Purpose: to study prognostic value of various biomarkers and their combinations in patients who survived decompensation of chronic heart failure.Materials and methods.Patients (n=159) who were hospitalized with diagnosis of heart failure (HF) decompensation were included in a prospective single-center study. Examination on admission and the day of hospital discharge, included measurement of concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), copeptin, soluble suppression of tumorigenicity 2 (sST2), kopetin, neutrophil gelatinase-associated lipocalin (NGAL), and galectin-3. Te combined primary endpoint comprised cardiovascular (CV) death, frst hospitalization because of HF heart failure decompensation, episodes of HF deterioration which required additional i/v diuretics, and CV death with successful resuscitation.Results.During one-year follow-up 56 pts (35.2%) reached the combined primary endpoint. Tere were 78 (49.1%) cardiovascular events. During hospitalization, patients with the decompensation of heart failure experienced a decrease of sST2, NT-proBNP, galectin-3, kopetin, hsTnT and an insignifcant increase of NGAL. ROC analysis identifed signifcant relation between concentrations of NT-proBNP, sST2, copeptin and, to a lesser degree, hsTnT, determined at hospital discharge, and risk of combined primary endpoint during 1-year follow-up: area under the curve (AUC) was 0.733 [95% CI 0.645–0.820], p<0.0001, 0.772 [95% CI 0.688–0.856], p<0.0001, 0.735 [95% CI 0.640–0.830], p<0.0001, and 0.659 [95% CI 0.553–0.764], p=0.005, respectively. Patients who during hospitalization did not achieve cut-off values of NT-proBNP ≤1696 rg/ml, sST2≤37.8 hg/ml, copeptin≤28.31 rmol/L and hsTnT≤28.37 rg/ml, had higher risk of reaching adverse events during 1 year; OR and 95% CI were 2.96 [1.61, 5.42] p<0.0001, 4.31 [2.34, 7.93] p<0.0001, 3.06 [1.59, 5.89] and 2.19 [2.12, 4.27]), respectively. According to Cox regression analysis, risk of the combined primary end point was the highest in patients with 3 or more elevated markers (OR = 6.6 [3.584, 12.158], p<0.0001), average in patients with 2 elevated markers (OR = 1.123 [0.51, 2.48]), p=0.7), and the lowest in patients with no markers increase or increase of only one marker (OR = 0.11 [0.049, 0.241], p<0.0001). In the Kaplan-Mayer survival analysis all three groups were statistically different. In order to identify the most prognostically strong model, a reclassifcation analysis was performed. According to this analysis, the combination of sST2 and NT-proBNP concentrations determined at hospital discharge, exceeded one NT-proBNP (reclassifcation = –8.1%). At the same time, predictive value of only sST2 just insignifcantly less than value of sST2 and NT-proBNP combination (reclassifcation = –1.9%).Conclusion.Patients with three and more elevated markers at hospital discharge have high risk of adverse events. Te biggest prognostic value has combination of sST2 and NT-proBNP concentrations. In order to determine the long-term prognosis of a patient with HF decompensation, it is sufcient to measure concentrations of sST2 and NT-proBNP at hospital discharge. Alternatively, it is possible to limit to sST2 only, which is just insignifcantly inferior to the sST2 and NT-proBNP combination. Patients with concentrations of sST2 ≥37.8 hg/ml and NT-proBNP ≥1696 rg/ml at hospital discharge have maximal 1year risk of death due to recurrent HF decompensation.
Клинико-демографические характеристики российской популяции амбулаторных пациентов с хронической сердечной недостаточностью на момент включения в регистр QUALIFY для оценки соблюдения клинических рекомендаций в отношении лекарственной терапии Ключевые слова: хроническая сердечная недостаточность, рекомендации, фармакологическое лечение, следование рекомендациям
Российский кардиологический научно-производственный комплекс Россия, 121552, Москва, ул. 3-я Черепковская, 15а Обзор анализирует новый метод лечения больных c хронической сердечной недостаточностью (ХСН) и низкой фракцией выброса -мо-дуляцию сердечных сокращений (МСС). МСС осуществляется за счет подачи электрических импульсов в абсолютно рефрактерный мио-кард желудочков, что приводит к положительному инотропному эффекту без увеличения потребности миокарда кислородом. Исполь-зование метода не зависит от длительности комплекса QRS, следовательно, может быть показана пациентам, не подходящим для про-ведения сердечной ресинхронизирующей терапии (СРТ). Следует отметить, что применение МСС для лечения ХСН должно начинать-ся только на фоне максимально активной терапии при ее недостаточной эффективности. Это не альтернатива, а дополнение к макси-мально активной терапии больных. Клинические исследования в первую очередь нацелены на пациентов с нормальной длительностью QRS ввиду того, что СРТ является оптимальной возможностью лечения пациентов с удлиненным QRS. Обсуждаются результаты, полученные при оценке клинической эффективности и безопасности лечения больных ХСН (n=617) в рандомизированных клинических исследо-ваниях FIX-HF-3 (n=25), FIX-HF-4 (n=164), FIX-HF-5 (n=428). Исходные характеристики пациентов были аналогичны для всех 3-х ис-следований. Все участники получали оптимальную медикаментозную терапию, имели нормальную длительность QRS. Все пациенты были II и III функционального класса (по NYHA). В исследованиях проводился анализ изменений функционального класса NYHA, фракции выброса, пикового потребления кислорода (VO 2 ), предшественника мозгового натрийуретического пептида (NT-proBNP). Проводилась оценка качества жизни по результатам Миннесотского опросника, уровень смертности сравнивался с прогнозируемым по шкале MAGGIC. МСС благоприятно влияла на выживаемость и качество жизни пациентов. Однако для оценки долгосрочных эффектов от про-ведения МСС требуется больше данных.Ключевые слова: хроническая сердечная недостаточность, имплантируемые устройства, модуляция сердечной сократимости. The review analyzes new treatment for patients with chronic heart failure (CHF) with low ejection fraction -cardiac contractility modulation (CCM). CCM is carried out by supplying electric signals to an absolutely refractory ventricular myocardium, to elicit a positive inotropic effect without increasing myocardial oxygen consumption. These effects are independent on QRS duration; consequently, the therapy might be beneficial for patients who are not candidates for cardiac resynchronization therapy (CRT). It should be noted that the use of CCM treatment of CHF should begin only with maximum active therapy when its efficacy is not enough. It is not an alternative, but complement to the most active treatment of patients. Clinical studies primarily focused on patients with normal QRS duration because the CPT is optimal treatment of patients with prolonged QRS. The article focuses on the prerequisites for the development of the method ...
The article presents a case report of a 28-year-old male patient with mixed dilated cardiomyopathy: myocardial noncompaction and chemotherapy-related cardiotoxicity, which led to severe heart failure (HF). With optimal drug therapy, the patient was implanted with a cardiac contractility modulation device in order to improve exercise tolerance, quality of life and relieve HF symptoms. Complex therapy has led to significant clinical and echocardiographic improvement. This case demonstrates a 4-year follow-up of a patient with a reduced left ventricular ejection fraction and an implanted cardiac contractility modulation device, whose condition, after several severe HF decompensations, was stabilized.
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