Continuously progressive heart failure (HF) with severe clinical symptoms, poor
sensitivity to therapy, frequent episodes of decompensation, and high mortality remains
a major epidemiological and medical problem for the healthcare system.
Given the above, this study aimed to improve the effectiveness of therapy and
reduce the percentage of complications during the treatment of patients with severe HF
caused by dilated cardiomyopathy (DCM) by choosing the optimal therapy tactics.
The thesis presents the results of a study based on the analysis of the results of the
use of different areas of treatment of patients with severe HF, and a comparative
analysis of the results obtained.
The study included 109 patients (mean age 40.2±12.02 years; men 87.16%,
women 12.84%) who underwent inpatient treatment at the State Institution "Heart
Institute of the Ministry of Health of Ukraine" from 2015 to 2020.
The study was conducted in accordance with the requirements of the Declaration
of Helsinki and other international and national documents concerning bioethical
principles of scientific and medical research. The study protocol was approved by the
Ethics Committees of the State Institution "Heart Institute of
the Ministry of Health of Ukraine" and the Shupyk National Healthcare Institution of
Ukraine. Patients gave written and oral consent to participate in the study.
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The methods of clinical examination and statistical data processing used in the
study were generally accepted for this category of patients and standardized, which
made it possible to obtain reproducible data with a high degree of reliability.
In the first stage, we chose 120 patients for this study. 11 patients who did not
meet the selected diagnostic criteria were excluded from the study.
In the second stage of the study, all 109 patients were divided into 3 groups
according to the main treatment method used. Patients in all study groups received
medical treatment, which included ACE inhibitors or angiotensin II receptor blockers,
ß-blockers, aldosterone antagonists, saluretics, and other symptomatic medications.
Group 1 (n=28) included patients who received only medical therapy. Patients in
group 2 (n=22) also underwent surgical interventions to correct HF - partial left
ventricular (LV) resection with plastic surgery. In patients of group 3 (n=59), drug
therapy was supplemented with a course of haemosorption consisting of 3 procedures
on the Terumo Advanced Perfusion System 1 using a granular deligandising
haemosorbent.
Based on the results of inpatient treatment, a comparative analysis of clinical,
laboratory, and instrumental data by group was performed.
Analysis of the dynamics of changes in clinical symptoms showed that patients in
all study groups had similar results. In groups 1 and 3, there was no dyspnoea at rest and
with minimal physical activity (p<0.001), in group 2, the prevalence of this symptom
decreased by 59.12% (p=0.0003). There were no severe peripheral edema in patients of
groups 1 and 2 (p<0.001), in group 3 the prevalence of this symptom decreased by
54.3% (p<0.001).
In addition, the prevalence of such signs of fluid overload as ascites and
hydrothorax in group 1 decreased by 46.43% (p=0.0003) and 42.87% (p=0.0016), in
group 3 - by 30.6% (p=0.0001) and 37.26% (p<0.001), respectively, indicating a
pronounced positive clinical effect of the treatment. No significant changes in these
symptoms were found in group 2.
The analysis and comparison of tachyarrhythmia and cardiac manifestations of
the disease showed no significant changes among patients in group 1, but in group 2 the
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prevalence of tachycardia decreased by 50.04% (p=0.002), and in group 3 - by 67.7%
(p<0.001). In addition, in group 3, the prevalence of other arrhythmias decreased by
34% (p=0.0002), cardialgia did not bother the patients of the group (p=0.0008), and
there were no signs and tendencies to develop pulmonary edema (p=0.0194).
According to the results of the analysis of the dynamics of changes in laboratory
parameters in group 2, an increase in leukocyte levels by 17.04±0.1% (p=0.025) was
recorded, which is associated with surgical intervention. In group 3, the level of NTproBNP decreased by 63.54±10.46% (p<0.001), which is evidence of a pronounced
positive therapeutic effect. In groups 1 and 2, no significant changes in NT-proBNP
levels were detected.
The analysis of the dynamics of changes in echocardiographic parameters showed
an increase in LV ejection fraction (EF) in all study groups. In group 1, LV EF
increased by 20.45±0.14% (p<0.001), in group 2 - by 25±0.3% (p=0.0002), and the
most pronounced result was obtained in group 3 - the increase was 34.17±0.11%
(p<0.001). In addition, in group 3, there was a decrease in LV EF by 11.25±0.76%
(p=0.048), indicating a process of reverse LV remodeling.
