Background. Reported levels of hepcidin, the major regulator of systemic iron homeostasis in CHF patients, are controversial. Relationship of hepcidin with inflammation markers, which are typically increased in CHF, is understudied; this issue is practically unstudied in old and older CHF patients. Aim. To study the role of hepcidin in development of anemia of chronic disease (ACD) and the association of hepcidin with inflammation in old and older CHF patients. Materials and methods. Ninety old and older patients with IHD were evaluated. 35 of these patients had CHF and ACD and 35 patients had CHF without ACD. The control group (CG) consisted of 20 IHD patients without CHF and ACD. Serum concentration of hepcidin was measured using ELISA by the competitive binding principle. Results. Patients with severe, congestive FC IV CHF prevailed among CHF patients with ACD, and their CHF was characterized with longer duration, more frequent hospitalizations, and lower compliance with the treatment. Significantly higher mean levels of hepcidin, C-reactive protein (CRP), erythrocyte sedimentation rate, and insignificantly higher levels of ferritin were observed in CHF patients with than without ACD. The high hepcidin, indexes of inflammation tests, and a significant positive correlation of hepcidin with hemoglobin levels suggested inflammation as a cause for the increased hepcidin, which induced anemia in old and older CHF patients with ACD.

Background. Life-time diagnostics of wild type transthyretin amyloidosis (ATTR(wt)-amyloidosis) is virtually absent, even though ATTR(wt)-amyloidosis is an underestimated cause for morbidity and mortality, particularly in the older age group. Aim. To study incidence, demographic characteristics, and morpho-functional features of ATTR(wt)-amyloidosis in patients with FC IV CHF and LV hypertrophy > 15 mm accord ing to autopsy data. Materials and methods. Postmortem reports were retrospectively analyzed for patients (n=141; 19% males, 81% females) of cardiology departments aged ≥69 with the underlying CHF syndrome. From all formalin-fixed fragments of the myocardium embedded in paraffin were prepared 5-7 mkm cuts, which were stained with Congo red (Sigma, USA) and viewed under normal and polarized light. Immunohistochemical analysis was also performed using antibodies to AA-amyloid, transthyretin, kappa and lambda-light chains of immunoglobulins. Results. Amyloid deposits were found in both old and very old persons aged 91.25±9.67, mostly in women due to shorter life span of men. In different FCs associated with LV hypertrophy, according to autopsy data amyloid deposits were observed in virtually every fifth deceased (21% of cases). The amount of myocardial amyloid deposits was generally small (56% of cases had (+) and 27% had (++) amyloid deposits); 17% of cases had considerable amyloid deposits (7% had (+++) and 10% had (++++)). The presence of amyloid deposits did not influence indexes of myocardial hypertrophy, such as ventricular septum thickness, LV posterior wall thickness, and heart mass. In the presented cases we observed focal amyloid deposition in the myocardium typical for old age-related amyloidosis; in 97% cases, amyloid was located in the interstitium, around cardiomyocytes and in 3% of cases - exclusively around blood vessels. Conclusion. ATTR (wt)-amyloidosis was detected in every fifth patient in the old and very old cohort, primarily in women (83%), and was not diagnosed during the life time. Characteristic morphological manifestations of ATTR(wt)-amyloidosis were focal amyloid deposits mostly in the myocardial interstitium.

Aim. To determine the effect of right ventricular myocardial contractility on the response to cardiac resynchronization therapy (CRT). Materials and methods. The study included 80 patients (49 men, mean age 54±10.5) diagnosed with dilated cardiomyopathy, complete left bundle branch block, and the QRS complex width 146 to 240 ms (183±32 ms). Heart failure was NYHA FC III, ejection fraction (EF) - 30.1±3.8%, 6-min walk test - 290.5±64.3 m, and end-diastolic volume (EDV) - 220.7±50.9 ml. 35 patients had permanent atrial fibrillation. All patients received implantable devices for CRT; complete artificial atrioventricular block was formed in patients with atrial fibrillation. LV and right ventricular (RV) contractile function was studied in all patients before and at 12 months of the implantation using equilibrium radionuclide tomoventriculography. Results. At 12 months, 69 (86.25%) patients were clinical responders to CRT and 11 (13.75%) patients did not respond to the treatment. The responders showed positive clinical dynamics; LV EF increased from 30.1±3.8 to 42.8±4.8% (p<0.001), LV EDV decreased from 220.7±50.9 to 197.9±47.8 ml (p<0.005). In non-responders, LV EF increased from 30.1±3.8 to 33.8±3.8% (p<0.001) and LV EDV increased from 220.7±50.9 to 227.8±27.8 ml (p<0.001). All patients were retrospectively divided into two groups: Group 1, CRT responders and Group 2, non-responders. A study using radionuclide methods showed that in Group 1 patients, maximum RV filling velocity increased from 1.8±0.36 to 2.17±0.67 (p≤0.001) and the mean velocity of RV filling for one third of diastole increased from 1±0.28 to 1.32±0.45 (p<0.001). In Group 2, these parameters were significantly worse by 30 and 60%, respectively. Conclusions: Cardiac resynchronization therapy is more effective in preserved contractility of the right heart, and higher values of maximum RV filling velocity for one third of diastole may serve a prognostic criterium for a beneficial response to CRT.

Aim. To determine time-related changes in prevalence, morbidity, and all-cause mortality of patients with CHF depending on the presence of DM in a representative sample of Nizhny Novgorod Region. Materials and methods. In 1998, a representative sample of Nizhny Novgorod Region was created, which included 1922 respondents. From 2000 through 2017, this sample was evaluated three times. Patients with CHF and DM were studied. Results. For 17 years, prevalence of NYHA FC IV CHF increased from 6.88 to 9.1% (р=0.04). Prevalence of NYHA FC III-IV CHF increased considerably from 1.2% to 4.8% (р<0.001). Morbidity of CHF patients increased from 10.8 to 16.4 per 1000 (р=0.02) and morbidity of DM patients increased from 3.7 to 6.6 per 1000 (р=0.03). DM significantly worsened the life prediction, particularly for patients with NYHA FC III-IV CHF. Conclusion. Prevalence of CHF is growing. Morbidity and all-cause mortality depend on the presence of DM and CHF FC severity. Risk for all-cause mortality increases following CHF decompensation no matter of the DM presence.

Heart failure and atrial fibrillation are the two new epidemics of cardiovascular disease. Their frequent coincidence increases mortality rates mainly because of increased risk of thromboembolic events. Their review focuses on epidemiology, mechanisms, prognosis in patients with heart failure and atrial fibrillation, approaches to the administration of direct oral anticoagulants and role of rivaroxaban.

In many patients, chronic heart failure (CHF) is associated with chronic kidney disease (CKD). Virtually all patients with terminal CKD and many patients with early CKD display various disorders of mineral and bone metabolism (MBM) related with all-cause mortality and high risk of cardiovascular complications. This review addressed disorders of mineral and bone metabolism in patients with CHF, including hypocalcemia, hyperphosphatemia, vitamin D insufficiency/deficiency, secondary hyperparathyroidism, changed levels of FGF23 and Klotho, osteoporosis, osteopenia, their clinical and prognostic significance, and possibilities of their correction.

Using the example of Russian and European clinical guidelines on diagnosis and treatment of heart failure the article addressed issues, which may arise from word-for-word or component-wise translation to Russian of some English medical terms, such as bendopnea (or flexo-dyspnea, a symptom of shortness of breath when bending forward), a symptom (subjective symptom), and a sign (objective symptom).