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SGLT2 inhibitors are included in the first line medical therapy of HFrEF. We report a case study of a patient in whom introduction of treatment with empagliflozin after recurrent heart failure decompensation lead to stabilization of the progress of the disease. Heart failure progress stabilization enabled interventions of cardiovascular comorbidities with delay of heart transplantation or mechanical assist device implantation need.

The presence of pulmonary and systemic congestion is the main cause of the poor outcome of the patients with heart failure. Despite of the availability of several tools of the modern medicine, the degree of congestion is usualy difficult to evaulate. The clinical, imaging and laboratory methods are the tools, which can estimated the degree of congestion.

Diabetes mellitus je významným rizikovým faktorem rozvoje srdecniho selhani a přitomnost diabetu zaroveň zhorsuje prognozu nemocných se srdecnim selhanim. Jednou z významných novinek v lecbě srdecniho selhani jsou glifloziny, ktere blokadou reabsorpce glukozy v proximalnim tubulu diky inhibici sodiko-glukozoveho kotransporteru 2 vedou ke sniženi glykemie navozenim glykosurie. Glifloziny byly a stale jsou primarně využivany jako ucinna antidiabetika, ktera kromě zlepseni kompenzace diabetu snižuji tělesnou hmotnost a krevni tlak bez zvýseni rizika hypoglykemie. Studie z poslednich let prokazaly, že glifloziny u diabetiků významně snižuji riziko kardiovaskularnich komplikaci a hospitalizace pro srdecni selhani. Nedavno ukoncene studie s dapagliflozinem a empagliflozinem navic ukazaly významne sniženi kombinace umrti z kardiovaskularnich přicin a hospitalizace pro srdecni selhani u pacientů se srdecnim selhanim s redukovanou ejekcni frakci, a to jak u diabetiků, tak i nediabetiků. Cilem toho clanku je formou expertniho konsenzu shrnout prakticke aspekty spoluprace kardiologa a diabetologa v peci o pacienty s chronickým srdecnim selhanim s redukovanou ejekcni frakci v kontextu soucasných doporuceni a dalsich lecebných možnosti. © 2021, CKS.

Aims: To test the hypothesis that spinal cord stimulation (SCS) acutely improves heart rate variability (HRV) and baroreceptor sensitivity (BRS) in patients with heart failure (HF). Methods: SCS (15 minutes) was delivered in four different settings: 90% of maximal tolerated stimulation amplitude (MTA) targeting the T1-T4 spinal cord segments (SCS90T1-4), 60% of MTA (SCS60T1-4), 90% of MTA with cranial (SCS90CR) and caudal (SCS90CA) electrode configuration. HRV and BRS were recorded continuously and stimulation was compared to device off. Results: Fifteen HF patients were included. SCS90T1-4 did not change the standard deviation of intervals between normal beats (SDNN, p = 0.90), BRS (p = 0.55) or other HRV parameters. In patients with baseline SDNN

Aims A retrospective nationwide observational analysis of diagnoses, procedures, and treatment reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018. Methods and results Prevalence of heart failure (HF) patients increased from 176 496 (1679.4 per 100 000 population) in 2012 to 285 745 (2689.0 per 100 000 population) patients in 2018 (mean age 74.4 ± 12.8 years). In the last years, a stable incidence of HF patients was observed (544 per 100 000 population in 2016 vs. 551 per 100 000 population in 2018; P = 0.310). Mortality rate decreased from 20.55% in 2012 to 15.89% in 2018. The number of hospitalized patients remained similar (318.2 per 100 000 population in 2012 vs. 311.8 per 100 000 population in 2018; P = 0.479). The most used drugs were diuretics (173 295; 60.6%) and beta‐blockers (178 823; 62.6%), followed by angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (angiotensin‐converting enzyme inhibitors 120.581; 42.2%; angiotensin II receptor blockers 47 216; 16.5%). Even though the whole number of implanted devices in HF patients increased steadily (from 25 205 in 2012 to 45 363 in 2018), the prevalence of all devices (pacemakers and defibrillators) in the HF patients remained about the same (14.3% in 2012; 15.9% in 2018). Conclusions The study included all patients with HF in the Czech Republic. These are the first nationwide data of HF epidemiology in the Eastern bloc. The incidence of HF remains stable in the last years. Due to aging of the population, the prevalence of HF significantly increased in the last 6 years. Despite a continuous increase in the prevalence of HF and a suboptimal utilization of its pharmacological therapy, mortality decreased, and the number of hospitalized patients remained the same.

Na zacatku roku 2021 vydala American College of Cardiology (ACC) update k lecbě srdecniho selhani v ca-sopise Journal of the American College of Cardiology. Přinasime strucne informace z tohoto dokumentu. Ocekava se, že Evropska kardiologicka spolecnost (ESC) vyda v tomto roce nova guidelines, ktera pravděpo-dobně potvrdi tento update, předevsim co je noveho v postaveni sacubitril/valsartanu (inhibitoru receptoru angiotenzinu a neprilysinu, ARNI) a inhibitorů sodikoglukozoveho kontransporteru 2 (SGLT2) jako nove lekove skupiny pro lecbu srdecniho selhani. Nový je i perkutanni přistup k lecbě mitralni regurgitace. Celý dokument ma 32 stran.

Anemia and iron deficiency are common non-cardiovascular comorbidities of heart failure. The prevalence of iron deficiency is up to 55 % of patients with chronic heart failure and up to 80 % subjects with acute heart failure including acute decompensated heart failure, independently on anemia. The European Society of Cardiology Heart Failure Guidelines 2021 recommend intravenous iron replacement in patients with heart failure and iron deficiency to improve symptoms, stress tolerance and quality of life in chronic heart failure and to reduce risk of subsequent hospitalization after acute decompenstation.

Chronicke srdecni selhani (CHSS) je v populaci caste a je spojeno se spatnou prognozou navzdory pokrokům v lecbě. V posledni dekadě probihaly studie s kardiovaskularnimi výslednými parametry u pacientů s diabetes mellitus 2. typu (DM2T) uživajicich inhibitory sodiko-glukozoveho kontransporteru 2 (SGLT2i). U tři těchto inhibitorů SGLT2 (empagliflozin, canagliflozin a dapagliflozin) byly prokazany přiznive ucinky na sniženi poctu hospitalizaci pro srdecni selhani. V posledni době navic bylo zjistěno, že dapagliflozin snižil riziko zhorseni srdecniho selhani nebo umrti z kardiovaskularnich přicin u pacientů s chronickým srdecnim selhanim se sniženou ejekcni frakci leve komory, nezavisle na přitomnosti diabetu 2. typu. Probiha a brzy bude prezentovana řada dalsich studii u pacientů se srdecnim selhanim se sniženou nebo zachovanou ejekcni frakci leve komory. Tento souborný dokument shrnuje nedavne důkazy z klinických studii a diskutuje roli inhibitorů SGLT2 při lecbě srdecniho selhani, než budou výsledky probihajicich studii u různých populaci pacientů s CHSS. © 2020 European Society of Cardiology. All rights reserved. Published by the Czech Society of Cardiology.

Tento dokument pojednava o ambulancich srdecniho selhani, ktere jsou zakladany na vsech urovnich kardiologických center a zajisťuji specializovanou peci o pacienty se srdecnim selhanim. © 2020, CKS.

Background and Aims: The prognosis of patients with heart failure (HF) is still generally unfavorable. HF with reduced ejection fraction (HFrEF) patients reach target medication doses in very low percentages in daily clinical practice. HF disease management programs (DMP), including nurse and telemedicine support that facilitate achieving target medication doses, may improve the unfavorable prognosis. Methods: We retrospectively analyzed the data of 738 patients with HFrEF who were followed in a single HF center during the years 1975-2011, for 6.4 (median) years. DMP, nurse and telemedicine support is established at this center. Results: The group achieved left ventricle (LV) recovery after the HF treatment. The median LV ejection fraction improved from 25.0% at baseline to 50.0% at the time of the latest data collection. The proportion of NYHA II, III and IV classes decreased from 27.6%, 30.2% and 29.7% to 26.6%, 7.2% and 0.1%, respectively while the proportion of NYHA class I increased from 12.5% to 66.1%. Median NT-proBNP decreased from 975.0 to 324.0 pg/mL. The survival of the patient group was favorable; 79.7% survived 18.1 years after diagnosis of HF. A high percentage of the patients received recommended target or higher than target doses of angiotensin-converting enzyme inhibitors (82.0%) and beta-blockers (78.1%). Conclusion: The established pharmacotherapy resulted from an effective DMP and this contributed to the favorable prognosis.

Background In prior unblinded studies, cardiac neuromodulation therapy (CNT) employing a sequence of variably timed short and longer atrioventricular intervals yielded sustained reductions of systolic blood pressure (SBP) in patients with hypertension. The effects of CNT on SBP were investigated in this double‐blind randomized pilot study. Methods and Results Eligible patients had daytime ambulatory SBP (aSBP) ≥130 mm Hg and office SBP ≥140 mm Hg despite taking ≥1 antihypertensive medication, and an indication for a dual‐chamber pacemaker. Patients underwent Moderato device implantation, which was programmed as a standard pacemaker during a 1‐month run‐in phase. Patients whose daytime aSBP was ≥125 mm Hg at the end of this period were randomized (1:1, double blind) to treatment (CNT) or control (CNT inactive). The primary efficacy end point was the between‐group difference of the change in 24‐hour aSBP at 6 months. Of 68 patients initially enrolled and who underwent implantation with the Moderato system, 47 met criteria for study continuation and were randomized (26 treatment, 21 control). The mean age was 74.0±8.7 years, 64% were men, left ventricular ejection fraction was 59.2%±5.7%, and aSBP averaged 141.0±10.8 mm Hg despite the use of 3.3±1.5 antihypertensive medications; 81% had isolated systolic hypertension. Six months after randomization, aSBP was 11.1±10.5 mm Hg (95% CI, −15.2 to −8.1 mm Hg) lower than prerandomization in the treatment group compared with 3.1±9.5 mm Hg (−7.4 to 1.2 mm Hg) lower in controls, yielding a net treatment effect of 8.1±10.1 mm Hg (−14.2 to −1.9 mm Hg) ( P =0.012). There were no Moderato device– or CNT‐related adverse events. Conclusions CNT significantly reduced 24‐hour aSBP in patients with hypertension with a clinical indication for a pacemaker. The majority of patients had isolated systolic hypertension, a particularly difficult group of patients to treat. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02837445.

Metabolický syndrom je definovan přitomnosti několika faktorů, ktere maji spolecný patofyziologický zaklad. Přitomnost metabolickeho syndromu je spojena s vysokým rizikem fatalnich kardiovaskularnich a cerebrovaskularnich přihod. Prevalence metabolickeho syndromu je vysoka. Lecba metabolickeho syndromu je vždy komplexni. Lecba arterialni hypertenze jako soucast metabolickeho syndromu ma sva specifika. Jsou preferovany metabolicky neutralni a metabolicky pozitivni leky, zejmena ze skupiny inhibitorů renin- angiotenzinoveho systemu. Výhodna je kombinace se statiny pro jejich potencial snižit riziko kardiovaskularnich přihod. Moderni lecba hypertenze a metabolickeho syndromu využiva možnosti fixnich lekových kombinaci, ktere zvysuji adherenci pacientů k terapii.

Graphical abstract The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15–45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure. Supplementary Information The online version contains supplementary material available at 10.1007/s12265-021-10133-9.

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 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 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 Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p 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 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

Background: Morbidity and mortality outcomes for patients admitted for acute decompensated heart failure are poor and have not significantly changed in decades. Current therapies are focused on symptom relief by addressing signs and symptoms of congestion. The objective of this study was to test a novel neuromodulation therapy of stimulation of epicardial cardiac nerves passing along the posterior surface of the right pulmonary artery. Methods: Fifteen subjects admitted for defibrillator implantation and ejection fraction ≤35% on standard heart failure medications were enrolled. Through femoral arterial access, high fidelity pressure catheters were placed in the left ventricle and aortic root. After electro anatomic rendering of the pulmonary artery and branches, either a circular or basket electrophysiology catheter was placed in the right pulmonary artery to allow electrical intravascular stimulation at 20 Hz, 4 ms pulse width, and ≤20 mA. Changes in maximum positive dP/dt (dP/dt Max ) indicated changes in ventricular contractility. Results: Of 15 enrolled subjects, 5 were not studied due to equipment failure or abnormal pulmonary arterial anatomy. In the remaining subjects, dP/dt Max increased significantly by 22.6%. There was also a significant increase in maximum negative dP/dt (dP/dt Min ), mean arterial pressure, systolic pressure, diastolic pressure, and left ventricular systolic pressure. There was no significant change in heart rate or left ventricular diastolic pressure. Conclusions: In this first-in-human study, we demonstrated that in humans with stable heart failure, left ventricular contractility could be accentuated without an increase in heart rate or left ventricular filling pressures. This benign increase in contractility may benefit patients admitted for acute decompensated heart failure.

Objective This study aimed to determine the importance of biomarkers of chronic heart failure (CHF) for assessing disease severity in euvolemic stable patients. Patients and methods N-terminal pro-B-type natriuretic peptide (NT-proBNP), growth differentiation factor (GDF)-15, galectin-3, cystatin-C, soluble suppression of tumorigenicity 2 (sST2), tissue type inhibitor of matrix metalloproteinase (TIMP)-1, and ceruloplasmin levels were measured in euvolemic patients with stable CHF. Severity of CHF was defined by echocardiographic and biochemical parameters. Results In 160 patients (123 men and 37 women, mean age: 65.8±12.2 years), we found strong associations between NT-proBNP and bilirubin levels ( r = 0.434) and the estimated glomerular filtration rate ( r = −0.321). GDF-15 and cystatin-C levels were significantly correlated with parameters of kidney function. In multivariable regression analysis, NT-proBNP levels were associated with the left ventricular ejection fraction and left ventricular end-systolic volume (coefficient of determination R2 = 0.777). Additionally, GDF-15 levels were correlated with urea levels (R2 = 0.742), and cystatin C levels were correlated with urea and bilirubin levels (R2 = 0.732). Conclusion Besides NT-proBNP, GDF-15 and cystatin C are promising biomarkers for establishing the severity of disease in euvolemic patients with stable CHF.

His bundle pacing is a relatively new method of cardiac pacing. This method is used in patients with atrioventricular block to prevent heart failure associated with right ventricular pacing, and in patients with bundle branch block and cardiomyopathy. We report a patient with cardiomyopathy and left bundle branch block with failure of cardiac resynchronization therapy. Permanent His bundle pacing was associated with clinical improvement and improvement of parameters of cardiac function.

Aims: Impaired left ventricular diastolic function leading to elevated left atrial pressures, particularly during exertion, is a key driver of symptoms and outcomes in heart failure with preserved ejection fraction (HFpEF). Insertion of an interatrial shunt device (IASD) to reduce left atrial pressure in HFpEF has been shown to be associated with short‐term haemodynamic and symptomatic benefit. We aimed to investigate the potential effects of IASD placement on HFpEF survival and heart failure hospitalization (HFH). Methods and results: Heart failure with preserved ejection fraction patients participating in the Reduce Elevated Left Atrial Pressure in Patients with Heart Failure study (Corvia Medical) of an IASD were followed for a median duration of 739 days. The theoretical impact of IASD implantation on HFpEF mortality was investigated by comparing the observed survival of the study cohort with the survival predicted from baseline data using the Meta‐analysis Global Group in Chronic Heart Failure heart failure risk survival score. Baseline and post‐IASD implant parameters associated with HFH were also investigated. Based upon the individual baseline demographic and cardiovascular profile of the study cohort, the Meta‐analysis Global Group in Chronic Heart Failure score‐predicted mortality was 10.2/100 pt years. The observed mortality rate of the IASD‐treated cohort was 3.4/100 pt years, representing a 33% lower rate (P = 0.02). By Kaplan–Meier analysis, the observed survival in IASD patients was greater than predicted (P = 0.014). Baseline parameters were not predictive of future HFH events; however, poorer exercise tolerance and a higher workload‐corrected exercise pulmonary capillary wedge pressure at the 6 months post‐IASD study were associated with HFH. Conclusions: The current study suggests IASD implantation may be associated with a reduction in mortality in HFpEF. Large‐scale ongoing randomized studies are required to confirm the potential benefit of this therapy.

Autoři upozorňuji na význam podavani vyssi davky antagonisty mineralokortikoidnich receptorů pro sniženi frekvence hospitalizaci 67leteho pacienta s pokrocilým chronickým srdecnim selhanim.

Left bundle branch block increases the risk of death in patients with chronic heart failure. We herein report four clinical cases of patients with chronic heart failure caused by nonischemic cardiomyopathy with left bundle branch block that occurred when adding ivabradine to optimal medical therapy, resulting in reverse electrical and mechanical remodeling. This phenomenon might be explained by the effect of ivabradine on reverse remodeling of the left ventricle with improvement of intraventricular conduction.

Background The identification of high-risk heart failure (HF) patients makes it possible to intensify their treatment. Our aim was to determine the prognostic value of a newly developed, high-sensitivity troponin I assay (Atellica®, Siemens Healthcare Diagnostics) for patients with HF with reduced ejection fraction (HFrEF; LVEF < 40%) and HF with mid-range EF (HFmrEF) (LVEF 40%–49%). Methods and results A total of 520 patients with HFrEF and HFmrEF were enrolled in this study. Two-year all-cause mortality, heart transplantation, and/or left ventricular assist device implantation were defined as the primary endpoints (EP). A logistic regression analysis was used for the identification of predictors and development of multivariable models. The EP occurred in 14% of the patients, and these patients had higher NT-proBNP (1,950 vs. 518 ng/l; p < 0.001) and hs-cTnI (34 vs. 17 ng/l, p < 0.001) levels. C-statistics demonstrated that the optimal cut-off value for the hs-cTnI level was 17 ng/l (AUC 0.658, p < 0.001). Described by the AUC, the discriminatory power of the multivariable model (NYHA > II, NT-proBNP, hs-cTnI and urea) was 0.823 (p < 0.001). Including heart failure hospitalization as the component of the combined secondary endpoint leads to a diminished predictive power of increased hs-cTnI. Conclusion hs-cTnI levels ≥ 17 ng/l represent an independent increased risk of an adverse prognosis for patients with HFrEF and HFmrEF. Determining a patient’s hs-cTnI level adds prognostic value to NT-proBNP and clinical parameters.

Background Spinal cord stimulation (SCS) reduces sympathetic activity in animal models of heart failure with reduced ejection fraction (HF) but limited data exist of SCS in patients with HF. The aim of the present study was to test the primary hypothesis that SCS reduces cardiac sympathetic nerve activity in HF patients. Secondary hypotheses were that SCS improves left ventricular function and dimension, exercise capacity, and clinical variables relevant to HF. Methods HF patients with a SCS device previously participating in the DEFEAT-HF trial were included in this crossover study with 6-week intervention periods (SCS-ON and SCS-OFF). SCS (50 Hz, 210-μs pulse duration, aiming at T2–T4 segments) was delivered for 12 hours daily. Indices of myocardial sympathetic neuronal function (heart-to-mediastinum ratio, HMR) and activity (washout rate, WR) were assessed using 123I-metaiodobenzylguanidine (MIBG) scintigraphy. Echocardiography, exercise testing, and clinical data collection were also performed. Results We included 13 patients (65.3 ± 8.0 years, nine males) and MIBG scintigraphy data were available in 10. HMR was not different comparing SCS-ON (1.37 ± 0.16) and SCS-OFF (1.41 ± 0.21, P = 0.46). WR was also unchanged comparing SCS-ON (41.5 ± 5.3) and SCS-OFF (39.1 ± 5.8, P = 0.30). Similarly, average New York Heart Association class (2.4 ± 0.5 vs 2.3 ± 0.6, P = 0.34), quality of life score (24 ± 16 vs 24 ± 16, P = 0.94), and left ventricular dimension and function as well as exercise capacity were all unchanged comparing SCS-ON and SCS-OFF. Conclusion In patients with HF, SCS (12 hours daily, targeting the T2–T4 segments of the spinal cord) does not appear to influence cardiac sympathetic neuronal activity or function as assessed by MIBG scintigraphy.

Uvod: ESC Heart Failure Long-Term Registry (ESC-HFLTR) je prospektivni observacni studie, ktere se ucastni 211 kardiologických center z 21 clenských zemi Evropske kardiologicke spolecnosti.Cil: Srovnat farmakologickou a přistrojovou lecbu pacientů hospitalizovaných pro akutni srdecni selhani a pacientů ambulantně sledovaných pro chronicke srdecni selhani v Ceske republice s celoevropskými udaji.Metody: Do ceske casti registru HFLTR bylo v obdobi od května 2011 do dubna 2013 zařazeno celkem 692 konsekutivnich pacientů (5,6 % celeho registru). Tito pacienti byli během jednoho předem stanoveneho dne v týdnu buď hospitalizovani, nebo vysetřeni na ambulanci pro srdecni selhani. Statisticky byla analyzovana farmakologicka a přistrojova lecba 160 hospitalizovaných (25,3 %) a 532 ambulantnich (74,7 %) pacientů. Ziskana data ceských ambulantnich pacientů byla nakonec porovnana s dostupnými udaji z celeho registru HFLTR.Výsledky: Ceským hospitalizovaným pacientům se v ramci lecby akutniho srdecniho selhani nejcastěji podaval i.v. furosemid (89,3 %), meně casto nitraty (21,9 %) a spise ojediněle inotropika (15,0 %). Ve srovnani s lecbou před přijetim uživali pacienti při propustěni castěji diuretika (69,4 vs. 87,5 %; p < 0,001) a antagonisty mineralokortikoidnich receptorů (MRA) (32,4 vs. 55,0 %; p < 0,001). Větsina ceských pacientů s chronickým srdecnim selhanim byla lecena podle soucasných evropských doporucených postupů. Vsechny prognosticky významne leky podavane při srdecnim selhani byly u ceske populace předepisovany castěji než v cele populaci HFLTR (inhibitory angiotensin-konvertujiciho enzymu nebo blokatory receptorů AT1 pro angiotensin II u 92,8 vs. 89,2 %; p = 0,018; beta-blokatory u 95,1 vs. 88,9 %; p < 0,001 a MRA u 67,0 vs. 59,3 %; p < 0,001). Doporucených cilových davek uvedených lekových skupin bylo dosaženo přibližně u 20 % ceských i evropských pacientů. Navic byl ceským ambulantnim nemocným se srdecnim selhanim castěji implantovan kardiostimulator (47 vs. 42 %; p = 0,028), zejmena pro indikovanou srdecni resynchronizacni lecbu (56 vs. 30,2 %; p < 0,001).Zavěr: Farmakoterapie ceských ambulantnich pacientů se srdecnim selhanim je v souladu se soucasnými evropskými doporucenými postupy pro lecbu srdecniho selhani, a jejich dodržovani v ramci Ceske republiky je dokonce významně lepsi než v celem HFLTR. Přesto bylo doporucených cilových davek dosaženo pouze u mensiny nemocných.

Background The guidelines recommend to determine natriuretic peptides, clinical status (NYHA classification) and comorbidities in order to predict the prognosis in patients with heart failure. The aim ofthis registry was to develop a prognostic score in chronic heart failure patients, using clinical status, comorbidities and natriuretic peptides. Methods Consecutive 1088 patients with stable chronic heart failure with reduced ejection fraction (HFrEF) (LVEF Results The occurrence of MACE was 14.9% and increased with higher NYHA, 4.9% (NYHA I), 11.4% (NYHA II) and 27.8% (NYHA III-IV) (p1000pg/ml respectively. Discrimination abilities of NYHA and NT-proBNP were (AUC 0.670; p40 mg furosemide daily) (AUC 0.773; p Conclusion Natriuretic peptides, clinical status and comorbiditis predict two year prognosis and they can help to a better identification of a high-risk groups of patients with heart failure with reduced and mid range ejection fraction in which more intense treatment should be considered, mainly LVAD implantation or listing to heart transplantation waiting list. Acknowledgement/Funding None

Background Beta-blockers (BB) decrease morbidity and mortality in heart failure patients and are part of the first line treatment together with inhibitors of angiotensin converting enzyme. New metaanalysis from year 2014 of main BB studies in chronic heart failure showed no benefit of BB in patients with atrial fibrillation (AF). Methods 1088 at least one month stable chronic heart failure patients with ejection fraction Results 80% patients were male with median age 66 years. Aetiology of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving beta-blockers 20% received low dose similar to the starting dose, 57% medium dose and 17% high dose which was set as the target BB dose. Nearly 93.8% of patients received BB. But only 17.0% received the high dose of BB. 6.2% of patients were not treated by BB at all. One third of patients (34.5%) had atrial fibrillation in medical history or newly recorded on electrocardiogram. Patients with AF were much older (median 63 vs. 70 years, respectively; p The primary endpoint was set as all cause death, mechanical circulatory support implantation, orthotopic heart transplantation or hospitalization for acute heart failure. Patients with AF survived without primary endpoint in 70.6%, patients without AF in 78.8% (p=0.005) even after age standardization. There was significantly different survival according to dose of beta-blocker, the higher was dose of BB, the higher was survival. Patients with no beta-blocker survived without primary endpoint in 63.9%, with low dose survived in 72.6%, medium dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients into two groups according to atrial fibrillation. Patients without AF had the better survival without primary endpoint. The higher dose of beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%, 85.1%; p=0.007). Also patients with AF had better survival without primary endpoint, the higher dose of beta-blocker they got, the higher was their survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007). Conclusion In FAR NHL registry of stable chronic heart failure patietnts was one third of patients with atrial fibrillation. Nearly 94% of patients received beta-blocker. But only 17% received the target dose. Pacients even with or without atrial fibrillation had the significantly better survival without primary endpoint the higher was the dose of beta-blocker.