Features of structural and functional state of the heart in patients with chronic heart failure with comorbid hypertension

Aim. To study indicators of epithelial dysfunction in the proximal renal tubules by determining the activity of organ-specific enzymes neutral α-glucosidase (NAG) and L-alanine aminopeptidase (LAAP), in patients with the initial stage of chronic heart failure in dyslipidemia, and the possibility of reducing with simvastatin.Material and methods. The study involved 90 subjects, who were divided into control and main groups. The control group consisted of 30 practically healthy individuals, the main group was divided into 2 subgroups: patients with stage I chronic heart failure (CHF) without type 2 diabetes mellitus (DM2) and patients with CHF with DM2. Patients of each of the main subgroups received simvastatin 20-40 mg/day in addition to treatment of the main pathology. The main group included patients with a total serum cholesterol level of more than 6.0 mmol/l, a BMI level of more than 30 kg/m2, and who had not previously taken statins. The exclusion criterion was a violation of the filtration capacity of the kidneys and the presence of gross dysfunction of organs and systems of the body. The functional state of the proximal renal tubules was assessed by the concentration of NAG and LAAP in dialized urine.Results. Initially, the level of activity of renal enzymes in representatives of both major subgroups is higher than the group of practically healthy individuals. Taking simvastatin in the CHF without DM2 subgroup does not cause an increase in enzyme activity throughout the entire observation period, either at a daily dosage of 20 mg (NAG - 12.36±2.65 ncat/1 14.1±5.23 ncat/1 and after 3 and 6 months, LAAP - 9.4±1.62 and 11.2±2.99 ncat/1 after 3 and 6 months), or at a dosage of 40 mg/day (NAG - 30.47±3.85 and 26.2±6.75 ncat/1 after 3 and 6 months; LAAP -17.3±3.56 and 19.58±3.83 ncat/1 after 3 and 6 months). Taking simvastatin 20 mg/day in patients with CHF with DM 2 causes an increase in the NAG activity: 26.68±6.03 and 34.57±9.73 ncat/1 after 3 and 6 months). Taking simvastatin 40 mg/day increase both enzyme activity: NAG -34.3±8.7 and 46.94±9.02 ncat/1 after 3 and 6 months, LAAP - 17.08±5.81 and 22.41±4.89 ncat/1 after 3 and 6 months).Conclusion. The appointment of simvastatin in patients with dyslipidemia on the background of obesity is permissible in order to normalize lipid metabolism. Safe for the functional state of the proximal renal tubules, long-term administration of simvastatin, within the limits of medium-therapeutic dosages, is possible for patients without type 2 diabetes. Long-term use of simvastatin in patients with dyslipidemia on the background of type 2 diabetes mellitus has a negative effect on the epithelium of the proximal renal tubules, in the form of an increase in the activity of renal organ-specific enzymes, which indicates an increased dystrophy of the epithelium.

Download Full-text

Development and optimization of pharmacotherapy for chronic heart failure with regards to kidney functional state

European Science Review ◽

10.20534/esr-16-1.2-62-63 ◽

2016 ◽

pp. 62-63

Author(s):

U. K. Kamilova ◽

D. R. Masharipova ◽

Z. D. Rasulova ◽

S. R. Ibabekova

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Functional State

Download Full-text

Eff ect of nebivolol and carvedilol on the functional state of patients with chronic heart failure and preserved left ventricular ejection fraction

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2021-99-4-282-287 ◽

2021 ◽

Vol 99 (4) ◽

pp. 282-287

Author(s):

V. G. Tregubov ◽

P. V. Khilkevich ◽

I. Z. Shubitidze ◽

V. M. Pokrovskii ◽

N. V. Yukhnova

Keyword(s):

Quality Of Life ◽

Heart Failure ◽

Chronic Heart Failure ◽

Combination Therapy ◽

Ejection Fraction ◽

Functional State ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Group I

Objective. Compare the eff ect of combination therapy with nebivolol or carvedilol on the functional state of patients with chronic heart failure (CHF) and preserved ejection fraction (pEF) of the left ventricle (LV). Material and methods. The study involved 80 patients with diastolic CHF, who were randomized into two groups. In group I was appointed of nebivolol (7.7 ± 2.4 mg/day, n = 40), in group II — carvedilol (30.5 ± 8.7 mg/day, n = 40). As part of the combination therapy, quinapril was prescribed (13.7 ± 2.7 mg/day, n = 40 and 13.5 ± 2.6 mg/day, n = 40), and if indicated — atorvastatin (15.3 ± 4.6 mg/day, n = 17 and 16.2 ± 5.2 mg/day, n = 17) and acetylsalicylic acid in the intestinal soluble shell (96.4 ± 13.4 mg/day, n = 14 and 93.8 ± 13.3 mg/day, n = 13), respectively. Initially and after 6 months of therapy were carried out: quantitative assessment of regulatory-adaptive status (RAS) (by means of a sample of cardiac-respiratory synchronism), echocardioscopy, treadmill test, test with a six-minute walk, subjective assessment of quality of life, determination of the level of the N-terminal fragment of the brain natriuretic peptide in blood plasma, daily monitoring of blood pressure. Results. Both schemes of combined therapy comparably improved the structural and functional state of the heart, controlled arterial hypertension. In comparison with carvedilol, nebivolol diff ered positive eff ect on the RAS, more increased tolerance to physical activity and improved quality of life. Conclusion. In patients with CHF pEF LV in combination therapy, the use of nebivolol, in comparison with carvedilol, may be preferable due to the more pronounced positive eff ect on the functional state.

Download Full-text

Pulmonary embolism in the presence of chronic heart failure syndrome: A structural-functional state of the cardiovascular system

Siberian Medical Journal ◽

10.29001/2073-8552-2020-35-2-114-122 ◽

2020 ◽

Vol 35 (2) ◽

pp. 114-122

Author(s):

T. V. Statkevich ◽

N. P. Mitkovskaya ◽

A. M. Balysh ◽

A. R. Rambalskaya ◽

K. B. Petrova ◽

...

Keyword(s):

Heart Failure ◽

Pulmonary Embolism ◽

Chronic Heart Failure ◽

Right Ventricular ◽

Cardiovascular System ◽

Functional State ◽

Systolic Dysfunction ◽

Right Ventricular Dysfunction ◽

Volume Index ◽

Fatty Acid Binding

Aim. To identify the features of the structural-functional state of the cardiovascular system in patients with pulmonary embolism (PE) in the presence of chronic heart failure (CHF) syndrome.Material and Methods. The study included 231 patients diagnosed with PE at admission to the hospital. Patients were further divided into subgroups depending on the verification of the diagnosis by computed tomography and the presence of CHF syndrome.Results and discussion. An increase in pressure in the pulmonary artery system contributed to the formation and aggravation of right ventricular systolic dysfunction, which acquired a greater prevalence and severity in the presence of CHF. This was confirmed by the echocardiographic signs of dysfunction of the right heart including increased linear dimensions of right cardiac chambers, right atrium volume index of 32.3 (29.4–37.9) mL/m2 versus 29.1 (26.6–32.3) mL/m2 (U = 1583.00, p < 0.001); greater prevalence of hemodynamic instability (proportion of patients with fainting or presyncope at hospital admission was 32% in the presence of CHF versus 16.7% without CHF; χ2 = 4,49, p < 0.05); and more significant increases in the laboratory markers of right ventricular dysfunction and injury included in the prediction model of adverse PE outcome [brain natriuretic peptide of 395 (204–789) pg/mL versus 104.2 (38.9–212) pg/mL (U = 1162.00, p < 0.001), high-sensitive troponin of 212 (194.5–297.6) ng/mL versus 184.8 (168.0–194.8) ng/mL (U = 279.50, p < 0.01), myocardial fatty acid-binding protein of 0.37 (0.18–1.2) ng/mL versus 0.2 (0.08–0.3) ng/mL (U = 530.00, p < 0.001), copeptin of 0.2 (0.05–0.92) ng/mL versus 0.09 (0.04–0.15) ng/mL (U = 563.00, p < 0.01), and reduced renal function].

Download Full-text