Aim. To examine the association of polymorphism 4a/4b and 4b/4b in endothelial nitric oxide synthase gene (eNOS) with levels of natriuretic peptide type-C, endothelin-1 and vasoregulative endothelial function in patients with chronic heart failure (CHF) depending on the ejection fraction of the left ventricle. Materials and methods. The study has included 280 patients with CHF of ischemic etiology and 60 somatically healthy individuals. A comprehensive assessment of the markers of the vascular endothelium function was carried out for all patients (endothelial function coefficient, natriuretic peptide type-C, endothelin-1) in association of polymorphism 4a/4b and 4b/4b gene of eNOS. Results. Correlations between the ejection fraction of the left ventricle and the levels of the natriuretic peptide-type C and endothelin-1 have been established. Endothelial dysfunction was revealed in all patients with CHF, but patients with 4a/4b gene of eNOS had more pronounced disorders. The association between the levels of biochemical markers of the endothelial dysfunction with polymorphism 4a/4b gene eNOS was also rervealed. The levels of the natriuretic peptide type C and endothelin-1 were higher in subgroups with genotype 4a/4b of gene eNOS both in patients with CHF with a preserved and with a reduced ejection fraction of the left ventricle. Conclusion. In patients with CHF with preserved and reduced ejection fraction of the left ventricle the association of polymorphism 4a/4b gene eNOS with levels of biochemical markers of endothelial dysfunction and vasoregulative endothelial function was revealed.

Aim. To estimate association between disorders of salt-water homeostasis on admision and the remote one-year prognosis for patients hospitalized with decompensated CHF NYHA FC III-IV. Materials and methods. This prospective study was based on clinical amnestic data and results of one-year follow-up of 111 consecutive patients admitted for decompensation of CHF to the State Clinical Hospital No. 24 in January 2015-February 2016. Results. The relative risk of death within one year for patients hospitalized for decompensated CHF with disorders of water and salt homeostasis increased 1.43 times by the end of one-year follow-up compared to patients with normal blood levels of sodium and potassium on admission (RR=1.43; 95% CI: 1.10-1.87; p<0.01). Furthermore, the relative risk of death within one year was significantly increased 1.4 times in the subgroup of patients with hypernatremia (RR=1.41; 95 % CI: 0.99-2.01; p<0.05, respectively) and 1.4 and 2.3 times in subgroups with hypo-/hyperkalemia respectively (RR=1.39; 95 % CI: 0.93-2.07; p<0.05 and RR=2.23; 95 % CI: 1.04-4.78; p<0.01) compared to patients with normal blood levels of sodium and potassium on admission. Conclusion. Disturbed water and salt homeostasis on admission of patients hospitalized for decompensated NYHA FC III-IV CHF is a predictor for an unfavorable remote prognosis.

Purpose. To identify different types and possible predictors of physical rehabilitation (PR) response in reduced ejection fraction heart failure (HFrEF) patients, selected on the basis of achievement the lactate threshold during cardiopulmonary exercising test (CPET). Methods. 64 patients, chronic heart failure (CHF) NYHA II-III functional class were included in our study. Mean age 54±12,5 years, body mass index (BMI) 26,5±6,4 kg/m², ejection fraction (EF) 26,4±1,4%, NYHA II: III (67%: 33% patients). ^e original estimated results of physical examination, laboratory parameters, CPET, quality of life (QOL), exercise tolerance (ET) and echocardiography (EchoCG). Physical rehabilitation (PR) efficiency was estimated on the basis of peak oxygen uptake (VO₂peak), QOL and ET dynamics after 1,3 and 6 months; EF dynamics was estimated after 6 months. Data were statistically processed using software package “Statistika, 9.0" Results. After 6 months PR EF increased by 7,5±0,5%, QOL - 17.5±8 points, ET - 9.5±1 points and VO₂ peak - 4.4 ml/min/kg, end-diastolic volume decreased by 6±2.0 ml from baseline (p₁,₂,₃,₄, respectively). Echocardiography, CPET, QOL and ET improvement revealed a significant number of patients (EF - 48%, VO₂ peak - 64%, QOL - 64%, ET - 67% of patients, respectively). Revealed a strong positive correlation between the initial values of VO₂ peak and EF (rEF=0,4, p), and between baseline levels of sodium, haemoglobin and the of PR efficiency (rNa= 0,41, p,0,05; rHb = 0,45, p<0,05). ^ere was a positive impact of the initial content of red blood cells (rEr=0,6, p=0.03), sodium (rNa=0,4, p=0.05), LV EF (r=0.5, p=0.05) and level VE at the peak of exercise load (r=0.5, p=0.01) on training efficiency. BNP level and HF long history had a negative effect on the result of PR (rBNP= - 0,7, p=0.05; rCHF= - 0,6, p=0.05). Revealed significant negative correlation between patient’s age and PR efficiency (r = -0,35, p<0,05). There was no significant impact of systolic blood pressure (rBP sist=0,11, p>00,5), diabetes mellitus on PR efficiency (r= -0,01, р<0,05). Conclusion. PR positive response predictors were VO₂ peak, hemoglobin and sodium higher initial values. Non-response predictors were CHF long history, older age, higher baseline NT-pro-BNP and uric acid blood.

Background. In Marfan syndrome early impairment of left ventricular systolic function has been reported. Our aim was to evaluate the left ventricular systolic function in young adults with Marfanoid habitus (MH) (includes arachnodactylia, dolichostenomelia, high palate, deformations of the thorax). Methods: We studied 137 young subjects (mean age 21.3±1.5) - 58 male, 79 female. Transthoracic echocardiography (Vivid 7 Dimension, GE) was performed in 24 asymptomatic MH with excluded Marfan syndrome and 42 healthy control subjects. Radial and circumferential systolic strain and strain rate were determined using spackle tracking (EchoPAC»08, GE). Results: Ascending aorta diameters were larger in subjects with MH. LV mass index did not differ significantly between groups, but interventricular septum and posterior wall thickness were greater in MH group. Local LV radial and circumferential systolic deformation indices were significant decreased in MH group. Conclusions: Young adults with MH in the absence of major findings of Marfan syndrome (ascending aortic aneurysm and ectopia lentis) have decreased LV systolic function.

Chronic kidney disease is observed in most patients with CHF with preserved ejection fraction (HFpEF) and presents a major risk factor facilitating development and progression of LV diastolic dysfunction. The review focused on the effect of chronic kidney disease on intracellular signaling pathways affecting stiffness and diastolic relaxation of cardiomyocytes in response to inflammation and endothelial dysfunction of coronary capillaries, excessive sympathetic activation, and dysregulation of natriuretic peptides, which directly participate in the development of CHF. Elucidation of these mechanisms allows to identify new cell targets for new approaches to drug therapy for patients with HFpEF.

The treatment of patients with CHF using autologous bone marrow-derived mononuclear cell fraction (or its derivatives) is a promising therapy for this serious and numerous group of patients. The article analyzed international and Russian experience of using the cell therapy in patients with CHF and possibilities for extensive use of the autologous bone marrow-derived mononuclear cell fraction in clinical practice.

The article focuses on current aspects of epidemiology, clinical picture, and diagnostics of patients with chronic heart failure (CHF) associated with preserved left ventricular (LV) systolic function. Heart failure with preserved LV ejection fraction (HFpEF) is shown to be prevalent in a population that accounts for more than a half of all CHF cases. The group at risk for HFpEF consists primarily of older women with arterial hypertension, type 2 diabetes mellitus, obesity, and atrial fibrillation. The article presents algorithms for diagnosis of HFpEF based on classic and tissue Doppler echocardiography and measurement of natriuretic peptides.