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Aim. To determine quantitative criteria for assessing the therapeutic benefits and the most informative time frames after cardiac resynchronization therapy (CRT) to assess its long-term effectiveness (1, 2, 3 years of follow-up) based on retrospective analysis. To assess the CRT effectiveness, parameters of left ventricular (LV) reverse remodeling and signs characterizing the clinical CRT response were considered.Material and methods. This single-center, retrospective, non-randomized study included data from 278 patients with implanted CRT devices. Quantitative criteria for assessing CRT effectiveness were determined using a two-step cluster analysis of patients 1, 2, and 3 years after CRT by LV reverse remodeling parameters.Results. In the dataset with satisfactory division accuracy, after the first year, two clusters were identified, which are conventionally named as “non-responders” and “responders”. Two and three years after therapy, patients were classified into three clusters: “non-responders”, “responders” and “super-responders”. For the obtained clusters, we found cutoff values for LV reverse remodeling parameters, which can be used as criteria for response to therapy.The study identified the most informative time frames for assessing the postoperative CRT effectiveness 1, 2, 3 years after the surgery. At the same time, the clinical response to therapy is manifested earlier in comparison with the reverse LV remodeling.Despite the high divisibility of patients into responders and non-responders, predictive models of CRT effectiveness created using the available data from standard diagnostic protocols for heart failure patients have insufficient accuracy to be used for making decisions on therapy appropriateness. This circumstance indicates the need to receive additional data to improve the forecasting quality.Conclusion. The study revealed a period for assessing the clinical response and changes in LV reverse remodeling after CRT surgery, which is important for the optimal choice of postoperative therapy. It has been shown that in most cases, one year after surgery is sufficient to assess the clinical response, and the process of LV reverse remodeling can last up to two years on average.When assessing the CRT effectiveness by reverse remodeling, along with a change in LV end-systolic volume (ESV), it is necessary to take into account LV end-diastolic volume (EDV) changes. The change in LV ejection fraction showed a significantly lower value among the analyzed parameters in assessing the CRT effectiveness. Based on the cluster classification of patients, a dividing rule was established for responders and non-responders in the first and second years after surgery with an accuracy of 97%: a decrease in LV ESV and EDV by 9% or more compared to preoperative values.

The response rate to therapy for rheumatoid arthritis (RA) rarely exceeds 60%. Mental disorders (MDs) of the anxiety-depressive spectrum (ADS) and cognitive impairment (CI) substantially affect the evaluation of the efficiency of RA therapy. Adequate psychopharmacotherapy is one of the possible approaches to optimizing the treatment of RA. The factors influencing the efficiency of RA therapy with standard disease-modifying antirheumatic drugs (DMARDs) and biological agents (BAs) in combination with adequate psychopharmacotherapy have not been previously identified. Objective: to determine the predictors of response to therapy in patients with RA receiving DMARDs and BAs with or without adequate psychopharmacotherapy for ADS disorders. Subjects and methods. The investigation included 128 patients (13% men and 87% women) with a reliable diagnosis of RA. At baseline, 75.1% of patients received DMARDs; 7.8% – BAs. ADS disorders were detected in 123 (96.1%) patients. Psychopharmacotherapy was offered to all the patients with MDs; 52 patients agreed to treatment and 71 refused. The following therapeutic groups were identified according to the performed therapy: 1) DMARDs (n = 39); 2) DMARDs + psychopharmacotherapy (n = 43); 3) DMARDs + BAs (n = 32); 4) DMARDs + BAs + psychopharmacotherapy (n = 9). The changes of MDs symptoms and the outcomes of RA were assessed in 83 (67.5%) patients at five-year follow-up. The efficiency of RA therapy was evaluated with DAS28 (EULAR criteria). Predictors of response to therapy were determined using linear regression modeling. Results and discussion. At 5 years, 22 (26.5%) and 37 (44.6%) patients were recorded to show good and moderate responses to therapy, respectively; 24 (28.9%) patients were non-respondents. The linear regression model included 14 factors (p

Aim. To evaluate an additional antihypertension efficacy and tolerability of perindopril comparing to sartans in real clinical practice. Material and methods . The study had been designed, that included 208 patients. Main inculsion criteria was arterial hypertension (AH) with insufficient blood pressure (BP) control on treatment by angiotensine receptor blocker (ARB) as monotherapy, with 1 or 2 risk factors by SCORE system and on treatment by a free ARB combination with other drugs classes. In inclusion to program, instead of ARB perindopril (Prestarium A) 10 mg was added or its disperging form 10 mg in the morning. Duration of program lasted for 3 months. The evaluation of BP decrease was done, as the target BP levels reach and treatment response. Results. On treatment with perindopril, in 2 weeks there was statistically significant (p

The identification of informative biomarkers that are able to predict prognosis and treatment response may be particularly important in triple negative breast cancer. The aim of the study was to investigate the relationship between vascular endothelial growth factor receptor VEGFR-2 expression and KDR gene polymorphisms with the efficacy of neoadjuvant chemotherapy (NAC) in patients with triple negative breast cancer. Methods. The study included 70 patients with triple negative operable breast cancer (T1–3N0–3M0), who had received 2–4 cycles of FAC and CAX regimens. The pathologic complete response (pCR) to treatment was determined by RECIST. VEGFR-2 expression level was evaluated using immunohistochemistry. Genotypes for KDR (rs2071559, rs2305948) were detected by a Real-time PCR. Results. The pCR rate was significantly associated with young age at diagnosis (≤50 years) (p=0.0044), a high level of Ki67 expression (≥20) (p=0.0322) and with CAX regimen (p=0.0246). Additionally, all patients with pCR had the lack of VEGFR-2 expression in tumor tissue after surgery (p=0.0000). The presence of the VEGFR-2 expression (negative or positive) in tumor tissue before NAC was associated with KDR rs2071559 (r=−0.297; p=0.0273). A significant correlation between the KDR rs2071559 and VEGFR-2 expression level (less than 70, 70% or more) in the tumor tissue before NAC was found (r=−0.314; p=0.0297). Multivariate logistic regression analysis showed that the young age of the patients (≤50 years), the lack of VEGFR-2 expression after surgery and CAX regimen were significant predictors of NAC. Conclusion . The VEGFR-2 expression level in tumor tissue and KDR gene polymorphism can be considered as new additional molecular predictive markers of pathologic complete response to NAC in triple negative breast cancer patients.

Objective. To reveal short course of glucocorticoid (GC) therapy efficacy predictors in pts with gout arthritis. Material and methods. 59 pts with tophaceous gout (crystal-verified diagnosis) and arthritis of three and more joints lasting more than a months in spite of treatment with sufficient doses of nonsteroidal anti-inflammatory drugs were included. Median age of pts was 56 [48;63], median disease duration - 15,2 years [7,4;20], median swollen joint count at the examination — 8 [5; 11]. The patients were randomized into 2 groups. Methylprednisolone was administered in one of them, betamethasone — in the other. Results, four variants of treatment response were described: full resolution of arthritis — 24 (41%), recurrent exacerbation — 28 (48%), insufficient arthritis resolution — 2 (3%) and clinically insignificant (unresponders) — 5 (8%) pts. Pts in group with arthritis recurrence at the entry were significantly younger than pts with resolved arthritis (52 [47;60] and 59 [52;68] respectively, U-test p=0,02), had more inflamed joints (9 [7,5; 11 ] and 5 [4;9[ respectively, U-test p=0,02), longer duration of last exacerbation (52 [8;52[ and 13 [7,5;52J respectively, U-test p>0,05), higher values of pain, joint index and swelling index (U-test p