Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure (HF) worldwide and is characterized by a severe course, poor prognosis, and limited effective treatments. To date, there are no reliable prognostic algorithms to identify high-risk patients, and prognostic significance has been determined only for generally accepted clinical and standard resting echocardiographic parameters. The discovery of independent predictors of poor prognosis/severe course of HFpEF is important for determining individual treatment tactics for such patients.The article provides a review of studies devoted to determining clinical, biochemical and hemodynamic predictors of unfavorable progression and prognosis of heart failure with preserved ejection fraction (HFpEF). Significance of assessing of these predictors for determining prognosis and choosing optimal treatment for patients with HFpEF is shown. Directions for further research were identified: identifying phenotypes of HFpEF, developing personalized therapy, construction of prognostic models to identify high-risk patients who require more careful monitoring and/or more intensive drug treatment.

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.

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 . To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) <5% based on a 10-year follow-up. Material and methods . The study included 379 patients with SCORE risk of CVEs <5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint. Results . The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p<0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p<0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p<0,05). Conclusion . The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk <5%.

These guidelines were developed to improve the outpatient care service for patients with chronic heart failure by creating specialized offices in the structure of first-level medical organizations, whose staff includes specialized personnel of both senior and middle medical level.

Aim. To create an advanced algorithm for predicting cardiovascular events (CVE) in low/moderate risk patients using a complex of traditional and new factors.Material and methods. The study included 700 patients with Systematic Coronary Risk Evaluation (SCORE) <5%, examined in 20092010. In addition to standard investigations, blood biochemistry tests, including high-sensitivity C-reactive protein (hsCRP), and sphygmography were carried. In 2019, a follow-up phone call was made to participants to identify recent CVEs: cardiovascular death, myocardial infarction, unstable angina, stroke, revascularization. The response rate was 79,6% (n=557; men, 100; women, 457).Results. CVEs were observed in 48 (8,6%) patients. The risk of CVEs increases systolic blood pressure (SBP) >130 mmHg (odds ratio (OR), 1,9 (95% confidence interval (CI), 1,0-3,6)), hsCRP >2,3 mg/L (OR, cardio-ankle vascular index (CAVI) >8,05 (OR, 1,25 (95% CI, 1,0-1,6)). In patients with a combination of ≥2 lipid profile abnormalities, SBP >130 mm Hg, hsCRP >2,3 mg/L and pulse wave velocity >13 m/s, the probability of developing CVEs (including cardiovascular death) increases 3,55 times (95% CI, 1,32-7,67).Conclusion. Levels of pulse wave velocity, CAVI, urea and hsCRP should be considered as additional risk factors for CVE in patients with low/moderate risk, estimated using standard scales. Combinations of traditional and new risk factors demonstrate a cumulative effect.

These guidelines were developed to improve the outpatient care service for patients with chronic heart failure by creating specialized offices in the structure of first-level medical organizations, whose staff includes specialized personnel of both senior and middle medical level.

Обзор литературы посвящен поиску новых факторов риска сердечно-сосудистых осложнений (ССО), дополняющих «классические» причины ССО. Депрессивные расстройства и хронический стресс могут быть предикторами системного воспаления. В первой части данного обзора основное внимание уделено общим звеньям патогенеза хронического системного воспаления, сопровождающего сердечно-сосудистые заболевания (ССЗ) и депрессию, роли гиперактивации ренин-ангиотензин-альдостероновой системы. Во второй части обзора рассматривается роль кишечной микробиоты в модулировании системного воспаления. Изменения микробиоты могут как стимулировать, так и препятствовать его развитию. Также имеются данные о роли изменений микробиоты в развитии депрессии. Частичное перекрытие патогенетических путей атеросклероза и психических расстройств могут послужить развитию новых терапевтических стратегий для лечения этих заболеваний.

Aim. To assess the contribution of anxiety (A) and depression (D) to the increased risk of cardiovascular events (CVEs) in patients with Systematic Coronary Risk Evaluation (SCORE) <5% according to 10-year follow-up.Material and methods. The work included 190 patients with SCORErisk <5%, examined in 2009-2010. In addition to the standard examination, a questionnaire was carried out using Hospital Anxiety and Depression Scale (HADS). In 2019, we contacted participants by telephone to identify CVEs over the past time: death from cardiovascular diseases (CVDs), acute myocardial infarction (MI), unstable angina, stroke, revascularization. The response was 86,3%.Results. CVEs occurred in 17 (10,2%) patients and included following outcomes: 3 deaths from CVDs, 6 acute MIs, 4 cases of unstable angina, 12 revascularizations. Patients with and without CVEs differed only in the depression level — 7 (5; 7) vs 5.0 (4; 5) points (p=0,0001). HADS-D score >6 increased the probability of CVEs — odds ratio (OR) 2,9 (1,1-7,7). In individuals with HADS-D score >6 and/or HADS-A score >7, the probability of CVEs increased — OR 4,9 (1,4-17,9). A combination of impaired two or more parameters of the lipid profile, systolic blood pressure >130 mm Hg and HADS-D score >6 and/or HADS-A score >7 increased the risk of CVE — OR 7,3 (2,48-21,36).Conclusion. Depression, including subclinical depression, is associated with an increased risk of CVEs in patients with a SCORE risk <5%.

Despite advances in pharma and high-technology medicine, the rate of burdensome hospital admissions and mortality in patients with chronic heart failure (CHF) remains high. Over half of all admission-entailing decompensations have been repeatedly shown to emerge from non-compliance with outpatient prescriptions. Poor adherence to medication and non-medication treatment can only be broken by improving the patient’s awareness of the disease and his closer monitoring by healthcare professionals. The power of clinical and laboratory illness monitoring in line with the recommended quality criteria of medical aid in heart failure (HF) is strongly limited today by time resources available in outpatient and midwifery clinics. Meanwhile, an international and certain domestic experience has been built up to run CHF outpatient centres with involvement of specially-trained nursing and senior medical staff. Analytic evidence on such centres suggests a reduction in mortality and hospitalisation rate among the visiting patients. To combat existing drawbacks of CHF outpatient care, the National Medical Research Center of Cardiology in alliance with the Specialist Society of Heart Failure have developed the nurses’ guidelines for CHF rooms and are launching a medical staff training programme to manage CHF rooms, registry and data analysis. Furthermore, a procedure has been developed for patient routing to regional CHF outpatient cabinets that is being actively deployed in the Tyumen Region.

Психологический статус больных и развитие сердечно-сосудистых осложнений у больных артериальной гипертонией с низким

Abstract Not only “classic” risk factors such as age, sex, smoking status, blood pressure (BP) and cholesterol (HS) levels, but also additional factors, one of which is the psychological status of the patient, need to be considered to improve the prediction of cardiovascular complications. This is especially true for low/moderate risk patients on the SCORE scale, whose risk of cardiovascular complications (CVC) is often underestimated. Aim To assess the contribution of psychological status of hypertensive patients and SCORE<5% to increase the risk of development of cardiovascular complications for a period of 10 years of observation. Materials and methods In 2009, 142 hypertensive patients with SCORE risk <5% (37 men and 105 women) in addition to the clinical examination, were interviewed on the HADS scale to assess the level of anxiety and depression. In 2019, these patients were interviewed by phone for CVC suffered over the past 10 years: all-cause mortality, cardiovascular death (CVD), fatal and nonfatal myocardial infarction (MI), stroke, revascularization, hospitalization for cardiac events. Results At the time of inclusion in the study, the age of the patients was 50, 9±8.2 years. At the first visit systolic BP (SBP) level was 130.0 (128.4; 133.7) mm Hg and diastolic BP (DBP) 80.0 (81.3; 84.5) mm Hg. The HS level was 6.1 (5.9; 6.3) mmol/L, triglycirides 1.4 (1.5:1.8) mmol/L, low dencity lipoproteins 3.8 (3.6; 4.0) mmol/L, high density lipoproteins 1.3 (1.4; 1.5) mmol/L. Level of anxiety (A) was 7.0 (7.0; 8.2) points, depression (D) – 5.7 (5.2; 6.2) points. The patients without the expressed symptom of D (0–7 points) – 76.8% (n=109), A (0–7 points) – 52% (n=74). The patients with clinically significant D (>11 points) – 8.5% (n=12), A (>11 points) – 18.3% (n=26). 2 CVD occurred in the observed group in 10 years (1.4%), 6 MI, 12 percutaneous coronary intervention (8 acute coronary syndrome), 4 strokes, 34 cardiovascular hospitalizations. 14 new onset cases of coronary artery disease (9.6%). Thus 31.7% of observed patients had CVC. Comparison of the initial data of the group with CVC with the group without CVC revealed a difference only in the level of D: 7.0 (5.6; 7.3) points in patients with CVC vs 5.0 (4.7; 5.8) p=0.04) – Fig. 1. The patients were comparable in sex and age. BP, lipid profile, glucose, heart rate, smoking status, levels of A did not differ significantly. Multi-factor regression analysis has demonstrated that depression levels D is an independent predictor of the development of complications in a model involving age, sex, BP, HS and A (β=0,218, p=0,03). Conclusion Level D is an independent risk factor development of CVC in hypertensive patients low/moderate risk on SCORE. Funding Acknowledgement Type of funding source: None