Systemic inflammation and coronary microvascular endothelial dysfunction are essential pathophysiological factors in heart failure (HF) with preserved ejection fraction (HFpEF) that support the use of statins. The pleiotropic properties of statins, such as anti-inflammatory, antihypertrophic, antifibrotic, and antioxidant effects, are generally accepted and may be beneficial in HF, especially in HFpEF. Numerous observational clinical trials have consistently shown a beneficial prognostic effect of statins in patients with HFpEF, while the results of two larger trials in patients with HFrEF have been controversial. Such differences may be related to a more pronounced impact of the pleiotropic properties of statins on the pathophysiology of HFpEF and pro-inflammatory comorbidities (arterial hypertension, diabetes mellitus, obesity, chronic kidney disease) that are more common in HFpEF. This review discusses the potential mechanisms of statin action that may be beneficial for patients with HFpEF, as well as clinical trials that have evaluated the statin effects on left ventricular diastolic function and clinical outcomes in patients with HFpEF.

Objective: Reduced cardiac reserves play an important role in poor exercise tolerance in heart failure with preserved ejection fraction (HFpEF). However, their prognostic role in HFpEF is not well defined. We aimed to evaluate the prognostic significance of key cardiac reserves in patients with HFpEF. Design and method: 348 patients (164 men, median age 68 years) with stable heart failure in NYHA functional class II-III, preserved left ventricular (LV) ejection fraction (>=50%), and increased LV filling pressure at rest and/or during exercise (determined by echocardiography) were included in retrospective cohort analysis. The median follow-up period between the initial visit and the follow-up call was 5.4 (3.5-7.0) years. Primary outcome included a composite of all-cause mortality and hospitalizations for congestive heart failure (HF). Primary outcome occurred in 166 patients (73 patients died and 93 patients were hospitalized for exacerbation of HF); 182 patients survived without hospitalizations. The event-free survival rate between groups were analysed using the Kaplan-Meier method, and the significance was evaluated using log-rank tests. Results: Patients who experienced primary endpoint had a greater enhancement in the early mitral inflow to mitral annulus relaxation velocity ratio (E/e’ ratio) on exercise (reflecting LV filling pressure and diastolic reserve), as well as a lesser enhancement in left atrial reservoir strain (LA reserve) and tricuspid annular plane systolic excursion (right ventricular [RV] reserve) on exercise. There were no differences in global longitudinal strain enhancement on exercise (LV contractility reserve) between groups. Reserve dysfunction showed a strong association with poor HFpEF prognosis: LA reserve (RR 1.81 [95% CI 1.28-2.56], P<0.001), LV diastolic reserve (RR 1.62 (95% CI 1.25-2.27, P<0.01), and RV reserve (RR 1.47 (95% CI 1.05-2.05), P<0.05). Conclusions: Here, we demonstrated for the first time the high predictive accuracy of cardiac reserves (LV diastolic, LA, RV) in HFpEF.

The article presents a clinical case of heart failure associated with the anthracycline-containing antitumor therapy in a breast cancer patient with an initially low risk of developing cardiovascular complications.

Aim    To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.Material and methods    Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.Results    The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.Conclusion    The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.

Left atrial dysfunction (left atrial myopathy) is not only a consequence of impaired left ventricular diastolic function but also plays a central role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left atrial myopathy in HFpEF is associated with a more severe course of heart failure and an unfavorable prognosis, and the choice of treatment largely depends on its severity. Echocardiography allows an accurate assessment of the left atrial condition, while the parameters of left atrial myocardial strain are sensitive to early functional disorders to help diagnosing HFpEF and determining the prognosis. This article discusses the participation of the left atrium in the left ventricular filling, its status at different stages of left ventricular diastolic dysfunction, the major mechanisms of atrial myopathy in HFpEF, and therapeutic approaches to its restriction and reversion.

Aim The article presents the principal results and conclusions of the study "SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)", organized by the Society of Experts in Heart Failure. Material and methods CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition. Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p<0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p<0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 +/- 16.3 in the IG (p<0.001) and 6.2 +/- 15.3 in the CG (p<0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation ofpatients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p<0.0001), to a greater extent in women. Conclusion The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up ofpatients in real clinical practice and serves as a vivid example ofthe importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.

Despite the existing recommendations for the diagnosis and treatment of arterial hypertension, a wide selection of antihypertensive drugs, the efficacy of treatment of arterial hypertension remains low. The main cause for unsatisfactory control of arterial hypertension is patients’ non-adherence to treatment, which adversely affects the prognosis for cardiovascular complications. The first step in increasing adherence to antihypertensive therapy is to determine its level. There are various methods characterized by their accessibility and accuracy for assessing adherence. There are several categories of factors influencing the level of adherence. Identifying the cause in a subsequent patient is a significant step in reducing adherence to antihypertensive therapy. In addition, it’s necessary to use strategies to increase adherence to antihypertensive therapy, including both “simplification” of the treatment regimen and strengthening the doctor-patient interaction. The aim of this consensus is to summarize and supplement knowledge about the prevalence of adherence to antihypertensive therapy in patients with arterial hypertension, methods for assessing the level of adherence, the reasons for low adherence to the treatment of arterial hypertension and approaches to improving adherence to antihypertensive medications.

Aim. To evaluate the impact of a decrease in glomerular filtration rate (GFR) on the prognosis of patients with chronic heart failure (CHF), to analyze real clinical practice regarding the frequency of prescribing pathogenetic therapy for CHF, achieving target dosages depending on the gradation of GFR in patients included in the CHF Register of the Tyumen region. Materials and methods. The analysis included medical data of 4077 patients (1662 men and 2415 women) with NYHA class I–IV CHF who underwent examination and treatment in medical organizations of the Tyumen region for the period from January 2020 to May 2023. Criteria for inclusion in the register: proven heart failure. Chronic kidney disease (CKD) was assessed by GFR calculated using the CKD-EPI formula (ml/min/1.73 m2). The primary end point was defined as death from all causes. Results. GFR60 ml/min/1.73 m2 was recorded in 34.6% of patients, more common in women (40.2 and 26.6%, respectively; p0.001). When dividing patients into phenotypes according to LVEF, no statistically significant differences were found in the distribution of patients according to GFR. In patients with HFrEF and HFpEF GFR45 ml/min/1.73 m2 was associated with an increased risk of meeting the endpoint. Analysis of prescribed pathogenetic therapy showed that in patients with HFrEF, the frequency of prescription of ACE inhibitors, â-blockers and MRA decreased (p=0.023, 006 and 0.01, respectively), and ARNI, on the contrary, increased with a decrease in GFR (p=0.026). In patients with HFpEF, a similar trend towards a decrease in the frequency of prescription of ACEIs and MCBs with a decrease in GFR (p0.001) remained, but it was compensated by an inversely proportional increase in the frequency of prescription of ARBs (p0.001). 100% of the target dosage is achieved in more than 90% of patients taking MRA across the entire LVEF range. While for â-blockers and ARNI/ACE/ARB the percentage of patients receiving the full therapeutic dosage of drugs is significantly lower. When analyzing target dosages of pathogenetic drugs, gradations of achieved doses were distributed evenly throughout the entire range of GFR. Conclusion. GFR60 ml/min/1.73 m2 occurs in every 3 patients with CHF across the entire range of LVEF. A decrease in GFR worsens the prognosis of patients with both HFrEF and HFpEF, increasing in direct proportion with the severity of the stage of CKD. Inclusion of patients in the monitoring program within the framework of the CHF service allows the treatment to be significantly brought closer to optimal drug therapy, at the same time, certain efforts are required to overcome difficulties with titration to target dosages.

The annual mortality of patients with clinically pronounced symptoms of chronic heart failure in the Russian Federation reaches 2629%, i.e., from 880 to 986 thousand patients with heart failure die in the country in one year, which is comparable to the population of a large city. Providing care for patients with heart failure places a heavy burden on the country's health care system, making a significant contribution to mortality rates, hospitalization rates, including readmissions, which in turn requires considerable costs. The article presents an overview of registry studies that are devoted to assessing the effectiveness of diagnostics, the completeness of examinations, as well as the adequacy of ongoing drug treatment.

The article is focused on the issues of poor patient adherence to medication treatments, including antiplatelet drugs, its reasons, and solutions for overcoming compliance barriers. As of today, treatment adherence remains low leading to a higher risk of cardiovascular complications. Poor adherence to acetylsalicylic acid (ASA) treatment is mainly linked to a relatively frequent development of gastrointestinal side effects. The solutions for overcoming this problem include the use of lowest effective doses and the development of different acetylsalicylic acid (ASA) formulations: enteric coated and buffered. The efficacy and safety of these formulations are compared in the article. Buffered formulation (e.g. ASA + magnesium hydroxide) is similar to plain ASA as regards its antiplatelet activity and the prevalence of "aspirin- resistance", while its intake is associated with a lower risk of enteropathy and gastropathy as compared to plain and even enteric coated ASA. This is particularly important for patients with obesity and diabetes mellitus, as these conditions are associated with an affected rate of absorption from the small intestine. Based on the study findings a conclusion is made that buffered ASA should be the preferred formulation for use. The literature review is illustrated by a clinical case. KEYWORDS: chronic ischemic heart diseases, secondary prevention, adherence to therapy, acetylsalicylic acid, antiaggregant therapy, acetylsalicylic acid buffered and enteric coated formulations, aspirin-resistance. FOR CITATION: Ageev F.T., Smirnova M.D., Fofanova T.V. Poor patient adherence to medication treatments and solutions for overcoming compliance barriers as illustrated by antiplatelet therapy. Russian Medical Inquiry. 2023;7(1):56–61 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-1-56-61.

The article focuses on modern views on the role and place of left ventricular ejection fraction (LV EF) in determining the status of cardiovascular patients (primarily patients with heart failure) in the algorithm for their diagnosis, treatment, and prediction of the outcome. Conclusions and recommendations on the use of LV EF in patients with chronic heart failure (CHF) are the following: 1) LV EF remains a familiar and convenient instrumental indicator not so much of myocardial contractility as of hemodynamics in general. Assessment of LV EF is useful for selection and ranking of CHF patients whereas the LV EF dynamics is useful for assessing the quality of their management. 2) In the entire population of cardiovascular patients, the "normal" LV EF (mortality nadir) is in the range of 60-65%. 3) LV EF demonstrates a U-shaped relationship with prognosis: in cardiovascular patients with LV EF below the mortality nadir, the relationship is inversely proportional, and above the mortality nadir, it is directly proportional. The question of the boundary between "normal" and "reduced" LV EF in terms of CHF syndrome remains open, but obviously, this boundary is most likely within the range of 50 to 60%. 4) LV EF determines the effectiveness of CHF treatment, but this rule is not applicable to all LV EF ranges and not to all classes of drugs.

Aim. To evaluate the effect of Sacubitril/Valsartan (S/V) on the functional status, systolic and diastolic function of the left ventricle (LV), tolerability of therapy and to determine predictors of its effectiveness in patients with cancer therapy-related heart failure (СTRHF). Materials and methods. Forty patients 58 [46; 65.5] years of age with HF associated with anthracycline-containing cancer therapy were enrolled. Clinical examination, echocardiography, and assessment of potassium and creatinine levels were performed at baseline and after 6 months of S/V therapy. Results. NYHA functional class (FC) improvement was observed in 22 (64.7%) patients. Radiation therapy (RT) decreased (OR 0.091; 95% CI 0.010.83; p=0.03) while baseline low LV EF increased (OR 9.0; 95% CI 1.7845.33; p=0.008) the odds of FC improvement. LV EF increased from 37.3 [30; 42.5] % to 45 [38; 48] % (p0.0001) and exceeded 50% in 7 (20.6%) patients. The odds of LV EF recovery increased when S/V therapy was initiated 1 year after anthracycline therapy (OR 10.67; 95% CI 1.5772.67; p=0.0016) and decreased in patients with the history of RT (OR 0.14; 95% CI 0.020.89; p=0.0037) and in patients over 58 years (OR 0.07; 95% CI 0.010.68; p=0.022). LV diastolic function improvement included E/e descent from 13.6 [10; 18.3] to 8.9 [6.9; 13.7] (p=0.0005), and decrease in diastolic dysfunction grade in 18 (45%) patients (p=0.0001). No significant change in serum potassium (4.45 [4.2; 4.8] versus 4.5 [4.3; 4.8]; p=0.5) and creatinine (75.4 [67.6; 85.1] versus 75.5 [68.2; 98.3]; p=0.08) levels were observed. Conclusion. S/V therapy is associated with improvement of EF, systolic and diastolic LV function, demonstrates a favorable tolerability profile in patients with СTRHF. Lack of RT and low baseline LV EF increased the odds of LV EF improvement; lack of RT, early (1 year) start of treatment after discontinuation of anthracycline therapy, and age 58 years increased the odds of LV EF recovery.