RESUMEN

The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.

Asunto(s)

RESUMEN

OBJECTIVE: To study the efficiency of the neuropsychological rehabilitation of patients with mild cognitive impairments. MATERIAL AND METHODS: The study included 103 elderly people, aged 59 to 88 years, including 90 women and 13 men with subjective complaints of memory loss (ICD-10: F06.70; F06.71; F06.78; F06.79). Participants were divided into experimental group (n=43) and comparison group (n=42). The estimated impact was the rehabilitation program «The psychosocial therapy and neurocognitive rehabilitation of elderly patients with cognitive impairments¼, within which the principle of complex stimulation of various parameters of the cognitive sphere was used in rehabilitation work with patients in the experimental group in accordance with the «Memory Clinic¼ program. The study was conducted using randomized, equalized comparison groups, and the principle of «triple-blind¼ research. Non-parametric statistics (SPSS) methods were used to assess differences. RESULTS: A significant difference between the comparison and experimental groups has been identified, primarily in relation to high-level mental processes associated with the function of the third structural-functional block according to A.R. Luria. After the training, the number of correct answers significantly increased (t(42)=-2.67, p<0.001) in the experimental group, while in the comparison group the indicator did not change (t(41)=0.50, p=0.617). The number of false alarms in the experimental group decreased significantly (t(42)=2.13, p=0.039). CONCLUSION: The results confirm the leading role of these processes in the hierarchy of mental functions, which suggests that they should primarily be targets of rehabilitation interventions.

Asunto(s)

RESUMEN

AIM: To assess the relationship between plasma chitotiosidase (CHIT) level and mortality in hospitalized patients with COVID-19. MATERIALS AND METHODS: 347 hospitalized patients with COVID-19 were enrolled in our single-center cohort prospective observational study. On the first day of hospitalization the patients were assessed by the level of CHIT in the venosus blood to addition to default laboratory examinations. The primary endpoint was all-cause death. The survival after hospital discharge were assessed via phone calls on 90 and 180 days since inclusion to the study (NCT04752085). RESULTS: Our study included 347 patients. The first symptoms appeared in 7 days [5; 7] before hospitalization; 283 (84.3%) patients had less than 50% of the involvement of the lung tissue to the inflammation process (CT 0-2); 36 (10.4%) patients had died since the start of our investigation; 30 (83.3%) of them died during hospitalization, others -no later than 60 days; 68 (19%) people didn't answer during phone call. The survivor's activity of the enzyme in the deceased was significantly lower in compare to deceased patients (90.5 [40.2; 178.0] nmol/h/mL vs 180.0 [77.2; 393.2] nmol/h/mL; p=0.001). Survivor of the patients with a higher level of the activity of the CHIT (more than 171 nmol/h/mL) was statically significantly lower. CONCLUSION: Rising of the CHIT's activity more than 171 nmol/h/mL might be an early independent predictor of the bad prognosis of the patients, who were hospitalized with COVID-19 infection.

Asunto(s)

RESUMEN

Aim    To study the effectiveness of a treatment based on monitoring the soluble ST2 receptor (sST2) concentration in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) after acute decompensated heart failure (ADHF).Material and methods    The study included 37 patients hospitalized for ADHF with LVEF ≤40% and sST2 concentration ≥37.8 ng/ml at the time of discharge from the hospital. Patients were randomized into two groups: a sST2 monitoring (sST2M) group (19 patients) and a standard therapy (ST) group (18 patients). The follow-up period was 12 months. At baseline, the groups practically did not differ by clinical, functional, laboratory, and instrumental characteristics. For the sST2M group, the goal was reducing the sST2 concentration by >30% of baseline or to <30 ng/ml.Results    Therapy in both groups was comparable both in doses and in frequency of administration of basic drugs. However, the diuretic therapy was more frequently adjusted in the sST2M group (3.0 [1.0; 4.0] vs. 1.0 [0; 3.0] adjustments per patient, p = 0.047), which required more visits to the clinic (7.0 [6.0; 9.0] vs. 6.0 [6.0; 6.0] visits per patient, p=0.024). In the sST2M group at 6 months, the sST2 concentration was decreased by 43.3% (p=0.001), and 13 patients (72.2%) achieved the goal. In the ST group, the sST2 concentration was decreased by 38.5% (p=0.001), and 11 patients (68.8%) reached the target values. After 12 months, the downward trend continued in both groups. In both groups, the NT-proBNP concentration decreased: in the sST2M group by 27.7% (p=0.014), and in the ST group by 31.9% (p = 0.006). By the 12th month, the decrease remained only in the sST2M group. Only the sST2M group had an increase in LVEF (+28.5%, p=0.003), a decrease in left ventricular end-systolic volume (LVESV) (-12.0%, p=0.017), and a decrease in left atrial volume (-13.4%, p=0.045); at 12 months, LVEF remained increased (26%, p=0.006), and LA volume remained decreased (-14.3%, p=0.028). Quality of life and results of 6-minute walk test (6MWT) improved in both groups. For 6 months of treatment, the sST2M group had a significantly lower incidence of composite endpoints (CEP, cardiovascular death and decompensation/hospitalization due to HF), 26.3% (5 events) of the sST2M group compared to the ST group, 83.3% (15 events) (p=0.029), primarily due to a lower incidence of decompensated HF. For 12 months of follow-up, the incidence of CEP in the ST group was 122.2% (22 events), and 47.4% (9 events) in the sST2M group (p=0.035).Conclusions    The tactics of sST2 monitoring used in the treatment of "high-risk" HFrEF patients (with high sST2 concentrations) is associated with increased LVEF, improved functional status of patients, a beneficial effect on LV remodeling, and decreased incidence of CEP.

Asunto(s)

RESUMEN

This study deals with potential flow of ideal fluid in an infinite cylindrical tube in the presence of a blocking object. The blockage effect of the object on the flow can be characterized by a lump parameter, blockage coefficient, which accounts for the object shape and size. For a cylindrical blocking object, analytical results for the blockage coefficient are known only in three limiting cases: for a long thin cylinder and for small and large blocking disks. We propose a simple analytical expression for the blockage coefficient of a cylindrical blocker of arbitrary length and radius that reduces to the known asymptotic results in the corresponding limits.

RESUMEN

BACKGROUND: Kidney involvement is a common manifestation of the systemic autoimmune rheumatic diseases. Kidney biopsy is the gold standard for the diagnosis of kidney diseases, however this method has not yet become the standard-of-care in rheumatology practice. AIM: To assess the diagnostic value of kidney biopsy in the management of patients of the rheumatology department. MATERIALS AND METHODS: In this retrospective observational study we analyzed the medical documentation including kidney morphology findings in the patients of the Department of Rheumatology at Tareev Clinic of Internal Diseases. All patients included in the research had signs of kidney involvement and had undergone needle biopsy of the kidney or re-evaluation of the kidney tissue received previously. RESULTS: From June 2016 to October 2021, 3110 patients were admitted to the rheumatology department. Among them 63 (2%) underwent kidney biopsy and were included in the study. Twenty (32%) were male. Mean age was 42.513.9 years. The most common preliminary diagnoses before kidney biopsy were ANCA-associated vasculitis (n=17), systemic lupus erythematosus (n=12), and AA-amyloidosis associated with inflammatory joint diseases (n=7). In 14 (27%) patients diagnosis was unspecified at the time of biopsy. Among 49 patients with established preliminary diagnosis morphological findings were in line 38 (78%) with the pre-liminary diagnosis. However, in 11 (22%) patients morphological findings resulted in the change of the diagnosis. In all 14 patients with unspecified condition kidney biopsy helped to establish clinical diagnosis. Ultrasound evaluation demonstrated hematoma formation in 18 (31%) patients, and among them two required blood component transfusions. CONCLUSION: Our study demonstrates significant value and safety of kidney biopsy in the patients with autoimmune rheumatic conditions. We suggest that kidney biopsy should be implemented in the management of this category of patients.

Asunto(s)

RESUMEN

El objetivo de este artículo es comparar y analizar dos enfoques de la afasia: La teoría de localización dinámica sistémica de las funciones mentales superiores desarrollada por A.R. Luria y modelo neurocognitivo de doble ruta. Hasta donde sabemos, nunca antes se había realizado un análisis comparativo de estas dos teorías. Encontramos similitudes entre estas dos teorías, así como diferencias entre ellas. Una de las diferencias clave es que, si bien el enfoque de Luria ve varios síntomas como consecuencias sistémicas de un impedimento primario, el modelo de ruta dual ve estos síntomas como independientes y no relacionados. Esta gran diferencia entre dos enfoques puede explicarse: el enfoque de Luria está en línea con el clásico «análisis del síndrome» de la afasia, al contrario del enfoque cognitivo, que asume que los síndromes clásicos son incapaces de explicar toda la diversidad de síntomas clínicos. (AU)

The aim of this paper is to compare and analyze two approaches to aphasia: The systemic dynamic localization of higher mental functions theory developed by A.R. Luria and neurocognitive dual-route model. To our knowledge, comparative analysis of these two theories was never done before. We found similarities between these two theories, as well as differences between them. One of the key differences is that while Luria’s approach views various symptoms as systemic consequences of a primary impairment, the dual-route model sees these symptoms as independent and unrelated. This major difference between two approaches can be explained: Luria’s approach is in line with classic “syndrome analysis” of aphasia, contrary to the cognitive approach, which assumes that classic syndromes are unable to explain all diversity of clinical symptoms. (AU)

Asunto(s)

RESUMEN

The document focuses on key issues of diuretic therapy in CHF from the standpoint of current views on the pathogenesis of edema syndrome, its diagnosis, and characteristics of using diuretics in various clinical situations.

Asunto(s)

RESUMEN

A numerical technique is proposed for synthesizing realizations of airfoil surface pressure induced by incoming turbulence. In this approach, realization of the surface pressure field is expressed as a set of uncorrelated wall plane waves. The amplitude of these plane waves is determined from the power spectrum density function of the incoming upwash velocity fluctuation and the airfoil aeroacoustic transfer function. The auto-spectrum of the surface pressure is obtained from an ensemble average of different realizations. The numerical technique is computationally efficient as it rapidly converges using a relatively small number of realizations. The surface pressures for different airfoils excited by incoming turbulence are numerically predicted, and the results are compared with experimental data in the literature. Further, the unsteady force exerted on an airfoil due to the airfoil-turbulence interaction is also computed, and it is shown to be in very good agreement with analytical results.

RESUMEN

Time-harmonic waves propagate along a cylindrical waveguide in which there is an obstacle. The problem is to calculate the reflection and transmission coefficients. Simple explicit approximations are found assuming that the waves are long compared to the diameter of the cross-section d. Simpler but useful approximations are found when the lateral dimensions of the obstacle are small compared to d. Results for spheres, discs, and spheroids are given.

RESUMEN

Current biomarkers allow diagnosing a wide array of pathological processes and evaluating effects of therapies and prognosis for cardiological patients. This review focuses on a possibility of using N-terminal pro-brain natriuretic peptide (NT-proBNP), soluble suppressor of tumorigenicity 2 (sST2), galectin-3, and other biomarkers in patients with chronic heart failure for evaluating the risk of life-threatening ventricular tachyarrhythmias and sudden cardiac death.

Asunto(s)

RESUMEN

The aim of the study was to develop an informative method for assessing chemoreflex sensitivity and to evaluate its prognostic capacity for restoring spontaneous breathing in patients with brain damage of various etiologies. The study included 16 healthy volunteers and 38 patients on prolonged mechanical ventilation (VE) after a traumatic brain injury, anoxic brain damage, and cerebrovascular events. The external respiration variables were assessed from the initial level to the development of the first episode of desaturation with spO2 in the range of 90-80% against the background of normobaric hypoxia as indicators reflecting the development of adaptive ventilatory response and characterizing the state of peripheral chemoreflex sensitivity (PCS). The peripheral chemoreflex sensitivity index (PCSI) was calculated using the equation: PCSI = [RR(e) : RR(i)] × [Vt(e) : Vt(i)] × [VE(e) : VE(i)] × Vt(e) × VE(e), where PCSI is the peripheral chemoreflex sensitivity index in L2/min; RR(i) and RR(e); Vt(i) and Vt(e); VE(i) and VE(e) are the respiratory rate, tidal volume, minute ventilation initially (i), before a functional stress test, and during a functional test of normobaric hypoxia with spO2 in the range of 90-80% (e). With the PCSI values ≥15.6 L2/min, successful weaning from ventilators and recovery of spontaneous breathing are predicted. The sensitivity and specificity of PCSI were 78.57 [95% CI: 49.2-95.26] and 83.3% [95% CI: 62.6-95.26], respectively. The sensitivity and specificity of the traditional indicator of the success rate of weaning from ventilators and recovery of spontaneous breathing, Rapid Shallow Breathing Index (RSBI), in this cohort of patients was 69.23 [95% CI: 38.6-90.9] and 28.0% [95% CI: 12.03-49.3], respectively. A predictor of the patient's weaning from mechanical ventilation is the assessment of peripheral chemoreflex sensitivity, which can be measured by a simple non-invasive bedside test based on measuring the difference in external ventilation parameters before and during a functional normobaric hypoxic trial.

RESUMEN

Background: Venous thromboembolism (VTE) with the prevalence of pulmonary microcirculatory thrombosis is considered a common complication of novel coronavirus disease (COVID-19) that develops despite anticoagulation. Methods: The clinical course of the disease and the autopsy findings of seven deceased patients with verified COVID-19 were analyzed. The chest computed tomography (CT) scan was routinely performed while CT pulmonary angiography and a duplex ultrasound scan (DUS) of the lower limbs were used in cases of suspected VTE. The VTE prophylaxis was administered to all patients with intermediate or therapeutic doses of low-molecular-weight heparin. The histological examination of the lung tissue and other organs was performed with particular attention paid to the pulmonary vasculature. Results: Venous thromboembolism, including deep vein thrombosis in one patient and pulmonary artery thrombosis in two patients, was confirmed by imaging tests despite anticoagulation. Systemic thrombolysis was performed in two patients with putative and confirmed pulmonary embolism. An autopsy revealed the signs of acute respiratory distress syndrome in all seven patients. Abnormalities of lung vessels were found in all cases and were represented by dystrophy and necrosis in the endothelium and muscle fibers, and by infiltration by plasmatic cells, neutrophils, and lymphocytes. Multiple clots of variable maturity were observed. All those changes developed despite anticoagulation and were preserved after systemic thrombolysis. Conclusion: Inflammatory and prothrombotic changes in the arterial wall in parallel with the lack of lung perfusion may cause diffuse arterial thrombosis in the lungs. This background may be responsible for the low response to systemic anticoagulation and thrombolysis in severe forms of COVID-19.

RESUMEN

The review aims to appraise the value of determining the concentrations of the new biomarker sST2 for assessing prognosis and monitoring treatment effectiveness of patients with decompensated heart failure during an episode of decompensation and during long-term follow-up after discharge from the hospital. The article analyses in detail the expedience of sST2 measurement in a patient with ADHF on admission and discharge from the hospital and the changes in the biomarker level during the period of active treatment for risk-stratification in patients, presents the optimal threshold values of sST2, which should be oriented when selecting patients with high and very high risk. The importance of subsequent monitoring of the marker concentration during long-term observation in emphasized to predict the risk of death, HF re-decompensation / HF rehospitalization. The potential benefits of choosing sST2 as the optimal marker for serial measurement during long-term follow-up, as well as evaluating the treatment effectiveness in patients with HF, compared to the "classical" variant - natriuretic peptides are shown.

Asunto(s)

RESUMEN

AIM: To present current treatment modes for DeBakey type I aortic dissection, to compare their early and mid-term postoperative results, to evaluate predictors of negative aortic remodeling after surgery. MATERIAL AND METHODS: Retrospective cohort analysis included 78 patients with DeBakey type I aortic dissection who underwent surgical treatment in 2009-2017. Patients were divided into 3 groups depending on type of intervention: group I (n=22) - Elephant Trunk procedure, group II (n=29) - hybrid interventions, group III (n=27) - proximal aortic replacement alone. Early postoperative results and aortic remodeling in mid-term postoperative period were compared. RESULTS: There were no significant differences in postoperative morbidity, in-hospital mortality and freedom from aortic death. However, 7 patients were lost for follow-up in group III. Analysis of false lumen patency showed results in favor of more aggressive approach (groups I and II) with significantly higher rate of false lumen thrombosis in segments 1 and 2 (p<0,001 and p=0,004 respectively). Freedom from negative aortic remodeling was also significantly higher in groups I and II. Risk factors of patent false lumen were residual fenestration, large volume of false lumen in segment 2, dissection of supra-aortic vessels and connective tissue disorders. Risk factors of negative aortic remodeling were connective tissue disorders, patent false lumen and dissection of supra-aortic vessels. CONCLUSION: Advanced surgical approach (Elephant Trunk procedure or hybrid interventions) should be preferred for DeBakey type I aortic dissection.

Asunto(s)

RESUMEN

PURPOSE: to study prognostic value of various biomarkers and their combinations in patients who survived decompensation of chronic heart failure. MATERIALS AND METHODS: Patients (n=159) who were hospitalized with diagnosis of heart failure (HF) decompensation were included in a prospective single-center study. Examination on admission and the day of hospital discharge, included measurement of concentrations of N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hsTnT), copeptin, soluble suppression of tumorigenicity 2 (sST2), kopetin, neutrophil gelatinase-associated lipocalin (NGAL), and galectin-3. Te combined primary endpoint comprised cardiovascular (CV) death, frst hospitalization because of HF heart failure decompensation, episodes of HF deterioration which required additional i/v diuretics, and CV death with successful resuscitation. RESULTS: During one-year follow-up 56 pts (35.2%) reached the combined primary endpoint. Tere were 78 (49.1%) cardiovascular events. During hospitalization, patients with the decompensation of heart failure experienced a decrease of sST2, NT-proBNP, galectin-3, kopetin, hsTnT and an insignifcant increase of NGAL. ROC analysis identifed signifcant relation between concentrations of NT-proBNP, sST2, copeptin and, to a lesser degree, hsTnT, determined at hospital discharge, and risk of combined primary endpoint during 1-year follow-up: area under the curve (AUC) was 0.733 [95% CI 0.645-0.820], p<0.0001, 0.772 [95% CI 0.688-0.856], p<0.0001, 0.735 [95% CI 0.640-0.830], p<0.0001, and 0.659 [95% CI 0.553-0.764], p=0.005, respectively. Patients who during hospitalization did not achieve cut-off values of NT-proBNP ≤1696 rg/ml, sST2≤37.8 hg/ml, copeptin≤28.31 rmol/L and hsTnT≤28.37 rg/ml, had higher risk of reaching adverse events during 1 year; OR and 95% CI were 2.96 [1.61, 5.42] p<0.0001, 4.31 [2.34, 7.93] p<0.0001, 3.06 [1.59, 5.89] and 2.19 [2.12, 4.27]), respectively. According to Cox regression analysis, risk of the combined primary end point was the highest in patients with 3 or more elevated markers (OR = 6.6 [3.584, 12.158], p<0.0001), average in patients with 2 elevated markers (OR = 1.123 [0.51, 2.48]), p=0.7), and the lowest in patients with no markers increase or increase of only one marker (OR = 0.11 [0.049, 0.241], p<0.0001). In the Kaplan-Mayer survival analysis all three groups were statistically different. In order to identify the most prognostically strong model, a reclassifcation analysis was performed. According to this analysis, the combination of sST2 and NT-proBNP concentrations determined at hospital discharge, exceeded one NT-proBNP (reclassifcation = -8.1%). At the same time, predictive value of only sST2 just insignifcantly less than value of sST2 and NT-proBNP combination (reclassifcation = -1.9%). CONCLUSION: Patients with three and more elevated markers at hospital discharge have high risk of adverse events. Te biggest prognostic value has combination of sST2 and NT-proBNP concentrations. In order to determine the long-term prognosis of a patient with HF decompensation, it is sufcient to measure concentrations of sST2 and NT-proBNP at hospital discharge. Alternatively, it is possible to limit to sST2 only, which is just insignifcantly inferior to the sST2 and NT-proBNP combination. Patients with concentrations of sST2 ≥37.8 hg/ml and NT-proBNP ≥1696 rg/ml at hospital discharge have maximal 1year risk of death due to recurrent HF decompensation.

Asunto(s)

RESUMEN

PURPOSE: To assess the suppression of tumorogenicity 2 (ST2) and copeptin significance for risk stratification of patient (pts) with acute decompensated heart failure (ADHF) during long-term follow-up compared with traditional risk factors. METHODS: We included in a prospective study 159 pts with ADHF. Blood samples to determine copeptin, sST2, NT-proBNP and hsTnT concentration were collected at admission and at discharge from the hospital. Serial determination of biomarker concentration was performed at 3, 6 and 12 months of follow-up. The combined primary end point of the trial included cardiovascular (CV) death, hospitalization due to HF, episodes of HF deterioration requiring additional intravenous diuretics and CV death with successful resuscitation. RESULTS: During 1-year follow-up (295.3±113.2 days) 56 pts (35.2%) had 78 (49.1%) cardiovascular events. Biomarker concentrations in low risk pts (without CV events) were significantly lower compared with high risk pts (with CV events). Discharge copeptin and NT-proBNP values were comparable for pts risk stratification: AUC=0.727 (95% CI 0.637-0.816), р.

Asunto(s)

RESUMEN

The main objective of laboratory diagnosis of a diphtheria is identification of the causative agent by means of the minimum quantity of diagnostic tests for obtaining the authentic answer in the most short time. One of the major stages is capture and delivery of pathological material on which the efficiency of carrying out and timeliness of issue of the final answer depends. Considering emergence in the market of commercial liquid transport mediums, assessment of their efficiency for diagnosis of diphtheria is advisable. In the real work the pilot studies allowing to predict efficiency of use of the commercial transport liquid medium ∑-Transwab® with the liquid medium of Ames in two systems - with the standard applicator (system 1) and with the thin extended tampon for sampling from narrow cavities - urethral and nazofarengialny are conducted (system 2). In a research used a control toxigenic strain of Corynebacterium diphtheriae of a biovar of gravis No. 665. In an experiment "imitated" operating conditions of the medical organizations for storage of tampons with pathological material on diphtheria before their transportation in laboratory - on a table at the room temperature (6 and 20 hours), in the refrigerator (6 and 20 hours), in the thermostat (6 and 20 hours). After an incubation all tampons sowed the environment for primary crops of pathological material on a blood tellurite agar.. Accounting of results was carried out in 24 and 48 hours of growth. It is established that the commercial transport liquid medium of Ames can be used for capture of pathological material on diphtheria in the second half of the working day at storage in the conditions of the refrigerator. At the same time, it is necessary to consider a tampon form as the best results on a identification of the causative agent of diphtheria have been received when using a universal tampon.

Asunto(s)

RESUMEN

AIM: Monitoring of concentrations of modern biomarkers to evaluate the efficacy of long­term treatment of patients after acute decompensated HF (ADHF). MATERIALS AND METHODS: The study included 100 patients with severe decompensated FC II-IV CHF and LV EF <40 % due to IHD, DCMP or AH. At discharge from the hospital, patients were divided into groups of low (NT­proBNP<1400 pg / ml) (control, n=30) and high (NT­proBNP≥1400 pg / ml) risk (n=70). Patients at high risk were randomized to two treatment groups, a group of NT­proBNP monitoring (NPM) (n=35) and a group of standard therapy (n=35). At the end of the study, noncompliant patients were isolated from these two groups into a separate group (n=10). The aim of the treatment was decreasing the NT­proBNP concentration to less than 1000 pg / ml and / or ≥50 % of the baseline level. In addition to the soluble suppression of tumorigenicity 2 (sST2) receptor, concentrations of copeptin, neutrophil gelatinase associated lipocalin (NCAL), galectin 3, and high­sensitivity troponin T were measured at discharge from the hospital (baseline) and at three and 6 months of treatment. RESULTS: The strongest correlations were found between changes in concentrations (Δ%) of NT­proBNP, copeptin, and sST2 and changes in CHF FC, 6­min walk distance, CCS, quality of life, LV EF, and Е / Е' (р<0.001). The incidence of cardiovascular events was directly related with the degree of decrease and / or increase in biomarker concentration. Patients of the NPM group had the lowest risk of adverse clinical outcome upon a decrease in NT­proBNP <988.5 pg / ml at 6 months of treatment or > 50 % of the baseline level at discharge from the hospital. For these patients, the mean Δ% was 60.7±8.5 % for NT­proBNP, 34.03±17.6 % for sST2, and 32.41±8.8 % for copeptin [OR at 95 % CI 0.08 (0.02-0.36), р <0.0001]. A significant increase in the risk for cardiovascular events was observed only at a considerable increase in NT­proBNP >50 % [OR at 95 % CI 3.8 (1.13-13.0), р=0.03], and the highest incidence of cardiovascular events was observed in the group of noncompliant patients (110 %). Besides NT­proBNP, to significantly decrease the risk of cardiovascular events, it was necessary to achieve a decrease in sST2 concentration to less than 30 ng / ml or by more than 24.9 % (Δ%) at the end of followup [ОR (95 % CI: 0.1 (0.02-0.5), р=0.004]. CONCLUSION: Among the modern biomarkers, changes in NT­proBNP, sST2, and copeptin concentrations most accurately reflect changes in the clinical and functional status, quality of life, and EchoCG parameters in HF patients during long­term monitoring. The lowest risk for adverse clinical outcomes was observed in post­decompensation patients with a decrease in NT­proBNP <988.5 pg / ml after 6 months of treatment or ≥50 % of baseline upon discharge from the hospital. The sST2 concentration has to be reduced by more than 24.9 % of baseline and less than 30 ng / ml in the course of long­term treatment after decompensated HF.

Asunto(s)

RESUMEN

.

Asunto(s)