The aim of the study was to evaluate the influence of chronopharmacotherapy on the indices of the structural and functional state of the left ventricular myocardium in patients with arterial hypertension (AH), type 2 diabetes mellitus and heart failure with preserved ejection fraction (HFpEF) considering of salt-sensitivity. Materials and methods. Included 130 patients with uncontrolled AH, type 2 diabetes and HFpEF (81 women and 49 men), median age - 59 (38-72) years. Patients were divided into 2 groups: salt-sensitive (group 1) and salt-resistant (group 2), and then randomized to 2 subgroups depending on the treatment option: morning ramipril and indapamide retard, in the evening amlodipine (subgroup 1A and 2A) or in the evening ramipril, in the morning indapamide-retard and amlodipine (subgroup 1B and 2B). Initially and after 24 weeks of antihypertensive therapy, an echocardiographic study was carried out with an assessment of the main indicators of the structural and functional state of the left ventricular (LV) myocardium, a 6-minute walk test for determining the functional state of patients. Results. After 24 weeks in all subgroups there was a reliable positive dynamics of echocardiographic indicators. In the group of salt-sensitive patients, the reception of the the angiotensin converting enzyme inhibitor (ACE inhibitor) in the evening and thiazide diuretic (TD) + calcium antagonists (AC) in the morning provided a significantly more significant reduction in the majority of LV myocardial remodeling parameters compared with the administration of ACE inhibitor + TD in the morning and AK in the evening. In the case of salt-resistant patients, comparable positive changes in echocardiographic indicators were noted against the background of both dosing regimens during the day. Against the background of the treatment, irrespective of the salt sensitivity and dosing regimen, an unreliable and comparable increase in the distance of the 6-minute walk test was recorded during the day. Conclusion. In salt-sensitive patients with AH, type 2 diabetes and HFpEF, the use of ACE inhibitor before bedtime provided significantly more significant regression of the parameters of the structural and functional state of LV myocardium compared with the morning reception. In the group of salt-resistant patients, the efficacy of both dosing regimens during the day was comparable.

Background. Despite the PCI in patients with ST-segment elevation myocardial infarction (STEMI) the development of acute heart failure (AHF) Killip ≥II is associated with a poor prognosis. Aim. To identify predictors of the development of AHF and the prognostic value of AHF in patients with STEMI after PCI. Materials and methods. In a prospective study, which lasted 6 months, included 233 patients (average age of 62.1±10.89 years, 73.4% of men) admitted to the hospital due to the development of STEMI who underwent PCI. The endpoint was defined as the death from cardiovascular causes. Statistical processing of the results was carried out using the statistical packages of the programs “SPSS Statistics 17.0" Result. During the follow-up observation from 1 day to 6 months (median follow-up of 5.2 months), 25 patients (10.7%) reported the onset of the endpoint, including 20 cases during the index hospitalization. AHF Killip ≥II during indexed hospitalization developed in 25 patients (10.7%). Independent predictors of Killip >II were: GFR<60 ml/min initially on admission to hospital (OR 95% 5.690 (2.082-15.551), p=0.001), anemia (OR 95% 5.317 (1.957-14.448), p=0.001), EF<40% (OR 95% 6.686 (1.291-34.628), p=0.024). OR of the development of Killip ≥II increased with a decrease in GFR initially when admitted to the hospital: GFR 45-59 ml/min (OR 95% 6.167 (1.432-26.563), p=0.015), GFR 30-44 ml/min (OR 95% 13.704 (2.795-67.187), p=0.001), GFR 15-29 ml/min (OR 95% 32.889 (4.967-217.770), p<0.001). The development of AHF Killip ≥II was associated with an increase in the frequency of the onset of the endpoint (7.2% and 40%, respectively, p<0.001), increasing with the increase in the class Killip (I 7.2%, II 0%, III 55.6%, IV 83.3%, p<0.001). In patients with AHF Killip ≥II, the incidence of acute kidney injury (AKI) increased (20.2% and 40%, respectively, p=0.025). Killip ≥II increases the OR of development of AKI by 2.6 times (OR 95% 2.635 (1.105-6.282), p=0.029). In the case of the development of both the AHF Killip ≥II and AKI, the OR of the onset of the endpoint increased many times (OR 95% 40.704 (8.990-184.283), p<0.001), while the AHF Killip ≥II without AKI increased the OR fourfold (OR 95% 4.361 (1.041-18.268), p=0.044). Conclusion. In patients with STEMI the development of the AHF Killip ≥II is associated with a poor prognosis, the development of AKI in patients with AHF Killip ≥II aggravates this prognosis.

Aim of the study. A study of the role of cardiac telocytes (Tc) in myocardial remodeling and the effect of changes in their morphology on the clinical outcome of coronary bypass (CABG) in patients with chronic heart failure (CHF). Materials and methods. The perioperative period was analyzed in 83 patients (43 men and 40 women) with CHF I, IIA and IIB, NYHA functional class I-III undergoing CABG. Myocardial biopsy of the right atrial appendage (RAA), obtained during the CABG, was studied using histological, immuno-histochemical (expression of CD-34/vimentin, MMP-2, TIMP-1, caspase-3, bcl-2) and morphometric methods. Results. In the analysis of the myocardium of RAA of a group of patients with cardiovascular complications (CVC) after CABG, a significant decrease in the diameter of cardiomyocytes (CMCs) of their nuclei, bulk density (BD) of CMC, a significant decrease in BD Tc, trophic index; an increase in CMC with signs of apoptosis, BD of stroma, a violation of the ratio of MMP-2/TIMP-1. Conclusions. The intercellular network Tc with secreted regulatory factors and microvesicles is an important structural and functional link of the myocardium. The decrease in BD Tc has a significant effect on the remodeling and regenerative potential of the myocardium, leading to the development of CVC in patients with CHF.

Spirometrie respiratory impairment is a significant and well-studied predictor for cardiovascular fatality in heart failure. However, reports of the interrelation between spirometric indexes and structural alterations of the heart, particularly left ventricular ejection fraction (LVEF), are scarce. Apparently, the respiratory function differs in patients with different LVEF and influences their clinical phenotype. The aim of this study was to investigate features of external respiration in patients with chronic heart failure (CHF) and different LVEF values. Materials and methods. 78 patients with stable, functional class (FC) I-IV CHF were evaluated and divided into three groups based on their LVEF (impaired, midrange, and preserved). Assessment of the clinical status (Clinical Condition Scale, quality of life, 6-min walk test), EchoCG, and spirometry with the bronchodilation test were performed for all patients. Results. 59.1% of studied patients had normal pulmonary function. 25.6% of patients had restrictive ventilatory defects; 5.1% had obstructive disorders, and 10.2% had mixed disorders. In the patient cohort with restrictive disorders, 55% had FC I-II CHF and 45% had FC III-IV CHF; among patients with obstructive disorders, 25% had FC I-II CHF and 75% had FC III-IV CHF; and among patients with mixed disorders, 12.5% had FC I-II CHF and 87.5% had FC III-IV CHF. Normal ventilatory function was observed in 64.7% of patients with preserved LVEF, 30% of patients with midrange LVEF, and 58.9% of patients with impaired LVEF (<40%). Incidence of restrictive defects was higher in patients with midrange LVEF (40%). Conclusion. Study results indicated presence of both restrictive and obstructive, mixed disorders resulting from secondary changes in lungs due to pulmonary hypertension. Therefore, to improve the treatment tactics spirometry should be performed for all patients with heart failure for timely diagnostics, which would possibly allow to introduce elements of individualized therapy.

Background. Earlier studies have demonstrated a high prevalence of atrial fibrillation (AF) in patients with CHF. It was noticed that tachycardia and hypotension provoked high risks for cardiovascular mortality. The presence of arterial hypertension (AH) in CHF patients also impairs life prognosis. Aim. To determine prognosis for patients based on the control of hemodynamic indexes and titration of pulse-slowing therapy in real-life clinical practice. Materials and methods. This prospective study with a one-year follow-up period included 580 patients after decompensated CHF who were discharged from the Municipal Center for Treatment of CHF. 46.9% of patients had AF. Patients with AF were divided into groups with paroxysmal and persistent AF (combined) and permanent AF. Results. Among patients with CHF and AF, 56.3%, 38.6%, and 5.1% had permanent, persistent, and paroxysmal AF, respectively. Patients with permanent AF had a higher CHF FC. The FC was evaluated using the 6-min walk test and Clinical Condition Scale at baseline and after the one-year follow-up. Incidence of hypotension and tachycardia was higher in the group with permanent AF. In patients without AF, baseline systolic blood pressure (SBP) (139.5±24.5 mm Hg) was higher than in patients with any AF type (132.1±24.2 mm Hg, p<0.001), paroxysmal and persistent AF (133.1±23.9 mm Hg, p=0.015), or permanent AF (131.3±24.6 mm Hg, p<0.001). After the one-year follow-up, SBP values decreased in the study groups to 127.7±18.5 mm Hg (p=0.02) for patients with AF; and to 133.5±21.4 mm Hg (р=0.002) for patients without AF. A statistically significant decrease in DBP was observed only in the group without AF. Heart rate significantly decreased only in patients with permanent AF (from 84.5±18.1 bpm to 79.7±15.8 bpm, р=0.017) and in patients without AF (from 73.9±14.0 bpm to 70.4±14.0 bpm, р=0.002). In a year of follow-up, the beta-blocker coverage increased with a statistically non-significant increase in beta-blocker doses. Risk for all-cause death was increased 1.9 times (odds ratio (OR), 1.9; 95% confidence interval (CI), 1.0-3.4; р=0.035) in combined CHF and AF; and 2.3 times in permanent AF (OR, 2.3; 95% CI 1.2-4.4; р=0.012) compared with CHF without AF. In persistent and paroxysmal AF, statistically significant increases in death risks were not observed. The risk for cardiovascular death was also increased in the AF group compared to patients without AF (7.7 vs. 4.5%, OR=1.8; 95% CI: 0.9-3.5, р=0.11). Acute decompensation of HF prevailed in the structure of cardiovascular mortality in patients with AF (86.4% of cases). Risks of nonfatal cardiovascular complications for patients with CHF and AF were comparable with risks for patients without AF (3.3 and 3.2% of cases per year (OR=1.0; 95% CI: 0.4-2.5; р=0.97). AF increased the risk of repeated hospitalization in CHF patients by 46.8% (OR=1.8; 95% CI: 1.2-2.5; р=0.001). Conclusion. The presence of any AF type, particularly permanent AF, considerably aggravated CHF due to hypotension and tachycardia. The presence of permanent AF associated with CHF increased risks for all-cause and cardiovascular death, nonfatal cardiovascular complications, and repeated hospitalizations.

Purpose of research. To examine the level changes of fractalkine in patients with chronic heart failure (CHF) depending on the ejection fraction of the left ventricle and the stage of the disease. Materials and methods. In total 340 people were examined. Of these, 280 patients with CHF divided into groups depending on the ejection fraction of the left ventricle (with a preserved and reduced ejection fraction) and the stage of the disease (stage I to III). Fractalkine level was determined by method of enzyme immunoassay in blood plasma. Results. We revealed an increase in the level of fractalkine in patients with CHF with preserved and reduced ejection fraction compared with the control group. An increase in the level of fractalkine was more pronounced in patients with reduced ejection fraction. In the group of patients with preserved ejection fraction of stage IIB+III, a statistically significant decrease in the level of fractalkin was observed in comparison with patients with stage I to stage III. ^e method of correlation analysis established that there is a correlation between the level of fractalkine and clinical manifestations of CHF. Conclusion. It was revealed an increase in the level of fractalkine in blood plasma in patients with CHF with the control group, which was more pronounced in patients with reduced ejection fraction and the presence of correlation level fractalkine with indicators of clinical manifestations of CHF.

Aim. To perform a comparative analysis of anemia of chronic disease (ACD) and iron-deficiency anemia (IDA) in late middle-aged and elderly patients with chronic heart failure (CHF) by ferrokinetic parameters, inflammation indexes, and their associations. Materials and methods. 65 patients with ischemic heart disease were evaluated, including 35 patients with CHF and ACD, 10 patients with CHF and IDA, and 20 patients without CHF, ACD, and IDA (control group, CG). Results. Patients with CHF and IDA had true iron deficiency whereas 54% of patients with CHF and ACD had functional iron deficiency, and 46% of patients had no iron deficiency. Levels of acute phase proteins, ferritin and hepcidin, C-reactive protein (CRP), and interleukin-6 (IL-6) were highly significantly different in patients with CHF and ACD and patients with CHF and IDA; positive and significant correlations were found for levels of IL-6 and ferritin, IL-6 and CRP, and CRP and hepcidin. In patients with CHF and IDA, levels of acute phase proteins, ferritin and hepcidin, CRP, and IL-6 were low and correlations of IL-6 with ferritin, IL-6 with CRP, and CRP with hepcidin were non-significant. Concentrations of erythropoietin were significantly higher in patients with CHF and ACD and patients with CHF and IDA compared to the control group; however, significant differences between them were absent.

The aim of the study. To evaluate the prevalence and clinico-functional features of myocardial dysfunction in persons 65 years or older in the primary care setting. Materials and methods. The prospective cohort study “Crystal” included participants 65 years and older. The arm of “Crystal” study evaluated a random sample size of 284 people. All participants were performed echocardiography using portable digital ultrasound scanner Mindray M5 ultrasound transducer of 2.5-3.5 MHz. It was also evaluated the clinical manifestations of heart failure (HF) on the scale SHOCKS, medical history and anthropometric data and parameters of the geriatric examination. Were determined muscle strength, walking speed, emotional status (Geriatric Depression Scale) and cognitive status (MiniMental State Examination). Assessment of dependence on external assistance was carried out based on the Barthel Index (Barthel Index). Results. The prevalence of all forms of myocardial dysfunction was 80.3%, among them of 73.2% of participants had clinical manifestations of heart failure, which was not associated with type or severity of structural and functional abnormalities of the myocardium. Symptoms and signs of HF were characterized by low sensitivity for detection in older people with MD and may be associated with other conditions. The most common complaint was shortness of breath (59%), with high sensitivity for the diagnosis (89%) but low specificity (51%). Patients with clinical manifestations of HF are more likely to have a BMI of over 30 kg/m², cognitive disorders, suspected depression, lower walking speed and low grip strength by dynamometry. In addition, participants with symptoms were older age (75,3±5.6 years vs 72,7±5.5 years, p<0.001). The analysis showed a significant negative effect of MD on survival of participants in the study: overall risk of mortality in participants with myocardial dysfunction aged 65-74 years was higher than 4.8, and at age 75 and over 2.9 times. The conclusion Low diagnostic value of symptoms of heart failure in the population older people were demonstrated. The need for a full geriatric examination at the outpatient stage in combination with early holding of echocardiography to persons with suspected myocardial dysfunction of the myocardium was showed, in connection with negative prognostic impact.