Abstract Background Neutrophil gelatinase-associated lipocalin (NGAL) is marker of renal function and is strongly associated with presence of comorbidities. AHEAD comorbidity score is commonly used to predict survival in acute heart failure patients and could predict events even in chronic heart failure. Methods 547 stable patients with chronic heart failure patients with left ventricular ejection fraction <50% were included in FARmacology and NeuroHumoraL activation (FAR NHL) registry. Three cardiological centres from The Czech Republic with speciality in heart failure were participating. Results Median age was 66 years, 80.3% were men. The etiology of heart failure was in 54% ischemic heart disease, in 40% dilatated cardiomyopathy, in 0.5% hypertrophic cardiomyopathy. 60% of patients were in NYHA class II. In the first two years of follow-up, 74 events (13.5%) occurred, including all-cause death, left ventricle assist device implantation or orthotopic heart transplantation. The AHEAD comorbidity score (Atrial fibrillation, low Haemoglobin level <120 g/L in female or <130 g/L in male, Elderly >70 years; Abnormal renal parameters with creatinine >130 μmol/L, Diabetes mellitus; 1 point for each comorbidity present) was set in this registry. Patients with AHEAD 0–1 survived without event in 89.2%, AHEAD 2–3 in 82.4% and AHEAD 4–5 only in 63.5% (p<0.001; pairwise comparison 0.034, <0.001, 0.021). Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p<0.001), Haemoglobin level (Spearman's rank correlation coefficient −0.240; p<0.001), Eldery (Spearman's coefficient 0.425; p<0.001), Abnormal creatinine level (Spearman's coefficient 0.528; p<0.001), Diabetes mellitus (57 vs. 51 ng/mL; p=0.006). NGAL levels are singificantly higher in patients with higher AHEAD score. Mean level of NGAL in AHEAD 0–1 (N=320) is 51 ng/mL, in AHEAD 2–3 (N=190) is 78 ng/mL and in AHEAD 4–5 (N=37) is 142 ng/mL (Kruskal-Wallis test p<0.001, pairwise comparision all <0.001). Conclusion In stable chronic heart failure registry FAR NHL, comorbidity score AHEAD can predict events. Serum NGAL level is significantly higher when AHEAD score comorbidities are present: Atrial fibrillation, low Haemoglobin, Eldery, Abnormal renal function and Diabetes mellitus. Funding Acknowledgement Type of funding source: None

10.1093/ehjci/ehaa946.1161

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Co nám přináší studie PARADIGM-HF

Lenka Špinarová Jindřich Špinar Jiří Vítovec

PARADIGM HF srovnavala inhibitor angiotenzinoveho receptoru a inhibitor neprilysinu LCZ696 s enalaprilem u nemocných se srdecnim selhanim a sniženou ejekcni frakci. Metodika: Jednalo se o dvojitě slepou studii u 8 442 nemocných se srdecnim selhanim NYHA klasifikace II, III a IV a ejekcni frakci pod 40 %, kteři dostavali LCZ696 (2 x 200 mg) neboenalapril (2 x 10 mg) přidane ke standardni medikaci. Primarni cil byl smisený-kardiovaskularni mortalita a hospita¬lizace pro prvni srdecni selhani. Studie byla naplanovana tak, aby odhalila rozdil v kardiovaskularni mortalitě. Výsledky: Studie byla ukoncena předcasně podle předepsaných pravidel při průměrne době sledovani 27 měsiců pro jasný prospěch z lecby LCZ696. V době ukonceni se primarni cil vyskytl u 914 nemocných (21,8 %) ve L.CZ696 skupině a u 1117 nemocných (26,5%) ve skupině lecene enalaprilem (HR LCZ696 skupina, 0,80; 95% CI, 0,73-0,87; p < 0,001). Celkem 711 nemocných (17,0%) lecených LCZ696 a 835 nemocných (19,8%) lecených enalaprilem zemřelo (HR pro umrti z jakekoli přiciny 0,84; 95% CI, 0,76-0,93; p < 0,001); z těchto nemocných 558 (13,3 %) a 693 (16,5%) zemřelo z kardiovaskularni přiciny (HR 0,80; 95% CI, 0,71-0,89; p < 0,001). LCZ696 ve srovnani s enalaprilem sni¬žoval riziko hospitalizace pro srdecni selhani o 21%(p< 0,001) a snižoval symptomy srdecniho selhani (p = 0,001). Ve skupině lecene LCZ696 bylo vice hypotenzi a nezavazných angioedemů, ale mensi výskyt renalniho selhani, hyperkalemie a kasle než ve skupině lecene enalaprilem. Zavěr: LCZ696 byl ucinnějsi než enalapril ve sniženi rizika kardiovaskularniho umrti a hospitalizaci pro srdecni selhani.

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Léčba srdečního selhání ve stáří

Lenka Špinarová Jindřich Špinar Jiří Vítovec

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Role of plasma endothelin level in mild to moderate chronicheart failure

Ondřej Ludka Jindřich Špinar Lenka Špinarová Gabriela Hubená Jiří Špác

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