Background: The venous excess ultrasound score (VExUS) is used to objectify systemic venous congestion. The aim of the paper was to determine the association between VExUS grades and worsening renal function (WRF), reduced natriuretic response, diuretics resistance, and mortality in patients with acute heart failure (AHF). Methods: One hundred patients were included, and Doppler ultrasound of hepatic, portal, and renal veins was performed. Severity of congestion was graded using the VExUS score (grade 0, 1, 2, or 3). Sodium concentration in a spot urine sample was assessed in 2 h after the first loop diuretic administration and was adjusted for the prescribed dose of furosemide (31 mmol/40 mg). Diuretics resistance was defined as the need to double the starting dose of intravenous furosemide in 6 h. Results: Patients with VExUS grade 3 showed a higher incidence of WRF (OR: 11.17; 95% CI: 3.86–32.29; p < 0.001) and a decreased natriuretic response: a spot urine sodium content of <50 mmol/L (OR: 21.53; 95% CI: 5.32–87.06; p < 0.001) and an adjusted spot urine sodium content of <31 mmol/40 mg (OR: 9.05; 95% CI: 3.15–25.96; p < 0.001). The risk of diuretic resistance (OR: 15.31; 95% CI: 5.05–46.43; p < 0.001), as well as the need for inotropic and/or vasopressor support (OR: 11.82; 95% CI: 3.59–38.92; p < 0.001), was higher in patients with severe congestion. The hospital mortality rate increased in patients with VExUS grade 3 compared to in patients with other grades (OR: 26.4; 95% CI: 5.29–131.55; p < 0.001). Conclusions: Patients with AHF and VExUS grade 3 showed a higher risk of developing WRF, a decreased diuretic and natriuretic response, a need for inotropic and/or vasopressor support, and a poor prognosis during their hospital stay.

Aim. To analyze the clinical significance of the sodium level in a single urine test obtained 2 hours after the first dose of a loop diuretic was administered in patients with acute decompensation of chronic heart failure (ADHF).Material and methods. An observational study was conducted on the basis of a rapid-care hospital. The concentration of sodium in urine analysis obtained 2 hours after intravenous administration of the first dose of loop diuretic and natriuresis for the first day of hospitalization were evaluated. The development of resistance to diuretics was taken as the primary endpoint (the need to increase the daily dose of furosemide by more than 2 times compared to the initial one or the addition of another class of diuretic drugs).Results. 25 patients with ADHF were included. The average age of patients was 69.0±14.8 years, 16 (64%) of them were men. The average left ventricular ejection fraction was 49.0±13.5%. The level of the N‐terminal fragment of the brain natriuretic peptide (NT-proBNP) was 3416 (2128; 5781) pg/ml. The average sodium concentration in the urine analysis obtained 2 hours after the start of treatment was 100.6±41.0 mmol / l. The concentration of sodium in urine for the first day was 102.2±39.0 mmol/l. 2 hours after the start of treatment, the sodium concentration in a single urine test was less than 50 mmol/l in 5 (20%) patients. Upon further observation, oligoanuria (defined as diuresis of less than 400 ml within 24 hours) developed in 2 of them. Oligoanuria was not detected among patients whose sodium concentration was more than 50 mmol/l. The need for escalation (any increase in the dose of a loop diuretic and/or the addition of another class of diuretic drugs) arose in 7 (28%) patients; at the same time, we diagnosed the development of resistance to diuretics in 5 (20%) of them. Resistance to diuretics was more common among patients with a sodium concentration in a single urine test obtained 2 hours after the start of furosemide administration, less than 50 mmol/l (p=0.037); when dividing the recruited patient population into subgroups with a sodium concentration in a single urine test ≥50 mmol/l and <50 mmol/l there was no significant difference in the need for any escalation of diuretic therapy [3 (60%) vs 4 (20%), p=0.07].Conclusion. Resistance to diuretics is more common among patients with a sodium concentration in a single urine test obtained 2 hours after the first dose of furosemide, less than 50 mmol / l. Evaluation of natriuresis allows to identify insufficient effectiveness of diuretic therapy already at the beginning of treatment.

Background: Acute heart failure (AHF) is a common cause of hospital admission with high morbidity and mortality. Up to one-third of AHF patients require rehospitalization during the first three months after discharge due to the nature of disease and the patient’s characteristics. In this regard, the first 3 months after an episode of decompensation of heart failure are called the “vulnerable” period. However, there is a gap in knowledge about the significance of this rehospitalization on heart failure course. The aim of the study is to evaluate impact on mortality of AHF rehospitalization during 3 months after hospital discharge on a retrospective registry with 3 year follow-up. Methods: Patients after AHF hospitalization episode between 1 December 2020 and 30 November 2023 were monitored via electronical medical records for 3 year follow-up. All patients who survived after index hospitalization were included. The primary endpoint was all-cause mortality. COX-multiple regression was used to evaluate the impact of rehospitalization during 90 days after index discharge on outcomes. p values less than 0.05 were considered to be significant. Results: A cohort of 204 patients, 56.6% males, with an average age of 72 ± 13 years, were included in the study with medium follow-up of 22 ± 12 months. Within 3 months after discharge, 55 (27%) patients were rehospitalized for AHF, and 11 (5%) patients died. Patients who experienced a recurrent episode of AHF were characterized by a history of previous hospitalizations for AHF before inclusion (39 (71%) vs. 72 (48%); p = 0.005), the use of intravenous inotropic drugs (5 (9%) vs. 2 (1%); p = 0.007), higher initial doses of furosemide during index hospitalization (98 ± 46 vs. 82 ± 37; p = 0.01), and higher doses of furosemide at discharge (54 ± 41; 41 ± 33; p = 0.02). Left ventricular ejection fraction (LVEF), prevalence of atrial fibrillation (AF), diabetes mellitus (DM), and chronic kidney disease (CKD) did not differ between the groups. Over 3 years follow-up, 68 (33.2%) patients died, and cardiovascular mortality was 15.6% (32 patients). In multivariate COX-regression age (HR 1.04 [1.008–1.07]), heart rate (HR) on admission (HR 1.02 [1.004–1.03]), and hospitalization within the first 3 months after discharge were independent predictors of death (HR 2.21 [1.32–3.83]). Conclusions: Readmission for AHF within the first 3 months after discharge is an independent risk factor for all-cause cardiovascular mortality during 3 years follow-up.

Aim . To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF). Material and methods . This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death. Results . According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration. Conclusion . Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

Aim. To evaluate the changes of cell-free DNA (cfDNA) levels before and after percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute coronary syndrome (STE-ACS). To identify associations of cfDNA concentration before and after PCI with complications and length of ulcerated plaque in patients with STE-ACS.Material and methods. This prospective single-center observational pilot study included 44 patients with STE-ACS admitted to the cardiac intensive care unit during the period of May-August 2023. In all patients, along with standard laboratory tests, cfDNA level was measured upon admission and 24 hours after PCI. Assessment of cfDNA associations before and after PCI was carried out in relation to following significant complications and conditions in STE-ACS patients: death, acute left ventricular failure (ALVF), acute heart failure (AHF), arrhythmia, number of stents implanted, number of segments with impaired local contractility, total stent length.Results. The mean age of the patients was 60,6±9,6 years, of which 74,6% were men. TIMI 0-1 flow was recorded in 93,2% of the subjects. The most common complications were cardiogenic shock (18,4%), arrhythmia (16,9%), AHF (13,6%), ALV (11,9%). Death was recorded in 8,5%. Implantation of 1 stent in PCI was performed in 75% of cases, while in the rest, 2 or more stents were implanted. The proportion of patients with impaired local contractility was 90%, the median stent length was 24,0 (20,0-50,0) mm. CfDNA level on admission did not differ from level after PCI 94,5 (78,3-155,5) ng/ml vs 115,0 (71,0-152,0), p=0,46. However, it signi­ficantly exceeded the cfDNA concentration from a group of healthy volunteers (78,0 (59,7-106,0), p=0,017). Characteristic curve showed significant relationships both for the concentration of cfDNA before (with implantation of 2 or more stents (AUC 0,71 with 95% confidence interval (CI) 0,56-0,86, p=0,039), stent length >24 mm (AUC 0,73 with 95% CI 0,58-0,89, p=0,009)) and after PCI (with the number of impaired local contractility segments (AUC 0,73 with 95% CI 0,57-0,89, p=0,014)). If the cfDNA level before PCI was >90 ng/ml, the risk of implantation of 2 or more stents per procedure increased by 5,4 times (odds ratio (OR) 5,4, 95% CI 1,11-28,93, p=0,044). The risk of a stent length >24 mm with pre-PCI cfDNA >107 ng/ml increased 9-fold (OR 9,0 with 95% CI 2,2-36,9, p=0,001), and the cfDNA level after PCI >105 ng/ml increased the risk of impaired local left ventricular (LV) contractility in 2 or more segments by 5 times (OR 5,0, 95% CI 1,23-20,3).Conclusion. In the studied group of patients with STE-ACS subject to intervention, the cfDNA concentration before PCI was associated with the implantation of ≥2 stents and the stent length (>24 mm). CfDNA level before PCI was associated with the number of segments of impaired local LV contractility (≥2).

Aim. To study the incidence and clinical prognostic significance of changes in heart failure (HF) phenotype based on left ventricular ejection fraction (LVEF) changes over 3 years. Material and methods . This retrospective study included 157 patients hospitalized with acute decompensated heart failure (ADHF). The results of baseline echocardiography and repeat examinations at 3, 6, 12, 24, and 36 months were assessed. Patients were divided into subgroups based on baseline LVEF as follows: HF with reduced LVEF (HFrEF) (10% was noted in 31% of patients. In the HFmrEF subgroup, LVEF normalized in 48% of patients, and decreased to <40% in 22%. In the HFpEF subgroup, a decrease in LVEF <40% was recorded in 10% of cases. According to the Cox model, the transition from the HFrEF subgroup to the HF with improved EF subgroup was associated with higher overall survival (HR (hazard ratio) 4,57; 95% confidence interval (CI): 1,039-20,177; p=0,04). The risk of cardiovascular death in patients who transitioned from the HFrEF subgroup to any other subgroup (HFmrEF, HFpEF) was also associated with improved survival (HR 8,852; 95% CI: 1,139-68,805, p=0,04). In the HFpEF subgroup, a decrease in LVEF <40% was associated with an increased risk of cardiovascular mortality (HR 4,906; 95% CI: 1,08622,153; p=0,039). Conclusion. Clinically significant improvement in cardiac function is observed in almost half of patients with a baseline reduced LVEF and is associated with a better prognosis. A decrease in LVEF in the HFpEF subgroup is a predictor of unfavorable outcome.