patients with LAA thrombosis diagnosed by transesophageal echocardiography. The following parameters were measured: soluble fibrin monomeric complex, fibrinogen, antithrombin, thrombin-activated fibrinolysis inhibitor levels and polymorphism of YP29, VKORC1, PAI-1 genes. Multifactor regression analysis revealed significant association of LAA thrombosis with thrombin-activated fibrinolysis inhibitor level in excess of 245%, the presence of CC genotype of the VKORC1 gene and 4G allele of the PAl-1 gene.