Combined Heart Injuries on the Data of Contrast-Enhanced Cardiac Magnetic Resonance Imaging in Patients With Post-Covid Syndrome.

Aim      Prospective assessment of the nature of cardiac injury in patients with post-COVID syndrome according to contrast-enhanced MRI in routine clinical practice.Material and methods  106 previously unvaccinated patients were evaluated. 62 (58.5%) of them were women with complaints that persisted after COVID-19 (median age, 57.5 [49; 64] years). In addition to standard indexes, markers of inflammation and myocardial injury were determined, and cardiac contrast-enhanced MRI was performed in each patient.Results The median time from the onset of COVID-19 to cardiac MRI was 112.5 [75; 151] days. The nature of cardiac injury according to MRI in patients with post-COVID syndrome was complex and included a decrease in left ventricular (LV) and right ventricular ejection fraction, pericardial effusion, and pathological foci of late and early contrast enhancement at various locations. In 29 (27.4%) cases, there was a combination of any two signs of heart injury. In 28 (26.4%) patients with focal myocardial injury during the acute phase of COVID-19, hydroxychloroquine and tocilizumab were administered significantly more frequently, but antiviral drugs were administered less frequently. The presence of focal myocardial injury was associated with pathological LV remodeling.Conclusion      According to contrast-enhanced cardiac MRI, at least 27.4% of patients with post-COVID syndrome may have signs of cardiac injury in various combinations, and in 26.4% of cases, foci of myocardial injury accompanied by LV remodeling are detected. The nature of heart injury after COVID-19 depends on the premorbid background, characteristics of the course of the infectious process, and the type of prescribed therapy. An algorithm for evaluating patients with post-COVID syndrome is proposed.

[Antihypertensive treatment compliance and obstacles to its improvement. Results of Russian program ARGUS-2].

AIM: To study barriers made by the patients for adequate treatment of arterial hypertension. MATERIAL AND METHODS: The ARGUS-2 trial was made in 15 centers of 13 cities of Russia. Anonymous questionnaire survey covered 1298 patients (796 outpatients and 502 inpatients). The patients answered the following questions: 1) what are basic problems of life with hypertension; 2) compliance with intake of antihypertensive drugs; 3) causes of missed intakes of the drugs; 4) opposition to intake of drugs by the patients. Questioning procedure was preset by the trial protocol. RESULTS: Only 37.4% (38.9% outpatients, 34.6% inpatients) were the treatment adopters. Drug intake was missed most frequently because offorgetting. The problems of life with hypertension were differently interpreted by patients and physicians: for the latter main problems were financial and routine while AH complications were on the 6-7 place. The latter were of primary importance for the patients while financial problems took place 4-6 Barriers to regular intake for the patients were poor self-control and unawareness about side effects of the drugs. CONCLUSION: Complience of the patient can be improved only by complex approach: improvement of education, higher motivation, active involvement of patients into the treatment process, better contacts between the physician and the patient.

[Problems of a physician-patient interaction and control of arterial hypertension in Russia. Main results of scientific-practical program ARGUS-2].

OBJECTIVE: To study the problems of physician-patient cooperation, patient- and physician related barrieres to target blood pressure (BP) achievement and to demonstrate improvement of BP control with indapamide SR 1.5 mg, when given to patients remaining uncontrolled while receiving antihypertensive therapy without thiazide diuretics (TD). METHODS: The trial Improvement of Arterial Hypertension Control in High-Risk Hypertensive Patients (ARGUS-2) run in 15 Russian centres during the year 2006. Retrospective analysis of medical notes of 684 outpatients and 575 inpatients with arterial hypertension. Validated questionnaires were used for interview of 373 physicians and 1298 patients. The study of Arifon retard efficacy was carried out in 1438 outpatients with difficult-to-control hypertension. RESULTS: BP was above the goal level in 97.1% pts at the first analyzed visit to an outpatient department. Antihypertensive therapy was unchanged in 20.5% cases, the drug dose was increased in 46,6%, additional medication was administered in 36,8%. In 30.8% pts antihypertensive agent was substituted by another class drug. At the last analyzed visit target BP was found in 24.4% pts. BP control was poorer in pts with BP goal <130/80 mmHg (20.1%) than in those with higher target BP (25.9%). Achievement of BP goal was associated with combination therapy, higher rate of TD administration and with more frequent visits to physician. During hospitalization target BP <140/<90 mmHg was achieved in 87.1%,<130/<80 mmHg in. 76.2%. Arifon retard administration resulted in target BO achievement in 84.5% patients. Physicians percept low adherence to antihypertensive treatment, lack of patients knowledge about risk related to arterial hypertension, economical problems as main barriers to improvement of arterial hypertension management. Patients considered economical problems related to antihypertensive treatment more much less important than physicians did. CONCLUSION: The study results suggest the importance of therapeutic inertia overcome to improve arterial hypertension management in Russia. Low rate of multiple combination therapy and TD prescription are important features of therapeutic inertia. Polar perception of problems related to arterial hypertension by physicians and patients should be considered as influencing factors for educational programs development.

[Clinical and vascular effects of ACE inhibitor enalapril in combination with thiaside-like diuretic indapamide in hypertensive outpatients. Results of the multicenter trial POEMA].

AIM: To evaluate efficacy and safety of a 6-month treatment of 237 patients with arterial hypertension (AH) of degree 1-3 with ACE inhibitor enalapril (mean dose 21.9 +/- 9.0 mg/day), 49.4% of which received adjuvant indapamide (2.5 mg/day), to study effects of this therapy on rigidity of the major arteries by dynamics of pulse wave velocity (PWV) and US rigidity index beta (RIB). MATERIAL AND METHODS: The study included only patients with initially elevated PWV which was detected in 266 (53%) of 501 examinees. RESULTS: Lowering of systolic and diastolic blood pressure (BP) was 16.8 and 14.0% to treatment month 3 and, in addition, 1.6 and 1. 7% to month 6, respectively (p < 0.001). Target BP (< or = 140/90 mm Hg) was achieved in 82.7% patients. During the trial 3 (1.2%) patients withdrew because of severe cough. Slowdown of PWV measured by brachiomalleolar (PWVbm) and carotid-femoral (PWVcf) methods was equal in the course of the trial and made up 2.45 and 6.1% to treatment month 3 (p < or = 0.05 for both) and additional 3.25 and 7.4% to month 6 (p < 0.001 for both), respectively. High PWV normalized completely in 42.6% patients. After 6 months of the trial US RIB decreased by 30.5% (p < or = 0.001). The correlation analysis detected a significant correlation between SAP fall and PWV decrease only during the first 3 months of therapy (r = 0.402, p = 0.005). In month 3-6 the correlation became insignificant (r = 0.28, p = 0.055). CONCLUSION: Combination of enalapril and indapamide is effective and safe in outpatients with arterial hypertension of the first-third degree and baseline high rigidity of the vascular wall. This treatment reduces PWV and rigidity of the major arteries associated with BP lowering (in the treatment month 1-3) and a vasoprotective effect of the drugs.