Роль мышечной ткани в патогенезе хронической сердечной недостаточности — возможности воздействия (исследование “ФОРМА”)

The article highlights the central components of Russian heart failure (HF) management programs in actual clinical practice. The experience of the Competence Center of Almazov National Medical Research Center, as well as opportunities and prospects for improving the monitoring of decompensated HF.

Heart failure (HF) is associated with skeletal muscle wasting and exercise intolerance. This study aimed to evaluate the exercise-induced clinical response and histological alterations. One hundred and forty-four HF patients were enrolled. The individual training program was determined as a workload at or close to the lactate threshold (LT1); clinical data were collected before and after 12 weeks/6 months of training. The muscle biopsies from eight patients were taken before and after 12 weeks of training: histology analysis was used to evaluate muscle morphology. Most of the patients demonstrated a positive response after 12 weeks of the physical rehabilitation program in one or several parameters tested, and 30% of those showed improvement in all four of the following parameters: oxygen uptake (VO2) peak, left ventricular ejection fraction (LVEF), exercise tolerance (ET), and quality of life (QOL); the walking speed at LT1 after six months of training showed a significant rise. Along with clinical response, the histological analysis detected a small but significant decrease in both fiber and endomysium thickness after the exercise training course indicating the stabilization of muscle mechanotransduction system. Together, our data show that the beneficial effect of personalized exercise therapy in HF patients depends, at least in part, on the improvement in skeletal muscle physiological and biochemical performance.

Динамика маркеров выраженности хронической сердечной недостаточности и обратное ремоделирование миокарда на фоне модуляции сердечной сократимости

Aim. To assess the 2-year prognosis of patients with heart failure with reduced ejection fraction (HFrEF) receiving cardiac contractility modulation (CCM).Material and methods. This single-center observational study included 55 patients (46 men, mean age 53±11 years) with NYHA class II-III HFrEF receiving optimal medical therapy, with sinus rhythm, QRS <130 ms or QRS<150 ms with nonspecific intraventricular conduction delay. NYHA class II and III were established in 76% and 24% of patients, respectively. All patients were implanted with CCM devices between October 2016 and September 2017. Follow-up visits were carried out every 3 months during the 1^styear and every 6 months during the 2^ndyear of observation. The primary composite endpoint was mortality and heart transplantation. Secondary composite endpoints included death, heart transplantation, paroxysmal ventricular tachycardia/ ventricular fibrillation, hospitalizations due decompensated HFResults.The one-year and two-year survival rate was 95% and 80%, respectively. Primary endpoint was observed in 20% of patients. NYHA class III and higher levels of N-terminal pro-brain natriuretic peptide (NTproBNP) were associated with unfavorable prognosis (p=0,014 and p=0,026, respectively). NTproBNP was an independent predictor of survival (p=0,018). CCM contributed to a significant decrease in hospitalizations due to decompensated HF (p<0,0001). The secondary endpoint was observed in 18 (33%) of patients during the 1^styear. The predictor for the secondary composite endpoint was NTproBNP (p=0,047).Conclusion. CCM is associated with a significant decrease in hospitalization rate due to decompensated HF. The 2-year survival rate of patients with NYHA class II-III HF receiving CCM was 80%. The NTproBNP level was an independent predictor of survival in patients receiving CMM for 2 years. Further longer-term studies of the CCM efficacy are required.

Background. Bladder cancer is the most common malignancy of the urinary tract and one of the most common neoplasias in this group. The incidence and mortality rates of the population from bladder cancer differ significantly in different geographical regions of Russia.Aim. To assess the main epidemiological indicators of malignant neoplasms of the bladder in residents of Saint Petersburg and the regions of Russia.Materials and methods. The main epidemiological indicators of malignant bladder neoplasms in Saint Petersburg, Russia and individual federal districts for the period 2012–2021 were studied: crude and standardized rates of morbidity, mortality, prevalence, age structure of patients, the number of cases of diagnosis of the disease at various stages, indicators of one-year mortality and 5-year survival, data on completed cases of treatment of bladder neoplasms. Sources of information: Form No. 7 “Information on cases of malignant diseases” and the database of the Medical Information and Analytical Center (Saint Petersburg).Results. During the period 2012–2021 in Russia, there was an increase in the incidence and prevalence of malignant neoplasms of the bladder. At the same time, mortality rates decreased, and 5-year survival rates increased. This fact indicates the effectiveness of the treatment of patients in this category. In more than 50 % of cases, the disease was detected at stage I of the pathological process, which is due to the proper level of diagnosis. The main medical and statistical indicators in patients with malignant bladder neoplasms in Saint Petersburg are comparable to the average Russian data, and in a number of parameters they exceed them.Conclusion. Oncourological assistance to the population with malignant neoplasms of the bladder in Saint Petersburg is provided properly. The study of medical and statistical indicators in dynamics can be used to improve the algorithms of medical and diagnostic care for cancer patients.