Background. Chronic heart failure is the most common condition in patients with cardiovascular diseases. Therefore, evaluating consistency of doctor’s recommendations with guidelines on drug therapy is a relevant issue. Aim. To evaluate consistency of doctor’s recommendations with guidelines on drug therapy for CHF. Materials and methods. The study presents enrollment visit data for the Russian part of the international prospective registry, QUALIFY. The study included 404 outpatient patients with CHF between February, 2013 through June, 2014. Consistency with guidelines for drug therapy was evaluated for 5 drug classes, including ACE inhibitors (ACEI), β-blockers (BB), angiotensin receptor antagonists (ARA), mineralocorticoid receptor antagonists (MRA), and ivabradine. Results. On the whole, the consistency was good in 64.9% of cases, moderate in 27.7% of cases, and poor in 7.4% of cases. Proportions of patients who received a target dose of a medicine and a dose ≥50% of the target dose were low, 21.5% and 62.3% for ACEI; 15% and 50.8% for BB; 20.3% and 39.8% for ARA; and 23.4% and 78.7% for ivabradine, respectively. These values, except for BB, were lower for patients with late hospitalization (hospitalization >6 months vs. <6 months). Conclusion. Data of the registry showed that consistency of doctors’ recommendations with guidelines on drug prescription was generally satisfactory. However, doses of medicines recommended for the treatment of CHF were lower than optimum. It is essential to develop a tactic for implementing guidelines on the treatment of CHF in clinical practice.

Aim. To study prevalence of left ventricular diastolic dysfunction (LVDD) and to evaluate the effect of pulmonary vein catheter isolation on left ventricular (LV) diastolic function in patients with paroxysmal and persistent forms of atrial fibrillation (AF). Materials and methods. 109 patients with paroxysmal (n=90; 82.6%) and persistent (n=19; 17.4%) AF were evaluated after 109 pulmonary vein catheter isolations. The patients were divided into two groups based on the operation efficacy. Heart ultrasound including evaluation of the LV diastolic function was performed for all patients on the day of operation and at 6 and 12 months. Results. After the surgery, 61 (56.5%) patients maintained sinus rhythm (SR) for 12 months and comprised Group 1. Group 2 consisted of patients with a relapse of AF (47 patients; 43.5%). At baseline, LVDD with SR was observed in 53 patients (48.6%), at 6 months - in 34 (31.2%) patients (p=0.001), and at 12 months - in 27 patients (24.8%) (p<0.001). In Group 1, the early LV filling velocity (peak E) was statistically significantly increased (p<0.001); the E/A ratio recovered (p<0.001); and mitral septal (e’ septal) (p=0.001) and lateral (e’ lateral) (p=0.03) annulus motion velocities were increased. Such changes in parameters did not occur in the group of patients with a relapse of AF. The increased velocity of peak E at 12 months of surgery statistically significantly influenced the absence of AF relapse (p=0.021). Conclusion. Approximately a half of patients with paroxysmal or persistent AF had LVDD. In patients who maintained SR following pulmonary vein catheter isolation, parameters of LV diastolic function recovered.

Aim. To evaluate the effect of decompensated HF with preserved or slightly impaired EF on the risk of cardiovascular complications during a 5-year follow-up. Materials and methods. 33 patients with arterial hypertension and HF with preserved or slightly impaired EF (NT-proBNP ≥125 pg/ml, mean, 500.1±590.32 pg/ml and EF ≥40%, mean, 57.0±10.29%) were observed for 5 years. EchoCG, markers of immune inflammation and hormonal changes (endothelin, tumor necrosis factor (TNF), interleukin-6 (IL-6), aldosterone, renin) were evaluated at baseline. The endpoint was development of acute fatal and non-fatal cardiovascular events (CVEs). Ue one-way regression analysis was used to identify predictors of the risk for CVEs. The ROC analysis was used to determine “threshold levels” of significant predictors for this risk. Results. During the 5-year follow-up period, CVEs developed in 13 (39.4%) patients. Ue CVE predictors included baseline increases in creatinine and IL-6, NT-proBNP and a greater decrease in EF (р<0.05 for each factor). The ROC analysis showed that NT-proBNP ≥235.8 pg/ml was the most effective predictor of CVEs (sensitivity, 92.3%; specificity, 60%; area under the curve, 0.736; р=0.045). Comparison of patient subgroups with baseline values of NT-proBNP higher or lower than the predetermined threshold (n=13 and n=20, respectively) detected an association of more severe HF decompensa tion with activation of neurohormonal systems and a worse prognosis. Specifically, patients with higher NT-proBNP had also higher levels of IL-6 (р=0.048) and creatinine (р=0.047) and a greater proportion of patients with CVEs (р=0.008). Conclusions. Possible mechanisms of cardiovascular complications in HF with preserved or slightly impaired ej ection fraction include activation of immune inflammatory systems. In its turn, the process of heart failure decompensation itself can become a factor intensifying production of proinflammatory cytokines. Heart wall tension may play a special role in the increased activity of inflammatory process and exert an independent effect on development of acute complications in CVDs.

Aim. To evaluate the effect of body composition on prediction of community-acquired pneumonia caused by Str. pneumoniae in patients with decompensated CHF. Materials and methods. The study included 216 patients. The pneumonia agent was identified by sputum culture. Body composition with determining lean body mass and fat mass was evaluated using a bio-impedance analysis; body mass index (BMI) was calculated. Patients with BMI 18.5-24.9 kg/m² were included into the study. Statistical analysis of obtained data was performed using the IBM SPSS Statistics 20 software. Results. The in-hospital mortality was 13.4%; the one-year mortality was 29.6%. Fat mass strongly, negatively correlated with a fatal outcome within a year, and the degree of lean body mass shortage moderately, positively correlated with the life span of patients. Conclusion. Body composition is significantly predictive for patients with decompensated CHF and community-acquired pneumonia caused by Str. pneumoniae.

This review focuses on the role of heart rate in patients with a combination of heart failure and atrial fibrillation and on methods for heart rate control in such patients.

The article shows major mechanisms for development of left ventricular dysfunction in patients with hypertensive heart and provides major trends in the treatment of heart failure with preserved ejection fraction in the light of state-of-the art in its pathogenesis.