Pub Date : 2023-09-23DOI: 10.15829/1560-4071-2023-5522
M. A. Druzhilov, T. Yu. Kuznetsova
Aim. To conduct a retrospective analysis of the prevalence of main risk factors for thromboembolic events (TEEs) and the prescription rate of anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and a low CHA2DS2-VASc score in certain Russian regions using artificial intelligence technologies. Material and methods . The information was obtained from the Webiomed predictive analytics platform. The sample included 87601 patients with AF aged 18-74 years (men, 49,5%, mean age, 59,3±12,3 years, mean CHA 2 DS 2 -VASc score, 2,3±1,5) who received care in medical organizations in 6 constituent entities of the Russian Federation in the period from 2016 to 2019. CHA 2 DS 2 VASc score of 1 and 2 in a man and a woman, respectively, was regarded as a moderate risk, while score of 0 and 1, respectively, as a low risk of TEEs. Results. There were 22337 (25,5%) patients with AF at moderate risk and 18366 (21,0%) patients at low risk of TEEs. With a moderate risk of TEEs, CHA 2 DS 2 -VASc score of 1 in 70,4% of cases was determined by hypertension, while in 15,7% — by age 65-74 years, in 9,0% — by heart failure, in 2,9% — by myocardial infarction and/or peripheral arterial disease, in 2,0% — by type 2 diabetes. In patients with AF and a moderate risk of TEEs, ACT was prescribed in 4927 (22,1%) patients, while with a low risk of TEEs — in 1833 (10,0%). Among patients with AF and a high risk of TEEs (n=46898, 53,5%), 1216 (24,6%) patients with ischemic stroke (IS) did not initially have a high CHA 2 DS 2 -VASc risk. Conclusion. In clinical practice, among patients with AF aged 18-74 years, there are quite often individuals with CHA 2 DS 2 -VASc score of 1 not associated with sex. These patients need an individualized approach in ACT, which is the basis for prospective studies in order to optimize the assessment of cardioembolic IS risk, as well as to analyze the efficacy and safety of long-term ACT.
{"title":"Patients with atrial fibrillation and a low risk of thromboembolic events: prescription rate of anticoagulant therapy according to a retrospective analysis","authors":"M. A. Druzhilov, T. Yu. Kuznetsova","doi":"10.15829/1560-4071-2023-5522","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5522","url":null,"abstract":"Aim. To conduct a retrospective analysis of the prevalence of main risk factors for thromboembolic events (TEEs) and the prescription rate of anticoagulant therapy (ACT) in patients with atrial fibrillation (AF) and a low CHA2DS2-VASc score in certain Russian regions using artificial intelligence technologies. Material and methods . The information was obtained from the Webiomed predictive analytics platform. The sample included 87601 patients with AF aged 18-74 years (men, 49,5%, mean age, 59,3±12,3 years, mean CHA 2 DS 2 -VASc score, 2,3±1,5) who received care in medical organizations in 6 constituent entities of the Russian Federation in the period from 2016 to 2019. CHA 2 DS 2 VASc score of 1 and 2 in a man and a woman, respectively, was regarded as a moderate risk, while score of 0 and 1, respectively, as a low risk of TEEs. Results. There were 22337 (25,5%) patients with AF at moderate risk and 18366 (21,0%) patients at low risk of TEEs. With a moderate risk of TEEs, CHA 2 DS 2 -VASc score of 1 in 70,4% of cases was determined by hypertension, while in 15,7% — by age 65-74 years, in 9,0% — by heart failure, in 2,9% — by myocardial infarction and/or peripheral arterial disease, in 2,0% — by type 2 diabetes. In patients with AF and a moderate risk of TEEs, ACT was prescribed in 4927 (22,1%) patients, while with a low risk of TEEs — in 1833 (10,0%). Among patients with AF and a high risk of TEEs (n=46898, 53,5%), 1216 (24,6%) patients with ischemic stroke (IS) did not initially have a high CHA 2 DS 2 -VASc risk. Conclusion. In clinical practice, among patients with AF aged 18-74 years, there are quite often individuals with CHA 2 DS 2 -VASc score of 1 not associated with sex. These patients need an individualized approach in ACT, which is the basis for prospective studies in order to optimize the assessment of cardioembolic IS risk, as well as to analyze the efficacy and safety of long-term ACT.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966595","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 : 2023-09-23DOI: 10.15829/1560-4071-2023-5443
E. V. Reznik, T.L. Nguyen, O. A. Ettinger, V. An. Lazarev, S. V. Borisovskaya, A. I. Guseva, A. V. Salikov, G. N. Golukhov
Introduction . The relationship between systemic amyloidosis and coronavirus disease 2019 (COVID-19) has not been sufficiently studied to date. This paper presents a case of the persistence of COVID-19 markers in an elderly patient with systemic amyloidosis. Brief description . A 74-year-old patient with heart failure with preserved ejection fraction and type 2 diabetes was repeatedly hospitalized due to decompensated heart failure. Based on the data of protein electrophoresis with immunotyping, biopsy of subcutaneous fat and bone marrow, echocardiographic data, the patient was diagnosed with systemic AL amyloidosis with cardiac involvement. During hospitalizations in April, August and December 2020, positive polymerase chain reaction test for SARS-CoV-2 were obtained, while there were no clinical manifestations of infection for a long time and adequate antibody production. Conclusion. A case report demonstrates multiple SARS-CoV-2 reinfection in a severe comorbid elderly patient, as an unfavorable prognostic factor.
{"title":"Severe cardiac AL amyloidosis in an elderly patient with multiple SARS-CoV-2 reinfection: a case report","authors":"E. V. Reznik, T.L. Nguyen, O. A. Ettinger, V. An. Lazarev, S. V. Borisovskaya, A. I. Guseva, A. V. Salikov, G. N. Golukhov","doi":"10.15829/1560-4071-2023-5443","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5443","url":null,"abstract":"Introduction . The relationship between systemic amyloidosis and coronavirus disease 2019 (COVID-19) has not been sufficiently studied to date. This paper presents a case of the persistence of COVID-19 markers in an elderly patient with systemic amyloidosis. Brief description . A 74-year-old patient with heart failure with preserved ejection fraction and type 2 diabetes was repeatedly hospitalized due to decompensated heart failure. Based on the data of protein electrophoresis with immunotyping, biopsy of subcutaneous fat and bone marrow, echocardiographic data, the patient was diagnosed with systemic AL amyloidosis with cardiac involvement. During hospitalizations in April, August and December 2020, positive polymerase chain reaction test for SARS-CoV-2 were obtained, while there were no clinical manifestations of infection for a long time and adequate antibody production. Conclusion. A case report demonstrates multiple SARS-CoV-2 reinfection in a severe comorbid elderly patient, as an unfavorable prognostic factor.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966414","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 : 2023-09-23DOI: 10.15829/1560-4071-20235408
K. G. Pereverzeva, S. S. Yakushin, A. An. Korshikova
The review article discusses the issues of anticoagulant therapy in cardiovascular patients with thrombocytopenia (TP), gives the concept of ethylenediaminetetraacetic acidand heparin-induced TP. The management of patients with heparin-induced TP is analyzed in detail, which consists in the discontinuation of unfractionated and low molecular weight heparin administration with replacement to direct thrombin inhibitors (lepirudin or argatroban), fondaparinux or direct oral anticoagulants. The authors emphasize that the anticoagulant administration to most patients with platelet count >50×109/l is possible in full prophylactic and therapeutic doses. Reducing the level of platelets to 25-50×109/l in most cases requires a reduction in the anticoagulant dose by 50%. At a platelet level of 20-25×109/l or less, anticoagulant therapy should be avoided in most patients. In addition to the scope of anticoagulant therapy, TP also determines the choice of anticoagulant as follows: in patients with acute coronary syndrome, bivalirudin or fondaparinux are recommended, while in patients with cancer and stable TP, warfarin or direct oral anticoagulants can be prescribed. In progressive TP (if heparin-induced TP is ruled out), low molecular weight heparins should be used.
{"title":"Potential of anticoagulant therapy in cardiology practice for thrombocytopenia. Literature review","authors":"K. G. Pereverzeva, S. S. Yakushin, A. An. Korshikova","doi":"10.15829/1560-4071-20235408","DOIUrl":"https://doi.org/10.15829/1560-4071-20235408","url":null,"abstract":"The review article discusses the issues of anticoagulant therapy in cardiovascular patients with thrombocytopenia (TP), gives the concept of ethylenediaminetetraacetic acidand heparin-induced TP. The management of patients with heparin-induced TP is analyzed in detail, which consists in the discontinuation of unfractionated and low molecular weight heparin administration with replacement to direct thrombin inhibitors (lepirudin or argatroban), fondaparinux or direct oral anticoagulants. The authors emphasize that the anticoagulant administration to most patients with platelet count >50×109/l is possible in full prophylactic and therapeutic doses. Reducing the level of platelets to 25-50×109/l in most cases requires a reduction in the anticoagulant dose by 50%. At a platelet level of 20-25×109/l or less, anticoagulant therapy should be avoided in most patients. In addition to the scope of anticoagulant therapy, TP also determines the choice of anticoagulant as follows: in patients with acute coronary syndrome, bivalirudin or fondaparinux are recommended, while in patients with cancer and stable TP, warfarin or direct oral anticoagulants can be prescribed. In progressive TP (if heparin-induced TP is ruled out), low molecular weight heparins should be used.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966594","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 : 2023-09-23DOI: 10.15829/1560-4071-20235555
A. N. Sumin, D. V. Duplyakov, F. I. Belyalov, A. E. Bautin, A. V. Bezdenezhnykh, S. V. Garkina, M. L. Gordeev, D. A. Zateishchikov, O. B. Irtyuga, E. V. Korok, T. Yu. Kulagina, E. A. Medvedeva, M. V. Menzorov, D. A. Napalkov, T. V. Pavlova, O. V. Petrunko, K. V. Protasov, Yu. S. Sibagatullina, N. A. Cherepanova, P. Sh. Chomakhidze, A. M. Shutov
Russian Society of Cardiology (RCS)
俄罗斯心脏病学会(RCS)
{"title":"Assessment and modification of cardiovascular risk in non-cardiac surgery. Clinical guidelines 2023","authors":"A. N. Sumin, D. V. Duplyakov, F. I. Belyalov, A. E. Bautin, A. V. Bezdenezhnykh, S. V. Garkina, M. L. Gordeev, D. A. Zateishchikov, O. B. Irtyuga, E. V. Korok, T. Yu. Kulagina, E. A. Medvedeva, M. V. Menzorov, D. A. Napalkov, T. V. Pavlova, O. V. Petrunko, K. V. Protasov, Yu. S. Sibagatullina, N. A. Cherepanova, P. Sh. Chomakhidze, A. M. Shutov","doi":"10.15829/1560-4071-20235555","DOIUrl":"https://doi.org/10.15829/1560-4071-20235555","url":null,"abstract":"Russian Society of Cardiology (RCS)","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966589","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 : 2023-09-23DOI: 10.15829/1560-4071-2023-5463
S. N. Tolpygina, M. I. Chernysheva, A. V. Zagrebelny, V. P. Voronina, N. P. Kutishenko, N. A. Dmitrieva, O. V. Lerman, Yu. V. Lukina, M. M. Lukyanov, E. Yu. Okshina, N. E. Parsadanyan, S. Yu. Martsevich, O. M. Drapkina
Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge. Material and methods . The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack. Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p<0,001), respectively) than in group 2 (31,2%, 55,4% (p<0,001)) and group 1 (23,7%, 37,0% and 54,3% (p<0,001)). Mortality of patients in group 1 was lower than group 2 (p<0,05-0,01). The relative risk of death in clinic visitors was 0,450 (95% confidence interval (CI), 0,333-0,608, p<0,0001), while in those visited by a doctor at home — 0,668 (95% CI, 0,482-0,927, p<0,05). In multivariate analysis and adjustment for sex and age (relative risk (RR) of death, 0,08 (95% CI, 0,048-0,133), p<0,0001 and 1,036 (95% CI, 1,031-1,042), p<0,001, respectively), the independent contribution of the factor of clinic visits was preserved. Thus, the RR of death in visitors was 0,996 (95% CI, 0,994-0,999), p<0,001 and 0,998 (95% CI, 0,995-1,0), p<0,05. Conclusion. The lower mortality among those visited the local clinic in the first year after CVA and among those who were visited by a doctor at home, compared with patients who were not observed, confirms the important role of medical supervision in the post-hospital period.
{"title":"Medical follow-up and long-term survival of patients with cerebrovascular accident: data from the REGION-M registry","authors":"S. N. Tolpygina, M. I. Chernysheva, A. V. Zagrebelny, V. P. Voronina, N. P. Kutishenko, N. A. Dmitrieva, O. V. Lerman, Yu. V. Lukina, M. M. Lukyanov, E. Yu. Okshina, N. E. Parsadanyan, S. Yu. Martsevich, O. M. Drapkina","doi":"10.15829/1560-4071-2023-5463","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5463","url":null,"abstract":"Aim. To assess the survival rate of patients after cerebrovascular accident (CVA), depending on the visits to the local outpatient clinic and the type of medical supervision, and in the first year after hospital discharge. Material and methods . The outpatient part of the REGION-M registry included 684 patients assigned to the City Polyclinic № 64 of Moscow, discharged from the F. I. Inozemtsev City Clinical Hospital (Moscow) in the period from January 1, 2012 to April 30, 2017 with a confirmed diagnosis of cerebral stroke/transient ischemic attack. Results. During the first year after the CVA, 451 (65,9%) patients visited the local clinic on their own (group 1), while 166 (24,3%) patients was consulted by house call (group 2), and 67 (9,8%) did not see the physician (group 3). Patients visited by house call were more likely to have prior coronary artery disease and stroke, and the age of men was older than in other groups. Patients who did not see a doctor were less likely to have comorbidities and disabilities, and were less likely to visit the clinic before stroke. The mortality of patients in group 3 was significantly higher throughout the entire follow-up period (55,2%, 70,1% and 77,6% at stages 1, 2 and 3 (p<0,001), respectively) than in group 2 (31,2%, 55,4% (p<0,001)) and group 1 (23,7%, 37,0% and 54,3% (p<0,001)). Mortality of patients in group 1 was lower than group 2 (p<0,05-0,01). The relative risk of death in clinic visitors was 0,450 (95% confidence interval (CI), 0,333-0,608, p<0,0001), while in those visited by a doctor at home — 0,668 (95% CI, 0,482-0,927, p<0,05). In multivariate analysis and adjustment for sex and age (relative risk (RR) of death, 0,08 (95% CI, 0,048-0,133), p<0,0001 and 1,036 (95% CI, 1,031-1,042), p<0,001, respectively), the independent contribution of the factor of clinic visits was preserved. Thus, the RR of death in visitors was 0,996 (95% CI, 0,994-0,999), p<0,001 and 0,998 (95% CI, 0,995-1,0), p<0,05. Conclusion. The lower mortality among those visited the local clinic in the first year after CVA and among those who were visited by a doctor at home, compared with patients who were not observed, confirms the important role of medical supervision in the post-hospital period.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966413","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 : 2023-09-23DOI: 10.15829/1560-4071-2023-5403
E. M. Rimskaya, S. Yu. Kashtanova, Kh. F. Salami, E. V. Kukharchuk, T. A. Malkina, S. A. Gaman, A. E. Komlev, N. A. Mironova, O. V. Stukalova, T. E. Imaev, R. S. Akchurin, S. P. Golitsyn
Aim. To develop diagnostic criteria for proximal left bundle branch block (LBBB) based on non-invasive methods and to determine the significance of these criteria in predicting the effect of cardiac resynchronization therapy (CRT). Material and methods . To develop criteria, 58 patients (21 men, mean age, 76,1±7,1 years) with LBBB occurred immediately after transcatheter aortic valve implantation (TAVI) were included. To assess the significance of the developed criteria, the second group included 22 patients (11 men, mean age, 57,9±9,3 years) with dilated cardiomyopathy (DCM), who had indications for CRT. The effectiveness of CRT was assessed by echocardiography 6 months after implantation. All patients in the DCM group and 15 patients in the TAVI group underwent superficial epiand endocardial non-invasive mapping using Amycard 01C EP Lab (EP Solutions SA, Switzerland). Patients in the DCM group underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) before device implantation. Results. The criteria for proximal LBBB included 3 electrocardiographic features: QRS complex >130 ms in women and 140 ms in men, QSor rS-configuration in V1 lead, notch in two or more lateral leads (I, avL, V5, V6), and 2 mapping criteria: characteristic location of block line and delayed activation point. In the DCM group, the criteria were positive in 13 of 22 patients (59%). The developed criteria for proximal LBBB showed a relatively strong, significant relationship with the positive effect of CRT (сhi-square test =5,46, p=0,02, Cramer test =0,5, odds ratio (OR)=15,0, 95% confidence interval (CI), 1,32-169,9, p=0,002). An additional analysis showed that both the criteria for proximal block and CRT effect are associated with myocardial fibrosis according to MRI. In particular, intramural stria-shaped contrast accumulation in the interventricular septum leads to a change in characteristic of proximal block mapping phenomena — displacement of delayed activation point (chi-square test =13,9, p<0,001, Cramer test =0,79) and displacement or absence of conduction block lines (chi-square test =6,92, p=0,009, Cramer test =0,56) and prevents the CRT effect (OR =8,67, 95% CI, 1,05-71,57 p=0,03). Conclusion. Proximal LBBB is only one of the factors determining the effectiveness of CRT. Proximal LBBB may mask significant myocardial structural changes that prevent the CRT success.
{"title":"Diagnostic criteria for proximal left bundle branch block and their significance in predicting the success of cardiac resynchronization therapy","authors":"E. M. Rimskaya, S. Yu. Kashtanova, Kh. F. Salami, E. V. Kukharchuk, T. A. Malkina, S. A. Gaman, A. E. Komlev, N. A. Mironova, O. V. Stukalova, T. E. Imaev, R. S. Akchurin, S. P. Golitsyn","doi":"10.15829/1560-4071-2023-5403","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5403","url":null,"abstract":"Aim. To develop diagnostic criteria for proximal left bundle branch block (LBBB) based on non-invasive methods and to determine the significance of these criteria in predicting the effect of cardiac resynchronization therapy (CRT). Material and methods . To develop criteria, 58 patients (21 men, mean age, 76,1±7,1 years) with LBBB occurred immediately after transcatheter aortic valve implantation (TAVI) were included. To assess the significance of the developed criteria, the second group included 22 patients (11 men, mean age, 57,9±9,3 years) with dilated cardiomyopathy (DCM), who had indications for CRT. The effectiveness of CRT was assessed by echocardiography 6 months after implantation. All patients in the DCM group and 15 patients in the TAVI group underwent superficial epiand endocardial non-invasive mapping using Amycard 01C EP Lab (EP Solutions SA, Switzerland). Patients in the DCM group underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) before device implantation. Results. The criteria for proximal LBBB included 3 electrocardiographic features: QRS complex >130 ms in women and 140 ms in men, QSor rS-configuration in V1 lead, notch in two or more lateral leads (I, avL, V5, V6), and 2 mapping criteria: characteristic location of block line and delayed activation point. In the DCM group, the criteria were positive in 13 of 22 patients (59%). The developed criteria for proximal LBBB showed a relatively strong, significant relationship with the positive effect of CRT (сhi-square test =5,46, p=0,02, Cramer test =0,5, odds ratio (OR)=15,0, 95% confidence interval (CI), 1,32-169,9, p=0,002). An additional analysis showed that both the criteria for proximal block and CRT effect are associated with myocardial fibrosis according to MRI. In particular, intramural stria-shaped contrast accumulation in the interventricular septum leads to a change in characteristic of proximal block mapping phenomena — displacement of delayed activation point (chi-square test =13,9, p<0,001, Cramer test =0,79) and displacement or absence of conduction block lines (chi-square test =6,92, p=0,009, Cramer test =0,56) and prevents the CRT effect (OR =8,67, 95% CI, 1,05-71,57 p=0,03). Conclusion. Proximal LBBB is only one of the factors determining the effectiveness of CRT. Proximal LBBB may mask significant myocardial structural changes that prevent the CRT success.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966592","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 : 2023-09-23DOI: 10.15829/1560-4071-2023-5409
E. E. Abramenko, T. R. Ryabova, I. I. Yolgin, V. V. Ryabov
Aim. To evaluate the diagnostic accuracy of exercise stress echocardiography on a horizontal cycle ergometer for the detection of obstructive coronary artery disease (CAD) in patients with low-risk non-ST-elevation acute coronary syndrome (NSTE-ACS). Material and methods . The study included 95 patients aged 53 (46;63) years (men, 58%), hospitalized in the regional vascular center with low-risk NSTE-ACS. Patients with known CAD, impaired resting left ventricular contractility were not included. During hospitalization, standard stress echocardiography on a horizontal cycle ergometer and invasive or non-invasive coronary angiography (CAG) were performed. All values of coronary obstruction ≥70% were verified by invasive CAG. The assessment of myocardial revascularization was observational. Results. All patients had normal structural and functional cardiac parameters at rest. No adverse events were recorded during the tests. The result of stress echocardiography according to impaired local contractility (ILC) criterion was positive in 9 (16%), negative in 28 (49%), incomplete symptom-limited in 20 (35%) patients. Coronary artery stenosis ≥50%/≥70% was detected in 78/78% of cases in the subgroup with a positive result, in 29/11% — with a negative result, 30/10% — with a non-diagnostic result. The association of ILC with stenosis ≥70% was higher, with an odds ratio of 30,1 (4,9; 186,5) vs 8,5 (1,6; 46,1) for stenosis ≥50%. There were following diagnostic accuracy for stenosis ≥70%: sensitivity — 70%, specificity — 93%, positive predictive value — 78%, negative predictive value — 89%, overall accuracy — 86%. Conclusion. Exercise stress echocardiography on a horizontal cycle ergometer in patients with low-risk NSTE-ACS patients is safe and feasible. The method has moderate sensitivity and positive predictive value and high specificity, negative predictive value and overall accuracy for the detection of anatomically significant coronary artery stenosis. In the structure of results, there is a significant proportion (35%) of symptom-limited tests incomplete due to heart rate, characterized by the lowest incidence of obstructive atherosclerosis.
的目标。目的评价运动应激超声心动图在水平循环测力仪上检测低危非st段抬高急性冠状动脉综合征(NSTE-ACS)患者阻塞性冠状动脉疾病(CAD)的诊断准确性。材料和方法。该研究纳入95例年龄53(46;63)岁(男性，58%)，在区域血管中心住院的低风险NSTE-ACS患者。已知的冠心病患者，静息左心室收缩力受损不包括在内。住院期间，在水平循环测力仪上进行标准应激超声心动图和有创或无创冠状动脉造影(CAG)。冠状动脉梗阻≥70%均经有创CAG验证。观察心肌血运重建情况。结果。所有患者静息时心脏结构和功能参数正常。试验期间无不良事件记录。根据局部收缩力受损(ILC)标准进行应激超声心动图检查，阳性9例(16%)，阴性28例(49%)，症状不完全受限20例(35%)。阳性亚组中78/78%的病例冠脉狭窄≥50%/≥70%，阴性结果29/11%，非诊断结果30/10%。ILC与狭窄≥70%的相关性更高，优势比为30.1 (4,9;186,5) vs 8,5 (1,6;46,1)狭窄≥50%。狭窄的诊断准确率≥70%:敏感性为70%，特异性为93%，阳性预测值为78%，阴性预测值为89%，总体准确率为86%。结论。运动应激超声心动图在低危NSTE-ACS患者的水平循环测力仪是安全可行的。该方法对解剖意义显著的冠状动脉狭窄的检测具有中等的敏感性和阳性预测值，具有较高的特异性、阴性预测值和总体准确性。在结果结构中，有相当大比例(35%)的症状受限试验因心率不全而不完整，其特征是梗阻性动脉粥样硬化发生率最低。
{"title":"Diagnostic value of exercise stress echocardiography on a horizontal cycle ergometer in patients with low-risk non-ST elevation acute coronary syndrome","authors":"E. E. Abramenko, T. R. Ryabova, I. I. Yolgin, V. V. Ryabov","doi":"10.15829/1560-4071-2023-5409","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5409","url":null,"abstract":"Aim. To evaluate the diagnostic accuracy of exercise stress echocardiography on a horizontal cycle ergometer for the detection of obstructive coronary artery disease (CAD) in patients with low-risk non-ST-elevation acute coronary syndrome (NSTE-ACS). Material and methods . The study included 95 patients aged 53 (46;63) years (men, 58%), hospitalized in the regional vascular center with low-risk NSTE-ACS. Patients with known CAD, impaired resting left ventricular contractility were not included. During hospitalization, standard stress echocardiography on a horizontal cycle ergometer and invasive or non-invasive coronary angiography (CAG) were performed. All values of coronary obstruction ≥70% were verified by invasive CAG. The assessment of myocardial revascularization was observational. Results. All patients had normal structural and functional cardiac parameters at rest. No adverse events were recorded during the tests. The result of stress echocardiography according to impaired local contractility (ILC) criterion was positive in 9 (16%), negative in 28 (49%), incomplete symptom-limited in 20 (35%) patients. Coronary artery stenosis ≥50%/≥70% was detected in 78/78% of cases in the subgroup with a positive result, in 29/11% — with a negative result, 30/10% — with a non-diagnostic result. The association of ILC with stenosis ≥70% was higher, with an odds ratio of 30,1 (4,9; 186,5) vs 8,5 (1,6; 46,1) for stenosis ≥50%. There were following diagnostic accuracy for stenosis ≥70%: sensitivity — 70%, specificity — 93%, positive predictive value — 78%, negative predictive value — 89%, overall accuracy — 86%. Conclusion. Exercise stress echocardiography on a horizontal cycle ergometer in patients with low-risk NSTE-ACS patients is safe and feasible. The method has moderate sensitivity and positive predictive value and high specificity, negative predictive value and overall accuracy for the detection of anatomically significant coronary artery stenosis. In the structure of results, there is a significant proportion (35%) of symptom-limited tests incomplete due to heart rate, characterized by the lowest incidence of obstructive atherosclerosis.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966569","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 : 2023-09-23DOI: 10.15829/1560-4071-2023-5588
L. A. Bokeria, A. I. Kim, M. M. Zelenikin, A. A. Avramenko, B. G. Alekyan, V. A. Belov, V. N. Bogdanov, M. V. Boriskov, N. A. Borisova, A. G. Brodsky, S. S. Volkov, R. Yu. Gavrilov, O. I. Garmash, I. V. Gladyshev, T. F. Golubova, K. V. Gorbatikov, Yu. N. Gorbatykh, S. V. Gorbachevsky, A. M. Grigoryan, L. V. Eliseeva, A. V. Yevtushenko, O. B. Irtyuga, I. A. Kovalev, M. I. Komissarov, E. V. Krivoshchekov, S. M. Krupyanko, A. A. Kupryashov, A. V. Kurganova, E. G. Levchenko, A. A. Lezhnev, V. N. Lyubchik, T. V. Martynyuk, R. R. Movsesyan, K. A. Nalimov, A. B. Nikiforov, D. Yu. Petrushenko, M. V. Plotnikov, A. Yu. Podoksenov, M. G. Pursanov, A. A. Svobodov, E. G. Semenyak, Y. S. Sinelnikov, V. P. Tataurova, P. V. Teplov, I. I. Trunina, A. E. Chernogrivov, R. M. Shekhmametyev, E. V. Shlyakhto, A. A. Shmalts, A. N. Yakovleva, S. A. Alexandrova, I. Yu. Baryshnikova, T. A. Bergen, I. E. Rychina, V. E. Sinitsyn, L. A. Yurpolskaya
Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC) Association of Pediatric Cardiologists of Russia Russian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and Treatment All-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy "Russian Society of Radiologists and Radiologists". Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.
{"title":"Atrial septal defect. Clinical guidelines 2023","authors":"L. A. Bokeria, A. I. Kim, M. M. Zelenikin, A. A. Avramenko, B. G. Alekyan, V. A. Belov, V. N. Bogdanov, M. V. Boriskov, N. A. Borisova, A. G. Brodsky, S. S. Volkov, R. Yu. Gavrilov, O. I. Garmash, I. V. Gladyshev, T. F. Golubova, K. V. Gorbatikov, Yu. N. Gorbatykh, S. V. Gorbachevsky, A. M. Grigoryan, L. V. Eliseeva, A. V. Yevtushenko, O. B. Irtyuga, I. A. Kovalev, M. I. Komissarov, E. V. Krivoshchekov, S. M. Krupyanko, A. A. Kupryashov, A. V. Kurganova, E. G. Levchenko, A. A. Lezhnev, V. N. Lyubchik, T. V. Martynyuk, R. R. Movsesyan, K. A. Nalimov, A. B. Nikiforov, D. Yu. Petrushenko, M. V. Plotnikov, A. Yu. Podoksenov, M. G. Pursanov, A. A. Svobodov, E. G. Semenyak, Y. S. Sinelnikov, V. P. Tataurova, P. V. Teplov, I. I. Trunina, A. E. Chernogrivov, R. M. Shekhmametyev, E. V. Shlyakhto, A. A. Shmalts, A. N. Yakovleva, S. A. Alexandrova, I. Yu. Baryshnikova, T. A. Bergen, I. E. Rychina, V. E. Sinitsyn, L. A. Yurpolskaya","doi":"10.15829/1560-4071-2023-5588","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5588","url":null,"abstract":"Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC) Association of Pediatric Cardiologists of Russia Russian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and Treatment All-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy \"Russian Society of Radiologists and Radiologists\". Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"177 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135966727","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 : 2023-09-21DOI: 10.15829/1560-4071-2023-5516
V. E. Oleinikov, L. I. Salyamova, N. A. Donetskskaya, A. V. Vdovkin
Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization. Material and methods . A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index. Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF <40% (n=7). The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p 1-3 <0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p 1-2, 3 <0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF <40% (p 1-3 <0,01). The detection rate of IMH prevailed in the 2 nd group (33,3%) compared with the 1 st group (12%) (p 1-2 <0,05). The global contrast index was the lowest in the 1 st group (14,7 (8,8; 27,9)%), intermediate in the 2 nd group (33,3±12,6%), the highest in the 3 th group (54,2±19,5%) (р 1-2, 3; 2-3 <0,05). Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.
{"title":"Effect of ischemic injury characteristics on left ventricular systolic function in patients with acute myocardial infarction","authors":"V. E. Oleinikov, L. I. Salyamova, N. A. Donetskskaya, A. V. Vdovkin","doi":"10.15829/1560-4071-2023-5516","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5516","url":null,"abstract":"Aim. To study laboratory and magnetic resonance imaging (MRI) characteristics of infarction area depending on left ventricular (LV) global systolic function in patients with acute myocardial infarction (AMI) after revascularization. Material and methods . A total of 78 patients with primary AMI were included. On days 7-10, contrast-enhanced cardiac MRI was performed. Blood brain natriuretic peptide (BNP) was analyzed. Cardiac MRI was used to determine the characteristics of scar tissue, peri-infarct zone (PIZ), microvascular obstruction (MVO), intramyocardial hemorrhage (IMH) and the global contrast index. Results. According to the MRI, patients were divided into following groups: group 1 — LV ejection fraction (LVEF) ≥50% (n=50), group 2 — LVEF 40-49% (n=21), group 3 — LVEF <40% (n=7). The BNP in groups 1, 2, 3 was 106,8 (37,5; 248), 232,6 (170,1; 337,7) and 548,5±236,4 ng/ml, respectively (p 1-3 <0,05). The scar tissue mass in groups 1, 2, 3 was 10,3 (2,4; 20,0), 34,7±21,3, 59,4±37,6 g, respectively (p 1-2, 3 <0,01). PIZ differences were found only between patients with preserved and mildly reduced EF. MVO was diagnosed in 26% of patients with LVEF ≥50%, in 47,6% of patients with LVEF of 40-49% and 85,7% with LVEF <40% (p 1-3 <0,01). The detection rate of IMH prevailed in the 2 nd group (33,3%) compared with the 1 st group (12%) (p 1-2 <0,05). The global contrast index was the lowest in the 1 st group (14,7 (8,8; 27,9)%), intermediate in the 2 nd group (33,3±12,6%), the highest in the 3 th group (54,2±19,5%) (р 1-2, 3; 2-3 <0,05). Conclusion. The following risk factors for a decrease in LV systolic function in patients with AMI after revascularization were identified: the size of scar tissue, PIZ, MVO and IMH characteristics, global contrast index, BNP level.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136238525","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 : 2023-09-21DOI: 10.15829/1560-4071-2023-5497
A. I. Mishkina, T. A. Atabekov, V. V. Shipulin, R. E. Batalov, S. I. Sazonova, S. V. Popov, K. V. Zavadovsky
Aim. To determine the prognostic significance of cardiac regional mechanical dyssynchrony (MD), assessed by radionuclide equilibrium ventriculography (REVG) in candidates for cardiac resynchronization therapy (CRT). Material and methods . The study included 65 patients with indications for CRT according to current guidelines. Prior to CRT, all patients underwent REVG to assess cardiac contractile function and MD. According to the phase analysis, indicators of global and regional cardiac MD were evaluated: phase standard deviation (PSD), histogram band width (HBW), entropy, and interventricular dyssynchrony. The regional assessment included an evaluation of phase histograms obtained from the analysis of the contraction of certain walls: left ventricular (LV) anterior, lateral, posterior wall, right ventricular (RV) free wall, and the interventricular septum. To evaluate the effectiveness of treatment 6 months after CRT, all patients underwent echocardiography, on the basis of which patients were divided into groups of responders and non-responders. Results. REVG revealed significant differences in the initial regional MD values between the groups of responders and non-responders: in responders, MD values of RV free wall (PSD: 39 (28-67) vs 28 (20-50), p=0,03) and LV anterior wall (PSD: 28,5 (16-40) vs 14 (11-24), p=0,0005) were higher, and the LV lateral wall was lower (PSD: 10 (7-14) vs 15 (9-26), p=0,007) than in non-responders. Multivariate logistic regression found following independent predictors of a positive response to CRT: heart failure of ischemic origin, LV HBW, RV free wall PSD, anterior wall PSD, LV lateral wall HBW (p<0,001). The sensitivity and specificity of the model was 93% and 91%, respectively. Conclusion. Regional MD scintigraphy parameters increase the predictive value of REVG in CRT candidates. The most informative in this regard are the PSD of RV free wall and LV anterior wall, as well as the HBW of LV lateral wall.
的目标。通过放射性核素平衡心室造影(REVG)评估心脏再同步化治疗(CRT)候选者的心脏局部机械非同步化(MD)的预后意义。材料和方法。该研究纳入了65例根据现行指南有CRT适应症的患者。CRT前，所有患者均行REVG评估心脏收缩功能和MD。根据相分析，评估整体和局部心脏MD的指标:相标准差(PSD)、直方图带宽(HBW)、熵和室间非同步化。区域评估包括从某些壁的收缩分析获得的相位直方图的评估:左心室(LV)前壁、侧壁、后壁、右心室(RV)自由壁和室间隔。为评价CRT后6个月的治疗效果，所有患者均行超声心动图检查，并在此基础上将患者分为反应组和无反应组。结果。REVG显示，应答组和无应答组的初始区域MD值存在显著差异:应答组中，左室游离壁(PSD: 39 (28-67) vs 28 (20-50)， p=0,03)和左室前壁(PSD: 28,5 (16-40) vs 14 (11-24)， p=0,0005)的MD值高于无应答组，左室侧壁(PSD: 10 (7-14) vs 15 (9-26)， p=0,007)的MD值低于无应答组。多因素logistic回归发现，CRT阳性反应的独立预测因子为:缺血性心力衰竭、左室HBW、左室游离壁PSD、前壁PSD、左室侧壁HBW (p< 0.001)。该模型的敏感性为93%，特异性为91%。结论。区域MD显像参数增加了CRT候选者REVG的预测值。在这方面信息量最大的是左室游离壁和左室前壁的PSD，以及左室侧壁的HBW。
{"title":"Role of radionuclide assessment of global and regional mechanical dyssynchrony of the heart in prognosis of cardiac resynchronization therapy in patients with heart failure","authors":"A. I. Mishkina, T. A. Atabekov, V. V. Shipulin, R. E. Batalov, S. I. Sazonova, S. V. Popov, K. V. Zavadovsky","doi":"10.15829/1560-4071-2023-5497","DOIUrl":"https://doi.org/10.15829/1560-4071-2023-5497","url":null,"abstract":"Aim. To determine the prognostic significance of cardiac regional mechanical dyssynchrony (MD), assessed by radionuclide equilibrium ventriculography (REVG) in candidates for cardiac resynchronization therapy (CRT). Material and methods . The study included 65 patients with indications for CRT according to current guidelines. Prior to CRT, all patients underwent REVG to assess cardiac contractile function and MD. According to the phase analysis, indicators of global and regional cardiac MD were evaluated: phase standard deviation (PSD), histogram band width (HBW), entropy, and interventricular dyssynchrony. The regional assessment included an evaluation of phase histograms obtained from the analysis of the contraction of certain walls: left ventricular (LV) anterior, lateral, posterior wall, right ventricular (RV) free wall, and the interventricular septum. To evaluate the effectiveness of treatment 6 months after CRT, all patients underwent echocardiography, on the basis of which patients were divided into groups of responders and non-responders. Results. REVG revealed significant differences in the initial regional MD values between the groups of responders and non-responders: in responders, MD values of RV free wall (PSD: 39 (28-67) vs 28 (20-50), p=0,03) and LV anterior wall (PSD: 28,5 (16-40) vs 14 (11-24), p=0,0005) were higher, and the LV lateral wall was lower (PSD: 10 (7-14) vs 15 (9-26), p=0,007) than in non-responders. Multivariate logistic regression found following independent predictors of a positive response to CRT: heart failure of ischemic origin, LV HBW, RV free wall PSD, anterior wall PSD, LV lateral wall HBW (p<0,001). The sensitivity and specificity of the model was 93% and 91%, respectively. Conclusion. Regional MD scintigraphy parameters increase the predictive value of REVG in CRT candidates. The most informative in this regard are the PSD of RV free wall and LV anterior wall, as well as the HBW of LV lateral wall.","PeriodicalId":21389,"journal":{"name":"Russian Journal of Cardiology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136238877","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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