Aim. To determine the incidence, risk factors and course of acute decompensated heart failure (ADHF) in patients with prediabetes.

Material and methods. Within 24 months, 426 patients hospitalized to cardiology department of a multidisciplinary hospital with ADHF were consecutively included in the study. In addition, 136 patients who met the inclusion criteria and did not have exclusion criteria were divided into 2 groups depending on prediabetes presence. The first group consisted of 51 (37,5%) patients with prediabetes, the second — 85 (62,5%) patients without this pathology. ADHF was verified based on a rapid increase in symptoms and signs of hypoperfusion. Prediabetes was defined according to World Health Organization criteria. The risk level for type 2 diabetes was determined using the FINDRISC online calculator. In the first 48 hours of hospitalization, echocardiography was performed. The serum concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) and cystatin C was determined using enzyme immunoassay.

Results. The incidence of prediabetes among patients with ADHF was 37,5%. In 9,8%, prediabetes was verified prior to hospitalization. Patients with prediabetes and ADHF were younger and were more likely to have obesity with a body mass index (BMI) of more than 30 kg/m², non-alcoholic fatty liver disease, and higher waist circumference. In patients with ADHF and prediabetes, congestion symptoms were more pronounced, their higher frequency was recorded, as well as the frequency of wet-warm phenotype. Spironolactone dose was higher during hospitalization in the group of patients with ADHF and prediabetes. In the same group, the duration of hospitalization was longer. Prevalence of ADHF with preserved and mildly reduced ejection fraction (EF), severity of LV diastolic dysfunction (DD), LV mass index in patients with BMI >30 g/m², left atrial volume index, pulmonary artery systolic pressure were significantly higher in the group of patients with ADHF and prediabetes. At a high risk of type 2 diabetes, the concentrations of NT-proBNP, triglyceride/glucose index, cystatin C, LV diastolic dysfunction severity were significantly higher, and the glomerular filtration rate was lower.

Conclusion. The development of ADHF in patients with prediabetes is interrelated with multiple risk factors and comorbidities, characterized by more pronounced congestion, longer hospitalization, predominantly preserved and mildly reduced EF in combination with severe LVDD, LV hypertrophy, and activation of nonspecific inflammation.

Aim. To assess the development of adverse cardiovascular events in patients with non-obstructive coronary artery disease (CAD) and coronary microvascular dysfunction (CMD), identified by dynamic myocardial single-photon emission computed tomography (SPECT), during 12-month follow-up compared with patients without CMD.

Material and methods. The study included 118 patients (70 men, mean age, 62,0 [58,0; 69,0] years) with preserved ejection fraction (62 [59; 64] %) and non-obstructive CAD. Serum levels of the N-terminal pro-brain natriuretic peptide were assessed at baseline by enzyme immunoassay. Coronary flow reserve (CFR) was assessed by dynamic SPECT. CFR ≤2 was a CMD marker.

Results. Six patients discontinued participation in the study due to loss of contact with them, while the rest were divided into groups depending on CMD presence: group 1 included patients with CMD (CFR ≤2; n=42), and group 2 was the control group and included patients without CMD (CFR >2; n=70). Within 12-month follow-up, 25 patients reported adverse events. According to Kaplan-Meier analysis, the prevalence of adverse cardiovascular events was higher in patients with CMD (45,2%, n=19) than in patients without it (8,6%, n=6) (p<0,001). Multivariate regression analysis showed that the presence of CMD (odds ratio (OR), 2,42; 95% confidence interval (CI), 1,26-5,85; p<0,001) and diastolic dysfunction (OR, 3,27; 95% CI, 2,26-5,64; p<0,001) were independent predictors of poor outcomes. The combination of CMD with diastolic dysfunction more than 5 times increased the risk of adverse events (OR, 5,18; 95% CI, 3,61-11,84; p<0,001).

Conclusion. We found that in patients with non-obstructive CAD, the presence of CMD, identified by dynamic myocardial SPECT, was associated with a higher risk of adverse cardiovascular events within 12-month follow-up period than in patients without CMD. At the same time, the combination of CMD with diastolic dysfunction more than 5 times increased the risk of adverse outcomes.

Aim. To determine the prevalence and show the features of the development of newly diagnosed heart failure (HF) in patients with dyspnea after a coronavirus disease 2019 (COVID-19).

Material and methods. This clinical prospective observational study was conducted during 2020-2022. The study consecutively included 368 outpatients with shortness of breath, who applied to the clinic. Depending on the presence of prior COVID-19, the patients were divided into 2 groups: the first group consisted of 205 patients with shortness of breath after COVID-19, the second group — 163 patients without prior COVID-19. All patients underwent a clinical examination within 3 days after presentation with an assessment of outpatient records and other medical documents for the differential diagnosis of dyspnea. The severity of dyspnea was determined using the Modified Medical Research Council Dyspnoea Scale (mMRC). The diagnosis of HF was verified in accordance with the 2020 Russian Society of Cardiology guidelines and in some cases reclassified in accordance with the 2021European Society of Cardiology guidelines. For further analysis, 2 subgroups of patients with HF were identified depending on the presence and absence of prior COVID-19. The subgroup analysis excluded patients with acute heart failure, acute illness, and conditions requiring hospitalization and/or intensive care.

Results. Among 368 patients who presented to the clinic with dyspnea during 2020-2022, 205 patients (55,7%) had COVID-19. The average period of treatment after COVID-19 was 3,5 [1,5; 22,4] months. Patients after COVID-19 applied earlier after the onset of dyspnea, which is associated with higher mMRC score. The prevalence of HF among patients with shortness of breath after COVID-19 was significantly higher than in patients without this pathology in history, and amounted to 19,0% vs 9,8% (p=0,021). Prior COVID-19 increased the relative risk (RR) of HF in patients with shortness of breath by 1,7 times. RR for HF in systolic blood pressure >140 mm Hg increased by 1,9 times, while  in diastolic blood pressure >90 mm Hg — by 1,9 times, with the development of a hypertensive crisis — by 28%, with a heart rate >80 bpm at rest — by 1,4 times, with the development of type 2 diabetes — by 31%, in the presence of pulmonary fibrosis — by 2,3 times. Patients with shortness of breath after COVID-19 had more severe HF, both according to clinical tests and according to the blood concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP), mainly with the preserved ejection fraction (EF) with a higher prevalence of left atrial (LA) enlargement in combination with a decrease in right ventricular (RV) systolic function and its dilatation. In patients after COVID-19 in the presence of chronic kidney disease, the RR for HF increased by 4,5 times; in the presence of C-reactive protein >4 mg/l — by 1,6 times.

Conclusion. Every fifth patient with shortness of breath 3,5 months after COVID-19 had more severe HF, both according to clinical tests and according to blood NT- proBNP concentration, mainly with preserved EF with a higher prevalence of LA increase in combination with a decrease in RV systolic function and its dilatation. The risk of HF is interrelated with the female sex and multiple comorbidities.

Aim. To determine the clinical features of sleep-related breathing disorders (SRBDs) and their prognostic role in patients with heart failure with reduced ejection fraction (HFrEF) depending on the body mass index (BMI).

Material and methods. This prospective cohort study included 111 patients with HFrEF who were hospitalized with symptoms of decompensated heart failure. All patients underwent a standard examination and polysomnography after HF compensation. Patients with HF were divided into 3 groups depending on the body mass index: group 1 — BMI of 18,5-25 kg/m², group 2 — BMI 25-30 kg/m², group 3 — BMI ≥30 kg/m². Primary endpoint was all-cause mortality. The median follow-up was 918 (163; 2495) days. Information was collected twice a year through telephone contacts.

Results. In the 1^st group, SRBDs occurred in 74% of cases, while in overweight and obese patients — in 84% and 86% of patients, respectively. In multiple comparisons of the three groups, the hypopnea index and apnea/hypopnea index (AHI) in the REM sleep were significantly different (p<0,05), when pairwise comparison revealed significant differences only between groups 1 and 3. Hypoxemia, estimated by average saturation ((95 (94,1-95,75), 96 (95,5-96,3), and 92,05 (91,6-92,5), p=0,0001) and average desaturation (5,9 (5,2-7,25), 4,1 (3,8-8,8), and 10 (8,6-11,4), p=0,002), was more pronounced in groups with obesity. In groups 1 and 2, negative correlations were observed between average oxygen saturation and BMI (r=-0,398, p=0,012 and r=-0,635, p=0,0001), which was not observed in patients with obesity. Survival analysis showed a worse prognosis in patients with normal BMI with and without moderate sleep apnea, while obese patients without moderate sleep apnea had a better prognosis than overweight patients (log-rank=5,989, p=0,05).

Conclusion. In patients with HFrEF, obesity is associated with a higher incidence of severe apnea, more severe hypoxemia, which does not correlate with BMI. The worst prognosis was observed in patients with normal BMI, while the most favorable prognosis — in obese patients without moderate sleep apnea.

Review of the article Medvedeva E. A., Korostovtseva L. S., Bochkarev M. V., Sazonova Yu. V., Sviryaev Yu. V. Clinical and prognostic role of sleep-related breathing disorders in patients with heart failure depending on body mass index. Russian Journal of Cardiology. 2023;28(3):5263. doi:10.15829/1560-4071-2023-5263. EDN LWBNSN

Aim. To study the prognostic relationship between heart failure (HF) and osteoporosis, as well to search for modern principles and approaches to the management of patients.

Material and methods. A search was conducted in the PubMed, RSCI databases from 2012 to 2022 using keywords. The studies were selected according to the PRISMA algorithm.

Results. Based on the results, 124 papers were received, and 9 articles were eventually selected. The age of the patients was at least 49 years (mainly elderly patients). The median follow-up ranged from 12 months to 10,5 years. The larger percentage were females.

Conclusion. Osteoporosis was associated with the HF risk, and patients with heart failure had a higher risk of accidental fracture due to accelerated bone turnover. The foregoing makes it possible to consider patients with HF as a group of increased risk of osteoporosis and associated fractures, and impaired mineral metabolism as a possible additional cardiovascular risk factor.

Aim. To compare the effect of insulin therapy and oral hypoglycemic agents (OHAs) on the risk of heart failure (HF) in patients with type 2 diabetes (T2D) using different databases.

Material and methods. The systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis included studies that compared the risk of HF in T2D patients, depending on the OHA therapy in the presence of a group of patients receiving insulin therapy. The inclusion criteria were a duration of treatment of at least two years with at least 1000 included patients. The analysis did not include studies that compared the types and regimens of insulin therapy without a control group (antidiabetic drugs), which included patients with acute complications of type 2 diabetes and unstable conditions associated with comorbidities, in which no clinical outcomes were reported. Search was conducted in August 2022 using several databases (PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) at the Cochrane Library, Elibrary) using the following keywords: heart failure development, 2 type diabetes mellitus, insulin.

Results. Of the 1085 publications found in the search, 5 retrospective observational cohort clinical trials, including a total of 179777 patients with a mean duration of treatment of 67,2 months, met all criteria and were included in the analysis. Statistical analysis of the relative risk (RR) of HF in T2D patients receiving insulin therapy revealed a RR increase in all studies with a total RR using fixed effects model of 2,598 (95% confidence interval (CI), 2,346-2,878; p<0,001), while using the random effects model — 2,382 (95% CI, 1,565-3,626; p<0,001). When checking the statistical heterogeneity of the studies, a high heterogeneity was revealed (I²=93,8%).

Conclusion. Meta-analysis of 5 retrospective observational studies including 179777 patients with T2D with a mean duration of treatment of 67,2 months showed that insulin therapy (without insulin glargine and degludec) in comparison with OHAs (without sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide type 1 receptor agonists) significantly increased the RR for HF using a fixed effects model by 2,6 times, while using the random effects model — by 2,4 times (p<0,001 for both).

Introduction. The data of epidemiological studies indicate maintaining high prevalence of heart failure (HF) and an unfavorable prognosis for such patients, which creates the need to change the treatment approach. A feature of the case presented is the young age of the patient and a significant effect that was achieved with quadruple therapy for HF with reduced ejection fraction (EF) after myocarditis.

Short description. A three-year follow-up of a patient with HFrEF was carried out. In 2019, at the age of 21, the patient had acute myocarditis, diagnosed according to magnetic resonance imaging. The outcome was postmyocarditis cardiosclerosis, complicated by HFrEF. She had two episodes of HF decompensation, followed by hospitalizations in a cardiology hospital. During the treatment, a quadruple therapy was initiated (angiotensin receptor-neprilysin inhibitor, beta-blocker, mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor), against which a significant improve was noted in the form of decrease in congestion symptoms, natriuretic peptide level from 1956 to 501,4 pg/ml, an increase in LVEF from 33% to 39%. The patient is currently on the waiting list for a donor heart transplant.

Conclusion. The case report focuses on the complexity of not only the timely diagnosis of myocarditis, but also the treatment of its consequences. The appointment of quadruple therapy for a patient with HF after myocarditis has improved the patient’s clinical condition before heart transplantation. However, this approach needs to be confirmed in a larger number of patients.

Aim. To study the features of anticoagulant and specific therapy in newly diagnosed patients with chronic thromboembolic pulmonary hypertension (CTEPH) depending on operability status.

Material and methods. The study included 319 patients with CTEPH, hospitalized for the first time in the E.I. Chazov National Medical Research Center of Cardiology for the period from 2012 to 2021. The diagnosis was established according to current guidelines. Depending on operability status, which was assessed by a multidisciplinary team, two following groups were formed: patients with inoperable CTEPH (n=222) and patients with operable CTEPH who underwent pulmonary thromboendarterectomy (n=97) (time from diagnosis to surgery, 13,3 [6,3; 27,1] months). Demographic, functional status, anticoagulant therapy and specific therapy regimens were analyzed.

Results. At the time of initial admission to the expert center, 80,56% of patients received anticoagulant therapy, most often warfarin in both inoperable (38,74%) and operable patients with CTEPH (55,67%), respectively, and rivaroxaban (25,68% and 20,62%, respectively); 6,27% took only antiplatelet agents, and 13,17% did not receive anticoagulant therapy. In the hospital, inoperable patients were most often prescribed low molecular weight heparins in therapeutic doses (47,3%), warfarin — 38,7%, and to a lesser extent (12,16%) — direct oral anticoagulants (DOACs). Operable patients were more often prescribed warfarin (54,64%), while low molecular weight heparins — in 37,1%, and individual patients were prescribed (8,25%) DOACs.

Specific therapy at the admission time was received by 19,59% of operable and 23,42% of inoperable patients with CTEPH, mainly in the sildenafil monotherapy regimen. After verification of the diagnosis, the majority of patients (64,4% of inoperable and 46,4% of operable patients with CTEPH) received monotherapy with sildenafil (72,82%) and riociguat (46,75%). The addition of a second drug, mainly within the initial combination therapy, was required in 5,15% of operable patients and 10,81% of inoperable patients, while 1,06% and 0,9% of operable and inoperable patients with CTEPH, respectively, received triple specific therapy.

Conclusion. For the first time in Russian practice, anticoagulant and specific therapy were studied in newly diagnosed patients with CTEPH, depending on the operability status.

Aim. To evaluate the cost-effectiveness of achieving the target indicator "Reduction of the cardiovascular mortality of the population" of the State Program "Health Development" when using drugs valsartan+sacubitril, dapagliflozin and empagliflozin in patients with New York Heart Association (NYHA) class II-IV heart failure with reduced ejection fraction ≤40% s in 2023-2024.

Material and methods. The target population was Russian patients who received preferential medicines in the last two years after an acute cardiovascular disease. The population size was determined on the basis of Russian literary and statistical sources. To predict the cardiovascular death, a parametric modeling method was used based on published data from clinical trials. The amount of drug costs required to prevent one cardiovascular death, as well as to achieve a one target for reducing cardiovascular mortality, was calculated using each of the comparator drugs in the whole country and separately in each region.

Results. The cost of drugs for the 1^st year of therapy to prevent one cardiovascular death in the case of valsartan+sacubitril was RUB 3,99 million, dapagliflozin — RUB 2,63 million, empagliflozin — RUB 4,43 million. There were following costs required to achieve one target indicator for reducing cardiovascular mortality of the State Program "Health Development" for valsartan+sacubitril, dapagliflozin and empagliflozin:

• in 2023 — RUB 2197,9 million, RUB 1451,5 million and RUB 2435,9 million, respectively;
• in 2024 — RUB 627,4 million, RUB 407,7 million and RUB 706,9 million, respectively.

Conclusion. Among the agents considered, dapagliflozin seems to be the most cost effective for preventing one cardiovascular death and achieving one of the target "Reduction of the cardiovascular mortality" of the State Program "Health Development" in 2023-2024.

Chronotherapy for hypertension has been a topic of debate over the past decade. A number of studies up to 2019 suggested that prescribing drugs in the evening has advantages compared to morning, both in terms of normalization of blood pressure and its circadian rhythm, as well as in terms of the risk of adverse outcomes. Some of these studies were not designed for such an analysis, and some have significant limitations that make their interpretation difficult. The results of the HARMONY and TIME studies published in the last 2 years did not confirm any advantage of taking drugs in the evening compared to the morning, but showed its safety. Selection of antihypertensive therapy should be guided by antihypertensive efficacy, duration and stability of the effect, as well as medical adherence. Therefore, a single intake of double or triple fixed-dose combination of long-acting agents at hours convenient for the patient is optimal.

Russian Society of Cardiology (RSC)

With the participation of the Eurasian Association of Therapists, the Russian Scientific Medical Society of Therapists (RNMOT), the Russian Society of Pathologists, the Russian Society of Radiologists and Radiologists (RSR)

Approved by the Scientific and Practical Council of the Russian Ministry of Health (30.09.2022)