[Decompensation of Heart Failure in "Fragile" Patients: Clinical Features and Approaches to Therapy].

AIM: To evaluate the impact of frailty syndrome (FS) on the course of acute decompensated heart failure (ADHF) and the quality of drug therapy before discharge from the hospital in patients with reduced and moderately reduced left ventricular ejection fraction (LVEF). MATERIAL AND METHODS: This open prospective study included 101 patients older than 75 years with reduced and mid-range LVEF hospitalized for decompensated chronic heart failure (CHF). FS was detected during the outpatient follow-up and identified using the Age is Not a Hindrance questionnaire, the chair rise test, and the One Leg Test. The "fragile" group consisted of 54 patients and the group without FS included 47 patients. Clinical characteristics of patients were compared, and the prescribing rate of the main drugs for the treatment of CHF was assessed upon admission to the hospital. The sacubitril/valsartan or dapagliflozin therapy was initiated in the hospital; prescribing rate of the quadruple therapy was assessed upon discharge from the hospital. Patients with reduced LVEF were followed up for 30 days, and LVEF was re-evaluated to reveal possible improvement due to optimization of therapy during hospitalization. Statistical analysis was performed with the SPSS 23.0 software. RESULTS: The main causes for decompensation did not differ in patients of the compared groups. According to the correlation analysis, FS was associated with anemia (r=0.154; p=0.035), heart rate ≥90 bpm (r=0.185; p=0.020), shortness of breath at rest (r =0.224; p=0.002), moist rales in the lungs (r=0.153; p=0.036), ascites (r=0.223; p=0.002), increased levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) (r= 0.316; p<0.001), hemoglobin concentration <120 g / l (r=0.183; p=0.012), and total protein <65 g / l (r=0.153; p=0.035) as measured by lab blood tests. Among patients with LVEF ≤40 % in the FS group (n=33) and without FS (n=33), the quadruple therapy was a part of the treatment regimen at discharge from the hospital in 27.3 and 3.0 % of patients, respectively (p=0.006). According to the 30-day follow-up data, improvement of LVEF was detected in 18.2% of patients with LVEF ≤40% in the FS group and 12.1% of patients with LVEF ≤40% in the FS-free group (p=0.020). In patients with LVEF 41-49 % in the FS (n=21) and FS-free (n=14) groups, the prescribing rate of the optimal therapy, including sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, no statistically significant differences were detected (14.3 and 7.1 %, respectively; p=0.515) at discharge from the hospital. CONCLUSION: Patients with ADHF and FS showed more pronounced clinical manifestations of decompensation, anemia, heart rate ≥90 beats/min, and higher levels of NT-proBNP upon admission. The inpatient therapy with sacubitril/valsartan or dapagliflozin was more intensively initiated in FS patients with reduced LVEF. An individualized approach contributed to achieving a prescribing rate of sacubitril/valsartan of 39.4%, dapagliflozin of 39.4%, and quadruple therapy of 27.3% upon discharge from the hospital.

[Echocardiographic Diagnostics of Heart Tumors].

The article focuses on ultrasound diagnosis of cardiac tumors (CT). In recent time, the frequency of detecting cardiac neoplasm has been growing. Correct diagnosis at an early stage of the process would allow timely treatment. Before the introduction of two-dimensional echocardiography (EchoCG), life-time diagnosis of CT was very rare. This article describes major echocardiographic criteria for most common benign, malignant, and metastatic CTs. The article is illustrated with original echocardiographic images.

[Atrial Fibrillation After Coronary Artery Bypass Surgery: Risk Factors, Prevention and Treatment].

This review focuses on the issue of atrial fibrillation (AF) following coronary bypass surgery in patients with ischemic heart disease. Risk factors of this complication are discussed in detail. The authors addressed the effect of diabetes mellitus on development of postoperative AF. Data on current methods for prevention and treatment of AF are provided.

[The effectiveness of radiofrequency ablation and repeated cardioversion in combination with antiarrhythmic drug therapy in maintaining stable sinus rhythm in patients with atrial fibrillation and heart failure].

Aim To compare the efficacy of radiofrequency ablation (RFA) and antiarrhythmic therapy (AAT) in patients with atrial fibrillation (AF) and chronic heart failure (CHF) during 12-month observation.Materials and methods This prospective, nonrandomized comparative observational study included 130 patients with AF (men, 65 %; mean age, 62.8±11.8 years) and CHF with left ventricular ejection fraction (LV EF) <50 %. Paroxysmal AF was observed in 60 (46 %) patients and persistent AF was observed in 70 (54 %) patients. According to results of transthoracic echocardiography (EchoCG) 107 (82 %) patients had intermediate LV EF (40-49 %) and 23 (18 %) patients had reduced LV EF (<40 %). RFA of AF was performed for 65 patients whereas 65 patients received an optimal AAT. The 24-h electrocardiogram monitoring, EchoCG, and assessment of the quality of life (QoL) with the SF-36 questionnaire were performed for all patients on admission and at 12 months of observation. Stability of sinus rhythm, EchoCG, QoL, and exercise tolerance were evaluated at 12 months of observation.Results 49 (75%) of patients in the RFA group and 26 (40%) of patients in the AAT group had stable sinus rhythm (SR) at 12 months. Repeated RFA for relapse of AF was performed for 6 (12 %) of 49 patients; repeated cardioversion was performed for 16 (61.5 %) of 26 patients. In the AAT group, there were more interventions for maintaining SR than in the RFA group (p<0.001). In patients with SR of the RFA group at 12 months of observation, LV EF was increased (р<0.001), left ventricular dimension (р<0.001) and volume (р<0.001) were decreased, and mental (р<0.001) and physical (p<0.001) components of health were improved according to the SF-36 questionnaire. In patients with SR of the AAT group, only improvement of mental (р<0.001) and physical (р<0.001) components of health was observed according to the SF-36 questionnaire.Conclusion RFA provided a considerable decrease in the frequency of AF relapse and improvement of LV EF in patients with CHF. The effectiveness of RFA did not depend on the type of arrhythmia. For 12 months of observation, the number of hospitalizations for decompensated CHF and interventions to maintain SR decreased in the RFA group compared to the AAT group.

[The Efficacy of Rivaroxaban in Reducing the Risk of Cardiovascular Events in Patients with Stable Ischemic Heart Disease and Peripheral Disease. Results of the COMPASS Trial].

The article considers modern approaches to the secondary prevention of cardiovascular events in patients with stable ischemic heart disease (IHD) and / or atherosclerosis of peripheral arteries (peripheral artery disease - PAD) with the oral anticoagulant rivaroxaban. The results of the first international prospective phase III study COMPASS for the evaluation of efficacy and safety of rivaroxaban including 27 395 patients with stable IHD or PAD, are discussed. The results of the study were presented at European Congress of Cardiology 2017. Rivaroxaban reduced of the risk of cardiovascular death, stroke and myocardial infarction by 24 %. The results of the study confirm the positive balance of risk / benefit and supplement the previously obtained data on the efficacy of rivaroxaban in patients with cardiovascular diseases.

[Prevention of Cardiovascular Complications in Patients With Arterial Hypertension While Use of Angiotensin II Receptor Antagonists. Possibilities of Candesartan].

The article demonstrates advantages of angiotensin II receptor antagonists in treatment of arterial hypertension (AH). Subjects for consideration are evidences of antihypertensive efficacy of candesartan and possibilities of the product in prevention of cardiovascular complications in patients with AH.

[Modern Approaches to Prevention of Thromboembolic Complications in Patients With Nonvalvular Atrial Fibrillation With a Direct Thrombin Inhibitor Dabigatran].

RESULTS: of recently completed clinical studies and preliminary results of still ongoing studies that support safety and efficacy of dabigatran in patients with nonvalvular atrial fibrillation are under discussion in this article. Currently available data on clinical use of a specific dabigatran antidote idarucizumab are also presented.

[The Possibility of Using Myocardial Cytoprotector Tiotriazoline in Cardiology Practice].

The improvement of approaches to the treatment of cardiovascular diseases is considered the number of primary concerns of modern cardiology. It is undoubtable that the main achievements of the last few decades are creation and introduction into clinical practice of metabolic drugs, which mechanism of action is assotiated with influence on basic pathogenesis of cardiovascular diseases. Myocardial cytoprotector tiotriazoline is one of the most active agents of this class of drugs. The medication shows antiischemic, antioxidant, membrane stabilizing and immunomodulatory effects. Results of experimental and clinical investigations performed by nowdays have demonstrated safety and efficacy of Tiotriazoline, especially in treatment of coronary heart disease.

[New Evidence of Efficacy and Safety of Rivaroxaban in Routine Clinical Practice].

The article contains results of two studies assessing efficacy and safety of rivaroxaban in routine clinical practice which were presented at European Congress of Cardiology 2015. These studies (recently completed XANTUS and ongoing post-marketing safety surveillance study in the United States) in total included more than 45 000 patients from Europe, Russia, Canada and the United States.

[Repetitive hospitalizations of patients with chronic heart failure according to data of one year follow-up study].

Patients with chronic heart failure (CHF) represent a group with high risk of repetitive hospitalizations. In order to assess frequency of repetitive hospitalizations and elucidate their risk factors we included in this study 962 patients with stage IIA-III and functional class II-IV CHF hospitalized in a multiprofile hospital once or repeatedly during 1 year. Rate of rehospitalizations during 1 year was 59%. The following factors of risk of rehospitalizations were revealed: admission because of progression of CHF, history of myocardial infarction, atrial fibrillation, systolic left ventricular dysfunction, hyperuricemia, and hyperglycemia.

[Brain natriuretic peptide as marker and factor of prognosis in chronic heart failure].

The role of natriuretic peptides in pathogenesis of chronic heart failure (CHF) is reviewed. Main attention is given to significance of measurement of brain natriuretic peptide in the following clinical situations related to CHF: diagnosis of CHF, screening of patients with symptomless left ventricular dysfunction, differential diagnosis of edematous syndrome, indications to therapy and monitoring of its effectiveness, assessment of long term prognosis of patients with CHF. Possibilities of curative use of natriuretic peptides and inhibitors of vasopeptidases are also discussed.