Vol 22, No 5 (2020)

Consensus Document "Management of treatment on the basis of adherence" developed by Russian Scientific Medical Society of Internal Medicine along based on clinical guidelines of Russian Scientific Medical Society of Internal Medicine approved the XIV National Congress of physicians (Moscow, 20 November, 2019). The document is intended primarily to assess adherence to drug therapy, lifestyle modification, and medical support for patients who need long-term or permanent treatment. By the adherence to treatment, the authors of the document consolidated the compliance of the patient's behavior with the recommendations received from the doctor regarding medication, diet and other measures of lifestyle change. Insufficient adherence to treatment is a global problem. Assessing adherence as a basis for making medical decisions is a critical part of improving the quality of the health system. Predictions of treatment outcomes cannot be considered effective if individualized levels of adherence are not used to justify project planning and evaluation. In medical practice, quantitative assessment of adherence is preferred, universal for patients with various diseases and with the possibility of automated data entry and processing. Sections on medical interventions based on assessment of treatment adherence should be reflected in national clinical guidelines. These Joint Recommendations are based on these provisions. Key words: adherence, quantitative assessment, drug therapy, medical support, lifestyle modification, treatment management. For citation: Nikolaev N.A., Martynov A.I., Skirdenko Yu.P. et al. Management of treatment on the basis of adherence. Consensus document - Clinical recommendations. RSMSIM, SSGR, NATH, SEBN, GS RAS, RSH, RSP Consilium Medicum. 2020; 22 (5): 9-18. DOI: 10.26442/20751753.2020.5.200078

Acute respiratory viral infections (ARI) is the most widespread group of infections that includes flu, coronavirus, adenovirus, and other infections. There is a direct correlation between increase in ARI incidence and increase of incidence of cardiovascular disorders such as acute myocardial infarction, myocarditis, arrythmia, cardiac insufficiency, pulmonary artery thromboembolia, and disseminated intravascular clotting. Patients with ischemic heart disease, cerebrovascular disease, arterial hypertension, and diabetes mellitus are most vulnerable to ARI negative impact on cardiovascular system. Changes of cardiovascular system caused by ARI are not always clinically evident. Their manifestation (clinical symptoms, cardiac cavity dilatation, hemodynamics disorders) may be postponed, may increase for several weeks or months. Timely diagnosis of cardiac pathology that developed in association with previous ARI depends on general practitioners and family doctors. All cases of development of dyspnoea, cardialgia, or arrythmia are indications for additional examination tests performance (electrocardiography, cardiac injury markers, natriuretic peptides) that will allow to confirm or exclude myocardium involvement and define management strategy. In many cases presence of myocardium pathology and its genesis become evident only in follow-up. Key words: acute respiratory viral infection, cardiovascular disorders, myocarditis. For citation: Kirichenko A.A. Acute respiratory viral infections and heart. Consilium Medicum. 2020; 22 (5): 22-27. DOI: 10.26442/20751753.2020.5.200136

Hereditary cardiovascular diseases are of great importance in the structure of cardiovascular disease. The article provides a review of materials on genetically mediated heart diseases, which were discussed at the "Genetics and Heart" First International Congress (Moscow). The most relevant current date on hypertrophic and dilated cardiomyopathies as well as hereditary issues of arrhythmogenesis are presented. The main participants of the congress are listed. Key words: hypertrophic cardiomyopathy, dilated cardiomyopathy, channelopathy, arrhythmogenic cardiomyopathy, pulmonary hypertension, myocardium genetic diseases, “Genetics and Heart” Congress. For citation: Sonicheva N.A., Zateyshchikov D.A. Cardiology: genetics’ time (by the materials of the “Genetics and Heart” Congress, January 24-25, 2020, Moscow). Consilium Medicum. 2020 (22); 5: 35-39. DOI: 10.26442/20751753.2020.5.200185

Aim. Our aim was to assess the accordance of treatment of patients with chronic heart failure and diabetes mellitus (CHF+DM) in real clinical practice with current guidelines and its association with prognosis. Materials and methods. We analyzed 2144 cases of patients admitted to а hospital due to decompensation of CHF in the period from 2014-2018. 207 (9.7%) of these patients had CHF with a left ventricular ejection fraction of <45% and type 2 diabetes [median of age was 69 (interquartile range of 62; 77) years]. The analysis of recommended medications at discharge and survival was performed. Results. Аngiotensin-converting enzyme inhibitors were prescribed to 132 (63.7%) patients: enalapril - 61 (29.4%), perindopril - 42 (20.3%), fosinopril - 29 (14.0%). The angiotensin II receptor antagonist losartan was prescribed to 10 (4.8%) patients. Beta-blockers were prescribed to 188 (90.8%) patients: bisoprolol - 149 (72.0%), metoprolol succinate - 2 (1%), carvedilol - 1 (0.5%). In addition, 36 (17.4%) patients were prescribed metoprolol tartrate not recommended for the treatment of heart failure. Diuretic therapy was prescribed in 200 (96.6%) patients: furosemide - 177 (85.5%), torasemide - 22 (10.6%), indapamide - 1 (0.5%). Mineralocorticoid receptor antagonist spironolactone was recommended 165 (79.7%) patients. Despite the persistence of heart failure III-IV NYHA functional class despite combined medical treatment in 95.1% of patients, the angiotensin receptor and neprilysin inhibitor and/or If-channel blockers and/or cardiac resynchronization therapy weren’t recommended. For glycemic control, metformin was prescribed to 28 (13.5%) patients, gliclazide SR - 53 (25.6%), insulin - 59 (28.5%); combination of metformin and gliclazide SR - 4 (1.9%), metformin and insulins - 5 (2.4%), gliclazide SR and insulins - 5 (2.4%), glimepiride and insulins - 3 (1.5%) patient. During 132 (92; 200) weeks follow up after discharge 107 (67.3%) patients died. The number of deaths was less - 19 (35.2%) in the group of patients whom the therapy in accordance with guidelines was prescribed and who were compliant compared to 88 (83.8%) deaths in others - p (x2)<0.000001. Conclusion. In order to improve the prognosis in patients with heart failure and diabetes mellitus in real clinical practice, it is necessary to carry out treatment strictly in accordance with current guidelines and use the modern achievements in cardiology, including ARNI, If-channel blockers, CPT and etc. Key words: chronic heart failure, diabetes mellitus, guidelines, reduced and middle left ventricular ejection fraction, drug therapy, prognosis, real practice. For citation: Reznik E.V., Lazarev V.A., Kalova M.R., Nikitin I.G. Management of patients with chronic heart failure and diabetes mellitus from the standpoint of modern recommendations and in real clinical practice. Consilium Medicum. 2020; 22 (5): 50-56. DOI: 10.26442/20751753.2020.5.200198

Background. Hyperuricemia has been considered as the risk factors for cardiovascular diseases in recent years. However, an ambiguous position remains regarding the association of hyperuricemia with a number of cardiometabolic conditions and chronic heart failure (CHF). Aim. To present data on the causes of hyperuricemia, its association with heart failure and the impact on the prognosis of patients with this syndrome. Materials and methods. The search for publications in search systems over the past 15 years was done. The review includes articles from peer-reviewed literature. Results. Many researchers have shown that hyperuricemia is associated with cardiovascular diseases, but studies with Mendelian randomization have not shown conclusive evidence of this association. Changes in the human body from the initiation of risk factors to the clinical symptoms can be both the cause of hyperuricemia and its consequence. Existing data indicate the development of hemodynamic and metabolic changes on the background of activation of neurohumoral systems, which may underlie the close association of hyperuricemia and heart failure, including the worse prognosis. Conclusion. Hyperuricemia is a component of complex pathophysiological, hemodynamic and inflammatory processes, which is why uric acid control in all patients with heart failure is important in order to detect decompensation or disease progression in a timely manner. Key words: risk factor, uric acid, hyperuricemia, heart failure, prognosis. For citation: Larina V.N., Larin V.G. Hyperuricemia and chronic heart failure: risk factors and prognostic parallels. Consilium Medicum. 2020; 22 (5): 62-66. DOI: 10.26442/20751753.2020.5.200158

Aim. The aim of our study was to assess the 5-year prognostic significance of contrast-induced acute kidney injury (CI-AKI) in patients with chronic coronary artery disease (CAD). Materials and methods. 561 patients with stable CAD and indications for procedures with intraarterial contrast media administration were included in prospective open cohort study (ClinicalTrials.gov ID NCT04014153). CI-AKI was defined as the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48 hours after administration of contrast media. The primary endpoint was CI-AKI according to KDIGO criteria. The secondary endpoints were total mortality, cardiovascular mortality, myocardial infarction, stroke, gastrointestinal bleeding, acute decompensation of heart failure, coronary artery bypass grafting, repeat percutaneous coronary intervention. Most of the patients, included in the study, were males aged 59.3±11.2 years with arterial hypertension and overweight (BMI 28.8±4.6 kg/m2). Results. CI-AKI was diagnosed in 104 (18.5%) patients. The rate of CI-AKI using the absolute creatinine rise definition was 17 cases (3%). The logistic regression model including age, weight, BMI, female gender, heart failure, proteinuria, arterial hypertension, anemia and baseline serum creatinine, was created. Age, female gender, heart failure, proteinuria and baseline creatinine were statistically significant (p<0.05) risk factors in the model obtained. During 5-year follow-up period CI-AKI seemed to increased the risk of acute decompensation of heart failure and stroke. Conclusion. Elderly female patients suffering from heart failure, proteinuria with higher levels of serum creatinine need more attention and preventive measures before contrast media administration. CI-AKI may indirectly lead to the increased risk of acute decompensation of heart failure and stroke, according to our single-center prospective study. Key words: contrast-induced acute kidney injury, contrast-induced nephropathy, contrast-associated acute kidney injury, coronary artery disease, percutaneous coronary intervention, contrast, prognosis, mortality. For citation: Mironova O.Iu., Fomin V.V. Prognostic significance of contrast-induced acute kidney injury in chronic coronary artery disease patients. Consilium Medicum. 2020; 22 (5): 73-76. DOI: 10.26442/20751753.2020.5.200218

Fractalkine (or chemokine CX3CL1) belongs to the chemokine family and is a protein with a molecular weight of 95 kDa, is considered as a marker of endothelial dysfunction. According to the available data of modern studies, fractalkine can be positioned as a marker of the activity of inflammatory processes of different genesis; as an important prognostic indicator in chronic heart failure of both ischemic and non-ischemic etiology and a marker for monitoring the effectiveness of the treatment in this group of patients; as a predictor of adverse outcomes and an indicator of the effectiveness of percutaneous coronary intervention in patients with acute myocardial infarction, a valuable prognostic marker for patients with stable angina (with hemodynamically significant stenosis of the coronary arteries), as well as a predictor of thrombotic and thromboembolic complications in atrial fibrillation. Currently, it is a highly promising to study drug effects on fractalkine (CX3CL1) and its receptor (CX3CR1) for the pathogenetic treatment of cardiovascular diseases. Key words: fractalkine, atherosclerotic cardiovascular diseases, chronic heart failure, acute myocardial infarction, left ventricle. For citation: Alieva A.M., Almazova I.I., Pinchuk T.V. et al. Fractalkin and cardiovascular disease. Consilium Medicum. 2020; 22 (5): 83-86. DOI: 10.26442/20751753.2020.5.200186

A scientific review of clinical and genetic research data on the role of p2-adrenergic receptor polymorphism in the development and outcomes of cardiovascular diseases is presented. Of the greatest importance in the genetic polymorphism of p2-adrenergic receptors are three loci - Arg16Gly, Gln27Glu and Thr164Ile. Variant alleles Gly16 and Glu27 alter the degree of suppression (down-regulation) of receptor expression against the background of agonist stimulation, which also affects the response of p-blockers. The variant allele Ile164 is extremely rare and leads to a decrease in the functional activity of the receptor. Vascular effects in carriers of the Arg16 and Gln27 alleles are manifested by lower initial blood flow and significantly weakened agonist-stimulated vasodilation compared to carriers of variant alleles Gly16 and Glu27. However, their role in the development of arterial hypertension has not been confirmed. Polymorphism of p2-adre-nergic receptors showed the greatest significance in terms of its effect on cardiac function, the development of adverse outcomes and survival in chronic heart failure, acute coronary syndrome and other cardiovascular diseases. Key words: genetic polymorphism, p2-adrenergic receptors, p-blockers, cardiovascular outcomes, arterial hypertension, heart failure. For citation: Leonova M.V. p2-Adrenergic receptors genetic polymorphism, cardiovascular disorders and influence of p-blockers’ effectiveness. Consilium Medicum. 2020; 22 (5): 92-97. DOI: 10.26442/20751753.2020.5.200107