Pub Date : 2023-09-29DOI: 10.20996/1819-6446-2023-2927
K. G. Pereverzeva, N. V. Dubova, S. A. Biryukov, G. V. Nozhov, S. S. Yakushi
Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.
{"title":"Wellens’ syndrome in clinical practice","authors":"K. G. Pereverzeva, N. V. Dubova, S. A. Biryukov, G. V. Nozhov, S. S. Yakushi","doi":"10.20996/1819-6446-2023-2927","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2927","url":null,"abstract":"Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135295748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.20996/1819-6446-2023-2921
Zh. D. Kobalava, R. Sh. Aslanova, A. F. Safarova, M. V. Vatsik-Gorodetskaya
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.
{"title":"Bedside ultrasound assessment of venous congestion by VExUS protocol in heart failure: clinical associations and prognostic value","authors":"Zh. D. Kobalava, R. Sh. Aslanova, A. F. Safarova, M. V. Vatsik-Gorodetskaya","doi":"10.20996/1819-6446-2023-2921","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2921","url":null,"abstract":"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.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135295746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.20996/1819-6446-2023-2923
S. Yu. Martsevich S.Yu., A. R. Navasardyan, K. V. Lobastov, M. V. Mikaelyan, E. V. Mikhaylenko, A. Yu. Suvorov, I. V. Schastlivtsev, O. N. Dzhioeva, V. V. Matveev, E. S. Akimova, V. V. Sytkov, E. Dubar, O. M. Drapkina
Nowadays, the pyramid of evidence is the main model of decision-making for healthcare professionals. According to this concept, data from randomized clinical trials (RCTs) are considered lower in hierarchy than data obtained from systematic reviews (SRs) and meta-analyses (MAs). However, it заменить на:is not established whether it is appropriate to rate large RCTs with hard endpoints lower than SRs and MAs that combine data from smaller RCTs of questionable quality, or even from prospective or retrospective observational studies. It is also important to consider that in addition to assessing the quality of the studies included in the SRs and MAs, it is necessary to assess the accuracy of the SRs and MAs themselves. If not rigorously conducted, they can also contain systematic errors, leading to increased risks of data manipulation. The publication covers the main stages and principles of preparing SRs and MAs, common types of systematic errors that can arise at each stage, and methods to minimize them. We believe that the tools, knowledge, and skills we offer will help practicing doctors and healthcare professionals critically assess the results obtained from SRs and MAs in terms of methodology and the mitigation of potential data manipulation risks.
{"title":"Systematic review and meta-analysis: a critical examination of the methodology","authors":"S. Yu. Martsevich S.Yu., A. R. Navasardyan, K. V. Lobastov, M. V. Mikaelyan, E. V. Mikhaylenko, A. Yu. Suvorov, I. V. Schastlivtsev, O. N. Dzhioeva, V. V. Matveev, E. S. Akimova, V. V. Sytkov, E. Dubar, O. M. Drapkina","doi":"10.20996/1819-6446-2023-2923","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2923","url":null,"abstract":"Nowadays, the pyramid of evidence is the main model of decision-making for healthcare professionals. According to this concept, data from randomized clinical trials (RCTs) are considered lower in hierarchy than data obtained from systematic reviews (SRs) and meta-analyses (MAs). However, it заменить на:is not established whether it is appropriate to rate large RCTs with hard endpoints lower than SRs and MAs that combine data from smaller RCTs of questionable quality, or even from prospective or retrospective observational studies. It is also important to consider that in addition to assessing the quality of the studies included in the SRs and MAs, it is necessary to assess the accuracy of the SRs and MAs themselves. If not rigorously conducted, they can also contain systematic errors, leading to increased risks of data manipulation. The publication covers the main stages and principles of preparing SRs and MAs, common types of systematic errors that can arise at each stage, and methods to minimize them. We believe that the tools, knowledge, and skills we offer will help practicing doctors and healthcare professionals critically assess the results obtained from SRs and MAs in terms of methodology and the mitigation of potential data manipulation risks.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135295752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-29DOI: 10.20996/1819-6446-2023-2938
N. N. Ilov, O. V. Petrova, D. K. Tverdokhlebova, I. R. Karimov, A. A. Nechepurenko, S. A. Boytsov
Aim . To study the role of blood biomarkers in predicting death from cardiovascular events in patients with heart failure with reduced ejection fraction (HFrEF) within one year after cardioverter defibrillator (ICD) implantation. Material and methods. This one-center observation study included 384 HFrEF patients (men, 84%, NYHA class III – 74%, NYHA class IV – 7%), who underwent prospective observation for 1 year after ICD implantation. The study of the original panel of modern biomarkers (blood electrolytes, C-reactive protein, creatinine, soluble growth stimulation expressed gene 2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3), allowing to evaluate HF pathogenesis was conducted. Based on the blood creatinine concentration, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to estimate the glomerular filtration rate (GFR). Results. In a one-year observation, the primary endpoint was recorded in 35 patients (11%). Single-factor logistic regression showed 3 biomarkers with the greatest predictive potential (p<0,01), related to the occurrence of the investigated endpoint. The concentration of potassium and NT-proBNP, the GFR (CKD-EPI) was included in the multi-factor predictive model with diagnostic efficiency of 68% (sensitivity of 60%, specificity 71%). It was shown that the cardiovascular death risk increased by 2,64 (OR=2,64; 95% CI: 1,28-5,46; p=0,007) at GFR <60 ml/min/1,73 m2 and increased by 3,32 (OR=3,32; 95% CI: 1,26-8,73; p=0,012) at NT-proBNP >2000 pg/ml. Conclusion. The study of blood biomarkers is promising and in demand for the prediction of adverse outcomes of HF. According to the data obtained, the factors «GFR <60 ml/min/1,73 m2» and «NT-proBNP >2000 pg/ml» may be relevant for one-year mortality prediction.
{"title":"Biomarkers in predicting mortality from cardiovascular events in patients with heart failure and an implanted cardioverter-defibrillator","authors":"N. N. Ilov, O. V. Petrova, D. K. Tverdokhlebova, I. R. Karimov, A. A. Nechepurenko, S. A. Boytsov","doi":"10.20996/1819-6446-2023-2938","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2938","url":null,"abstract":"Aim . To study the role of blood biomarkers in predicting death from cardiovascular events in patients with heart failure with reduced ejection fraction (HFrEF) within one year after cardioverter defibrillator (ICD) implantation. Material and methods. This one-center observation study included 384 HFrEF patients (men, 84%, NYHA class III – 74%, NYHA class IV – 7%), who underwent prospective observation for 1 year after ICD implantation. The study of the original panel of modern biomarkers (blood electrolytes, C-reactive protein, creatinine, soluble growth stimulation expressed gene 2 (sST2), N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3), allowing to evaluate HF pathogenesis was conducted. Based on the blood creatinine concentration, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula was used to estimate the glomerular filtration rate (GFR). Results. In a one-year observation, the primary endpoint was recorded in 35 patients (11%). Single-factor logistic regression showed 3 biomarkers with the greatest predictive potential (p<0,01), related to the occurrence of the investigated endpoint. The concentration of potassium and NT-proBNP, the GFR (CKD-EPI) was included in the multi-factor predictive model with diagnostic efficiency of 68% (sensitivity of 60%, specificity 71%). It was shown that the cardiovascular death risk increased by 2,64 (OR=2,64; 95% CI: 1,28-5,46; p=0,007) at GFR <60 ml/min/1,73 m2 and increased by 3,32 (OR=3,32; 95% CI: 1,26-8,73; p=0,012) at NT-proBNP >2000 pg/ml. Conclusion. The study of blood biomarkers is promising and in demand for the prediction of adverse outcomes of HF. According to the data obtained, the factors «GFR <60 ml/min/1,73 m2» and «NT-proBNP >2000 pg/ml» may be relevant for one-year mortality prediction.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135295750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.20996/1819-6446-2023-2929
V. A. Mareyeva, A. A. Klimenko, N. A. Shostak
Pulmonary hypertension is a serious cardiovascular pathology, often complicating the course of heart failure (HF). Excessive pulmonary artery pressure increases right ventricular afterload and progressively leads to dysfunction, which is associated with adverse outcomes regardless of left ventricular ejection fraction. In this regard, more attention should be paid to determining the right ventricular condition. Currently, in order to assess the right heart function in patients with pulmonary hypertension and HF, the right ventricular (RV)-pulmonary arterial (PA) coupling, is increasingly being used. The conventional formula to calculate this parameter is the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). This index has proven to be a powerful predictor of adverse outcomes. But this calculation method has a number of limitations and can lead to errors. It is extremely important to exclude or minimize any possible inaccuracies during prognostic assessment, which is why new researches of alternative RV-PA calculation options have been recently published. Such things as problems that can occur during TAPSE and PASP evaluation, ways of modifying the assessment of right heart’s functioning in patients with pulmonary hypertension and heart failure have been addressed. The value of new RV-PA alternative «surrogate» indexes has been discussed.
{"title":"Pulmonary hypertension and heart failure: alternative indexes of right ventricular-pulmonary artery coupling","authors":"V. A. Mareyeva, A. A. Klimenko, N. A. Shostak","doi":"10.20996/1819-6446-2023-2929","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2929","url":null,"abstract":"Pulmonary hypertension is a serious cardiovascular pathology, often complicating the course of heart failure (HF). Excessive pulmonary artery pressure increases right ventricular afterload and progressively leads to dysfunction, which is associated with adverse outcomes regardless of left ventricular ejection fraction. In this regard, more attention should be paid to determining the right ventricular condition. Currently, in order to assess the right heart function in patients with pulmonary hypertension and HF, the right ventricular (RV)-pulmonary arterial (PA) coupling, is increasingly being used. The conventional formula to calculate this parameter is the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). This index has proven to be a powerful predictor of adverse outcomes. But this calculation method has a number of limitations and can lead to errors. It is extremely important to exclude or minimize any possible inaccuracies during prognostic assessment, which is why new researches of alternative RV-PA calculation options have been recently published. Such things as problems that can occur during TAPSE and PASP evaluation, ways of modifying the assessment of right heart’s functioning in patients with pulmonary hypertension and heart failure have been addressed. The value of new RV-PA alternative «surrogate» indexes has been discussed.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135866854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-13DOI: 10.20996/1819-6446-2023-2930
R. N. Shepel, M. I. Kolesnokova, V. P. Lusnikov, A. V. Kontsevaya, O. M. Drapkina
Aim. To analyze the indicators of hospitalization and outpatient visits of patients aged 18 years and older with hypertension (HЕТ) in federal districts (FD) and subjects of the Russian Federation from the perspective of the World Health Organization concept of ambulatory care sensitive conditions. Material and methods. The analysis included data from the annual forms of federal statistics (forms № 12 and № 14), on the number of hospitalizations and the outpatient visits of patients aged 18 years and older diagnosed of HTN (ICD10: I10-I12) in 2022. Results. We analyzed the data of the federal statistics (forms № 12 and № 14) of the FDs and subjects of the Russian Federation in 2022. It was found that the Siberian FD has one of the highest rates of adult outpatient visits with HЕТ aged 18 years and older, where, at the same time, one of the lowest rates of hospitalizations is recorded. In FDs with adult outpatient visits higher than the Russian average, there were higher adult hospitalization than the Russian average (Ural, Central and Volga FDs). In FDs with adult outpatient visits lower than the Russian average, there were higher adult hospitalization than the Russian average (South, North Caucasus and Far East FDs). In the Northwestern FD, adult outpatient visits and adult hospitalization were lower than the Russian average. When analyzing the HTN ratio among the adult population aged 18 years and older, the highest indicator was recorded in the North Caucasus FD, while the heterogeneity of the indicator within the FD was one of the highest among the other FDs. The lowest HTN ratio indicator among the adult population aged 18 years and older was recorded in the Ural FD, while the heterogeneity of the indicator within the FD was the lowest among the other FDs. There was a high variability of the ratio both for all subjects of the Russian Federation and FDs. The ratio values ranged from 1,2 in the Nizhny Novgorod region to 12,26 in the Republic of Dagestan. Conclusion. Accounting for diseases that can be treated on an outpatient basis can help to assess the quality of care to the adult population in primary health care facilities. However, before including this indicator as a quality criterion, a deeper understanding of the reasons influencing its change is required.
{"title":"Regional features of hospitalizations and outpatient medical care among adults with established hypertension","authors":"R. N. Shepel, M. I. Kolesnokova, V. P. Lusnikov, A. V. Kontsevaya, O. M. Drapkina","doi":"10.20996/1819-6446-2023-2930","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2930","url":null,"abstract":"Aim. To analyze the indicators of hospitalization and outpatient visits of patients aged 18 years and older with hypertension (HЕТ) in federal districts (FD) and subjects of the Russian Federation from the perspective of the World Health Organization concept of ambulatory care sensitive conditions. Material and methods. The analysis included data from the annual forms of federal statistics (forms № 12 and № 14), on the number of hospitalizations and the outpatient visits of patients aged 18 years and older diagnosed of HTN (ICD10: I10-I12) in 2022. Results. We analyzed the data of the federal statistics (forms № 12 and № 14) of the FDs and subjects of the Russian Federation in 2022. It was found that the Siberian FD has one of the highest rates of adult outpatient visits with HЕТ aged 18 years and older, where, at the same time, one of the lowest rates of hospitalizations is recorded. In FDs with adult outpatient visits higher than the Russian average, there were higher adult hospitalization than the Russian average (Ural, Central and Volga FDs). In FDs with adult outpatient visits lower than the Russian average, there were higher adult hospitalization than the Russian average (South, North Caucasus and Far East FDs). In the Northwestern FD, adult outpatient visits and adult hospitalization were lower than the Russian average. When analyzing the HTN ratio among the adult population aged 18 years and older, the highest indicator was recorded in the North Caucasus FD, while the heterogeneity of the indicator within the FD was one of the highest among the other FDs. The lowest HTN ratio indicator among the adult population aged 18 years and older was recorded in the Ural FD, while the heterogeneity of the indicator within the FD was the lowest among the other FDs. There was a high variability of the ratio both for all subjects of the Russian Federation and FDs. The ratio values ranged from 1,2 in the Nizhny Novgorod region to 12,26 in the Republic of Dagestan. Conclusion. Accounting for diseases that can be treated on an outpatient basis can help to assess the quality of care to the adult population in primary health care facilities. However, before including this indicator as a quality criterion, a deeper understanding of the reasons influencing its change is required.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135787493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-07DOI: 10.20996/1819-6446-2023-2961
K. G. Pereverzeva
.
．
{"title":"For the anniversary of Sergey S.Yakushin","authors":"K. G. Pereverzeva","doi":"10.20996/1819-6446-2023-2961","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2961","url":null,"abstract":".","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135098845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-07DOI: 10.20996/1819-6446-2023-2896
V. E. Oleynikov, E. V. Averyanova, A. A. Tonkoglaz, M. V. Lukyanova
Aim . To determine the predictors of recurrent cardiovascular events in patients after ST-segment elevation myocardial infarction (STEMI) and hemodynamicallysignificant stenosis only in the infarct-related coronary artery. Material and methods . The present study involved 151 patients with STEMI. The mean age of patients was 51 (95% confidence interval (CI), 41–61 years) years. One of the inclusion criteria of patients was significant stenosis exclusively in the infarct-related artery. All patients underwent a 24-hour Holter electrocardiography (ECG) monitoring with the analysis of heart rate turbulence (HRT), heart rate variability (HRV), ventricular late potentials and chronotropic load; two-dimensional (2D) echocardiography with the analysis of volumetric parameters and left ventricular ejection fraction; determination of brain natriuretic peptide (BNP). The follow-up duration was 144 weeks. Repeated cardiovascular events (acute heart failure, revascularization, repeated myocardial infarction, cardiovascular death) were analyzed as endpoints. Two groups of patients were identified depending on the recurrent event endpoints: “RE” group — 26 patients (17.2%) with registered recurrent cardiac events, and “ST” group — 125 patients (82.8%) without cardiovascular events in stable post-infarction period. Results . Initial BNP values were lower in the “ST” group (p48=0.0035, p96=0.004, p144=0.001). The intergroup differences demonstrate a higher concentration of BNP levels in the “RE” group both initially (p=0,001) and at the 96th week (p=0,04). Left ventricular ejection fraction was higher in the “ST” group (p=0,001) both initially and at the 144th week in contrast to the “RE” group: 48,9% (44,7-53,2) vs 44,2% (38,5-49,9) (p=0,009). Pathological HRT was also significantly higher in the “RE” group both initially (p=0,003) and by the 96th week of the follow-up (p=0,007), while HRV demonstrated low initial values with a slow tendency to restoration. There were following risk factors for recurrent cardiovascular events in patients in the post-infarction period: weight — relative risk (RR), 1.21 (95% CI, 1,01-1,46) (p=0,03); body mass index — RR, 0,56 (95% CI, 0,325-0,96) (p=0,046); chronotropic load — RR, 1,03 (95% CI, 1,02-1,12) (p=0,04); BNP — RR, 1,012 (95% CI, 1,003-1,08) (p=0,01); left ventricular end-systolic dimension (ESD) — RR, 1,04 (95% CI, 1,01-1,13) (p=0,36). Conclusion . There were following independent predictors of recurrent cardiovascular events in patients after STEMI: weight, body mass index, chronotropic load, BNP and ESD.
{"title":"Predictors of recurrent cardiovascular events in patients with a single-vessel coronary artery disease after ST-segment elevation myocardial infarction","authors":"V. E. Oleynikov, E. V. Averyanova, A. A. Tonkoglaz, M. V. Lukyanova","doi":"10.20996/1819-6446-2023-2896","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2896","url":null,"abstract":"Aim . To determine the predictors of recurrent cardiovascular events in patients after ST-segment elevation myocardial infarction (STEMI) and hemodynamicallysignificant stenosis only in the infarct-related coronary artery. Material and methods . The present study involved 151 patients with STEMI. The mean age of patients was 51 (95% confidence interval (CI), 41–61 years) years. One of the inclusion criteria of patients was significant stenosis exclusively in the infarct-related artery. All patients underwent a 24-hour Holter electrocardiography (ECG) monitoring with the analysis of heart rate turbulence (HRT), heart rate variability (HRV), ventricular late potentials and chronotropic load; two-dimensional (2D) echocardiography with the analysis of volumetric parameters and left ventricular ejection fraction; determination of brain natriuretic peptide (BNP). The follow-up duration was 144 weeks. Repeated cardiovascular events (acute heart failure, revascularization, repeated myocardial infarction, cardiovascular death) were analyzed as endpoints. Two groups of patients were identified depending on the recurrent event endpoints: “RE” group — 26 patients (17.2%) with registered recurrent cardiac events, and “ST” group — 125 patients (82.8%) without cardiovascular events in stable post-infarction period. Results . Initial BNP values were lower in the “ST” group (p48=0.0035, p96=0.004, p144=0.001). The intergroup differences demonstrate a higher concentration of BNP levels in the “RE” group both initially (p=0,001) and at the 96th week (p=0,04). Left ventricular ejection fraction was higher in the “ST” group (p=0,001) both initially and at the 144th week in contrast to the “RE” group: 48,9% (44,7-53,2) vs 44,2% (38,5-49,9) (p=0,009). Pathological HRT was also significantly higher in the “RE” group both initially (p=0,003) and by the 96th week of the follow-up (p=0,007), while HRV demonstrated low initial values with a slow tendency to restoration. There were following risk factors for recurrent cardiovascular events in patients in the post-infarction period: weight — relative risk (RR), 1.21 (95% CI, 1,01-1,46) (p=0,03); body mass index — RR, 0,56 (95% CI, 0,325-0,96) (p=0,046); chronotropic load — RR, 1,03 (95% CI, 1,02-1,12) (p=0,04); BNP — RR, 1,012 (95% CI, 1,003-1,08) (p=0,01); left ventricular end-systolic dimension (ESD) — RR, 1,04 (95% CI, 1,01-1,13) (p=0,36). Conclusion . There were following independent predictors of recurrent cardiovascular events in patients after STEMI: weight, body mass index, chronotropic load, BNP and ESD.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135098846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-29DOI: 10.20996/1819-6446-2023-2934
D. V. Pevzner, N. S. Kostritca, I. A. Merkulova, O. B. Dorogun, A. L. Komarov, I. S. Yavelov
{"title":"Clinical features of heart failure in patients with atrial fibrillation: the role of the endovascular left atrial appendage closure","authors":"D. V. Pevzner, N. S. Kostritca, I. A. Merkulova, O. B. Dorogun, A. L. Komarov, I. S. Yavelov","doi":"10.20996/1819-6446-2023-2934","DOIUrl":"https://doi.org/10.20996/1819-6446-2023-2934","url":null,"abstract":"","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136348810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-08-17DOI: 10.20996/10.20996/1819-6446-2023-2919
V. I. Podzolkov, N. A. Dragomiretskaya, A. V. Tolmacheva, I. I. Shvedov, A. A. Ivannikov, I. V. Akyol
Aim . To study the prognostic significance of cardiobiomarkers - NT-proBNP and soluble suppression of tumorigenecity (sST2) in patients with CHF with preserved (CHFpEF) and mildly reduced EF (CHFmrEF). Material and methods . Along with a clinical examination, 207 patients (111 men and 96 women), mean age - 72.6 ± 11.4 years, underwent tests for the level of NT-proBNP and sST2 in serum. All patients were divided into 3 groups: 1 - CHFpEF (n=85), 2 - CHFmrEF (n=50); 3 (comparison group)- CHFrEF (n=72). All patients signed informed consent to participate in the study. The primary endpoint was all-cause death in 12 months. Statistical processing of the results was carried out using the Statistica 12.0 and Medcalc programs. Results . The initial values of NT-proBNP in patients with CHFmrEF were 691.9 [248; 1915.5] pg/ml and were significantly higher than those of CHFpEF - 445.8 [214.6; 945.7] pg/ml, but significantly lower than in CHFrEF - 1131.4 [411.5;3039.5] pg/ml, p<0.05. sST2 values in group 1 (23.21 [12.17;48.7] ng/ml and group 2 (27.11 [16.98;53.76] ng/ml) did not differ, but were significantly lower than in patients with CHFrEF (44.6 [21.1; 93.5] ng/ml). After a median of 12 months 51 patients reached the primary endpoint. All-causes mortality in patients with HFpEF was 11.8%, HFmrEF - 31.9% (p <0.05), and HFrEF – 36%. A retrospective analysis of the data showed that in patients independent of their initial ejection fraction, who survived for 12 months, the levels of NT-proBNP and sST2 were significantly lower than those of the deceased. In survivors and deceased patients with CHFpEF the values of NT-proBNP and sST2 were 443 [154;862,8] vs 1143,2 [223,9;2021,9] pg/ml (p=0.009) and 22,8 [12,3;33,8] vs 26,8 [9,6;74,8] ng/mL (p<0.05). In survivors and deceased patients with CHFmrEF the values of NT-proBNP and sST2 were 397.4 [128.9;1088.5] vs 1939.7 [441.9;2536] pg/ml (p=0.009) and 18.6 [14.9;30.27.1] vs 59.9 [53.76;84.4] ng/mL (p=0.002). There were no significant differences in NT-proBNP and sST2 values in patients with cardiac and non-cardiac causes of death. sST2 parameters in deceased patients with CHFpEF (26.8 [9.6;74.8] ng/mL) and CHFmrEF (59.9 [53.76;84.4] ng/mL) also had no significant differences (p >0.05). At ROC analysis to one-year adverse events, both NT-proBNP and sST2 showed a significant predictive value in patients with EF >40% with an optimal cut-off value of 746 pg/ml (AUC 0.709; p = 0.005, sensitivity 62%, specificity 69%) and 27.1 ng/ml (AUC 0.742; p = 0.03, sensitivity 80%, specificity 75.8%) respectively. Conclusion : NT-proBNP levels >746 pg/ml and sST2 >27.1 ng/ml should be considered as predictors of poor prognosis in CHF patients with LVEF >40%.
{"title":"Prognostic significance of NT-proBNP and sST2 in patients with heart failure with preserved and mildly reduced ejection fraction","authors":"V. I. Podzolkov, N. A. Dragomiretskaya, A. V. Tolmacheva, I. I. Shvedov, A. A. Ivannikov, I. V. Akyol","doi":"10.20996/10.20996/1819-6446-2023-2919","DOIUrl":"https://doi.org/10.20996/10.20996/1819-6446-2023-2919","url":null,"abstract":"Aim . To study the prognostic significance of cardiobiomarkers - NT-proBNP and soluble suppression of tumorigenecity (sST2) in patients with CHF with preserved (CHFpEF) and mildly reduced EF (CHFmrEF). Material and methods . Along with a clinical examination, 207 patients (111 men and 96 women), mean age - 72.6 ± 11.4 years, underwent tests for the level of NT-proBNP and sST2 in serum. All patients were divided into 3 groups: 1 - CHFpEF (n=85), 2 - CHFmrEF (n=50); 3 (comparison group)- CHFrEF (n=72). All patients signed informed consent to participate in the study. The primary endpoint was all-cause death in 12 months. Statistical processing of the results was carried out using the Statistica 12.0 and Medcalc programs. Results . The initial values of NT-proBNP in patients with CHFmrEF were 691.9 [248; 1915.5] pg/ml and were significantly higher than those of CHFpEF - 445.8 [214.6; 945.7] pg/ml, but significantly lower than in CHFrEF - 1131.4 [411.5;3039.5] pg/ml, p<0.05. sST2 values in group 1 (23.21 [12.17;48.7] ng/ml and group 2 (27.11 [16.98;53.76] ng/ml) did not differ, but were significantly lower than in patients with CHFrEF (44.6 [21.1; 93.5] ng/ml). After a median of 12 months 51 patients reached the primary endpoint. All-causes mortality in patients with HFpEF was 11.8%, HFmrEF - 31.9% (p <0.05), and HFrEF – 36%. A retrospective analysis of the data showed that in patients independent of their initial ejection fraction, who survived for 12 months, the levels of NT-proBNP and sST2 were significantly lower than those of the deceased. In survivors and deceased patients with CHFpEF the values of NT-proBNP and sST2 were 443 [154;862,8] vs 1143,2 [223,9;2021,9] pg/ml (p=0.009) and 22,8 [12,3;33,8] vs 26,8 [9,6;74,8] ng/mL (p<0.05). In survivors and deceased patients with CHFmrEF the values of NT-proBNP and sST2 were 397.4 [128.9;1088.5] vs 1939.7 [441.9;2536] pg/ml (p=0.009) and 18.6 [14.9;30.27.1] vs 59.9 [53.76;84.4] ng/mL (p=0.002). There were no significant differences in NT-proBNP and sST2 values in patients with cardiac and non-cardiac causes of death. sST2 parameters in deceased patients with CHFpEF (26.8 [9.6;74.8] ng/mL) and CHFmrEF (59.9 [53.76;84.4] ng/mL) also had no significant differences (p >0.05). At ROC analysis to one-year adverse events, both NT-proBNP and sST2 showed a significant predictive value in patients with EF >40% with an optimal cut-off value of 746 pg/ml (AUC 0.709; p = 0.005, sensitivity 62%, specificity 69%) and 27.1 ng/ml (AUC 0.742; p = 0.03, sensitivity 80%, specificity 75.8%) respectively. Conclusion : NT-proBNP levels >746 pg/ml and sST2 >27.1 ng/ml should be considered as predictors of poor prognosis in CHF patients with LVEF >40%.","PeriodicalId":20759,"journal":{"name":"Racionalʹnaâ Farmakoterapiâ v Kardiologii","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136337519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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