Background and Aims There is little information on the incremental prognostic importance of frailty beyond conventional prognostic variables in heart failure (HF) populations from different country income levels. Methods A total of 3429 adults with HF (age 61 ± 14 years, 33% women) from 27 high-, middle- and low-income countries were prospectively studied. Baseline frailty was evaluated by the Fried index, incorporating handgrip strength, gait speed, physical activity, unintended weight loss, and self-reported exhaustion. Mean left ventricular ejection fraction was 39 ± 14% and 26% had New York Heart Association Class III/IV symptoms. Participants were followed for a median (25th to 75th percentile) of 3.1 (2.0–4.3) years. Cox proportional hazard models for death and HF hospitalization adjusted for country income level; age; sex; education; HF aetiology; left ventricular ejection fraction; diabetes; tobacco and alcohol use; New York Heart Association functional class; HF medication use; blood pressure; and haemoglobin, sodium, and creatinine concentrations were performed. The incremental discriminatory value of frailty over and above the MAGGIC risk score was evaluated by the area under the receiver-operating characteristic curve. Results At baseline, 18% of participants were robust, 61% pre-frail, and 21% frail. During follow-up, 565 (16%) participants died and 471 (14%) were hospitalized for HF. Respective adjusted hazard ratios (95% confidence interval) for death among the pre-frail and frail were 1.59 (1.12–2.26) and 2.92 (1.99–4.27). Respective adjusted hazard ratios (95% confidence interval) for HF hospitalization were 1.32 (0.93–1.87) and 1.97 (1.33–2.91). Findings were consistent among different country income levels and by most subgroups. Adding frailty to the MAGGIC risk score improved the discrimination of future death and HF hospitalization. Conclusions Frailty confers substantial incremental prognostic information to prognostic variables for predicting death and HF hospitalization. The relationship between frailty and these outcomes is consistent across countries at all income levels.
As a rule, heart damage in patients with sarcoidosis of respiratory organs (SOD) is not diagnosed in time, so a very important and urgent task is to identify common heart rhythm and conduction disorders.The aim of the study was to investigate the main clinical manifestations of sarcoidosis in SOD, depending on the peculiarities of the disease course and to compare the frequency and severity of pulmonary and extrapulmonary manifestations of sarcoidosis, including myocardial lesions and electrocardiographic (ECG) signs of heart rhythm disorders.Methods. In the period 2006– 2016, the pilot open prospective uncontrolled study conducted at the Pulmonology Department of the Regional State Autonomous Healthcare Institution "Tomsk Regional Clinical Hospital" included patients (n = 84) aged 20–67 years with the diagnosis of SOD. Patients were divided into 2 clinical groups: the 1st comprised 45 (53.5%) patients with a favorable course of sarcoidosis, the second one included 39 (46.4%) patients with an unfavorable course of the disease. A full range of studies was carried out, including the analysis of medical history and clinical and epidemiological data, instrumental methods (including ECG and Holter ECG monitoring (HM), pathomorphological study of lung biopsy samples.Results. According to the data of frequency analysis of occurrence of pulmonary and extrapulmonary clinical manifestations in ODS, it was shown that the leading clinical manifestations, most frequently occurring in patients of both groups, included asthenia syndrome (72.6%), bronchial syndrome (66.7%) and fever syndrome (33%). In 33% of cases, clinical manifestations of myocardial damage were detected. In 41 (51.2%) patients in both groups, changes on ECG were recorded at rest. Regardless of the course of the disease, in 23.5% of patients of both clinical groups, according to the results of the HM ECG, rhythm and conduction disturbances were found – a combination of ventricular arrhythmias and conduction disorders (ventricular extrasystole and right His bundle branch block of various degrees) and a combination of supraventricular arrhythmias and conduction disturbances (supraventricular extrasystole and right His bundle branch block of various degrees).Conclusion. Thus, regardless of the severity of the disease course, SOD patients are concerned about complaints from both respiratory system and extrapulmonary manifestations, including cardiac complaints, as well as heart rhythm and conduction disorders (according to the results of ECG and HM ECG), the frequency of which, according to the comparative analysis, has not significantly changed in both clinical groups, which indicates the non-specific character of clinical manifestations.
Here we present a clinical case of cardiac sarcoidosis. The article discusses the difficulties of differential diagnosis in patients emergently hospitalized in the cardiology department with recurrent chest pain, no changes in the electrocardiogram (ECG), and a presumptive diagnosis of acute coronary syndrome without ST segment elevation (NSTE-ACS). A careful history taking, invasive coronary angiography, and contrast-enhanced (gadolinium-based contrast media) cardiac magnetic resonance imaging (CMR) contributed to the correct diagnostic decision in search for and identification of cardiac sarcoidosis in the patient.
Aim: to study the changes in heart rate variability (HRV) in patients with anxiety and depressive disorders who suffered acute coronary syndrome (ACS) and to determine the effects of antidepressant agomelatine on HRV and sleep quality during six-month follow up.Material and Methods. The study included 54 people with ACS, anxiety, and depressive disorders. Patients were randomly assigned to two groups. Antidepressant agomelatine 25 mg/day was administered to patients of group 1 in addition to standard therapy for ACS; group 2 received placebo. Twenty four-hour Holter ECG monitoring, HRV study, mental status monitoring, and sleep quality assessment were performed during hospitalization and at six-month follow up.Results. Patients of both groups had clinically significant anxiety, subclinical depression, and insomnia of varying severity. According to Holter monitoring data, all patients had decline in HRV parameters. After six months, anxiety and depression significantly improved in patients administered with agomelatine; these patients had sleep normalization and improved HRV. The comparison group did not have similar changes.Conclusion. Additional administration of agomelatine 25 mg/day to patients with anxiety and depressive disorders after ACS resulted in improvement of mental status, heart rate variability, and sleep quality. Due to the absence of pro-arrhythmogenic effects, administration of agomelatine allows to correct anxiety-depressive disorders in patients with ACS.
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