EFFECT OF PHARMACOTHERAPY ON COLLAGEN METABOLISM IN PATIENTS WITH HEART FAILURE WITH MIDDLE RANGE EJECTION FRACTION OF SENILE AGE

2021 ◽  
pp. 956-963
Author(s):  
О. А. Осипова ◽  
Е. В. Гостева ◽  
А. Н. Ильницкий ◽  
К. И. Прощаев ◽  
О. А. Рождественская ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Coronary Disease ◽  
Beta Blocker ◽  
Systolic Dysfunction ◽  
Collagen Metabolism ◽  
Middle Range

Особый интерес представляет изучение механизмов развития ХСН, особенно c промежуточной ФВ (ХСНпрФВ), у больных старческого возраста. В условиях ХСН многократно возрастает значимость развития фиброза миокарда, приводящего к необратимой дисфункции, что способствует дальнейшему прогрессированию ХСН. Фибрилляция предсердий является дополнительным фактором, способствующим систолической дисфункции ЛЖ. Цель исследования -изучение влияния β-блокаторов на изменения маркеров фиброза у больных старческого возраста с ХСНпрФВ, в том числе и с фибрилляцией предсердий. Обследованы 104 больных ХСНпрФВ ишемического генеза II ФК по классификации NYHA, средний возраст - 78,4±3,2 года. Через 12 мес нами выявлено достоверное снижение уровня матриксной металлопротеиназы 1-го типа, 9-го типа (ММП-1, ММП9), тканевого ингибитора ММП-1 (ТИМП-1), а также соотношения ММП-1/ТИМП-1, ММП-9/ТИМП-1 у больных старческого возраста, имеющих ХСНпрФВ ишемического генеза, в том числе и с фибрилляцией предсердий (ММП-1, ММП-9, ТИМП-1, ММП-9/ТИМП-1), принимавших в качестве β-блокатора небиволол. У больных, принимавших бисопролол, достоверных изменений изучаемых показателей не выявлено (кроме ММП-9). Изменения метаболизма коллагена обусловливают восстановление функции миокарда после терапии β-блокатором небивололом у пациентов с ХСНпрФВ, в том числе и при фибрилляции предсердий. Сывороточные маркеры оборота коллагена могут служить неинвазивным методом документирования и мониторинга как степени, так и механизмов фиброза миокарда у больных ХСНпрФВ ишемического генеза, в том числе и на фоне фибрилляции предсердий. Of particular interest is the study of the mechanisms of development of chronic heart failure, especially with middle range ejection fraction (HFmrEF). In conditions of HF, the significance of the development of myocardial fibrosis increases many times, leading to irreversible dysfunction, which contributes to the further progression of HF. Atrial fibrillation is an additional factor contributing to systolic dysfunction of the left ventricle. The purpose of this study was to study the effect of beta-blockers on changes in fibrosis markers in senile patients with HF, including those with AF. 104 patients with HF, coronary disease of functional class II were examined according to the classification of NYHA, the average age was 78,4±3,2 years. After 12 months, we found a significant decrease in the level of matrix metalloproteinase-type 1, -type 9 (MMP-1, MMP-9), tissue inhibitor MMP-1 (TIMP-1), as well as the ratio of MMP-1/TIMP-1, MMP-9/TIMP-1 in senile patients with HF, including those with atrial fibrillation who took nebivolol as a beta-blocker. While in patients who took bisoprolol, no significant changes in the studied parameters were detected (except for MMP-9). Changes in collagen metabolism cause the restoration of myocardial function after therapy with the beta-blocker nebivolol in patients with chronic heart failure with an middle range ejection fraction, including atrial fibrillation. Serum markers of collagen turnover can serve as a noninvasive method for documenting and monitoring both the degree and mechanisms of myocardial fibrosis in patients with HF, coronary disease, including in the presence of AF.

3057Relation of atrial remodeling to circulating biomarkers of myocardial fibrosis and apoptotic microparticles in patients with atrial fibrillation and heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M S Dzeshka ◽  
E Shantsila ◽  
V A Snezhitskiy ◽  
G Y H Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Matrix Metalloproteinase ◽  
Myocardial Fibrosis ◽  
Univariate Analysis ◽  
Volume Index ◽  
Atrial Remodeling ◽  
Preserved Ejection Fraction ◽  
Circulating Biomarkers

Abstract Introduction Left atrial (LA) remodeling is a mainstay for atrial fibrillation (AF) occurrence. AF further promotes structural changes in LA, as fibrosis and stretching, followed by AF progression to its permanent form. Many profibrotic pathways have been studied, and circulating microparticles (MPs) may have a role. MPs are extracellular submicron anucleoid phospholipid vesicles released from different cells. Annexin V-binding (AnV+) MPs were suggested as a marker of apoptosis. Purpose To evaluate association of circulating biomarkers of myocardial fibrosis and MPs subsets with LA remodeling in patients with AF and heart failure with preserved ejection fraction. Methods We studied 274 patients (median age 62 years, 37% females). Paroxysmal AF was diagnosed in 150 patients (55%) and non-paroxysmal AF (persistent or permanent) in 124 (45%). Median CHA2DS2-VASc score was 3 in males and 4 in females. Patients with valvular AF, recent (<6 months) thromboembolic or hemorrhagic event, advanced chronic kidney or hepatic dysfunction, malignancy or active inflammatory disorders were excluded. Transthoracic echocardiography was performed. LA maximum volume index (LAVi) was measured as an index of LA structural remodeling in AF. Average values from ten consecutive cardiac cycles were calculated. Blood levels of galectin 3, interleukin-1 receptor-like 1 (ST2), transforming growth factor beta 1 (TGF-β1), procollagen type III aminoterminal propeptide (PIIINP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), angiotensin II and aldosterone were assayed as surrogate biomarkers of myocardial fibrosis with ELISA. Using microflow cytometry (Figure), numbers of platelet-derived (CD42b+), monocyte-derived (CD14+), endothelial (CD144+), and apoptotic MPs (AnV+) were quantified in plasma samples. Linear regression was used to reveal parameters associated with LAVi. Raw data were normalized with Box-Cox transformation. Results Median LAVi in studied patients was 48 (39–59) ml/m2 and increased from patients with paroxysmal AF (42 [35–51] ml/m2) to persistent AF (53 [43–62] ml/m2) and permanent AF (57 [46–69] ml/m2), p<0.001. On univariate analysis male gender (β=0.11, p=0.04); history of hypertension (β=0.18, p=0.03); AF type, i.e. progression from paroxysmal to permanent (β=0.38, p<0.001); AnV+ MPs (β=0.19, p=0.005); ST2 (β=0.15, p=0.02); and early mitral inflow velocity (E)/early mitral annular diastolic velocity (E/E') averaged for LV septal and lateral basal regions (β=0.18, p=0.005) were associated with LAVi. Using stepwise multivariate regression AnV+ MPs (β=0.14, p=0.03); AF type (β=0.35, p<0.001); and E/E' ratio (β=0.11, p=0.04) remained significant predictors of LAVi (adjusted for age and gender). Apoptotic MPs detection with microFCM Conclusion Level of circulating apoptotic MPs is associated with LAVi in AF patients with HFpEF, and may be involved in remodeling process or could represent surrogate markers of myocardial damage in AF. Acknowledgement/Funding ESC Research Grant, EHRA Academic Research Fellowship Programme

Beta-blocker is Effective in Reducing Cardiovascular Events in Patients with Chronic Heart Failure Complicated by Atrial Fibrillation

2005 ◽  
Vol 11 (9) ◽  
pp. S294
Author(s):  
Nobuyuki Shiba ◽  
Tomohiro Tada ◽  
Tsuyoshi Shinozaki ◽  
Koji Fukuda ◽  
Jun Takahashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Beta Blocker ◽  
Cardiovascular Events

P1369Predictors of atrial fibrillation recurrence after radiofrequency ablation in patients with chronic heart failure with preserved ejection fraction

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Zolotarova
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Atrium ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Preserved Ejection Fraction ◽  
Af Recurrence

Abstract Introduction. Randomized controlled trials and meta-analyzes have shown high efficacy of the radiofrequency ablation (RFA) for both initial and secondary strategies after unsuccessful drug therapy (DT) to maintain sinus rhythm (SR) and improve functional and morphological quality of life; in patients with chronic heart failure (CHF), RFA were associated with a significant relative reduction in the risk of overall mortality, atrial fibrillation (AF) recurrence, and hospitalization for cardiac pathology (compared with DT). High risk of arrhythmia recurrence (up to 45% within 6 - 12 months after intervention) remains a major RFA problem. Purpose. to evaluate predictive properties of demographic, hemodynamic and electrocardiographic parameters for recurrence after atrial fibrillation ablation in patients with chronic heart failure with preserved ejection fraction. Methods. We included 120 patients, aged 59.80 ± 10.08 years with CHF with preserved ejection fraction (EF) of left ventricle (LV) who underwent first time RFA for AF with LV EF(&gt; 40%) I-III FC NYHA. Baseline clinical data, ECG before and after the procedure, ECHO parameters were collected Results Thirty-two patients had AF recurrence after a mean follow-up of twelve months. Those experiencing recurrence were more female (50% vs.39%, p &lt;0,01), had a longer QTc interval before ablation than those without recurrence (387,23 ± 2,31 vs. 341,22 ± 8,91 ms, p &lt; 0,01) and after ablation (439,01 ± 4,73 vs. 373,21 ± 7,92 ms, p &lt; 0,001), lower LV EF (59% vs. 63%, p &lt; 0,05), higher left atrium diameter (4,59 ± 0,45 vs. 4,08 ± 0,61 cm, p &lt; 0,001) and higher mean pulmonary artery gradient (32,86 ± 9,67 vs. 25,15 ± 9,73, p &lt; 0,01). Conclusions. QTc duration to radiofrequency ablation and its prolongation after intervention are independent predictors of arrhythmia recurrence in patients with chronic heart failure with a preserved left ventricular ejection fraction. The size of the left atrium before ablation is a highly sensitive predictor of recurrence of arrhythmia

P3789Circulating biomarkers of myocardial fibrosis and cellular apoptosis in patients with atrial fibrillation and heart failure with preserved ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M S Dzeshka ◽  
E Shantsila ◽  
V A Snezhitskiy ◽  
G Y H Lip
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Angiotensin Ii ◽  
Ejection Fraction ◽  
Matrix Metalloproteinase ◽  
Diastolic Dysfunction ◽  
Diastolic Function ◽  
Myocardial Fibrosis ◽  
Volume Index ◽  
Preserved Ejection Fraction

Abstract Introduction Atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) commonly coexist. AF is associated with left atrial (LA) and ventricular (LV) myocardial fibrosis, contributing to diastolic dysfunction in HFpEF. Many profibrotic pathways have been studied in AF and HFpEF, but scarce data are available on the role of circulating microparticles (MPs). Purpose To evaluate association of circulating biomarkers of fibrosis and MPs subsets with Doppler-derived parameters of diastolic function in AF and HFpEF. Methods We studied 274 patients with non-valvular AF and HFpEF (median age 62 years, 37% females). Paroxysmal AF was diagnosed in 150 patients (55%) and non-paroxysmal AF (persistent or permanent) in 124 (45%). Median CHA2DS2-VASc score was 3 in males and 4 in females. Transthoracic echocardiography was performed to assess LV diastolic function, including early mitral inflow velocity (E), E/A velocities ratio (on sinus rhythm), early mitral annular diastolic velocity (E') for LV septal and lateral basal regions, E/E' ratio, LA maximum volume index (LAVi), E-wave velocity deceleration time (DT), flow propagation velocity (Vp). Average values from ten consecutive cardiac cycles were calculated. E/E' ratio was chosen as valid and reproducible index of diastolic function in AF patients for regression analysis. Blood levels of galectin 3, interleukin-1 receptor-like 1 (ST2), transforming growth factor beta 1 (TGF-β1), procollagen type III aminoterminal propeptide (PIIINP), matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase 1 (TIMP-1), angiotensin II and aldosterone level were assayed as surrogate biomarkers of myocardial fibrosis and profibrotic signaling. Using microflow cytometry, numbers of platelet-derived (CD42b+), monocyte-derived (CD14+), endothelial (CD144+), and apoptotic MPs (Annexin V+) were quantified in plasma samples. Linear regression was used to reveal parameters associated with diastolic function assessed as E/E' ratio. Data were normalized with Box-Cox transformation. Results Grade I diastolic dysfunction was found in 149 (54%); 94 (34%), and 31 (11%) patients had grade II and grade III diastolic dysfunction, respectively. On univariate analysis, age (β=0.23, p=0.0001); male gender (β=-0.19, p=0.02); history of hypertension (β=0.15, p=0.02); AF type, i.e. progression from paroxysmal to permanent (β=0.14, p=0.02); AnV+ MPs (β=0.19, p=0.01); angiotensin II (β=0.13, p=0.04); ST2 (β=0.1, p=0.04); and TIMP-1 (β=0.13, p=0.03) were associated with E/E' ratio. Using stepwise multivariate regression, AnV+ MPs (β=0.15, p=0.01) and TIMP-1 (β=0.3, p=0.04) remained significant predictors of E/E' ratio, adjusted for age, gender, hypertension and AF type. Relation of E/E' to TIMP-1 and AnV+ MPs Conclusion Apoptotic (AnV+) MPs and TIMP-1 were independently associated with diastolic dysfunction in AF and HFpEF. These may contribute to the pathophysiology of AF and HFpEF, and complications related to the presence of both. Acknowledgement/Funding ESC Research Grant, EHRA Academic Research Fellowship Programme

1412Effect of beta-blocker dose on the prognosis in chronic heart failure patients depending on the presence of atrial fibrillation. Data from FAR NHL (FARmacology and NeuroHumoraL activation) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Labr ◽  
J Spinar ◽  
J Parenica ◽  
L Spinarova ◽  
F Malek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Primary Endpoint ◽  
Beta Blocker ◽  
Low Dose ◽  
Beta Blockers ◽  
High Dose ◽  
Heart Failure Patients ◽  
Medium Dose

Abstract Background Beta-blockers (BB) decrease morbidity and mortality in heart failure patients and are part of the first line treatment together with inhibitors of angiotensin converting enzyme. New metaanalysis from year 2014 of main BB studies in chronic heart failure showed no benefit of BB in patients with atrial fibrillation (AF). Methods 1088 at least one month stable chronic heart failure patients with ejection fraction <50% were included in FAR NHL (FARmacology and NeuroHumoraL activation) registry. Three centers with speciality in heart failure in the Czech Republic were participating from November 2014 to December 2015. Results 80% patients were male with median age 66 years. Aetiology of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving beta-blockers 20% received low dose similar to the starting dose, 57% medium dose and 17% high dose which was set as the target BB dose. Nearly 93.8% of patients received BB. But only 17.0% received the high dose of BB. 6.2% of patients were not treated by BB at all. One third of patients (34.5%) had atrial fibrillation in medical history or newly recorded on electrocardiogram. Patients with AF were much older (median 63 vs. 70 years, respectively; p<0.001), had higher heart rate (72 vs. 74 /min; p<0.006) and were also in higher class of NYHA (New York Heart Association; p=0.005). The primary endpoint was set as all cause death, mechanical circulatory support implantation, orthotopic heart transplantation or hospitalization for acute heart failure. Patients with AF survived without primary endpoint in 70.6%, patients without AF in 78.8% (p=0.005) even after age standardization. There was significantly different survival according to dose of beta-blocker, the higher was dose of BB, the higher was survival. Patients with no beta-blocker survived without primary endpoint in 63.9%, with low dose survived in 72.6%, medium dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients into two groups according to atrial fibrillation. Patients without AF had the better survival without primary endpoint. The higher dose of beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%, 85.1%; p=0.007). Also patients with AF had better survival without primary endpoint, the higher dose of beta-blocker they got, the higher was their survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007). Conclusion In FAR NHL registry of stable chronic heart failure patietnts was one third of patients with atrial fibrillation. Nearly 94% of patients received beta-blocker. But only 17% received the target dose. Pacients even with or without atrial fibrillation had the significantly better survival without primary endpoint the higher was the dose of beta-blocker.

AGE-RELATED ISSUES OF THE QUALITY OF LIFE IN PATIENTS WITH CHRONIC HEART FAILURE MIDDLE RANGE EJECTION FRACTION OF ELDERLY AND SENILE AGE AGAINST THE BACKGROUND OF PHARMACOTHERAPY

2021 ◽  
pp. 734-741
Author(s):  
О.А. Осипова ◽  
Е.В. Гостева ◽  
Н.И. Жернакова ◽  
С.Г. Горелик ◽  
О.М. Кузьминов ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Middle Age ◽  
Depression Scale ◽  
The Elderly ◽  
Age Related ◽  
Middle Range

В статье рассмотрены вопросы изменения качества жизни лиц пожилого и старческого возраста с ХСН и промежуточной ФВ (ХСНпрФВ) в процессе длительной (12 мес) фармакотерапии. Были обследованы 377 больных, из них 129 - 45-59 лет (средний возраст), 128 - 60-74 лет (пожилой возраст), 120 - 75 лет и старше (старческого возраста). Диагноз устанавливали в соответствии с Рекомендациями по диагностике и лечению ХСН (2013, 2016 г.) Проведена оценка качества жизни по опроснику MLHFQ. Установлено улучшение качества жизни через 12 мес терапии во всех группах больных, но наиболее выраженные результаты получены в старческом возрасте. Максимальное снижение уровня тревоги наблюдали у мужчин средней возрастной категории, у женщин - в пожилом возрасте. В пожилом и старческом возрасте отмечено сопоставимое снижение баллов по шкале депрессии Цунга как у мужчин, так и у женщин. The article deals with the issues of changing the quality of life of elderly and senile people with chronic heart failure with middle range ejection fraction (CHFmrHF) during long-term (12 months) pharmacotherapy. 377 patients were examined, including 129 people aged 45 to 59 years (middle age), 128 people aged 60 to 74 years (elderly), and 120 people aged over 75 years (senile age). The diagnosis was made in accordance with the Recommendations for the diagnosis and treatment of CHF (2013, 2016). The quality of life was assessed according to the MLHFQ questionnaire. There was an improvement in the quality of life after 12 months of therapy in all groups of patients, but the most pronounced results were obtained in old age. The maximum decrease in the level of anxiety was observed in men in the middle age group, in women - in the elderly. In the elderly and senile age, there was a comparable decrease in the scores on the Zung depression scale in both men and women.

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