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1.
Kardiologiia ; 61(7): 4-13, 2021 Jul 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34397336

RESUMO

Aim    Optimal combination therapy for chronic heart failure (CHF) currently implies the mandatory use of at least four classes of drugs: renin-angiotensin-aldosterone (RAAS) system inhibitors or angiotensin receptor blocker neprilysin inhibitors (ARNI); beta-adrenoblockers (BAB); mineralocorticoid receptor antagonists; and sodium-glucose cotransporter 2 inhibitors. Furthermore, many of these drugs are able to decrease blood pressure even to hypotension and alleviate tachycardia. This study focused on the relationship of 24-h blood pressure (BP) and heart rate (HR) with the prognosis for CHF patients with sinus rhythm and left ventricular ejection fraction (LV EF) <50 % as well as on suggesting possible variants of safe therapy for CHF depending on the combination of studied factors.Material and methods    Effects of clinical data, echocardiographic parameters, 24-h BP, and heart rhythm (data from 24-h BP and ECG monitors) on the prognosis of 155 patients with clinically pronounced CHF, LV EF <50 %, and sinus rhythm who were followed up for 5 years after discharge from the hospital.Results    The one-factor analysis showed that the prognosis of CHF patients was statistically significantly influenced by the more severe functional class (FC) III CHF compared to FC II, reduced LV EF (<35 %), a lower 24-h systolic BP (SBP) (<103 mm Hg), the absence of hypotensive episodes in daytime, a low variability of nighttime BP (<7.5 mm Hg), a higher 24-h HR (>71 bpm vs. <60 bpm), the absence of therapy with RAAS inhibitors + BAB, and a lower body weight index. The multi-factor analysis showed that more severe CHF FC, lower LV EF, and the absence of RAAS inhibitors + BAB therapy retained the influence on the prognosis. After eliminating the influencing factor of drug therapy, also a low SBP variability significantly influenced the prognosis. An additional analysis determined the following four groups of CHF patients with reduced heart systolic function according to mean 24-h HR and SBP: the largest group (38.1 % of all patients) with controlled HR (≤69 bpm), preserved SBP (>103 mm Hg), and the lowest death rate of 15.3 %; the group with increased HR (>69 bpm) but preserved SBP (30.3 % of all patients) where the death rate was 44.7 %, which was significantly higher than in the first group; the group with normal HR (≤69 bpm) but reduced SBP (≤103 mm Hg) (16.1 % of patients) where the death rate was 40 %, which was comparable with the second group and significantly worse than in the first group; and the group with both increased HR (>69 bpm) and reduced SBP (≤103 mm Hg) (15.5 % of patients), which resulted in the maximal risk of death (70.8 % of patients with CHF and LV EF <50 %), which was significantly higher than in the three other groups.Conclusion    Low SBP (including 24-h SBP with reduced variability in day- and nighttime) in combination with high HR (including by data of Holter monitoring), low LV EF, more severe clinical course of CHF, and the absence of an adequate treatment with neurohormonal modulators (RAAS inhibitors and BAB) significantly increased the risk of death. Isolating four types of FC II-III CHF with sinus rhythm and EF <50% based on the combination of HR and BP identifies patients with an unfavorable prognosis, which will help developing differentiated therapeutic approaches taking into account clinical features.


Assuntos
Insuficiência Cardíaca , Função Ventricular Esquerda , Pressão Sanguínea , Insuficiência Cardíaca/tratamento farmacológico , Frequência Cardíaca , Humanos , Prognóstico , Volume Sistólico
2.
Kardiologiia ; 61(6): 4-10, 2021 Jul 01.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34311683

RESUMO

Major principles for treatment of chronic heart failure with reduced left ventricular ejection fraction <40% (HFrEF) include a "triple neurohormonal blockade" as a main approach. However, in recent 6 years, two new classes of drugs for the treatment of HFrEF have appeared, which beneficially influence the prognosis. These drugs are angiotensin receptor neprilysin inhibitors (ARNI) and type 2 sodium-glucose cotransporter 2 (SGLT2) inhibitors.Aim    To compare the net effect of simultaneous treatment with ARNI and SGLT2 inhibitors with the triple neurohormonal blockade in stable or decompensated patients with CHF based on Russian data.Material and methods    We analyzed the risk of death per 100 patient-years in patients with HFrEF. Stable patients were followed up at the A.L. Myasnikov Institute of Cardiology (presently, A.L. Myasnikov Research Institute of Clinical Cardiology of the National Medical Research Center of Cardiology) from 2006 through 2007; data from the EPOCH-Decompensation-CHF study were used for decompensated patients (12.2 % and 36.8 %, respectively).Results    When patients with stable HFrEF were successively switched from renin-angiotensin-aldosterone system (RAAS) inhibitors to ARNI (-16 %) and subsequently supplemented with SGLT2 (-13 %) the risk of death per 100 patient-years decreased from 12.2 % to 8.9 % (total risk decreased by 27 %; to save one patient the ARNI+ SGLT2 combination has to be prescribed to 30 patients). The estimated risk of death upon discharge from the hospital for the patients with decompensated CHF switched from RAAS inhibitors to ARNI (-16 %) and subsequently supplemented with SGLT2 (-13 %) was 26.9 deaths per 100 patient-years, whereas the number of patients to be treated for saving one life was only 10. Based on available data that demonstrate a greater effect of ARNI+ SGLT2 in patients immediately after CHF aggravation, the risk of death was recalculated. According to this analysis, the death rate per 1000 patient-years decreased from 36.8 to 19.9 % (relative risk decrease, 46 %), and to save one life only 6 patients had to be treated after they have achieved compensation of HFrEF.Conclusions    This analysis shows the importance of early initiation of the ARNI+ SGLT2 therapy in patients with both decompensated and with stable HFrEF.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Insuficiência Cardíaca , Neprilisina , Inibidores do Transportador 2 de Sódio-Glicose/uso terapêutico , Angiotensinas , Glucose , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Neprilisina/antagonistas & inibidores , Prognóstico , Federação Russa , Sódio , Volume Sistólico , Função Ventricular Esquerda
3.
Kardiologiia ; 61(5): 79-81, 2021 May 31.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34112079

RESUMO

On December 18, 2020, an expert council was held with the participation of members of the Russian Society of Cardiology, the Eurasian Association of Ther-apists, the National Society for Atherothrombosis, the National Society for Evi-dence-Based Pharmacotherapy, and the Russian Heart Failure Society. The event was devoted to the discussion of the correct use of research data of "real clinical practice" in decision making.


Assuntos
Cardiologia , Insuficiência Cardíaca , Insuficiência Cardíaca/diagnóstico , Humanos , Federação Russa , Sociedades Médicas
4.
Kardiologiia ; 61(4): 4-14, 2021 Mar 23.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33998403

RESUMO

Aim    To study the etiology and the dynamics of prevalence and mortality of CHF; to evaluate the treatment coverage of such patients in a representative sample of the European part of the Russian Federation for a 20-year period. Material and methods    A representative sample of the European part of the Russian Federation followed up for 2002 through 2017 (n=19 276); a representative sample of the population of the Nizhny Novgorod region examined in 1998 (n=1922).Results    During the observation period since 2002, the incidence of major CHF symptoms (tachycardia, edema, shortness of breath, weakness) tended to decrease while the prevalence of cardiovascular diseases has statistically significantly increased. During the period from 1998 through 2017, the prevalence of I-IV functional class (FC) CHF increased from 6.1 % to 8.2 % whereas III-IV FC CHF increased from 1.8 % to 3.1 %. The main causes for the development of CHF remained arterial hypertension and ischemic heart disease; the role of myocardial infarction and diabetes mellitus as causes for CHF was noted. For the analyzed period, the number of treatment components and the coverage of basic therapy for patients with CHF increased, which probably accounts for a slower increase in the disease prevalence by 2007-2017. The prognosis of patients was unfavorable: in I-II FC CHF, the median survival was 8.4 (95 % CI: 7.8-9.1) years and in III-IV FC CHF, the median survival was 3.8 (95 % CI: 3.4-4.2) years.


Assuntos
Diabetes Mellitus , Insuficiência Cardíaca , Doença Crônica , Seguimentos , Insuficiência Cardíaca/epidemiologia , Humanos , Federação Russa/epidemiologia
5.
Kardiologiia ; 61(4): 73-78, 2021 May 03.
Artigo em Russo | MEDLINE | ID: mdl-33998412

RESUMO

In recent years there has been significant interest in treating iron deficiency (ID) in patients with heart failure (HF) due to its high prevalence and detrimental effects in this population. As stated in the 2020 Russain HF guidelines, Intravenous ferric carboxymaltose remains the only proven therapy for ID.This document was prompted by the results from the recent AFFIRM-AHF trial which demonstrates that treatment of ID after acute HF decompensation reduces the risk of future decompensations. Experts have concluded that in HF patients with acute decompensation, a left ventricular ejection fraction of < 50% and ID, Intravenous ferric carboxymaltose reduces future HF hospitalisations. Patients with stable HF may also benefit from treatment of ID to improve quality of life and alleviate symptoms.  It is, therefore, reasonable to screen for and treat ID in patients with HF.


Assuntos
Anemia Ferropriva , Insuficiência Cardíaca , Anemia Ferropriva/tratamento farmacológico , Consenso , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Ferro , Qualidade de Vida , Volume Sistólico , Função Ventricular Esquerda
6.
Kardiologiia ; 61(2): 28-39, 2021 Mar 02.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734044

RESUMO

Actuality One of the most widely discussed treatments for patients with COVID-19, especially at the beginning of the epidemy, was the use of the antimalarial drug hydroxychloroquine (HCQ). The first small non-randomized trials showed the ability of HCQ and its combination with azithromycin to accelerate the elimination of the virus and ease the acute phase of the disease. Later, large, randomized trials did not confirm it (RECOVERY, SOLIDARITY). This study is a case-control study in which we compared patients who received and did not receive HCQ.Material and Methods 103 patients (25 in the HCQ treatment group and 78 in the control group) with confirmed COVID-19 (SARS-CoV-2 virus RNA was detected in 26 of 73 in the control group (35.6%) and in 10 of 25 (40%) in the HCQ group) and in the rest - a typical picture of viral pneumonia on multislice computed tomography [MSCT]) were included in the analysis. The severity of lung damage was limited to stages I-II, the CRP level should not exceed 60 mg/dL, and oxygen saturation in the air within 92-98%. We planned to analysis the duration of treatment of patients in the hospital, the days until the normalization of body temperature, the number of points according to the original SHOCS-COVID integral scale, and changes in its components (C-reactive protein (CRP), D-dimer, and the percentage of lung damage according to MSCT).Results Analysis for the whole group revealed a statistically significant increase in the time to normalization of body temperature from 4 to 7 days (by 3 days, p<0.001), and the duration of hospitalization from 9.4 to 11.8 days (by 2.4 days, p=0.002) when using HCQ in comparison with control. Given the incomplete balance of the groups, the main analysis included 46 patients who were matched by propensity score matching. The trend towards similar dynamics continued. HCQ treatment slowed down the time to normalization of body temperature by 1.8 days (p=0.074) and lengthened the hospitalization time by 2.1 days (p=0.042). The decrease in scores on the SHOCS -COVID scale was statistically significant in both groups, and there were no differences between them (delta - 3.00 (2.90) in the HCQ group and - 2.69 (1.55) in control, p=0.718). At the same time, in the control group, the CRP level returned to normal (4.06 mg/dl), and with the use of GC, it decreased but remained above the norm (6.21 mg/dl, p=0.05). Side effects requiring discontinuation of treatment were reported in 3 patients in the HCQ group and none in the control group.Conclusion We have not identified any positive properties of HCQ and its ability to influence the severity of COVID-19. This antimalarial agent slows down the normalization of the body's inflammatory response and lengthens the time spent in the hospital. HCQ should not be used in the treatment of COVID-19.


Assuntos
COVID-19 , Infecções por Coronavirus , COVID-19/tratamento farmacológico , Estudos de Casos e Controles , Humanos , Hidroxicloroquina , SARS-CoV-2 , Resultado do Tratamento
7.
Kardiologiia ; 61(2): 15-27, 2021 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-33734043

RESUMO

Actuality The course of the novel coronavirus disease (COVID-19) is unpredictable. It manifests in some cases as increasing inflammation to even the onset of a cytokine storm and irreversible progression of acute respiratory syndrome, which is associated with the risk of death in patients. Thus, proactive anti-inflammatory therapy remains an open serious question in patients with COVID-19 and pneumonia, who still have signs of inflammation on days 7-9 of the disease: elevated C-reactive protein (CRP)>60 mg/dL and at least two of the four clinical signs: fever >37.5°C; persistent cough; dyspnea (RR >20 brpm) and/or reduced oxygen blood saturation <94% when breathing atmospheric air. We designed the randomized trial: COLchicine versus Ruxolitinib and Secukinumab in Open-label Prospective Randomized Trial in Patients with COVID-19 (COLORIT). We present here data comparing patients who received colchicine with those who did not receive specific anti-inflammatory therapy. Results of the comparison of colchicine, ruxolitinib, and secukinumab will be presented later.Objective Compare efficacy and safety of colchicine compared to the management of patients with COVID-19 without specific anti-inflammatory therapy.Material and Methods Initially, 20 people were expected to be randomized in the control group. However, enrollment to the control group was discontinued subsequently after the inclusion of 5 patients due to the risk of severe deterioration in the absence of anti-inflammatory treatment. Therefore, 17 patients, who had not received anti-inflammatory therapy when treated in the MSU Medical Research and Educational Center before the study, were also included in the control group. The effects were assessed on day 12 after the inclusion or at discharge if it occurred earlier than on day 12. The primary endpoint was the changes in the SHOCS-COVID score, which includes the assessment of the patient's clinical condition, CT score of the lung tissue damage, the severity of systemic inflammation (CRP changes), and the risk of thrombotic complications (D-dimer) [1].Results The median SHOCS score decreased from 8 to 2 (p = 0.017), i.e., from moderate to mild degree, in the colchicine group. The change in the SHOCS-COVID score was minimal and statistically insignificant in the control group. In patients with COVID-19 treated with colchicine, the CRP levels decreased rapidly and normalized (from 99.4 to 4.2 mg/dL, p<0.001). In the control group, the CRP levels decreased moderately and statistically insignificantly and achieved 22.8 mg/dL by the end of the follow-up period, which was still more than four times higher than normal. The most informative criterion for inflammation lymphocyte-to-C-reactive protein ratio (LCR) increased in the colchicine group by 393 versus 54 in the control group (p = 0.003). After treatment, it was 60.8 in the control group, which was less than 100 considered safe in terms of systemic inflammation progression. The difference from 427 in the colchicine group was highly significant (p = 0.003).The marked and rapid decrease in the inflammation factors was accompanied in the colchicine group by the reduced need for oxygen support from 14 (66.7%) to 2 (9.5%). In the control group, the number of patients without anti-inflammatory therapy requiring oxygen support remained unchanged at 50%. There was a trend to shorter hospital stays in the group of specific anti-inflammatory therapy up to 13 days compared to 17.5 days in the control group (p = 0.079). Moreover, two patients died in the control group, and there were no fatal cases in the colchicine group. In the colchicine group, one patient had deep vein thrombosis with D-dimer elevated to 5.99 µg/mL, which resolved before discharge.Conclusions Colchicine 1 mg for 1-3 days followed by 0.5 mg/day for 14 days is effective as a proactive anti-inflammatory therapy in hospitalized patients with COVID-19 and viral pneumonia. The management of such patients without proactive anti-inflammatory therapy is likely to be unreasonable and may worsen the course of COVID-19. However, the findings should be treated with caution, given the small size of the trial.


Assuntos
COVID-19 , Colchicina/uso terapêutico , Infecções por Coronavirus , SARS-CoV-2 , Anti-Inflamatórios/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Humanos , Estudos Prospectivos , Resultado do Tratamento
8.
Kardiologiia ; 60(12): 13-47, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522467

RESUMO

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.


Assuntos
Diuréticos , Insuficiência Cardíaca , Doença Crônica , Insuficiência Cardíaca/tratamento farmacológico , Humanos , Federação Russa
9.
Kardiologiia ; 60(12): 48-63, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522468

RESUMO

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.


Assuntos
Pesquisa Biomédica , Cardiologia , Insuficiência Cardíaca , Consenso , Ecocardiografia , Ecocardiografia sob Estresse , Teste de Esforço , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Federação Russa , Volume Sistólico , Função Ventricular Esquerda , Carga de Trabalho
10.
Kardiologiia ; 60(8): 4-15, 2020 Sep 07.
Artigo em Russo | MEDLINE | ID: mdl-33155953

RESUMO

The article focuses on effective treatment of the novel coronavirus infection (COVID-19) at early stages and substantiates the requirement for antiviral therapy and for decreasing the viral load to prevent the infection progression. The absence of a specific antiviral therapy for the SARS-CoV-2 virus is stated. The authors analyzed results of early randomized studies using lopinavir/ritonavir, remdesivir, and favipiravir in COVID-19 and their potential for the treatment of novel coronavirus infection. Among the drugs blocking the virus entry into cells, the greatest attention was paid to the antimalaria drugs, chloroquine and hydroxychloroquine. The article addresses in detail ineffectiveness and potential danger of hydroxychloroquine, which demonstrated neither a decrease in the time of clinical recovery nor any improvement of prognosis for patients with COVID-19. The major objective was substantiating a possible use of bromhexine, a mucolytic and anticough drug, which can inhibit transmembrane serin protease 2 required for entry of the SARS-CoV-2 virus into cells. Spironolactone may have a similar feature. Due to its antiandrogenic effects, spironolactone can inhibit X-chromosome-related synthesis of ACE-2 receptors and activation of transmembrane serin protease 2. In addition to slowing the virus entry into cells, spironolactone decreases severity of fibrosis in different organs, including the lungs. The major part of the article addresses clinical examples of managing patients with COVID-19 at the University Clinic of the Medical Research and Educational Centre of the M. V. Lomonosov Moscow State University, including successful treatment with schemes containing bromhexine and spironolactone. In conclusion, the authors described the design of a randomized, prospective BISCUIT study performed at the University Clinic of the M. V. Lomonosov Moscow State University with an objective of evaluating the efficacy of this scheme.


Assuntos
Bromoexina , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Espironolactona , Betacoronavirus , Bromoexina/uso terapêutico , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Hospitalização , Humanos , Moscou , Pneumonia Viral/tratamento farmacológico , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , SARS-CoV-2 , Espironolactona/uso terapêutico
11.
Kardiologiia ; 60(9): 4-21, 2020 Oct 05.
Artigo em Russo | MEDLINE | ID: mdl-33131470

RESUMO

The article is devoted to the treatment of the new coronavirus infection (COVID-19) in the advanced stages of the disease. The types of response of the immune system to the viral load of SARS-CoV-2 with the start of the inflammation process are considered. The situation is analyzed in detail in which the growing autoimmune inflammation (up to the development of a "cytokine storm") affects not only the pulmonary parenchyma, but also the endothelium of the small vessels of the lungs. Simultaneous damage to the alveoli and microthrombosis of the pulmonary vessels are accompanied by a progressive impairment of gas exchange, the development of acute respiratory distress syndrome, the treatment of which, even with the use of invasive ventilation, is ineffective and does not really change the prognosis of patients with COVID-19. In order to interrupt the pathological process at the earliest stages of the disease, the necessity of proactive anti-inflammatory therapy in combination with active anticoagulation treatment is substantiated. The results of the first randomized studies on the use of inhibitors of pro-inflammatory cytokines and chemokines (interleukin-6 (tocilizumab), interleukin-17 (secukinumab), Janus kinase blockers, through which the signal is transmitted to cells (ruxolitinib)), which have potential in the early treatment of COVID- 19. The use of a well-known anti-inflammatory drug colchicine (which is used for gout treatment) in patients with COVID-19 is considered. The design of the original COLORIT comparative study on the use of colchicine, ruxolitinib and secukinumab in the treatment of COVID-19 is presented. Clinical series presented, illustrated early anti-inflammatory therapy together with anticoagulants in patients with COVID-19 and the dangers associated with refusing to initiate such therapy on time.


Assuntos
Colchicina , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais Humanizados , Anticoagulantes/uso terapêutico , Betacoronavirus , COVID-19 , Colchicina/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Humanos , Estudos Prospectivos , Pirazóis , SARS-CoV-2
12.
Kardiologiia ; 60(10): 86-98, 2020 Nov 12.
Artigo em Russo | MEDLINE | ID: mdl-33228511

RESUMO

Aim Patients with heart failure with reduced left ventricular (LV) ejection fraction (HFrEF) who have had acute myocardial infarction have an unfavorable prognosis, largely due to ventricular arrhythmias (VA) and risk of sudden cardiac death (SCD). The optimal treatment (triple neurohormonal blockade plus implantable cardioverter defibrillator and cardiac resynchronization therapy) reduced the risk of SCD primarily due to reverse cardiac remodeling, but has not solved this problem completely. Efficacy of purified ω-3 polyunsaturated fatty acid esters (PUFA) in low doses (1 g/day) in reducing VA and risk of SCD in HFrEF patients was demonstrated in two large randomized clinical trials. The PUFA effects was suggested to be related also with increased heart rhythm variability (HRV) and chronotropic action, which might depend on the drug dose. The present open, prospective, randomized, comparative study in parallel groups evaluated the effect of Omacor in different doses on noninvasive markers of SCD risk in patients with ischemic HFrEF receiving the optimal drug therapy.Methods Patients (n=40) were randomized at a 1:1:2 ratio to the control group (n=10), the Omacor 1 g/day treatment group (n=10), and the Omacor 2 g/day treatment group (n=20) and were followed up for 12 months. Clinical evaluation included changes in the CHF functional class (FC) and Clinical Condition Scale (CCS) score; concentration of N-terminal pro-hormone brain natriuretic peptide (NT-proBNP); and peak oxygen consumption during exercise (peak VO2). The LV function was evaluated by LVEF. Holter ECG monitoring was used for evaluation of HRV (SDNN), average 24-h heart rate (HR), number of ventricular extrasystoles (VE) per hour and severity of VA, and presence of paired VE and VT runs.Results Improvement of CHF FC became significant only with the high-dose Omacor treatment (2 g/day). The CCS score showed a tendency towards decrease also with a lower dose (1 g/day) whereas the level of NT-proBNP significantly decreased with both Omacor doses. The increase in LV EF was significant only with the use of Omacor 2 g/day (+3 %, р=0.002). A negative chronotropic effect of ω-3 PUFA was observed. Average 24-h HR decreased by 8 bpm (р=0.05) and 11 bpm (р<0.001) with Omacor 1 g/day and 2 g/day, respectively. Either dose of ω-3 PUFA significantly improved VO2, which directly correlated with LV EF and inversely correlated with HR. The decrease in number of VE was associated not only with improved HRV (SDNN) but also with the decrease in 24-h HR, and thus Omacor 2 g/day significantly decreased the number of VE (by 16 per hour) and dangerous VA (paired VE and VT runs ceased to be detected in 40 % of patients).Conclusion Since HR, HRV, and VA are closely interrelated, the effect of ω-3 PUFA specifically on these noninvasive markers apparently determines its ability to decrease the risk of SCD in patients with ischemic HFrEF. The antiarrhythmic effect of Omacor was greater with higher doses of this drug.


Assuntos
Morte Súbita Cardíaca , Ácidos Graxos Ômega-3 , Insuficiência Cardíaca , Arritmias Cardíacas/etiologia , Morte Súbita Cardíaca/etiologia , Morte Súbita Cardíaca/prevenção & controle , Ésteres , Ácidos Graxos Ômega-3/uso terapêutico , Insuficiência Cardíaca/complicações , Humanos , Estudos Prospectivos , Volume Sistólico
13.
Kardiologiia ; 60(6): 15-29, 2020 07 07.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-32720612

RESUMO

Introduction Coronavirus pneumonia not only severely affects the lung tissue but is also associated with systemic autoimmune inflammation, rapid overactivation of cytokines and chemokines known as "cytokine storm", and a high risk of thrombosis and thromboembolism. Since there is no specific therapy for this new coronavirus infection (COVID-19), searching for an effective and safe anti-inflammatory therapy is critical.Materials and methods This study evaluated efficacy and safety of pulse therapy with high doses of glucocorticosteroids (GCS), methylprednisolone 1,000 mg for 3 days plus dexamethasone 8 mg for another 3-5 days, in 17 patients with severe coronavirus pneumonia as a part of retrospective comparative analysis (17 patients in control group). The study primary endpoint was the aggregate dynamics of patients' condition as evaluated by an original CCS-COVID scale, which included, in addition to the clinical status, assessments of changes in the inflammation marker, C-reactive protein (CRP); the thrombus formation marker, D-dimer; and the extent of lung injury evaluated by computed tomography (CT). Patients had signs of lung injury (53.2 % and 25.6 %), increases in CRP 27 and 19 times, and a more than doubled level of D-dimer (to 1.41 µg/ml and 1.15 µg/ml) in the active therapy and the control groups, respectively. The GCS treatment group had a more severe condition at baseline.Results The GCS pulse therapy proved effective and significantly decreased the CCS-COVID scores. Median score difference was 5.00 compared to the control group (р=0.011). Shortness of breath considerably decreased; oxygen saturation increased, and the NEWS-2 clinical status scale scores decreased. In the GCS group, concentration of CRP significantly decreased from 134 mg/dl to 41.8 mg/dl (р=0.009) but at the same time, D-dimer level significantly increased from 1.41 µg/ml to 1.98 µg/ml (р=0.044). In the control group, the changes were nonsignificant. The dynamics of lung injury by CT was better in the treatment group but the difference did not reach a statistical significance (р=0.062). Following the GCS treatment, neutrophilia increased (р=0.0001) with persisting lymphopenia, and the neutrophil/lymphocyte (N/L) ratio, a marker of chronic inflammation, increased 2.5 times (р=0.006). The changes in the N/L ratio and D-dimer were found to correlate in the GCS pulse therapy group (r =0.49, p=0.04), which underlined the relationship of chronic autoimmune inflammation with thrombus formation in COVID-19. No significant changes were observed in the control group. In result, four patients developed venous thromboembolic complications (two of them had pulmonary artery thromboembolism) after the GCS pulse therapy despite the concomitant antiplatelet treatment at therapeutic doses. Recovery was slower in the hormone treatment group (median stay in the hospital was 26 days vs 18 days in the control group, р=0.001).Conclusion Pulse therapy with high doses of GCS exerted a rapid anti-inflammatory effect but at the same time, increased the N/L ratio and the D-dimer level, which increased the risk of thromboembolism.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Esteroides/efeitos adversos , Trombose Venosa , COVID-19 , Infecções por Coronavirus/tratamento farmacológico , Humanos , Inflamação , Pneumonia Viral/tratamento farmacológico , Estudos Retrospectivos , SARS-CoV-2 , Trombose Venosa/induzido quimicamente
14.
Kardiologiia ; 60(4): 4-9, 2020 Apr 08.
Artigo em Russo | MEDLINE | ID: mdl-32394850

RESUMO

The review addressed the relationship of coronavirus disease 2019 (COVID-19) with functioning of the renin-angiotensin-aldosterone axis and the causes for unfavorable prognosis depending on patients' age and comorbidities. The authors discussed in detail potential effects of angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists on the risk of infection and the course of COVID-2019 as well as the effect of SARS-COV2 virus on the cardiovascular system.


Assuntos
Antagonistas de Receptores de Angiotensina/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Aldosterona , Angiotensinas , COVID-19 , Comorbidade , Humanos , Pandemias , Renina , Sistema Renina-Angiotensina , SARS-CoV-2
15.
Kardiologiia ; 60(11): 35-41, 2020 Dec 05.
Artigo em Russo | MEDLINE | ID: mdl-33487148

RESUMO

Aim Development of a novel scale for assessing medical state in patients with new coronavirus infection based on clinical and laboratory disease severity's markers, named SHOKS-COVID scale.Material and Methods Clinical Assessment Scale (SHOKS-COVID) is based on1: clinical parameters (respiratory rate, Body temperature, SpO2 need and type of ventilation support) 2: Inflammation markers (C reactive protein (CRP) and prothrombotic marker (D-dimer)) and 3: percent of lungs injury by CT. This scale was used in several clinical studies in patients with varying severity of the course of the COVID 19. SHOKS-COVID scale was also compared against some additional biomarkers and with length of hospital stay.Results In patients with severe COVID-19 (Clinical Trial WAYFARER - 34 patients), SHOKS-COVID scores were correlated with the degree of inflammation: CRP (r = 0.64; p <0.0001); the ratio lymphocytes / CRP (r = - 0.64; p <0.0001). Also, SHOKS-COVID score correlated with the D-dimer (r = 0.35; p <0.0001) and percentage lung damage on multispiral computed tomography (MSCT) - (r = 0.77, p < 0.0001) and length stay in the clinic (r = 0.57, p = 0.0009). In patients with mild course (BISQUIT Study - 103 patients), SHOKS-COVID scores had a statistically significant positive correlation with length of fever (r = 0.37; p = 0.0002) and length of stay in the clinic (r = 0.52, p <0.0001) and negatively correlated with the ratio of lymphocytes / CRP (-0.78, p <0.0001) and the level of CRP (r=0.78; p <0.0001). Patents were grouped based on severity of COVID 19 and median and interquartile range (IQR) of SHOCKS-COVID were measured in these groups. Median and IQR of SHOCKS-COVID were 2.00 [1.0-2.5] points in mild course, 4.0 points [3.0-5.0] in moderate course, 7.0 points [6.0-9.0] in moderately severe course,12.0 points [10.0-14.0] in severe course of disease and 15.0 points [14.5-15.5] in extremely severe patients.Conclusion Here we report a novel scale of COVID 19 disease progression. This scale ranges from zero in asymptomatic patients (with normal range of biomarkers and without lung damage on CT) to fifteen in extremely severe patients. The scores for SHOKS-COVID are increasing, in parallel with the deterioration of all other biomarkers of severity and prognosis in patients with new coronavirus infection. Based on the analysis carried out, we were able to determine values of SHOKS-COVID scale and levels of main clinical and laboratory markers in patients with different severity of COVID 19.


Assuntos
COVID-19 , Infecções por Coronavirus , Hospitais , Humanos , Pacientes Ambulatoriais , Estudos Retrospectivos , SARS-CoV-2
16.
Kardiologiia ; 60(11): 4-15, 2020 12 03.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-33487145

RESUMO

Introduction The aim of this study was to assess the efficacy and safety of a combination of bromhexine at a dose of 8 mg 4 times a day and spironolactone 50 mg per day in patients with mild and moderate COVID 19.Material and methods It was an open, prospective comparative non-randomized study. 103 patients were included (33 in the bromhexine and spironolactone group and 70 in the control group). All patients had a confirmed 2019 novel coronavirus infection (COVID 19) based on a positive polymerase chain reaction (PCR) for SARS-CoV-2 virus RNA and/or a typical pattern of viral pneumonia on multispiral computed tomography. The severity of lung damage was limited to stage I-II, the level of CRP should not exceed 60 mg / dL and SO2 in the air within 92-98%. The duration of treatment is 10 days.Results The decrease in scores on the SHOKS-COVID scale, which, in addition to assessing the clinical status, the dynamics of CRP (a marker of inflammation), D-dimer (a marker of thrombus formation), and the degree of lung damage on CT (primary endpoint) was statistically significant in both groups and differences between them was not identified. Analysis for the group as a whole revealed a statistically significant reduction in hospitalization time from 10.4 to 9.0 days (by 1.5 days, p=0.033) and fever time from 6.5 to 3.9 days (by 2.5 days, p<0.001). Given the incomplete balance of the groups, the main analysis included 66 patients who were match with using propensity score matching. In matched patients, temperature normalization in the bromhexine/spironolactone group occurred 2 days faster than in the control group (p=0.008). Virus elimination by the 10th day was recorded in all patients in the bromhexine/spironolactone group; the control group viremia continued in 23.3% (p=0.077). The number of patients who had a positive PCR to the SARS-CoV-2 virus on the 10th day of hospitalization or longer (≥10 days) hospitalization in the control group was 20/21 (95.2%), and in the group with bromhexine /spironolactone -14/24 (58.3%), p=0.012. The odds ratio of having a positive PCR or more than ten days of hospitalization was 0.07 (95% CI: 0.008 - 0.61, p=0.0161) with bromhexine and spironolactone versus controls. No side effects were reported in the study group.Conclusion The combination of bromhexine with spironolactone appeared effective in treating a new coronavirus infection by achieving a faster normalization of the clinical condition, lowering the temperature one and a half times faster, and reducing explanatory combine endpoint the viral load or long duration of hospitalization (≥ 10 days).


Assuntos
Bromoexina , COVID-19 , Infecções por Coronavirus , Hospitalização , Humanos , Estudos Prospectivos , SARS-CoV-2 , Espironolactona , Resultado do Tratamento
17.
Kardiologiia ; 59(9S): 4-15, 2019 Sep 11.
Artigo em Russo | MEDLINE | ID: mdl-31644412

RESUMO

Actuality. High risk of hospitalisation and death in patients with heart failure highlight the importance of developing methods to moni­ tor weight, diuresis, heart rate and other parameters and provide the physicians with an ability to change the therapy immediately if needed. The aim of this work is an analysis of clinical trials which investigate telemonitoring in patients with heart failure. Discussion. The Cochrane meta-analysis is also discussed in this work. Main conclusions. Our analysis showed that there is no consistency among trials. Not all trials have demonstrated that telemonitoring can reduce the risk of death and heart failure hospitalisations. Potentials explanations are lack of compliance with systems which didn't include the direct contact between the patient and the caregivers, using parameters with low sensitivity in some of the methods and including of stable patients in some of the studies. It is also seeming that effect of telemonitoring is low in regions with existing programs to treat heart failure.


Assuntos
Insuficiência Cardíaca/diagnóstico , Monitorização Fisiológica , Telemedicina , Doença Crônica , Ensaios Clínicos como Assunto , Hospitalização , Humanos
18.
Kardiologiia ; 59(12S): 37-45, 2019 Nov 12.
Artigo em Russo | MEDLINE | ID: mdl-31995724

RESUMO

This pilot study was aimed to assess the percentage of patients admitted to a Russian hospital and diagnosed with heart failure with preserved ejection fraction (HFpEF) maintaining this diagnosis when evaluated against the ESC 2016 and Russian 2017 heart failure guidelines. In addition, we reviewed the probability of an HFpEF diagnosis when patients were assessed against the H2FPEF score. Forty-two patients (mean age 68 ±7,5) diagnosed with HFpEF on their discharge record, admitted between March 2018 and May 2018, were included. Twenty percent of patients did not meet Russian guideline criteria for HFpEF due to either the absence of symptoms and/or echocardiographic evidence of structural/functional abnormalities. Using the ESC 2016 guidelines (which required an elevation in NT Pro BNP) the diagnosis was confirmed in only 37% of patients, mostly due to the normal level of NTproBNP in 54.8% of those investigated. The probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by ESC 2016 criteria was 93% and without HFpEF by ESC 2016 criteria 68% (p = 0.054). In contrast, the probability of HFpEF by H2FPEF score in patients with dyspnea and HFpEF by Russian criteria was 84.4%.


Assuntos
Insuficiência Cardíaca , Idoso , Ecocardiografia , Humanos , Pessoa de Meia-Idade , Peptídeo Natriurético Encefálico , Fragmentos de Peptídeos , Projetos Piloto , Federação Russa , Volume Sistólico , Função Ventricular Esquerda
20.
Kardiologiia ; 58(12S): 18-26, 2018 Dec 26.
Artigo em Russo | MEDLINE | ID: mdl-30625105

RESUMO

AIM: To investigate the difference in characteristics of patients admitted to the Tomsk National Research Medical Center with a diagnosis of heart failure (HF) in 2002 and 2016. METHODS: Medical charts of all patients hospitalised in a single centre, with a diagnosis of HF, were included. Two three­month periods were compared from January 2002 (n=210) and January 2016 (n=378). RESULTS: Fewer patients with HF had symptoms or required diuretics in 2016 (63 % vs 98,6 %, p<0.001). During this period the percentage of patients with HFpEF increased from 58.6 % to 74.1 % (p=0.001) whereas those with HFrEF remained similar (19.5 % vs 14.0 %, p=0.1) and those with HFmrEF declined (21.9 % vs 11,9 %, p=0.007). In patients with HFrEF the prescription of ACEi / ARB remained similar (80.4 vs 88 %, p=0.3), beta­blockers increased from 68 to 85 % (p=0.03) and aldosterone antagonists from 9.7 to 49 % (p<0.001). CONCLUSION: Prescription rates for prognostic medications in HFrEF improved in 2016. The substantial percentage of patients diagnosed with HFpEF without symptoms or diuretic raises the question of whether a diagnosis of HF was appropriate in some cases.


Assuntos
Insuficiência Cardíaca , Hospitalização , Humanos , Antagonistas de Receptores de Mineralocorticoides , Prognóstico , Volume Sistólico
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