Along with the known risk factors of cardiovascular diseases (CVDs) constituting metabolic syndrome (MS), the gut microbiome and some of its metabolites, in particular trimethylamine-N-oxide (TMAO), are actively discussed. A prolonged stay under natural hypoxic conditions significantly and multi-directionally changes the ratio of gut microbiome strains and their metabolites in feces and blood, which is the basis for using hypoxia preconditioning for targeted effects on potential risk factors of CVD. A prospective randomized study included 65 patients (32 females) with MS and optimal medical therapy. Thirty-three patients underwent a course of 15 intermittent hypoxic–hyperoxic exposures (IHHE group). The other 32 patients underwent sham procedures (placebo group). Before and after the IHHE course, patients underwent liver elastometry, biochemical blood tests, and blood and fecal sampling for TMAO analysis (tandem mass spectrometry). No significant dynamics of TMAO were detected in both the IHHE and sham groups. In the subgroup of IHHE patients with baseline TMAO values above the reference (TMAO ≥ 5 μmol/l), there was a significant reduction in TMAO plasma levels. But the degree of reduction in total cholesterol (TCh), low-density lipoprotein (LDL), and regression of liver steatosis index was more pronounced in patients with initially normal TMAO values. Despite significant interindividual variations, in the subgroup of IHHE patients with MS and high baseline TMAO values, there were more significant reductions in cardiometabolic and hepatic indicators of MS than in controls. More research is needed to objectify the prognostic role of TMAO and the possibilities of its correction using hypoxia adaptation techniques.

Background: Acute heart failure (AHF) is one of the leading causes of admissions to the emergency department (ED). There is a need to develop an easy-to-use score that can be used in the ED to risk-stratify patients with AHF and in hospitalization decisions regarding cardiac wards or intensive care units (ICUs). Methods: A retrospective observational study was conducted at a city hospital. The data from the presentation of AHF patients at the ED were collected. The combined primary endpoint included death from any cause during hospitalization or transfer to an intensive care unit (ICU) for using inotropes/vasopressors. Feature selection was performed using artificial intelligence. Results: From August 2020 to August 2021, 908 patients were enrolled (mean age: 71.6 ± 13 years; 500 (55.1%) men). We found significant predictors of in-hospital mortality and ICU transfers for inotrope/vasopressor use and built two models to assess the need for ICU admission of patients from the ED. The first model included SpO₂ < 90%, QTc duration, prior diabetes mellitus and HF diagnosis, serum chloride concentration, respiratory rate and atrial fibrillation on admission, blood urea nitrogen (BUN) levels, and any implanted devices. The second model included left ventricular end-diastolic size, systolic blood pressure, pulse blood pressure, BUN levels, right atrium size, serum chloride, sodium and uric acid concentrations, prior loop diuretic use, and pulmonary artery systolic blood pressure. Conclusions: We developed two models that demonstrated a high negative predictive value, which allowed us to distinguish patients with low risk and determine patients who can be hospitalized and sent from the ED to the floor. These easy-to-use models can be used at the ED.

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 Evaluation of clinical, demographic, laboratory, and instrumental characteristics of patients with acute decompensated heart failure (ADHF) depending on the outcome over the hospitalization period. Material and methods The prevalence of chronic heart failure (CHF) and ADHF remains extremely high. Hospitalization for ADHF is the most important predictor of death and readmission in the long term, and each subsequent hospitalization significantly increases the risk of death. Research of in-hospital mortality in this group of patients is limited in the Russian literature; however, numerous studies have examined mortality at 30, 60, and more days after discharge. This comprehensive retrospective study included patients aged > 18 years who were hospitalized for ADHF in a multidisciplinary hospital from December 1, 2019 through December 1, 2021. Patients were divided into two groups based on their outcomes during their hospital stay. Laboratory, clinical, and instrumental characteristics were assessed with subsequent multivariate data analysis. Statistical analysis was performed using an IBM SPSS Statistics version 24.0 software. Results During the observation period, 498 patients were included. In-hospital mortality was 8% (n=41). According to the results of binary logistic regression, the need for inotropic drugs (odds ratio (OR) 94.6; 95% confidence interval (CI): 19.8-451; p 99th percentile on admission (OR 6.1; 95% CI: 1.35-28.1; p =0.01), and systolic blood pressure <110 mmHg. (OR 4.2; 95% CI 1.06-16.6; p =0.01) were directly associated with the likelihood of death during the hospital stay. The resulting regression model was statistically significant ( p 99th percentile upon admission, which was directly associated with the in-hospital mortality. These patients represent a special group with a poor prognosis during their hospital stay, and myocardial injury markers have a high predictive value for assessing clinical outcomes in this patient population.  

Aim. To evaluate clinical, demographic, laboratory and instrumental characteristics, treatment, and outcomes of patients with acute decompensated heart failure depending on left ventricular ejection fraction. Material and methods. A consecutive retrospective study was conducted including patients aged 18 years hospitalized with acute decompensated heart failure to a multidisciplinary hospital between December 1, 2019 and December 1, 2021. All patients were divided into 3 groups according to left ventricular ejection fraction, followed by an analysis of patient characteristics. Results. A total of 486 patients were included (55 % men); mean age was 72 ± 12 years. The number of patients with heart failure with reduced ejection fraction was 235 (48 %), with mildly reduced ejection fraction – 117 (24 %), and with preserved ejection fraction – 134 (28 %). More than 60 % of patients required admission to the intensive care unit. The groups differed in sex, age, presence of coronary artery disease, postinfarction cardiosclerosis, history of myocardial revascularization, presence of infection at admission, as well as in physical examination findings, laboratory and instrumental parameters; however, no differences in mortality were observed between the groups (p 0.05). Conclusion. Despite the fact that patients with heart failure with reduced ejection fraction had more severe condition at admission per clinical, laboratory, and instrumental parameters, more often had a history of coronary artery disease, postinfarction cardiosclerosis, and myocardial revascularization, more frequently required inotropic / vasopressor support, and had longer hospital stays, mortality rates were comparable between the groups.

Objective To identify clinical, laboratory, and imaging predictors of myocardial sodium accumulation in patients with chronic heart failure (CHF). Methods This was a prospective two-center observational study including 15 patients with decompensated CHF on a high-salt diet and 5 healthy volunteers on a low-salt diet. All participants underwent dual-energy computed tomography (DECT) with generation of material decomposition maps (H₂O|Na, H₂O|NaCl) for quantitative assessment of myocardial sodium and NaCl. Estimated plasma osmolarity (eOSM) was calculated as 2[Na⁺] + 2[K⁺] + [Urea] + [Glucose], followed by calculation of osmolyte fractions (PropNa/eOSM, PropUrea/eOSM, etc.). Between-group comparisons, correlation analysis, ROC analysis, and regression modeling (univariate and multivariate models with FDR correction; internal bootstrap validation of the multivariate model) were performed. Results Compared with healthy controls, CHF patients had higher myocardial relative density (HU: 51.69 ± 5.67 vs. 38.65 ± 4.72; p = 0.004) and sodium concentration (72.24 ± 26.38 vs. 25.49 ± 44.04 mmol/kg; p = 0.025). Myocardial sodium concentration correlated inversely with the sodium fraction of eOSM (R=–0.63; p = 0.0027) and positively with the urea fraction (R = 0.66; p = 0.0014). Similar associations were observed for NaCl (R=–0.54; p = 0.015 and R = 0.66; p = 0.0015, respectively). In ROC analysis, sodium and urea fractions of eOSM demonstrated comparable discrimination for low myocardial sodium (AUC = 0.829 and 0.843; Youden thresholds 45.6% and 2.25%, respectively). In a multivariate linear model, myocardial sodium accumulation was associated with reduced sodium (β=–54; p < 0.001) and glucose fractions of eOSM (β=–27; p = 0.014), as well as increased absolute monocyte count (β = 21; p = 0.047). Internal validation confirmed acceptable calibration of the model. Conclusion Patients with decompensated CHF demonstrate increased myocardial sodium content and higher HU on DECT. The plasma osmometric profile—particularly sodium and urea fractions of eOSM—together with inflammatory markers, are associated with myocardial sodium accumulation and may serve as predictors for risk stratification and personalized therapy.