Aim. To assess the healthcare system costs for the management of patients with heart failure (HF) based on a retrospective analysis of primary medical documentation.

Material and methods. We performed the analysis of outpatient records of 1000 patients, followed up for 1 year by a general practitioner or cardiologist in ambulatory clinic in 7 Russian regions. The assessment of the HF socioeconomic burden was carried out from the perspective of the state. A bottom-up approach was applied to the cost analysis. To calculate the average costs per patient per year, the costs for each patient were calculated, followed by estimation for the entire cohort. Direct costs (medical: outpatient care, inpatient care, drug therapy; nonmedical: disability pensions and temporary disability) and indirect costs (loss of gross domestic product) were estimated.

Results. It was shown that the average cost of managing 1 HF patient is RUB 160338 per year. The cost of drug therapy varied significantly depending on the source of funding. So, the total therapy cost was about RUB 90000 per year, while within the drug assistance programs — about RUB 7000 per year. Thus, the proportion of drug therapy in cost pattern per patient from the state’s perspective was only 4,7%, while the maximum costs were for inpatient care (45,5%), stay in intensive care units (16,4%) and disability payments (21,6%). The direct costs for HF therapy, with the exception of drug therapy (examination, inpatient and outpatient treatment), averages RUB 108291 per year. The total direct nonmedical and indirect costs per HF patient per year were about RUB 44519 per year. It should be noted that the rehabilitation costs were not included in the calculation.

Conclusion. Taking into account the significant burden of HF on the Russian healthcare system, the growing costs of healthcare and the increase in life expectancy, prevention and treatment of HF should be improved. The development of a HF centers’ network, creating a seamless system of HF care, as well as improving the availability of medication therapy and the inpatient management of patients can improve the healthcare quality for HF patients in Russia.

Aim. To evaluate functional, clinical and psychological status of patients with class II-III heart failure, who underwent comprehensive cardiac rehabilitation program.

Material and methods. Patients of both sexes with class II-III heart failure who met the inclusion criteria, did not have the exclusion criteria, and signed informed consent were included. The training process consisted of a 4-week respiratory muscle (RM) training using the THRESHOLD® IMT breathing trainer followed by a 12-week moderate intensity aerobic exercise (AE). AE were conducted under the supervision of an instructor 3 times a week for 40 minutes. RM training was carried out by patients at home on their own 5-7 times a week. Minnesota Living With Heart Failure Questionnaire (MLwHFQ.23) was used to assess quality of life. In addition, we applied Hospital Anxiety and Depression Scale (HADS). The evaluation was performed before the start of the study (visit 1), after 4 weeks of respiratory training (visit 2) and at the end of 16 weeks of AE (visit 3). The baseline characteristics of patients who were screened and not enrolled in the study were compared with those who participated in training.

Results. A total of 102 patients were included in the study (passed the first visit). Subsequently, for various reasons, including due to the pandemic, 82 patients refused to participate in the study. Only 20 patients participated in RM training for 4 weeks followed by a 12-week cycle of moderate-intensity AR (median age, 67,0 (58,7-74,3) years; men, 70%; Δ peak oxygen uptake (VO₂peak) (1-2) =1,1, p=0,3863; ΔVO₂ peak (1-3) =2,3 ml/kg/min, p=0,139. During 16-week training, we revealed an increase in expiratory muscle strength (EMS) (ΔEMS =10 cmH₂O (p=0,037), six-minute walk test (6MWT) (Δ6MTX=60 meters, p=0,005), and SHOKS score (p=0,0117), as well as improvement in anxiety and depression symptoms (ΔHADS =-2 points, p=0,0346). Patients who refused to be included in the study were older, had lower blood pressure, and had a worse quality of life. The groups did not differ significantly in other clinical, functional and laboratory parameters.

Conclusion. Patients’ motivation to exercise was associated with younger age and better subjective health perception and did not depend on objective status. In patients undergoing a comprehensive rehabilitation program, there was a significant change in RM strength, as well as an increase in 6MWT distance, clinical and psychological status already at the stage of respiratory training. This trend continued at the AE stage as well.

Aim. To assess the prognostic value of the integral assessment using various modern methods for diagnosing congestion in patients hospitalized with acute decompensated heart failure (ADHF).

Material and methods. This single-center prospective study included 165 patients with ADHF. All patients underwent a standard clinical and paraclinical examination, including assessing NT-proBNP levels, lung ultrasound B-lines, liver transient elastography, bioelectrical impedance vector analysis (BIVA) at admission and discharge. To assess clinical congestion, the Heart Failure Association consensus document scale was used. Long-term clinical outcomes were assessed by telephone survey 1, 3, 6, 12 months after discharge. As an end point, the allcause mortality and readmissions were estimated.

Results. In patients hospitalized with ADHF, at discharge, differences were found in the incidence of residual congestion according to certain paraclinical methods — from 22 to 38%, subclinical — from 14,5 to 27%. When using the integral assessment of stagnation, the incidence of residual and subclinical congestion was 53,6% and 35%, respectively. Patients with residual congestion had more severe symptoms of congestion, compared with those with subclinical congestion. Patients in whom congestion was detected by 4 methods, in contrast to those by 1, 2, and 3 methods, had worse clinical and paraclinical parameters. There was a significant increase in the risk of all-cause mortality and readmission in the presence of congestion, identified by 3 (hazard ratio, 9,4 (2,2-40,6); p<0,001) and 4 methods (hazard ratio, 15,2 (3,3-68,1); p<0,001).

Conclusion. For patients hospitalized with ADHF, integral assessment of residual and subclinical congestion at should be performed at discharge. The introduction of an integral assessment of congestion into routine practice will allow to identify a group of patients with more unfavorable prognostic characteristics in relation to the risk of death and readmissions, as well as to intensify drug therapy and followup at the outpatient stage.

Aim. To assess the risk of heart failure (HF) depending on the state of renal filtration function in patients with uncomplicated hypertension (HTN) without kidney dysfunction.

Material and methods. This cross-sectional screening clinical trial consecutively included 176 outpatients with uncomplicated HTN and without chronic kidney disease (CKD). To assess the HF risk, the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined. To assess the renal filtration function, the blood serum concentration of creatinine and cystatin C was determined, followed by glomerular filtration rate (GFR) estimation using the CKDEPI equation with both parameters. Echocardiography was performed to assess the cardiac structural and functional state.

Results. Correlation analysis revealed a moderate direct relationship between NT-proBNP and blood cystatin C concentration (r=0,370; p<0,005), as well as a moderate inverse relationship with GFR (CKD-EPIcre) and GFR (CKD-EPIcys) (r= -0,321; p<0,05 and r=-0,360; p<0,005, respectively). ROC curve for all available values of blood cystatin C revealed the most optimal cut-off threshold of 1016 ng/ml (AUC=0,726, p<0,001), which ensures the sensitivity of 72,2% (p<0,001) and specificity of 62,0% (p<0,001). ROC curve for all available GFR values (CKD-EPIcys) revealed a cut-off threshold of 74 ml/min/1,73 m² (AUC=0,702, p=0,002) with a sensitivity and specificity of 55,6% and 74,7%, respectively (p=0,001 and p=0,001, respectively). Taking into account the cut-off points for cystatin C and GFRcys, the first group consisted of 73 (41,48%) patients with cystatin C ≥1016 ng/ml and GFR (CKD-EPIcys) ≤74 ml/min/1,73 m², while the second one — 103 (58,52%) patients with cystatin C <1016 pg/ml and GFR (CKDEPIcys) >74 ml/min/1,73 m². The presence of impaired glucose tolerance, left ventricular diastolic dysfunction (LV DD), LV hypertrophy and left atrial enlargement leads to an additional increase in HF risk in patients with uncomplicated HNT without CKD.

Conclusion. The ROC analysis showed that cystatin C and cystatin C-based GFR (CKD-EPIcys) can be used as markers of HF risk in patients with uncomplicated HTN without CKD. With an increase in cystatin C ≥1016 ng/ml, the relative risk of HF is 2,99, while with a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m2 — 1,26. The presence of impaired glucose tolerance, LV DD, LV hypertrophy and left atrial enlargement in patients with uncomplicated HTN without CKD with a cystatin C increase ≥1016 ng/ml and a decrease in GFR (CKD-EPIcys) ≤74 ml/min/1,73 m² and below further increases the risk of developing CHF.

Aim. To study the parameters of myocardial blood flow (MBF) and coronary flow reserve (CFR) in patients with heart failure (HF) with preserved ejection fraction and evaluate their relationship with the severity of HF.

Material and methods. The study included 47 patients (men, 68,7%) aged 65,0 (58,0; 72,0) years with left ventricular ejection fraction of 62 (56; 67)% and coronary artery stenosis <50%. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were assessed by enzyme immunoassay. MBF and CFR values were assessed using cardiac single photon emission computed tomography.

Results. Depending on NT-proBNP levels, the patients were divided into 2 groups (p<0,001): the 1st group included (n=15) patients with NT-proBNP <125 pg/ml (58,2 [41,6; 70,7] pg/ml), while in the 2nd group (n=32) — with NT-proBNP ≥125 pg/ml (511,4 [249,8; 1578,1] pg/ml). The group of patients with high NTproBNP levels was characterized by higher values (by 33,8%, p=0,0001) of resting MBF and reduced CFR (by 14,7%, p=0,001) compared with patients with normal NT-proBNP level: resting MBF — 0,65 (0,44; 0,79) vs 0,43 (0,30; 0,58) ml/min/g; CFR — 2,21 (1,52; 2,83) vs 2,59 (2,47; 3,05), respectively. At the same time, MBF at stress did not differ between the groups. The relationship of NTproBNP levels with global CFR (p=0,012; r=-0,339) and MBF at rest (p=0,012; r=0,322) was established. A stepwise decrease in global CFR was revealed depending on the NYHA class as follows (p<0,001): 2,79 (2,52; 2,93); 1,8 (1,55; 2,08); 1,31 (1,23; 1,49) — for class I, II, and III, respectively.

Conclusion. A decrease in CFR in patients with HF with preserved ejection fraction indicates impaired myocardial blood supply, which, in this group of patients, is associated with microcirculatory changes. At the same time, the severity of MBF alterations is closely related to HF severity.

Aim. To determine the peculiarities of heart failure (HF) development in human immunodeficiency virus (HIV)-infected patients, depending on the blood concentration of C-reactive protein (CRP).

Material and methods. This cross-sectional screening clinical trial included 100 patients hospitalized with HIV infection and a history of HF for 28 months. The patients were divided into 2 groups depending on blood CRP concentration. The cut-off point was CRP of 15 mg/l. The first group included 37 HIV-infected patients with HF and blood CRP <15 mg/l, while the second group — 63 HIV-infected patients with HF and CRP concentration ≥15 mg/l. The inclusion criteria were HIV infection and prior HF, stable medical state, taking into account the underlying disease that required hospitalization. The study did not include patients with acute cardiovascular diseases within prior 3 months, acute decompensated and acute heart failure, cancer, infectious diseases, conditions that required surgical intervention. N-terminal pro-brain natriuretic peptide (NT-proBNP) was determined in all patients.

Results. Correlation analysis revealed a strong inverse relationship between the blood concentrations of NT-proBNP and CRP (r=-0,639; p<0,005). A ROC curve revealed the most optimal cut-off threshold of 9,8 mg/l (AUC=0,796, p<0,05), which ensures sensitivity of 92,9% (p<0,05) and specificity of 57,6% (p<0,05). The odds ratio (OR) of an increase in NT-proBNP >450 pg/ml, and hence the risk of acute decompensated HF in the presence of a CRP concentration of 1-9,8 mg/l in HIV-infected patients with HF was 44,73 (95% CI=8,62;311,10), while relative risk (RR) — 18,73 (95% CI=4,94;112,94). In the presence of in hospital inflammatory diseases and CRP ≥15 mg/l in HIV-infected patients and prior HF, the RR of acute decompensated HF is reduced by 88% (RR=0,12, 95% CI=0,03-0,33).

Conclusion. CRP values from 1 to 9,8 mg/l in HIV-infected patients with HF are predictors of its severity, characterized by a higher incidence of HF with reduced ejection fraction, diastolic dysfunction and left ventricular hypertrophy without significant differences with patients who have CRP >9,8 mg/l. CRP concentration >9,8 mg/l in HIV-infected patients and prior HF indicates the development of an inflammatory process, and not a worsening of the HF course.

Aim. To determine the risk factors and diagnostic value of urinary N-terminal probrain natriuretic peptide (NT-proBNP) for verification of heart failure in human immunodeficiency virus (HIV)-infected patients

Material and methods. This cross-sectional screening clinical trial included 115 HIV-infected patients who were hospitalized during 24 months. The patients were divided into 2 groups, depending on the data suggestive of HF and the blood and urinary NT-proBNP concentration. So, group 1 included 69 HIV-infected patients with HF symptoms and increased blood and urinary NTproBNP, while group 2 — 46 HIV-infected patients not meeting HF criteria. NTproBNP concentration was determined on Immulite 1000 Immunoassay System (DPC, USA) in blood plasma and frozen urine using Vector Best reagents (Russia).

Results. Correlation analysis revealed a significant direct moderate correlation between blood and urinary NT-proBNP in the entire cohort of studied patients (r=0,367; p<0,05). Urinary NT-proBNP ≥8,6 pg/ml ml is diagnostic for HF verification in HIV-infected patients. Significant differences between the groups were obtained in the incidence of ventricular arrhythmias, viral hepatitis B and C, liver cirrhosis, infective endocarditis, other inflammatory diseases, thrombocytopenia, left ventricular (LV) diastolic dysfunction and its severity. In addition, there were differences in LV mass index, left atrial volume index, incidence of LV hypertrophy and left atrial enlargement, concentration of hemoglobin and CD4 cells <200 in 1 µl. The preserved LV ejection fraction was detected significantly more often (p<0,001). Conclusion. In HIV-infected patients, blood plasma and urinary NT-proBNP concentration correlates with each other. Urinary NT-proBNP ≥8,6 pg/ml is diagnostic for HF verification in HIV-infected patients. Risk factors and features of developing HF, estimated by NT-proBNP concentration in frozen urine in HIV-infected patients, are comparable to data obtained from blood plasma NTproBNP.

Aim. To investigate the baseline characteristics of patients with resistant hypertension (HTN) undergoing radiofrequency renal sympathetic denervation (RD) and to determine immediate procedural effects.

Material and methods. During 2018-2019, two series of radiofrequency RD procedures were performed in patients with true resistant HTN using balloon-type (bipolar ablation) or spiral-type (unipolar ablation) multielectorde catheters. The basic demographic, clinical and laboratory characteristics of included patients were assessed. A comparative analysis of two groups was carried out depending on the type of catheter used. Dynamics of office systolic blood pressure (SBP) were assessed as ∆ between the two following timepoints: at screening and at hospital discharge. The safety of radiofrequency RD was assessed. Multiple linear regression was used to determine the factors associated with the ∆ of office SBP after radiofrequency RD.

Results. A total of 48 patients taking 4 (4;6) antihypertensive drugs were sequentially included. Radiofrequency RD was performed with a balloon-type catheter in 27 patients (mean age, 56±12 years old; 12 males) and with a spiral-type catheter in 21 patients (50±14 years old; 8 males). Radiofrequency RD was significantly longer in the spiral catheter group than in balloon one (110 versus 60 minutes, p<0,001), as was the mean number of RF applications (24 versus 12, p=0,002). None of the patients had acute kidney injury after RD (creatinine ∆, -0,6 µmol/L; 95% CI [-3,97; 2,78]). A total of 4 patients had complications (3 femoral arterial pseudoaneurisms, one renal arterial dissection), all of which did not affect the average length of hospital stay (from 4 to 5 days). At discharge, there was a pronounced decrease in office SBP (adjusted for baseline characteristics) with the mean of -26 mm Hg (95% CI [-29; -23]). There were following main factors associated with the office SBP ∆: smoking status (positive), baseline office SBP (positive), and blood glucose (negative).

Conclusion. Radiofrequency RD using multielectode catheters is characterized by favorable short-term hemodynamic effects. We have found novel potential predictors of these effects. Further research will focus on testing initial hypotheses in the long term.

Aim. To study the immediate and short-term outcomes of transcatheter mitral valve edge-to-edge repair with the MitraClip NT in patients with severe mitral regurgitation as part of the MitraClip Russia prospective single-center study.

Material and methods. The study included 16 patients (men, 10; women, 6) with mean age of 70,1±2,1 years (mean Euroscore II, 6,90±5,56%; STS, 6,33±3,94%). Immediate technical success was defined as successful access, delivery, and removal of the device, and adequate placing the clip(s) to reduce the mitral regurgitation to grade 2 or below without the need for device- or procedure-related reintervention.

Results. Immediate technical success was achieved in all patients. The average number of implanted clips per 1 patient was 1,7. In 1 patient (6,3%), a clip was attached to one mitral leaflet, which required an non-scheduled implantation of a second clip. In hospital mortality was 6,3%: a 92-year-old patient on the 3rd day after the operation had a sudden cardiac arrest followed by coma, hemispheric ischemic stroke and death on the 6th day. An autopsy revealed an iatrogenic atrial septal defect. Echocardiography performed on the 10th and 30th day after surgery showed a decrease in mitral regurgitation grade in 15 patients, while grade 3 residual mitral regurgitation did not reveal in any patient.

Conclusion. Transcatheter mitral valve edge-to-edge repair with the MitraClip is a minimally invasive method for treating severe symptomatic mitral regurgitation (degenerative and functional). The results demonstrate high immediate efficacy and an acceptable safety profile in high surgical risk patients. Based on the analysis of death causes, the authors conclude that it is necessary to include initial pulmonary hypertension above 75 mm Hg as a relative contraindication to this procedure. The study limitations are the small sample size and short follow-up period.

Aim. To assess the relationship between the level of salt (NaCl) consumption and clinical and hemodynamic parameters in patients with hypertrophic cardiomyopathy (HCM) of different age groups.

Material and methods. We examined 57 patients with HCM (mean age, 59,2±16,2 years). The patients were divided into groups according to the World Health Organization (WHO): I — young age (≤44 years old) — 12,4% of patients; II — middle (45-59 years old) — 37,2%; III — elderly (60–74 years old) — 36%; IV — senile (≥75 years old old) — 14,4%. The clinical status of patients was assessed, during which special attention was paid to syncope not related to cardiac arrhythmias. NaCl intake was assessed by the 24-hour urine sodium (Na+) level.

Results. In the general cohort, in Na+ level <50 mmol/day, the lowest left ventricular stroke volume (LVSV) index was observed, which were associated with syncope (r=-0,9, p=0,03). With the urinary sodium level of 50-70 mmol/day, an increase in LVSV index was observed and the absence of syncope. At Na+ level more than 70 mmol/day, no increase in LVSV index was observed. In this regard, a predictive model was created, as a result of which it was found that with an increase in Na+ consumption by 1 mmol/day, an increase in LVSV index by 0,3 ml/m² should be expected. There were no significant differences in the effect of NaCl intake on the studied parameters in patients with HCM of different ages. At the same time, low NaCl intake in elderly patients was associated with syncope.

Conclusion. Minimal values of Na+ intake (<50 mmol/day or NaCl 3 g/day) were found, which are unfavorable for patients with HCM due to the risk syncope. The 24-hour urine sodium level to maintain a hemodynamically safe level of LVSV index in patients with HCM should be more than 70 mmol/day (NaCl 4,1 g/day). Monitoring of Na+ consumption level is especially important in elderly people with HCM.

The article provides a summary of the 2021 European Society of Cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure (CHF). The most significant changes for general practitioners, internists and primary care cardiologists, from our point of view, regards etiology, terminology, as well as algorithms for diagnosing and treating CHF in accordance with phenotypes, new indications to a number of drugs, in particular sodium-glucose cotransporter type 2 inhibitors (dapagliflozin and empagliflozin) with assignment of class I recommended therapy and vericiguat. The article discusses the diagnostic criteria for different heart failure phenotypes, the potential of treating patients with heart failure mildly reduced and preserved ejection fraction.

Pulmonary hypertension (PH) is a pathophysiological and hemodynamic condition that complicates the course of various diseases and negatively affects morbidity and mortality. The search for the new pathophysiological mechanisms for PH development and progression, the markers for predicting the PH course, and the possible targets for therapy remains relevant. This review is devoted to the role of neurotrophin (NT) system in PH pathogenesis, the possible use of NT and their receptors as a laboratory marker of its severity, and also as a potential target for influencing the pulmonary artery remodeling in PH. In addition, the participation of NTs in neoangiogenesis and restoration of nervous and muscle tissues was described.