Aim. To analyze management and outcomes in patients with CHF managed by specialists in heart failure (HF) or general cardiologists/ physicians in real-life clinical practice. Materials and methods. Survival rate, rehospitalization rate, general health condition, and the administered therapy were evaluated for HF patients with reduced LV ejection fraction at three years of discharge from cardiological hospitals. These patients had been included in a prospective, multicenter, observational study, “The Russian Hospital HF Registry” (RUS-HFR). The first group consisted of patients who were managed at a specialized HF department of the Federal Center and followed up at the outpatient stage by a cardiologist specializing in HF (Group 1, St.-Petersburg; n =74). The other two groups (Group 2 and Group 3) included patients who were managed at other cardiological departments of the Federal Center (n=186) or the Regional Center (n=130) and subsequently followed up at the place of residence. Results. After the discharge from the hospital, 58-95 and 12-19% of RUS-HFR patients were followed up by a cardiologist or a physician, respectively, on an outpatient basis while 5-23% of patients did not visit a doctor at all. In three years, the survival rate of Group 1, 2, and 3 patients was 80 vs. 78 (р>0.05) vs. 52% (р<0.01) (these differences were most obvious for patients with functional class III CHF), and the rate of hospitalization for decompensated HF was 33 vs. 28 (р>0.05) vs. 100% (p_1,2<0.01), respectively. Specialists in HF more frequently prescribed ACE inhibitors/angiotensin receptor antagonists, beta-blockers, mineralocorticoid receptor antagonists, and diuretics (89, 91, 75, and 88% of cases vs. 67-73, 81-85, 54-55, and 60-79% of cases, respectively) and more frequently than other doctors titrated ACE inhibitors/angiotensin receptor antagonists and beta-blockers to ≥50% of a target dose -46 vs. 26-38% and 74 vs. 52-56%, respectively. High-tech care was more frequently recommended and used for patients of Group 1 and Group 2. During the follow-up period, electrophysiological methods of treatment were recommended and used only for Federal Center patients. Conclusion. Despite similar recommendations on drug therapy, the mortality and rehospitalization rates may considerably differ in patients with CHF depending on the management at the outpatient stage. Multimodality cardiological centers that include specialized HF departments have comprehensive capacities for examination and treatment of HF patients with reduced LV ejection fraction providing high-tech treatments and a multidisciplinary approach. HF specialists use more aggressive tactics with respect of the quality and volume of drug therapy, which, along with successive management and correction of patients’ compliance, is associated with lower rates of mortality and rehospitalizations.

Objective: There is growing evidence that liver stiffness (LS) in decompensated heart failure (DHF) is related to congestion, however data about its impact on outcomes are limited. Ue aim of the study was to evaluate associations and long-term prognostic significance of LS measured by transient elastography (TE) in DHF. Methods: Single-center prospective observational study of 194 patients hospitalized with DHF, of whom 71% were male, 68 ± 11 years (mean ± SD), had a left ventricular ejection fraction of 39±14%. LS by TE (FibroScan 502, Echosens, France) was measured on admission (n=176) and/or discharge (n=165). Outcomes of interest were all- cause death or heart transplantation, heart failure (HF) rehospitalisation, heart valve repair surgery. Outcome analysis was performed with Kaplan-Meier survival curves compared by log-rank test and with Cox proportional hazards regression. Results: Median LS on admission and discharge were 11.1 (interquartile range 6.3,22.9) and 8.2 (5.8,14.0) kPa, respectively. Higher LS was associated with more clinical congestion on admission and discharge. Patients with LS on admission ≥11.1 kPa and at discharge ≥8.2 kPa were characterised by more pronounced clinical and echocardiographic signs of right-sided HF. Total of 5 (2.6%) patients died in hospital. Further, 31 (17.3%) deaths, 1 (0.6%) heart transplantation, 3 (1.7%) valve repair surgeries and 54 (30.2%) HF rehospitalizations occurred during follow-up (median 183 days). LS > median was associated with higher probability of HF rehospitalizations and composite end point (all-cause death, heart transplantation, HF rehospitalisation and valve replacement therapy) both on admission (logrank p=0.004 and p=0.006) and at discharge (log-rank p=0.001 and p=0.004). Multivariable Cox regression analysis revealed that on a continuous scale LS increase per 1 kPa on admission was related to higher risk of HF hospitalization (hazard ratio [HR] 1.024, 95% confidential interval [CI] 1.002-1.046, p=0.03). LS at discharge was independently associated with increased all-cause mortality (HR per 1 kPa increase 1.098, 95% CI 1.025-1.176, p=0.008), higher risk of HF hospitalization (HR 1.075, 95% CI 1.035-1.117, p <0.001) and composite end point (HR 1.066, 95% CI 1.031-1.102, p <0.001). Conclusions: LS was associated with clinical congestion and right ventricular dysfunction both on admission and at discharge as well as a negative impact on long-term outcomes.

Aim. 1) To study the role of soluble ST2 (sST2) in evaluation of left ventricular (LV) myocardial remodeling and 2) to evaluate the predictive value of sST2 for development of adverse cardiovascular events (CVE) during 12 months following myocardial revascularization in patients with ischemic heart disease (IHD) and chronic heart failure (CHF) with preserved LV ejection fraction (EF). Materials and methods. The study included 55 patients (42 men) with IHD and NYHA FC I-III CHF with LV EF 63 [59; 65] % aged 65 [58; 69] who were scheduled for myocardial revascularization. Echocardiographic evaluation of myocardial stress and myocardial remodeling indexes was performed for all patients. Content of sST2 was measured using enzyme immunoassay. Results. Group 1 included patients with sST2 overexpression (≥35 ng/ml) (n=26; sST2-43.75 ng/ml) and group 2 - patients with the sST2 expression <35 ng/ml (n=29; sST2-25.8 ng/ml). LV EF was lower by 5.8% (р=0.017) in group 1 than in group 2. Cardiovascular resistance was 6.7% higher (р=0.022) in group 1 than in group 2. Indexes of myocardial stress were higher by 8.2% (р=0.026) during systole and by 7.8% (р=0.027) during diastole in group 1 compared with group 2. During 12 months following myocardial revascularization, the incidence of adverse CVEs was significantly higher in group 1 (67.59% of cases, р=0.006) than in group 2 (17.24% of cases). Levels of sST2 correlated with EchoCG indexes of LV structure and function (р<0.05): sST2 inversely correlated with LV EF (r= -0.301) and end systolic elasticity (r= -0.346), and positively correlated with end systolic volume (r=0.453), end diastolic volume (r=0.396), end systolic dimension (r=0.373), end diastolic dimension (r=0.288), cardiovascular resistance (r=0.286), and LV myocardial mass (r=0.346). Conclusion. In IHD patients with CHF and preserved LV EF, increased levels of sST2 were correlated with markers of LV structure and function. The study showed an interrelationship between myocardial stress and processes of myocardial ischemic remodeling and sST2 levels in patients with IHD and CHF.

Background: the incidence of acute kidney injury (AKI) is high in patients with acute decompensated heart failure (ADHF) and is linked with increased morbidity and mortality rates. Predictive biomarkers of AKI could allow improve outcomes in AKI. Purpose: to evaluate the value of serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations for early diagnosis of AKI in patients with ADHF with left ventricular (LV) systolic function. Methods: we enrolled 60 men (average age was 62.0±11.1 years) hospitalized with ADHF with reduced LV systolic function (LV ejection fraction (LVEF) <40%). AKI was defined according to KDIGO Clinical Practice Guidelines. We measured of serum NGAL (sNGAL) concentrations by a quantitative sandwich enzyme immunoassay technique (RD systems, DLCN20, USA) at admission. Results: sNGAL concentrations were significantly higher in patients with AKI 171.2 (159.0-241.2) ng/mL compared without AKI 136.8 (108.2-163.0) ng/mL P < 0.001. For predicting AKI, ROC analysis was performed. Ерe area under curve (AUC) of sNGAL concentrations at admission was 0.83 (95% confidence interval [95% CI], 0.73 to 0.93; P<0.001). A cutoff of 157.35 ng/mL yielded sensitivity (0.83) and specificity (0.74). sNGAL concentrations > 157.35 ng/mL had 13.8-fold increase in the odds of developing AKI (95% CI, 3.93 to 48.42). Conclusion: sNGAL can be used for early diagnosis of AKI in patients with ADHF with reduced LV systolic function.

Background. Chronic lymphocytic leukemia (CLL) remains an uncurable disease, in which the age, number and severity of comorbidities primarily determine the choice of therapeutic tactics and objectives. Aim. To evaluate actual comorbidity and polymorbidity in patients with CLL and a possible relationship between the diseases and comorbidities that are considered concurrent and side effects of the administered treatment. Materials and methods. The study consisted of two parts. In a retrospective study, we analyzed records of patients with CLL from the Registry for Diagnostics and Treatment of Lymphoproliferative Diseases. In addition, we thoroughly evaluated and prospectively followed up 124 patients in the course of their preparation to a new stage of CLL tratement. Results. Examining data from the Russian Registry for Diagnostics and Treatment of Lymphoproliferative Diseases (n=1361) showed that in Russia, the age of patients with newly diagnosed CLL has increased in the recent decade with the increase in life span, which might change the comorbidity structure. Comparing retrospective and our own data (n=124) showed that diagnoses of concurrent diseases are often recorded formally (p<0.0001). This suggests a need for thorough evaluation of CLL patients by therapists and cardiologists. In this study, where the cardiological and therapeutic status of CLL patients was assessed adequately, the computed Charlson index and the trans-nosological comorbidity index determined the cumulative survival of CLL patients; the presence of three or more concurrent diseases and/or Charlson index >3 suggested a poor prognosis for patients with CLL. Conclusion. Diagnosis and treatment of comorbidities in patients with CLL require participation of different medical specialists working in a close contact with oncohematologists.

Background. Pneumonia is one of most important causes of in-hospital mortality in patients with decompensated chronic heart failure (CHF). Aim. To evaluate the effect of adipose tissue mass and body weight index (BWI) on prognosis for patients with community-acquired pneumonia and decompensated CHF. Materials and methods. The study included 286 patients aged 53-90 with BWI 18.5- 24.9 kg/m² who were hospitalized in cardiology and therapy departments of an emergency care hospital for decompensated CHF and pneumonia, which was verified within the first day of admission. Body composition was analyzed using a bioimpedance analyzer of body water sectors (ABC-01, Medass); BWI was calculated for all patients. Sputum samples collected with proper observation of sterility rules were analyzed in a specialized microbiological laboratory. Statistical analysis was performed with methods of binary logistic regression, Kaplan-Meier, Cox regression, and two-step cluster analysis using the IBM SPSS Statistics 20 software. Results. Assessing the body composition showed that groups with sputum Str. Pneumonia and mixed infection differed in indexes of lean body mass and adipose tissue mass but not in BWI. In-the mixed group, the in-hospital mortality was 38.71% and the one-year mortality -95.16%. In the group with Str. Pneumonia in the sputum culture, the in-hospital mortality was 18.52% and the one-year mortality -42.59%. The two-step cluster analysis allowed to isolate two clusters in the structure of the studied totality. All patients of the first cluster died during the first 9 months of the year following hospitalization. They were distinguished by lower values of lean body mass and BWI, older age, and the presence of mixed infection in the sputum culture in 39.1% of cases. Conclusion. In the structure of the studied totality, the most important risk factor for in-hospital mortality and one-year death was the value of adipose tissue mass.

This review presents relevant information about development and course of chronic heart failure (CHF) associated with rheumatoid arthritis (RA). One of the most discussed issues is the effect of systemic inflammatory process on prognosis of CHF. The review focused on current evidence for significance of this comorbidity in CHF. The diagnostic role of current immune markers, such as galectin 3, pentraxin 3, growth differentiation factor 15, and osteopontin was described. The review discussed the significance of antiinflammatory therapy for prognosis of CHF in the presence of systemic diseases. Possible beneficial effects of the basis therapy for RA on CHF outcomes were assessed. The authors noted a positive prognostic significance of methotrexate for the risk of decompensated CHF.