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Aim. To evaluate the frequency, dynamics, clinical associations and prognostic value of venous congestion at bedside ultrasound using VExUS protocol in patients with decompensated heart failure (HF).Material and methods. This prospective study included 273 patients over 18 years old with NYHA class II-IV decompensated HF. All patients underwent standard clinical and paraclinical analysis, including NT-proBNP determination, transient elastometry and lung ultrasound. To assess venous congestion by bedside ultrasound using the VExUS protocol, the inferior vena cava (IVC) diameter was estimated and the congestion severity was determined on the deviation of Doppler curves of hepatic, portal and renal veins. If the IVC diameter was ≥2 sm, venous congestion was determined. To assess pulmonary congestion, lung ultrasound (LUS) was performed according to the 8-zone protocol, and the sum of B-lines ≥5 was taken as pulmonary congestion. All patients received standard therapy for heart failure. Statistical analysis was performed in SPSS Statistics program, version 26.0.Results. A high detection rate of venous congestion (75,8%) was revealed in patients with decompensated HF on admission at bedside ultrasound examination according to the VExUS protocol: mild – in 35,5%, moderate – in 12,8%, severe – in 27,5% of patients. The detection rate of venous congestion at discharge was 48,7%: mild – in 28,2%, moderate – in 9,5%, and severe – in 11,0% of cases. Pulmonary congestion on admission was detected in 98,9% of cases. Venous congestion was associated with the severity of HF, NT-proBNP level, renal and cardiac dysfunction, liver stiffness and sum of B-lines. The prognostic role of venous congestion according to the VExUS protocol on re-hospitalization for decompensated HF and the combined endpoint (hospitalization for decompensated HF + allcause death) at 12 months was established.Conclusion. The established incidence, associations, and prognostic value of venous congestion in patients with decompensated HF suggest the utility of bedside ultrasound using the VExUS protocol as an available noninvasive method to optimize therapy and risk stratification.

The article presents a systematic review of publications devoted to the study of genetic markers of severe pneumonia.The aim of the study was to compile a list of genetic markers that contribute to a severe course of pneumonia on the basis of the published data.In the current study, we searched for and analyzed articles published between January 2000 and April 2021. Following the search for and subsequent selection of articles, a list of 10 publications was compiled, which demonstrated a clear association of certain gene variants with severe and complicated pneumonia. Finally, we made a list of genetic markers of severe pneumonia consisting of 16 polymorphisms in 12 genes (CD86, IL6, IL10, PAI1, TNFα, HMGB1, ATG16L1, AGTR1, GCLC, CAT, IFNγ, FCGR2A).These genetic markers of severe and complicated pneumonia are responsible for various innate immune responses. The odds ratio for complicated pneumonia with a risk allele in the polymorphisms in the mentioned genes ranges from 1.39 to 4.28. To understand molecular and genetic mechanisms of severe pneumonia, further investigation of the effect of these genetic factors on the outcomes of pneumonia in different groups of patients with a simultaneous assessment of the cumulative effect of genetic variants and genetic interactions is required.

Aim. To evaluate the impact of acute kidney injury (AKI) on in-hospital (death) and long-term outcomes (rehospitalization or death within 30 days; death within 180 days) in hospitalized patients with coronavirus disease 2019 (COVID-19).Material and methods. The registry of patients with COVID-19 was analyzed to identify risk factors (RFs) for mortality. Discharged patients were included in a prospective study. Outcomes were assessed by telephone contacts.Results. The study included 1000 patients. The mortality rate was 20,8%, while AKI was registered in 29,6% of patients. According to multi­variate analysis, AKI, regardless of other risk factors, increased the risk of death (hazard ratio (HR), 1,62, 95% confidence interval (CI): 1,08-2,44, p=0,02). The prospective part included 691 patients. We revealed that 10% were rehospitalized or died within 30 days, while independent risk factors were age >65 years (HR, 2,72, 95% CI: 1,47-5,01, p=0,001) and AKI in the acute phase of COVID-19 (HR, 1,67, 95% CI: 1,00-2,80, p=0,05). In addition, 6% of patients died within 180 days, while AKI was the risk factor for death according to univariate analysis; the only independent predictor was age >65 years (HR, 5,96, 95% CI: 2,26-15,72, p

Atrial fibrillation and renal dysfunction often coexist, each disorder may predispose to the other and contribute to worsening prognosis. Both atrial fibrillation and chronic kidney disease are associated with increased risk of stroke and thromboembolic complications. Oral anticoagulation for stroke prevention is therefore recommended in patients with atrial fibrillation and decreased renal function. Each direct oral anticoagulant has unique pharmacologic properties of which clinician should be aware to optimally manage patients. The doses of direct oral anticoagulants require adjustment for renal function. There is debate regarding which equation, the Chronic Kidney Disease Epidemiology (CKD-EPI) equation vs. the Cockcroft-Gault equation, should be used to estimate glomerular filtration rate in patients with atrial fibrillation treated with direct oral anticoagulants. Our review tries to find arguments for benefit of direct oral anticoagulants in patients with renal dysfunction.

Aim. To assess the prognostic value of the integral assessment using various modern methods for diagnosing congestion in patients hospitalized with acute decompensated heart failure (ADHF).Material and methods. This single-center prospective study included 165 patients with ADHF. All patients underwent a standard clinical and paraclinical examination, including assessing NT-proBNP levels, lung ultrasound B-lines, liver transient elastography, bioelectrical impedance vector analysis (BIVA) at admission and discharge. To assess clinical congestion, the Heart Failure Association consensus document scale was used. Long-term clinical outcomes were assessed by telephone survey 1, 3, 6, 12 months after discharge. As an end point, the allcause mortality and readmissions were estimated.Results. In patients hospitalized with ADHF, at discharge, differences were found in the incidence of residual congestion according to certain paraclinical methods — from 22 to 38%, subclinical — from 14,5 to 27%. When using the integral assessment of stagnation, the incidence of residual and subclinical congestion was 53,6% and 35%, respectively. Patients with residual congestion had more severe symptoms of congestion, compared with those with subclinical congestion. Patients in whom congestion was detected by 4 methods, in contrast to those by 1, 2, and 3 methods, had worse clinical and paraclinical parameters. There was a significant increase in the risk of all-cause mortality and readmission in the presence of congestion, identified by 3 (hazard ratio, 9,4 (2,2-40,6); p

Congestion associated with pressure and/or volume overload plays a central role in the pathophysiology, manifestations and prognosis of heart failure, being one of the important aims of its therapy. The current methods for congestion diagnosis, mainly clinical, have low sensitivity and specificity, which can lead to a delay in diagnosis and initiation of treatment.Over the past decades, novel, more sensitive and specific ultrasound techniques have been developed to detect increased intracardiac pressure and/or volume overload, providing early and accurate diagnosis and facilitating treatment strategies. The review discusses the role of modern investigations for detecting and quantifying congestion, including visualization of the lungs (B-lines), kidneys (intrarenal venous flow) and the venous system (diameter of the inferior vena cava and internal jugular veins), and transient elastography.