Chronic and acute decompensated heart failure: topical issues

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.

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Acute decompensated heart failure in patients with prediabetes: relationship with risk factors and comorbidities

Козиолова

Mironova

Ulybina

2023

Russ J Cardiol

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Decompensated heart failure: a reconceptualization in the light of updated consensus statement of the European Society of Cardiology

Larina,

Kokorin,

Larin

et al. 2023

Russ J Cardiol

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The article presents a brief analytical review of the European Society of Cardiology consensus statement on the definition and clinical features of heart failure (HF) with a summary of the latest results on the treatment and prevention of exacerbation. The main viewpoints are compared with existing approaches in the Russian Federation. The definition and classification of worsening HF (WHF), as well as its main clinical manifestations, epidemiology, outcomes, pathophysiology, approaches to early detection, patterns of in- and outpatient treatment of WHF are discussed. Attention is paid to the terminology necessary to identify a cohort of patients with HF exacerbation with a previously established diagnosis of HF in order to unify approaches to diagnosis and treatment.

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Dynamics of structural and functional characteristics of the heart in patients after myocardial infarction with ST segment elevation as a marker of progression of chronic heart failure

Каретникова

Бернс²,

Шмидт

et al. 2022

Arter. gipertenz.

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Objective. To identify the association of a number of clinical features and structural and functional characteristics of the heart with the progression of chronic heart failure (CHF) in patients one year after ST-segment elevation myocardial infarction (MI) (STEMI) with preserved and reduced left ventricular ejection fraction (EF) (LVEF).Design and methods. 120 patients with STEMI were included in a prospective study. During the study, all patients underwent an echocardiographic study using a Sonos 2500 device (Hewlett Packard, USA) on the 1st day (point I), on the 12th day (point II) of hospitalization, and also after 1 year (point III). Depending on the parameters of EF on the 1st day of the disease, the total sample of patients was divided into two: the 1st group — with preserved LVEF was represented by 86 (71,7 %), the 2nd group — with a reduced LVEF was represented by 34 (28,3 %) patients.Results. A total of 19 (15,8 %) adverse events were registered. In two cases, a fatal outcome (1,7 %) was recorded, the cause of which was repeated MI, in five (4,2 %) patients decompensation of СHF was noted, in eight (6,7 %) patients a clinic of progressive angina was traced, in four (3, 3 %) of patients were diagnosed recurrent MI. Deterioration of systolic and diastolic function was established one year after STEMI with preserved (≥ 50 %) LVEF: 17,6 % of patients began to correspond to the intermediate range of EF (40-49 %), the number of patients with diastolic dysfunction increased by 10 % compared to with acute study.Conclusions. Within a year after a STEMI with initially preserved LVEF, there is a deterioration in myocardial function in the form of a decrease in myocardial contractility and an increase in the number of patients with diastolic dysfunction.

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Chronic and acute decompensated heart failure: topical issues

Cited by 6 publications

References 41 publications

Acute decompensated heart failure in patients with prediabetes: relationship with risk factors and comorbidities

Acute decompensated heart failure in patients with prediabetes: relationship with risk factors and comorbidities

Decompensated heart failure: a reconceptualization in the light of updated consensus statement of the European Society of Cardiology

Dynamics of structural and functional characteristics of the heart in patients after myocardial infarction with ST segment elevation as a marker of progression of chronic heart failure

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