Treatment optimisation in patients with functional Class II chronic heart failure and arterial hypertension

Aim.To identify the optimal treatment tactics in patients with Functional Class (FC) II chronic heart failure (CHF) (NYHA classification) and essential arterial hypertension (EAH), via investigating the effects of different medication classes on regulatory and adaptive status (RAS). Material and methods.The study included 100 patients with FC II CHF and Stage II EAH, who were randomised into 2 groups. Group I included 53 patients (mean age 52,9±2,3 years) receiving metoprolol succinate (mean dose 97,3±9,5 mg/d). Group II included 47 patients (mean age 57,5±1,3 years) administered quinapril (mean dose 24,7±6,3 mg/d). At baseline and after 6 months of therapy, the following procedures were performed: treadmill test with VO2max assessment; echocardiography; 24-hour blood pressure monitoring; N-terminal pro-brain natriuretic peptide (NT-proBNP) level measurement; and cardio-respiratory synchronism test. Results.While both medications improved left ventricular (LV) diastolic function, only quinapril demonstrated beneficial effects on LV structure, geometry, and systolic function. Only in Group II, exercise capacity and VO2max increased, RAS improved, and NT-proBNP levels decreased to a greater extent. Conclusion.Quinapril was more effective than metoprolol succinate in the treatment of patients with FC II CHF and Stage II EAH.

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Effects of transluminal balloon angioplasty and stenting on the clinical course of ischemic chronic heart failure with preserved or reduced left ventricular ejection fraction: radionuclide 4D tomoventriculography data

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2012-1-73-78 ◽

2012 ◽

Vol 11 (1) ◽

pp. 73-78

Author(s):

N. V. Shashkova ◽

S. N. Tereshchenko ◽

L. E. Samoylenko ◽

D. F. Satlykova ◽

A. M. Gerasimov

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Balloon Angioplasty ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Group I ◽

Filling Time ◽

Group Ii

Aim. To study the effects of transluminal balloon angioplasty (TLBAP) and stenting on right and left ventricular (RV, LV) hemodynamics, as well as on long-term clinical prognosis, in patients with ischemic chronic heart failure (CHF). Material and methods. In 20 patients with ischemic CHF, Functional Class (FC) II–III (NYHA), radionuclide 4D tomoventriculography (4D-RTVG) was performed at baseline and 6 and 12 months after TLBAP, in order to assess cardiac hemodynamics. Based on ejection fraction (EF) values, all participants were divided into two groups. Group I (n=10; mean age 57,2 (2,7) years) included men with EF <45%, FC II–III CHF, and mean CHF duration of 3,1 (0,6) years. Group II (n=10; mean age 62,6 (2,7) years) included 5 men and 5 women with EF >45%, FC II CHF, and CHF duration of 2 (0,4) years. Results. Twelve months after TLBAP, Group I demonstrated a significant increase in stroke volume (SV), LV EF, and RV EF, as well as an improvement in LV maximum ejection velocity (MEV), maximum filling velocity (MFV), and maximum filling time (MFT), as well as in LV and RV one-third filling fraction (1/3 FF) (p<0,05). A decrease in LV enddiastolic volume (EDV), LV end-systolic volume (ESV), and RV ESV, some increase in RV EDV, and an improvement in RF MEV, MFV, and MFT were non-significant (p>0,05). In Group II, an increase in LV SV and LV EF, as well as an improvement in RV 1/3FF and MFT, was statistically significant (p<0,05). At the same time, an increase in RF SV, EF, EDV, and ESV, as well as an improvement in LV and RV MEV and MFV, LV 1/3FF and LV MFT, without any substantial changes in LV EDV and ESV, lacked statistical significance (p>0,05). Cardiac hemodynamic changes were associated with improved quality of life (QoL) and reduced CHF FC and angina FC. Conclusion. TLBAP and stenting facilitated an increase in EF and SV, an improvement in LF and RF systolic and diastolic function, an improvement in QoL and exercise capacity, and a reduction in CHF FC and angina FC.

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Dissociation Between Improvement in Left Ventricular Performance and Functional Class in Patients With Chronic Heart Failure

Journal of Cardiovascular Pharmacology ◽

10.1097/01.fjc.0000175235.33949.c4 ◽

2005 ◽

Vol 46 (3) ◽

pp. 262-268 ◽

Cited By ~ 5

Author(s):

Pierre V Ennezat ◽

Caroline A Ennezat ◽

Pugazhendhi Vijayaraman ◽

Justine Lachmann ◽

Philippe Asseman ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Left Ventricular ◽

Functional Class ◽

Left Ventricular Performance ◽

Ventricular Performance

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Arterial hypertension as a trigger for the development of cardiorenal failure in patients of different genders

Siberian Medical Journal ◽

10.29001/2073-8552-2019-34-3-114-121 ◽

2019 ◽

Vol 34 (3) ◽

pp. 114-121

Author(s):

E. A. Lopina ◽

N. P. Grishina ◽

R. A. Libis

Keyword(s):

Heart Failure ◽

Glomerular Filtration Rate ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Arterial Hypertension ◽

Glomerular Filtration ◽

Cystatin C ◽

Filtration Rate ◽

Left Ventricular ◽

Left Ventricular Ejection

Aim. To study the peculiarities of changes in the functional state of the kidneys and heart muscle in patients with arterial hypertension.Materials and Methods. A total of 88 patients with arterial hypertension were included in the study. Chronic kidney disease was detected based on glomerular filtration rate, albuminuria, and cystatin levels in serum and urine. The stage of chronic heart failure was determined according to Strazhesko–Vasilenko classification with functional class according to NYHA; functional class of chronic heart failure was determined based on six-minute walking test. Patient inclusion criteria were the presence of essential hypertension of degree 1–3 and the age from 50 to 70 years. Patients underwent anthropometry, biochemical blood tests, six-minute walking test, and standard echocardiography.Results. Arterial hypertension of degree 1–2 was diagnosed in 50 patients including 33 women and 17 men. Grade 3 arterial hypertension was found in 38 patients (28 women and 10 men). Patients were divided into two groups according to gender. The groups with arterial hypertension degree 1–2 differed in their blood pressure levels. Echocardiography data showed the formation of heart failure with preserved ejection fraction. The groups differed in the values of left ventricular ejection fraction and end-systolic and end-diastolic sizes of the left ventricle. The levels of cystatin C in serum were elevated in both groups. The serum and urine creatinine levels and glomerular filtration rates differed between groups. Women had more significant decreases in the values of glomerular filtration rate, cystatin C, and urine creatinine. Correlation relationships were found between systolic blood pressure and glomerular filtration rate (r = 0.27, p < 0.05) and between systolic blood pressure and left ventricular back wall thickness (r = 0.41, p < 0.05). Inverse relationship was found between left ventricular ejection fraction and albuminuria (r = –0.31, p < 0.05). Cystatin C level had inverse relationship with glomerular filtration rate (r = –0.47, p < 0.05) and direct relationship with left ventricular myocardial mass index (r = 0.24, p < 0.05).Discussion. Chronic kidney disease and chronic heart failure with preserved left ventricular ejection fraction were detected in patients at early stages. In the group of women, more pronounced changes in the renal and cardiac functions were found. Cystatin C is a marker of kidney function reduction and an alternative marker of chronic heart failure. The study showed that the level of cystatin C in blood serum of patients was increased, which correlated with the functional activities of the kidneys and the heart.Conclusion. In case of arterial hypertension in the presence of chronic kidney disease, the development of the left ventricular hypertrophy and heart failure with preserved ejection fraction was found. Women had more significant changes in the renal and cardiac functions compared with those in men.

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Prognostic Value of Combination of Cardiac Troponin T and B-Type Natriuretic Peptide after Initiation of Treatment in Patients with Chronic Heart Failure

Clinical Chemistry ◽

10.1373/clinchem.2003.021311 ◽

2003 ◽

Vol 49 (12) ◽

pp. 2020-2026 ◽

Cited By ~ 66

Author(s):

Junnichi Ishii ◽

Wei Cui ◽

Fumihiko Kitagawa ◽

Takahiro Kuno ◽

Yuu Nakamura ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Cardiac Troponin ◽

Troponin T ◽

Myocardial Damage ◽

Left Ventricular ◽

Functional Class ◽

Cardiac Troponin T ◽

Cardiac Events ◽

Nyha Functional Class

Abstract Background: Recent studies have suggested that cardiac troponin T (cTnT) and troponin I may detect ongoing myocardial damage involved in the progression of chronic heart failure (CHF). This study was prospectively designed to examine whether the combination of cTnT, a marker for ongoing myocardial damage, and B-type natriuretic peptide (BNP), a marker for left ventricular overload, would effectively stratify patients with CHF after initiation of treatment. Methods: We measured serum cTnT, plasma BNP, and left ventricular ejection fraction (LVEF) on admission for worsening CHF [New York Heart Association (NYHA) functional class III to IV] and 2 months after initiation of treatment to stabilize CHF (n = 100; mean age, 68 years). Results: Mean (SD) concentrations of cTnT [0.023 (0.066) vs 0.063 (0.20) μg/L] and BNP [249 (276) vs 753 (598) ng/L], percentage increased cTnT (>0.01 μg/L; 35% vs 60%), NYHA functional class [2.5 (0.6) vs 3.5 (5)], and LVEF [43 (13)% vs 36 (12)%] were significantly (P <0.01) improved 2 months after treatment compared with admission. During a mean follow-up of 391 days, there were 44 cardiac events, including 12 cardiac deaths and 32 readmissions for worsening CHF. On a stepwise Cox regression analysis, increased cTnT and BNP were independent predictors of cardiac events (P <0.001). cTnT >0.01 μg/L and/or BNP >160 ng/L 2 months after initiation of treatment were associated with increased cardiac mortality and morbidity rates. Conclusion: The combination of cTnT and BNP measurements after initiation of treatment may be highly effective for risk stratification in patients with CHF.

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Abstract 3295: De-induction of the Maladaptive Fetal Gene Program During Chronic Monotherapy with Metoprolol Succinate is Retained Following Withdrawal of Therapy in Dogs with Chronic Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_742-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Rasha Bazari ◽

Sharad Rastogi ◽

Valerio Zaca ◽

Sidney Goldstein ◽

Hani N Sabbah

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Mrna Expression ◽

Natriuretic Peptide ◽

Left Ventricular ◽

Lv Function ◽

Metoprolol Succinate ◽

Myosin Heavy Chain Isoform ◽

Chronic Therapy ◽

Lv Remodeling

Background: Chronic therapy with extended release metoprolol succinate (MET), a selective β1 adrenergic receptor blocker, improves left ventricular (LV) function and attenuates global LV remodeling in dogs with chronic heart failure (HF). We previously showed that chronic therapy with β-blockade results in de-induction of the fetal gene program (FGP) in LV myocardium of dogs with HF. In this study, we tested the hypothesis that in dogs with HF withdrawal of chronic MET does not lead to re-induction of FGP. Methods: Studies were performed in 17 intracoronary microembolization-induced HF dogs randomized to 3 months oral therapy with MET (100 mg, once daily, n=11) or no therapy at all (Controls, n=6). In dogs randomized to MET, 6 were sacrificed after 3 months of therapy and in the remaining 5, MET was withdrawn after 3 months of therapy and dogs were observed for 6 weeks after withdrawal of MET (MET-W) and then sacrificed. LV tissue was also obtained from 6 normal (NL) dogs for comparison. mRNA expression of the FGP genes namely, atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), sarcoplasmic reticulum calcium ATPase (CAA), cardiac β-1 adren-ergic receptor (AR) and α-myosin heavy chain isoform (α-MHC) was measured using reverse transcriptase polymerase chain reaction (RT-PCR) and bands were quantified in densitometric units (du). Results: In Controls, mRNA expression of ANP and BNP increased and expression of CAA, β 1-AR and α-MHC decreased. Treatment with MET decreased expression of ANP and BNP and increased expression of CAA, β 1-AR and α-MHC. Except for α-MHC, the improvement in FGP seen during MET treatment was preserved in MET-W dogs. Conclusions: Withdrawal of MET is associated with sustained de-induction of the FGP in LV myocardium of dogs with HF. This observation supports the concept that chronic β-blockade therapy in HF confers lasting reversal of LV remodeling and molecular recovery of the failing myocardium.

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Anemia an Old Player or a Cut-Throat in Patients with Coronary Artery Disease or Chronic Heart Failure.

Blood ◽

10.1182/blood.v110.11.3762.3762 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3762-3762

Author(s):

Giorgio Corinaldesi ◽

Christian Corinaldesi

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Chronic Heart Failure ◽

Apoptotic Cell ◽

Binding Capacity ◽

Left Ventricular ◽

Functional Class ◽

Peak Oxygen Consumption ◽

Artery Disease

Abstract Anemia is associated with an increased number of adverse cardiovascular events (CVD) in particular with coronary artery disease (CAD), and chronic heart failure (CHF), and it is also correlated with gender, aging, renal insufficiency, low BMI. Anemia involves inflammatory cytokines (C-reactive protein, IL-6, MCP-1, TNF-alfa), it reduces marrow response to erythropoietin (EPO) and heme-oxygenases-1(HO-1), it also reduces red cells life span and it may impairs reuse of iron, it mostly reduces, the peak VO-2 (peak aerobic power). The latter appears to be an independent factor that may be associated with an adverse outcome, in fact, for a reduction of one gram of heamoglobin (Hb) the risk of morbility and mortality increase respectively by 32% and 18%. The aim of the study was to determine the clinical implication of anemia in patients with CHF or CAD; we have studied 48 patients (32 male, 16 female) with CHF, and 52 patients (34 male, 18 female) with CAD, with a range of Hb concentration included between 9.4gr/dl and 12.6gr/dl. We have evaluated moreover the tolerance to exercise on a treadmill and six minute walk distance (210+/− 32 m in CAD), (180+/− 28 m in HF), the presence of rest dyspnea, the presence of supraventricular or ventricular arrhythmias (atrial/or ventricular premature beats, sinus tachycardia, or ventricular tachycardia, atrial fibrillation); lower levels of Hb, Fe, TIBC correlate with a greater tendency to develop ventricular arrhytmias instead of supraventricular arrhytmias. Anaemia management included erythropoietin stimulating protein, blood transfusion; we have used darbopoietin 50 mcg every week, and this treatment is associated to a significant improvement in functional class and cardiac and renal function. Epo has a strong cardioprotective effect: reducing left ventricular hypertrophy, infarct size, a higher beta natriuretic peptide level, apoptotic cell death, increase FE and capillary vessels; we have remarked a longer endurance time of exercise testing a greater distance walked (282+/− 64 m in CAD), (248+/− 32m in CHF), a significant increased in the peak oxygen consumption VO2 from 12.6+/− 2.4 to 16.2+/− 2.8 mL/Kg x min. in CAD, 9.8+/− 2.0 to 13.2 +/− 3.4 mL/Kg x min. in CHF. Our data also confirm the link between an increased tendency to develop CVD and a decreased level of Hb. RISK FACTORS CAD CHF Sex (M/F) 32/16 34/18 Age (Years) 62+/− 6 66+/− 4 Hb (g/dl) 10.8+/− 1.8 10.6+/− 1.2 MCV (fl) 82.6+/− 4.4 77+/− 4.2 Iron (mg/dl) (Fe) 42.8+/− 10.2 36+/− 9.4 Total Iron Binding Capacity (TIBC) 316+/− 68.8 280+/− 62.8

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Progression of Chronic Heart Failure: Prognostic Criteria and Non-Drug Prevention

Kardiologiia ◽

10.18087/cardio.2019.4.10248 ◽

2019 ◽

Vol 59 (4) ◽

pp. 26-32

Author(s):

E. R. Kurlyanskaya ◽

T. L. Denisevich ◽

A. G. Mrochek

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Arterial Hypertension ◽

Functional Class ◽

Drug Prevention ◽

Self Control ◽

Therapeutic Education ◽

Multifactor Models ◽

Prognostic Criteria ◽

Prognostic Accuracy

Purpose: to study frequency of progression of chronic heart failure (CHF), to develop multifactorial models for evaluation of risk of progression, and measures of non-drug secondary prevention of CHF. Materials and methods. We included in this study 531 patients with functional class (FC) I–III CHF (FC I – n=254, FC II – n=255, FC III – n=22). Examination included clinical-instrumental, clinical-functional, and laboratory (with determination of NT-proBNP concentration) investigations, use of the AUDIT and Morisky Green questionnaires. Results. Rate of CHF progression for 24 months was 11.7 % (FC I – 16.1, FC II – 7.8, FC III – 4.5 %). Irrespective of FC significant factors of CHF progression were history of myocardial infarction, and low adherence to treatment. Additional prognostic criteria of increase of CHF FC I to FC II were age >74 years, excessive body mass, disturbance of carbohydrate metabolism, arterial hypertension, and frequent intake of alcohol. FC II CHF progression was associated with such factors as type 2 diabetes, 3‑degree arterial hypertension, permanent atrial fibrillation, and smoking. Using these prognostic criteria, we developed multifactor models, based on which scales for assessing the risk of FC I and II CHF progression were created. These models demonstrated high accuracy of prognosis and good reproducibility (on independent test samples of patients with CHF FC I and FC II prognostic accuracy was 86.3 и 85.5 %, respectively). We also developed a program of secondary non-drug prevention of CHF progression, with inclusion of structured dynamic education of patients with organization of control and self-control of knowledge quality. After this therapeutic education progression CHF in high risk patients was 2.2 %. Conclusion. Complex application of scores for evaluation of risk of FC I–II CHF progression and the program of secondary non-drug prevention determined lowering of frequency of increases of class of CHF severity from 11.7 to 2.2 %.

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Morphofunctional state of the brain in chronic heart failure

Cardiosomatics ◽

10.26442/cs45342 ◽

2017 ◽

Vol 8 (2) ◽

pp. 59-62

Author(s):

N. S Akimova ◽

I. M Sokolov ◽

T. V Martynovich ◽

Yu. G Shvarts

Keyword(s):

Heart Failure ◽

White Matter ◽

Chronic Heart Failure ◽

Morphological Changes ◽

Left Ventricular ◽

Functional Class ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

The Brain

The aim of the study was to examine the dependence of functional and morphological changes in the brain and factors of the severity of chronic heart failure. Materials and methods: 54 patients with chronic heart failure of ischemic genesis, I-IV functional class were cognitive tests, echocardiography, nuclear magnetic resonance imaging of the brain. Results. With an increase in the functional class of chronic heart failure, the worst results of Veksler-5 and 7 cognitive subtests are noted, a smaller thickness of gray matter of parietal lobes, lower diffusion coefficients of water molecules in the white matter of the parietal and occipital lobes, and a smaller thickness of the middle legs of the cerebellum. Comparative analysis of the central nervous system state indices in patients with chronic heart failure with different fraction of left ventricular ejection did not show significant differences. The conclusion. The established results confirm the significance of the functional class of chronic heart failure as a marker of cognitive dysfunction and pathological changes in both gray and white matter of the brain, whereas the size of the left ventricular ejection fraction is obviously less useful in this respect.

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A modern view of the place of b-blockers in the treatmentof cardiovascular disease: the choice of drug within a class is crucial

Systemic Hypertension ◽

10.26442/sg29128 ◽

2015 ◽

Vol 12 (4) ◽

pp. 69-74

Author(s):

O D Ostroumova ◽

V M Fomina ◽

E A Smolyarchuk

Keyword(s):

Heart Failure ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cardiovascular Diseases ◽

Chronic Heart Failure ◽

Arterial Hypertension ◽

Clinical Studies ◽

Metoprolol Succinate ◽

Selection Of

In the article discusses questions of application of b-blockers (b-AB) for the treatment of arterial hypertension, coronary heart disease, chronic heart failure. The data from modern Russian and European recommendations about the place of b-AB in the treatment of cardiovascular diseases. Analyzed in detail the selection of b-AB inside the class from the standpoint of pharmacokinetics, selectivity, study in clinical studies. Data about efficiency and safety of application of metoprolol succinate for the treatment of arterial hypertension, coronary heart disease, chronic heart failure.

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Comparison between Spironolactone and Eplerenone on LV Systolic Function in Patients with Chronic Heart Failure

University Heart Journal ◽

10.3329/uhj.v16i2.49649 ◽

2020 ◽

Vol 16 (2) ◽

pp. 65-70

Author(s):

Md Noornabi Khondokar ◽

Khurshed Ahmed ◽

Mohammad Ashraf Hossain ◽

Rakibulh Rashed ◽

Mohamed Mausool Siraj ◽

...

Keyword(s):

Heart Failure ◽

Blood Pressure ◽

Side Effects ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Systolic Function ◽

Nyha Class ◽

Left Ventricular ◽

Group I ◽

Lv Systolic Function

Background:Chronic heart failure (CHF) is the most common and prognostically unfavorable outcome of many diseases of the cardiovascular system. Clinical trials have demonstrated mortality and morbidity benefits of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure. These studies have used either eplerenone or spironolactone as the MRA. Eplerenone is a selective aldosterone antagonist expected to have a lower incidence of hormonal side effects than spironolactone. The present study is designed to compare these two drugs in chronic heart failure patients as no head to head trial between these two drugs is found regarding improvement of systolic function, tolerability and safety. The aim of this study is to compare the effects of eplerenone and spironolactone on LV systolic function in patients with chronic heart failure in a single center. Methods:It was a randomized clinical trial single blind study. A total of 224 cases of chronic heart failure with reduced ejection fraction and NYHA class III or IV were selected by random sampling, from July 2017 to June 2018. Each patient was randomly allocated into either of the two arms, and was continued receiving treatment with either spironolactone (Arm-I) or eplerenone(Arm-II). Each patient was evaluated clinically, biochemically and echocardiographically at the beginning of treatment (baseline) at 1 month and at the end of 6th month. Echocardiography was performed to find out change in left ventricular systolic function. Result: After 6 months of treatment, ejection fraction was found higher in the eplerenonearm (40.3 ± 6.5 versus 38.3 ± 4.6%; P < 0.05). Ejection fraction (EF) changes were 6.2% in eplerenone group and 4.1% in spironolactonearm. A significant reduction in left ventricular end-systolic volume (21.9±2.5 in group I versus 14.9±5.7 in group II; P < 0.05) and left ventricular systolic diameter (48.7±4.0 in arm I versus 45.2±4.9 in arm II; P<0.05) occurred after 6 months of treatment. But no significant differences were observed in left ventricular end-diastolic volume (187.8±37.4 versus 184.5±33.9; P=0.101) and left ventricular diastolic diameter (60.1±4.5 versus 61.0±4.9; P=0.0818) between arms. Assessment of blood pressure six months after treatment shows, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were improved in both arms but difference between two arms were statistically non-significant (p>0.05). Conclusion: In this study, the improvement in systolic function was more in eplerenone arm, which also had fewer adverse side effects when compared to spironolactone arm. So, it can be concluded that eplerenone can be advised in patient with chronic heart failure in addition to other drugs that are used to treat heart failure. University Heart Journal Vol. 16, No. 2, Jul 2020; 65-70

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