The myocardial diseases and heart failure department
Head of the Department
Tereshchenko Sergey Nikolaevich, MD, PhD, professor
The myocardial diseases and heart failure department was established in the 1970s. It was formed from 2 clinical departments of the A. L. Myasnikov Institute of Clinical Cardiology. The myocardial diseases and heart failure department was the first specialized medical unit in the USSR for the diagnosis and treatment of myocardial diseases, valvular heart diseases and heart failure. Outstanding scientists, such as Aleksey Vinogradov and Nurmukhamed Mukharlyamov, worked in the department. In 1972 N. Muharlyamov became the head of the department and determined the main topics of scientific and clinical work that remain relevant today: chronic heart failure and cardiomyopathy. The results of scientific work are reflected in scientific publications, systematic reviews and guidelines on heart failure.
The main areas of research
- The department researches the pathogenesis of heart failure (HF), the role of microRNA and new biomarkers, reflecting changes in the main links to HF pathogenesis: the heart [damage, fibrosis and remodeling: high-sensitivecardiac troponin T (hs-cTn), natriuretic peptides (NPs), galectin-3, soluble receptor ST2 (sST2)]; kidney [acute kidney injury, dysfunction: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), cystatin-C]; inflammation [sST2]; the development of edema syndrome and neurohormonal activation [NT-proBNP/BNP, copeptin, the renin-angiotensin system].
- The department studies the role of new biomarkers in diagnosis, risk stratification and evaluation of the effectiveness of HF personalized therapy under new biomarker model control.
- The department studies Apelin-12 and the development of new inotropic drugs for treatment of HF based on it.
- The department searches for new markers of epigenetic regulation of energy metabolism in the myocardium to create a prototype of diagnostic panels, differentiated by the etiology of HF and severity of the pathological process. The department is working on the study of epigenetic factors that cause transcriptional and post-transcriptional modifications that determine the final quantity and quality of the protein composition of the cell. The study is to determine and correlate the levels of microRNA, SIRT1, SIRT3 and РРАRs in patients with different etiology and severity of HF in the blood and myocardium.
- The department studies the pathological mechanisms of acute decompensated HF (ADHF) due to various cardiovascular diseases and the effect of decompensation episodes on the prognosis of patients with HF. We study new diagnostic, the prognostic markers of target organs damage and clinical and laboratory characteristics of patients with ADHF. Also we are creating an algorithm of a differentiated approach for treatment of patients with ADHF to correct the damage of the structure and function of target organs to improve the short-term and long-term prognosis of patients with HF decompensation. Lastly we are compiling and maintaining a register of patients with decompensated HF.
- The department studies the pathogenesis of dilated cardiomyopathy. We research the role of immunological biomarkers in the study of endomyocardial biopsy specimens (EMB) and peripheral blood samples in the diagnosis of inflammatory cardiomyopathy and the evaluation of the effectiveness of immunotropic and antiviral therapy in patients with active inflammation and viral genome persistence in myocardium. Clinical practice of new laboratory (including microRNA) and instrumental methods for diagnosing inflammatory cardiomyopathy and its treatment approaches is also being developed and implemented.
- Our department has long-term observation of patients with systolic and diastolic left ventricular dysfunction and chronic heart failure, this aims to assess the effectiveness of the treatment and prognosis of patients with HF.
- The department studies the diagnosis and treatment of patients with HF in combination with atrial fibrillation (AF), with the development of new approaches in the treatment of these patients after introduction of direct oral anticoagulants.
- We compile a national registry of patients with HF and AF from different regions of the Russian Federation.
- The department participates in clinical trials and introduction of new drugs for treatment of heart failure.
- The department develops new strategies for treatment of patients with HF.
The main scientific and practical achievements
- • The pilot clinical program evaluating the effect of the therapy under control of NT-proBNP in high-risk patients after acute decompensation of heart failure (ADHF) has been completed. Achievement of the targets concentrations of NT-proBNP ( < 1000 pg/ml and/or reducing > 50% of the initial level) during the follow up period under control of NT-proBNP was associated with lower risk of cardiovascular events, such as cardiovascular death and HF hospitalization. Regular assessment of the concentration of NT-proBNP ensures the stability of the patient’s clinical condition, allows early detection of worsening of HF and performs the necessary correction of therapy, thereby reducing the number of decompensations and hospitalizations due to HF in high-risk patients.
- The results of analysis values of biomarkers on prognosis of patients after ADHF have been received. Compared to treatment under new biomarker model control with NT-proBNP, hs-cTn, kopeptin, galectin-3, NGAL and standard therapy, the concentration of sST2 has a greater predictive value at risk of death due to cardiovascular cause/HF hospitalization in patients after ADHF. At the same time, it was shown that the combination of NT-proBNP and sST2 significantly improves model of risk stratification in patients after ADHF. Patients with sST2 concentration>37.8 ng/ml (HR = 6.775, p <0.0001) and NT-proBNP>1696 pg/ml (HR = 4.41, p<0.0001), at discharge, have the highestone-year risk of death due to cardiovascular cause/HF hospitalization.
- The study of the role of immunological biomarkers in the research of endomyocardial biopsy (EMB) and peripheral blood samples in the diagnosis of inflammatory cardiomyopathy (ICMP), and assessment of efficiency of immunotropic and antiviral therapy in patients with active inflammatory process and viral persistence in myocardium has been completed. For the first time, it was shown that concentration of MMP-9>680 ng/ml was associated with active inflammatory process in the myocardium in patients with dilated cardiomyopathy. The combination of biomarkers with values of MMP-9 > 680 ng/ml, complement C3 > 1.2 g/l and complement C4 > 0.256 g/l in 92% of cases indicates inflammation in the myocardium in patients with dilated cardiomyopathy syndrome, if the acute and exacerbation of chronic inflammatory diseases is absent.
- The use of immunosuppressive therapy in patients with dilated cardiomyopathy in the absence of myocardial viral persistence and the prescription of antiviral/immunomodulatory therapy in virus-positive patients with dilated cardiomyopathy syndrome has been confirmed.
- The employees of our department managed to create the first Russian registry of dilated cardiomyopathy. The prevalence of dilated cardiomyopathy among patients with HF was 2.6%. At the same time, there was a significant variability of prevalence dilated cardiomyopathy in different regions, which ranged from 0.25% in Barnaul to 25.6% in Krasnoyarsk and 31.7% in Kazan. 90% of patients were younger than 60 years. The register brought out poor diagnosis of dilated cardiomyopathy in many regions of the Russian Federation.
- The results of the Russian registry of patients with HF and AF (Reef-CHF) were received. In prospective survey we enrolled a total of 1003 patients with heart failure in combination with atrial fibrillation from February 2015 to December 2015. The results of the Reef-CHF show that compliance with the treatment guidelines in patients with heart failure in combination with atrial fibrillation remains suboptimal. Our data shows that levels of administration of oral anticoagulants in patients with heart failure and atrial fibrillation was low (64%), especially in the group of patients with high risk for thromboembolic events (58%). As a result, the registry identified the clinical characteristics of patients with HF and AF, complies with international guidelines for the diagnosis and treatment of HF, AF, and the prevalence oflong-term anticoagulant therapy in clinical practice.
- MicroRNAs are considered promising biomarkers. According to our data with HF associated such microRNAs as microRNA-34a, microRNA-21 and microRNA-423.According to the results of blood tests of determining microRNA (PCR with fluorescent hybridization detection of amplification products) 2 patents were obtained.
- SIRT1 and SIRT3 are NAD-dependent protein deacetylases, which are considered to be cell energy sensors. A change in their activity is associated with mitochondrial dysfunction and, as a result, with disturbance of energy production. In our study, no significant differences in the levels of sirtuins in the myocardium of patients with coronary artery disease and dilated cardiomyopathy were obtained.
- In the department, an active study and analysis of the clinical and demographic characteristics of patients hospitalized with decompensation of heart failure is carried out in order to identify various predictors of response to treatment. It was shown that severe heart failure with reduced systolic LV function is about 3% of cases from the total number of hospitalizations. At the same time, the main factors contributing to decompensation were low patient adherence to treatment and insufficient treatment of heart failure at the outpatient stage. It is important that most patients have normal or elevated SBP. These data indicate that the most of these patients may use all groups of drugs, according to current recommendations, including peripheral vasodilators.
The data was introduced into the practice of the myocardial diseases and heart failure department and the department of neurohumoral and immunological research of the A. L. Myasnikov Institute of Clinical Cardiology.