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Valve in valve and valve in ring transcatheter aortic valveimplantation 瓣中瓣和瓣环经导管主动脉瓣植入术
Pub Date : 2022-06-20 DOI: 10.3897/bgcardio.28.e82414
P. Simeonov, B. Barzashka, D. Trendafilova, J. Jorgova, D. Petkov, P. Abedinov
In recent years the trend towards surgical bioprosthetic valve implantation, especially among young patients, has increased in order to avoid anticoagulant therapy. The patient’s age remains one of the leading risk factors for valve dysfunction. Gold standard for treating such diseases was surgical reintervention until the development of transcatheter heart valves. By 2050 the annual number of patients undergoing surgical bioprosthetic valve implantation is expected to triple from an average of 290,000 in 2003 to over 850,000. This study presents the literature review of Valve in Valve and Valve in Ring procedures, as well as our experience in ViV and ViR transcatheter valve implantation.
近年来,为了避免抗凝治疗,外科生物瓣膜植入的趋势有所增加,尤其是在年轻患者中。患者的年龄仍然是瓣膜功能障碍的主要危险因素之一。治疗此类疾病的黄金标准是手术再干预,直到开发出经导管心脏瓣膜。到2050年,每年接受外科生物瓣膜植入手术的患者人数预计将增加两倍,从2003年的平均29万人增加到85万多人。本研究介绍了瓣膜中瓣膜和环中瓣膜手术的文献综述,以及我们在ViV和ViR经导管瓣膜植入方面的经验。
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引用次数: 0
Clinical significance and change in the degree of mitral insufficiency after TAVI TAVI后二尖瓣关闭不全程度的变化及临床意义
Pub Date : 2022-06-20 DOI: 10.3897/bgcardio.28.e82855
D. Trendafilova, J. Djorgova, H. Varnaliyska, N. Naidenova, R. Stoycheva, R. Valchev, H. Angelov
Introduction: Hemodynamically signifi cant mitral regurgitation (MR) occurs in up to 20-30% of patients with high-grade aortic stenosis (AC) indicated for transcatheter aortic valve implantation (TAVI). Despite the establishment of the method as a standard in the treatment of high-risk patients for surgery worldwide and the growing number of patients treated interventionally, behavior in concomitant signifi cant MR continues to be a diagnostic and therapeutic challenge. The decision to intervene on multiple valves must take into account the additional surgical risk of the combined procedures. Signifi cant MR is associated with a worse prognosis in both surgical and interventional treatment. With high operative risk and signifi cant MR, TAVI is a possible solution due to the proven reduction in severity in a signifi cant proportion of patients. The aim of this paper is to evaluate the impact of signifi cant secondary MR on mortality and rate change after TAVI. Material and methods: The article is a retrospective analysis of 50 patients with high-grade symptomatic aortic stenosis who underwent successful TAVI. Patients were followed for a period of 1 year and were divided into two major groups – no signifi cant MR (0.1 degree) and those with signifi cant secondary MR (≥ grade 2). Overall mortality, cardiovascular mortality, functional class of heart failure according to the NYHA classifi cation, ejection fraction and need for rehospitalizations weremonitored. Conclusions: Hemodynamically signifi cant secondary MR, concomitant high-grade AC before TAVI undergoes positive dynamics in a signifi cant proportion of patients postprocedurally and should be considered when deciding on a therapeutic strategy by the Heart team. The worsening of signifi cant secondary MI in the studied patients is associated with 30-day and one-year cardiovascular mortality and the need for rehospitalization, which is consistent with data that the prognosis is important not only the presence of signifi cant secondary MR, but its dynamics after TAVI.
引言:在经导管主动脉瓣植入术(TAVI)所需的高度主动脉瓣狭窄(AC)患者中,高达20-30%的患者出现血液动力学显著的二尖瓣反流(MR)。尽管该方法已被确立为世界范围内手术高危患者治疗的标准,并且越来越多的患者接受了干预治疗,但伴随显著MR的行为仍然是一个诊断和治疗挑战。对多个瓣膜进行干预的决定必须考虑到联合手术的额外手术风险。在外科和介入治疗中,严重的MR与较差的预后相关。对于高手术风险和显著的MR,TAVI是一种可能的解决方案,因为已证明在很大比例的患者中严重程度降低。本文的目的是评估TAVI后显著的继发性MR对死亡率和发病率变化的影响。材料和方法:本文对50例成功接受TAVI的高级症状性主动脉瓣狭窄患者进行了回顾性分析。对患者进行了为期1年的随访,并将其分为两大组——无明显MR(0.1度)和有明显继发MR(≥2级)。监测了总死亡率、心血管死亡率、根据NYHA分类的心力衰竭功能分级、射血分数和再次住院的需要。结论:血液动力学显著的二次MR,TAVI前伴发的高级别AC在很大比例的患者术后经历正动力学,心脏团队在决定治疗策略时应予以考虑。在所研究的患者中,显著的继发性MI的恶化与30天和一年的心血管死亡率以及再次住院的必要性有关,这与预后重要的数据一致,不仅是显著的继发MR的存在,而且是TAVI后的动态。
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引用次数: 0
[Iron deficiency in Russia heart failure patients. Observational cross-sectional multicenter study]. [缺铁对俄罗斯心力衰竭患者的影响]观察性横断面多中心研究]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n2083
V. Mareev, Y. L. Begrambekova, Y. Mareev, Z. Kobalava, L. Karapetyan, S. Galochkin, E. R. Kazakhmedov, A. Lapshin, A. A. Garganeeva, E. A. Kuzheleva, A. Efremushkina, E. Kiseleva, O. Barbarash, T. Pecherina, A. Galyavich, Z. Galeeva, L. Baleeva, N. Koziolova, A. Veklich, D. Duplyakov, M. N. Maksimova, S. Yakushin, E. Smirnova, E. Sedykh, I. Shaposhnik, N. Makarova, A. A. Zemlyanukhina, V. Skibitsky, A. Fendrikova, A. V. Skibitsky, N. Spiropulos, E. Seredenina, Y. Orlova, K. Eruslanova, Y. Kotovskaya, O. Tkacheva, M. Fedin
Aim    To evaluate the prevalence of iron deficiency (ID) in Russian patients with heart failure (HF).Material and methods    Iron metabolism variables were studied in 498 (198 women, 300 men) patients with HF. Data were evaluated at admission for HF (97 %) or during an outpatient visit (3 %). ID was determined according to the European Society of Cardiology Guidelines.Results    83.1 % of patients had ID; only 43.5 % of patients with ID had anemia. Patients with ID were older: 70.0 [63.0;79.0] vs. 66.0 years [57.0;75.2] (p=0.009). The number of patients with ID increased in parallel with the increase in HF functional class (FC). Among patients with ID, fewer people were past or current alcohol users (p=0.002), and a greater number of patients had atrial fibrillation (60.1 vs. 45.2 %, p=0.016). A multiple logistic regression showed that more severe HF (HF FC) was associated with a higher incidence of ID detection, whereas past alcohol use was associated with less pronounced ID. An increase in N-terminal pro-brain natriuretic peptide (NT-proBNP) by 100 pg/ml was associated with an increased likelihood of ID (odds ratio, 1.006, 95 % confidence interval: 1.002-1.011, p=0.0152).Conclusion    The incidence rate of HF patients is high in the Russian Federation (83.1 %). Only 43.5 % of these patients had anemia. The prevalence of ID in the study population increased with increases in HF FC and NT-proBNP.
目的评价俄罗斯心力衰竭(HF)患者缺铁(ID)的患病率。材料与方法对498例心衰患者(女性198例,男性300例)的铁代谢指标进行研究。数据在HF入院时(97%)或门诊期间(3%)进行评估。ID是根据欧洲心脏病学会指南确定的。结果83.1%的患者有ID;只有43.5%的ID患者有贫血。ID患者年龄较大:70.0岁[63.0;79.0岁]vs. 66.0岁[57.0;75.2岁](p=0.009)。ID患者数量与HF功能分级(FC)的增加同步增加。在ID患者中,过去或现在饮酒的人数较少(p=0.002),而更多的患者患有心房颤动(60.1比45.2%,p=0.016)。多重逻辑回归显示,更严重的HF (HF FC)与更高的ID检测发生率相关,而过去的酒精使用与不太明显的ID相关。n端脑利钠肽前体(NT-proBNP)增加100 pg/ml与ID的可能性增加相关(优势比为1.006,95%置信区间为1.002-1.011,p=0.0152)。结论俄罗斯联邦HF患者发病率较高(83.1%)。这些患者中只有43.5%患有贫血。研究人群中ID的患病率随着HF FC和NT-proBNP的增加而增加。
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引用次数: 3
[Determination of factors influencing the desire and possibilities of prevention of inactivity and other behavi-oral risk factors by primary care physicians (REFLECTION). The results of a one-time survey]. [决定初级保健医生预防不活动和其他行为-口腔风险因素的愿望和可能性的因素(反思)。]一次性调查的结果]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n2022
O. Drapkina, Y. L. Begrambekova, D. O. Orlov, R. Shepel, T. V. Samojlov
Aim    To evaluate clinical practice of primary care physicians with respect of preventing behavioral risk factors in patients as well as objective and subjective factors that influence their motivation for taking preventive measures. Material and methods    This study was a cross-sectional survey. The questionnaire was anonymous and included closed questions and multiple-choice questions. Based on the obtained results, prevalence of modifiable risk factors for chronic noninfectious diseases (CNID) was comprehensively evaluated in the survey population. Also, a special quantitative variable was introduced, the Index of Behavioral Risk Factors. that reflected the burden of risk factors. This composite index included the degree of risk factor in a specific respondent, for example, obesity degree, number of cigarettes smoked per day, severity of hypodynamia. Physicians' knowledge and beliefs about the effect of physical activity (PA) on certain diseases were evaluated. Result    623 physicians (mean age 40 years (31-52), 85.5 % women) participated in the survey. The respondents included general practitioners (7.5%), cardiologists (2.9 %), preventive care physicians (4.8 %), internists (25.4 %), and other specialists (59.4 %). 70.8 % of respondents never smoked, 17.5 % were current smokers. 38.5% (240) of the surveyed had a normal body weight index (BWI); 41.7 % (260) were overweight; 11.6 % (72) had degree 1 obesity; 3.7 % (23) had degree 2 obesity; and 0.8 % had degree 3 obesity. A very low PA level was noticed; most of the surveyed exercised not more than once a week (median, 1 (0-3) time). More than 90 % had behavioral risk factors, low PA and excessive body weight. The physicians with a higher index of behavioral risk factors 50% less frequently checked the body weight of patients (odds ratio (OR), 0.541; 95 % confidence interval (CI): 0.388-0.753, p<0.05); 33% less frequently asked whether the patient smoked (OR, 0.675; 95 % CI: 0.465-0.978, p=0.037); 50% less frequently asked the patients about his/her level of PA (OR, 0.482; 95 % CI: 0.343-0.678, p<0.001); and 60% less frequently recommended increasing the PA (OR, 0.408; 95 % CI: 0.292-0.570, p<0.001).Conclusion    Most of the surveyed were aware of the benefits of PA for prevention and treatment of CNID, however, they related the mechanism of this effect only with weight loss. The most frequently mentioned barriers to behavioral risk counseling were uncertainty about whether such counseling was within the physician's professional competence, lack of time, lack of confidence in the provision of advice and the effectiveness of interventions, and lack of patients' compliance.
目的评价初级保健医生在预防患者行为危险因素方面的临床实践,以及影响其采取预防措施动机的客观和主观因素。材料与方法本研究为横断面调查。问卷是匿名的,包括封闭式问题和多项选择题。根据获得的结果,对调查人群中慢性非传染性疾病(CNID)可改变危险因素的患病率进行综合评估。并引入了一个特殊的定量变量——行为危险因素指数。这反映了风险因素的负担。该综合指数包括特定被调查者的危险因素程度,例如肥胖程度、每天吸烟的数量、动力不足的严重程度。评估医生对体育锻炼对某些疾病的影响的认识和信念。结果共有623名医师参与调查,平均年龄40岁(31 ~ 52岁),其中女性占85.5%。受访者包括全科医生(7.5%)、心脏病专家(2.9%)、预防保健医生(4.8%)、内科医生(25.4%)和其他专科医生(59.4%)。70.8%的受访者从不吸烟,17.5%的受访者目前是吸烟者。38.5%(240)的被调查者体重指数(BWI)正常;41.7%(260人)超重;11.6%(72人)为1级肥胖;3.7%(23人)为2级肥胖;0.8%为3级肥胖。发现PA水平非常低;大多数被调查者每周锻炼不超过一次(中位数,1(0-3)次)。超过90%的人有行为危险因素,低PA和超重。行为危险因素指数越高的医生检查患者体重的频率越低50%(优势比(OR), 0.541;95%置信区间(CI): 0.388 ~ 0.753, p<0.05);33%的患者被问及是否吸烟(OR, 0.675;95% CI: 0.465-0.978, p=0.037);50%的患者较少询问其PA水平(OR, 0.482;95% CI: 0.343-0.678, p<0.001);60%的人建议增加PA (OR, 0.408;95% CI: 0.292 ~ 0.570, p<0.001)。结论大多数被调查者都意识到PA在预防和治疗CNID方面的益处,但他们只将这种作用的机制与减肥联系起来。行为风险咨询最常被提及的障碍是不确定这种咨询是否在医生的专业能力范围内,缺乏时间,对提供建议和干预措施的有效性缺乏信心,以及患者缺乏依从性。
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引用次数: 1
[Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings]. [影响在门诊治疗普通心血管疾病的医生接受国家实践指南的因素]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1945
N. Pogosova, S. Isakova, O. Sokolova, A. Ausheva, R. Zhetisheva, A. Arutyunov
Aim      To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods  This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion      The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working co
目的探讨影响门诊医师在常见心血管疾病(cvd)患者诊治中实际处方与国家适用指南一致性的因素。材料和方法本研究是一项横断面研究,随机选择16个城市综合诊所,内科医生填写有效问卷,包括Maslach倦怠量表-人类服务调查(MBI-HSS)、医院焦虑和抑郁量表(HADS)、视觉模拟量表(VAS)、世卫组织生活质量-BREF (WHOQOL-BREF)和个人决策因素(PDF-25)。参与医生提供连续到达的心血管疾病高风险或确诊心血管疾病患者在2-3个工作日内的门诊病例报告,对应于问卷周期±1周。评估了这些病例报告中记录的处方与俄罗斯心脏病学会(RSC)指南的一致性。结果本研究纳入108名医生(平均年龄44.0±13.1岁,女性占87%),提供了341例患者(平均年龄64.4±13.2岁,女性占59.5%)的病例报告,其中最常见的诊断为动脉高血压(92.1%)、缺血性心脏病(60.7%)和慢性心力衰竭(32.8%)。多因素回归分析结果显示,以下因素增加了处方与指南不一致的可能性:医生拥有最高的认证类别(OR 2.56;95% ci 1.39-4.7;p<0.002), 5年内参加专业活动少于2次(OR 2.23;95% ci 1.18-4.22;p=0.013),有额外的兼职工作(OR 15.58;95% ci 1.51-160.5;p=0.021),倾向于规定熟悉的商品名称(OR 2.04, 95% CI 1.08-3.85;p = 0.028),感知药品供应问题是影响决策的重要因素(OR 5.13, 95% CI 2.69-9.75;p<0.001),情绪衰竭量表总分(OR 1.03, 95% CI 1.01-1.06;р= 0.031)。此外,这种可能性随着患者年龄的增长而增加(OR 3.29;95% ci 1.65-6.55;(r <0.001)和患者过度饮酒(OR 1.79, 95% CI 1.31-2.43;р< 0.001)。根据WHOQOL-BREF问卷对自身健康状况进行高度评估(OR 0.19;95% ci 0.05-0.72;p = 0.014),对自己工作条件的高度评价(OR 0.76;95% ci 0.64-0.9;p=0.002),近5年内的研究生教育(OR 0.14;95% ci 0.06-0.36;p < 0.001)。结论本研究确定了影响门诊医生为心血管疾病患者开具处方与国家临床指南一致性可能性的因素。在这些因素中,最重要的是参加教育活动的机会、额外的外部兼职工作、以前执业的惰性指标、药物供应的问题、对自身健康状况和工作条件的满意度、情绪疲惫(职业倦怠的一个组成部分)、患者年龄较大和过度饮酒。
{"title":"[Factors affecting the uptake of national practice guidelines by physicians treating common CVDS in out-patient settings].","authors":"N. Pogosova, S. Isakova, O. Sokolova, A. Ausheva, R. Zhetisheva, A. Arutyunov","doi":"10.18087/cardio.2022.5.n1945","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1945","url":null,"abstract":"Aim      To study factors that influence the consistency of real prescriptions with applicable national guidelines for outpatient physicians in the management of patients with common cardiovascular diseases (CVDs).Material and methods  This was a cross-sectional study based on 16 randomly selected municipal polyclinics, where internists filled in validated questionnaires, including the Maslach Burnout Inventory - Human Services Survey (MBI-HSS), Hospital Anxiety and Depression Scale (HADS), Visual Analogue Scale (VAS), WHO Quality of Life - BREF (WHOQOL-BREF), and the Personal Decision-Making Factors (PDF-25). Participating physicians provided outpatient case reports of sequentially arriving patients with a high risk of CVD or confirmed CVDs during 2-3 working days, corresponding to the questionnaire period of ±1 week. The consistency of the prescriptions recorded in these case reports with the Russian Society of Cardiology (RSC) Guidelines was assessed.Results This study included 108 physicians (mean age, 44.0±13.1 years, 87.0 % women) who provided case reports of 341 patients (mean age, 64.4±13.2 years, 59.5 % women) with most common diagnoses of arterial hypertension (92.1 %), ischemic heart disease (60.7 %), and chronic heart failure (32.8 %). According to results of multivariate regression analysis, the following factors increased the likelihood of the prescription inconsistency with the guidelines: the fact that the physician had the highest attestation category (OR 2.56; 95% CI 1.39-4.7; p<0.002), attended professional events less than 2 times in 5 years (OR 2.23; 95% CI 1.18-4.22; p=0.013), had an additional, part-time job (OR 15.58; 95% CI 1.51-160.5; p=0.021), was prone to prescribe familiar trade names (OR 2.04, 95% CI 1.08-3.85; p = 0.028), perceived drug supply problems as an important factor influencing the decision making (OR 5.13, 95% CI 2.69-9.75; p<0.001), and a total score on the emotional exhaustion scale (OR 1.03, 95 % CI 1.01-1.06; р=0.031). Also, this likelihood was increased by older age of the patient (OR 3.29; 95 % CI 1.65-6.55; р<0.001) and excessive alcohol consumption by the patient (OR 1.79, 95 % CI 1.31-2.43; р<0.001). The likelihood of non-compliance with the guidelines was reduced by a high assessment of own health status according to the WHOQOL-BREF questionnaire (OR 0.19; 95% CI 0.05-0.72; p = 0.014), a high assessment of own working conditions (OR 0.76; 95% CI 0.64-0.9; p=0.002), and postgraduate education within the last 5 years (OR 0.14; 95% CI 0.06-0.36; p<0.001).Conclusion      The study identified the factors that influence the likelihood of the consistency of prescriptions made by outpatient physicians for patients with CVD with applicable national clinical guidelines. Among these factors, the most important ones were access to educational events, additional, external part-time job, indicators of inertia of previous practice, problems with drug provision, satisfaction with own health status and working co","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"7 1","pages":"33-44"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88942809","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}
引用次数: 0
[Physicians' adherence to the guidelines on the chronic heart failure diagnosis and treatment]. [医生对慢性心力衰竭诊断和治疗指南的依从性]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1755
N. B. Perpech, A. Tregubov, I. E. Mikhailova
Aim      To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect.   In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion      The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.
目的评估医师对慢性心力衰竭(CHF)诊断和治疗临床指南基本条款的了解程度,并确定医师在日常临床实践中如何遵守这些条款。材料与方法本研究分析了185名医生(127名心脏病专家,40名内科医生和全科医生,18名其他专家)在2020/2021学年接受高级培训项目培训的匿名问卷。问卷的主要部分包括15个问题,涉及到CHF患者的分类、诊断、药物治疗和植入式装置的使用。结果内科医师对慢性心力衰竭主要临床诊疗指南的了解程度低于心脏科医师。然而,心脏病专家的知识也不能被认为是足够的。57.5%的内科医生和30%的心脏病专家错误地指出了诊断伴有左室射血分数降低(CHFrEF)的CHF的主要超声心动图标准。超过40%的内科医生不认为伴有充血综合征的液体潴留是对CHFrEF患者给予环状利尿剂的强制性条件。34.6%的心脏病专家和25%的内科医生正确地确定了矿皮质激素受体拮抗剂的适应症。37.6%的内科医生和21.1%的心脏科医生错误地指出了为达到神经调节效果而推荐的螺内酯剂量。在确定血管紧张素转换酶(ACE)抑制剂和受体阻滞剂的剂量时,在达到必须停止其升滴后,大多数医生倾向于根据收缩压(SBP)而不是低血压症状来确定剂量。然而,在治疗师中,有医生认为患者的健康和临床症状,而不是收缩压水平,是选择ACE抑制剂和受体阻滞剂治疗策略的优先因素。这两个专业的医生都不太熟悉心律转复除颤器植入的适应症;只有14.2%的心脏病专家和5%的内科医生选择了正确的适应症措辞。结论对CHF的认识不足是导致医生对诊断和治疗指南依从性较低的原因。在制定CHF医生高级培训计划时,应特别注意肾素-血管紧张素-醛固酮系统抑制剂和β受体阻滞剂的使用,并详细讨论剂量原则、植入适应症和使用心律转复除颤器的结果。
{"title":"[Physicians' adherence to the guidelines on the chronic heart failure diagnosis and treatment].","authors":"N. B. Perpech, A. Tregubov, I. E. Mikhailova","doi":"10.18087/cardio.2022.5.n1755","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1755","url":null,"abstract":"Aim      To evaluate the physician's knowledge of basic provisions of clinical guidelines for diagnosis and treatment of chronic heart failure (CHF) and to determine how the actions of physicians in their everyday clinical practice comply with these provisions.Materials and methods The study analyzed anonymous questionnaires of 185 physicians (127 cardiologists, 40 internists and general practitioners, 18 other specialists) who were trained in advanced training programs during the 2020/2021 academic year. The main part of the questionnaire included 15 questions related to the classification, diagnosis, pharmacotherapy, and the use of implantable devices in the treatment of patients with CHF.Results The results showed that internists were less than cardiologists aware of major provisions of clinical guidelines for diagnosis and treatment of CHF. However, the knowledge of cardiologists could not be considered sufficient either. 57.5% of internists and 30% of cardiologists incorrectly indicated the main echocardiographic criterion for diagnosis of CHF with reduced left ventricular ejection fraction (CHFrEF). More than 40% of internists did not consider fluid retention with development of the congestion syndrome as a mandatory condition for administration of a loop diuretic to a patient with CHFrEF. 34.6% of cardiologists and 25% of internists correctly determined the indication for the administration of mineralocorticoid receptor antagonists. 37.6% of internists and 21.1% of cardiologists incorrectly indicated the dose of spironolactone recommended for achieving the neuromodulation effect.   In determining doses of angiotensin-converting enzyme (ACE) inhibitors and beta-blockers, after arriving at which it is necessary to stop their up-titration, most of the physicians preferred to be based on systolic blood pressure (SBP) rather than on symptoms of hypotension. However, among therapists there were doctors for whom the patient's well-being and clinical symptoms, and not the level of SBP, were priority factors for choosing the tactics of the treatment with ACE inhibitors and beta-blockers. Physicians of both specialties were poorly familiar with indications for cardioverter defibrillator implantation; only 14.2% of cardiologists and 5% of internists chose the correct wording of indications.Conclusion      The insufficient knowledge should be considered the basis for the low adherence of doctors to guidelines for diagnosis and treatment of CHF. When developing programs for advanced training of physicians in CHF, special attention should be paid to the use of renin-angiotensin-aldosterone system inhibitors and beta-blockers with detailed discussion of the dosing principles as well as of indications for implantation and results of using cardioverter defibrillators.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"50 1","pages":"53-61"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85708499","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}
引用次数: 1
[Development and implementation of a heart failure telemonitoring system: the single centre experience]. [心力衰竭远程监测系统的开发与实施:单中心体验]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1825
V. Agapov, Y. Kudryashov, I. V. Graifer, V. Samitin
Aim      To evaluate the efficacy of remote monitoring by the compliance with body weight control and drug therapy in patients with CHF, using a specially developed software module for chronic heart failure (CHF) monitoring.Material and methods  During 2018-2020, 79 patients with dilated cardiomyopathy (mean age, 36.1 [34.2; 38.4] years) and NYHA II-IV functional class CHF were included in the outpatient telemonitoring (TM) program.Results The duration of monitoring was 965 [768; 1065] days. During the monitoring time, the compliance with outpatient body weight control significantly improved: 73.3 [70; 80] % at baseline vs. 86.7 [76.7; 86.7] % at the end of the 31st month (p<0.001). The proportion of patients measuring their body weight at least 6 times a week significantly increased: 8.9 % at baseline vs. 58.1 % by the end of the monitoring (p<0.001). There was no significant association between the time-related changes in the compliance with body weight control and drug therapy and the patient's gender. In addition, during long-term TM, a small but statistically significant increase in left ventricular ejection fraction was noted (36.3 [35.5; 37.2] % at baseline vs. 37.2 [35.8; 38.3] % at the end of monitoring; p=0.0008). The involvement of staff physicians in the remote correction of therapy for CHF decreased during the study: the number of system notifications that required a physician's response reduced over two years from 26.6 to 13 % (p=0.011).Conclusion      Participation of patients with dilated cardiomyopathy and CHF in the structured TM program was associated with a significant increase in the compliance with regular self-control of body weight and drug therapy for heart failure.
目的利用专门开发的慢性心力衰竭(CHF)监测软件模块,通过对CHF患者体重控制依从性和药物治疗依从性进行远程监测,评价其疗效。材料与方法2018-2020年,79例扩张型心肌病患者(平均年龄36.1岁;38.4]年)和NYHA II-IV功能级CHF纳入门诊远程监测(TM)计划。结果监测时间为965 [768];1065)天。监测期间,门诊体重控制依从性明显提高:73.3 [70];80 %基线vs. 86.7 [76.7;在第31个月末,86.7]% (p<0.001)。每周测量体重至少6次的患者比例显著增加:基线时为8.9%,监测结束时为58.1% (p<0.001)。体重控制依从性和药物治疗依从性的时间相关变化与患者性别无显著相关性。此外,在长期TM期间,左心室射血分数(36.3 [35.5;基线时的37.2% vs. 37.2% [35.8%;38.3] %在监测结束时;p = 0.0008)。在研究期间,工作人员医生参与远程纠正治疗CHF的情况有所减少:需要医生回应的系统通知数量在两年内从26.6%减少到13% (p=0.011)。结论扩张型心肌病和CHF患者参加结构化TM计划与常规体重自我控制和心力衰竭药物治疗依从性显著增加有关。
{"title":"[Development and implementation of a heart failure telemonitoring system: the single centre experience].","authors":"V. Agapov, Y. Kudryashov, I. V. Graifer, V. Samitin","doi":"10.18087/cardio.2022.5.n1825","DOIUrl":"https://doi.org/10.18087/cardio.2022.5.n1825","url":null,"abstract":"Aim      To evaluate the efficacy of remote monitoring by the compliance with body weight control and drug therapy in patients with CHF, using a specially developed software module for chronic heart failure (CHF) monitoring.Material and methods  During 2018-2020, 79 patients with dilated cardiomyopathy (mean age, 36.1 [34.2; 38.4] years) and NYHA II-IV functional class CHF were included in the outpatient telemonitoring (TM) program.Results The duration of monitoring was 965 [768; 1065] days. During the monitoring time, the compliance with outpatient body weight control significantly improved: 73.3 [70; 80] % at baseline vs. 86.7 [76.7; 86.7] % at the end of the 31st month (p<0.001). The proportion of patients measuring their body weight at least 6 times a week significantly increased: 8.9 % at baseline vs. 58.1 % by the end of the monitoring (p<0.001). There was no significant association between the time-related changes in the compliance with body weight control and drug therapy and the patient's gender. In addition, during long-term TM, a small but statistically significant increase in left ventricular ejection fraction was noted (36.3 [35.5; 37.2] % at baseline vs. 37.2 [35.8; 38.3] % at the end of monitoring; p=0.0008). The involvement of staff physicians in the remote correction of therapy for CHF decreased during the study: the number of system notifications that required a physician's response reduced over two years from 26.6 to 13 % (p=0.011).Conclusion      Participation of patients with dilated cardiomyopathy and CHF in the structured TM program was associated with a significant increase in the compliance with regular self-control of body weight and drug therapy for heart failure.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":"64 1","pages":"45-52"},"PeriodicalIF":0.0,"publicationDate":"2022-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86975171","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}
引用次数: 1
[Clinical case of the cardiovascular system involvement in a patient with Charcot-Marie-Tooth disease]. [腓骨肌萎缩症患者心血管系统受累的临床病例]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1810
D. Sokolov, E. Zhelyakov, V. V. Koval’chuk, N. V. Kondratova, V. A. Snezhitskij, L. V. Kalatsei, Y. Belenkov, A. Ardashev
Hereditary motor and sensory type 1A neuropathy (known as Charcot-Marie-Tooth disease) is a disease of peripheral nerves characterized by symptoms of progressive polyneuropathy with preferential damage of distal extremity muscles. Damage to the cardiovascular system is extremely rare and heterogenous in this pathology. This disease is not included in the list of indications for interventional antiarrhythmic aid. We could not find in available literature a clinical description of the development of sinus node dysfunction associated with this pathology. The present clinical report presents a case of detection and successful treatment of a damage to the cardiovascular system that manifested itself as sinus node dysfunction/sick sinus syndrome in the tachy-brady variant. A combination treatment approach using radiofrequency catheter ablation, implantation of a permanent pacemaker, and antiarrhythmic therapy associated with drug and non-drug treatment of motor sensory neuropathy resulted in recovery and long-term maintenance of sinus rhythm as well as in beneficial changes in the patient's neurological status.
遗传性运动和感觉1A型神经病(又称charcott - marie - tooth病)是一种周围神经疾病,其特征是进行性多神经病变,优先损害远端肢体肌肉。在这种病理中,对心血管系统的损害是极其罕见和异质性的。此病不包括在介入抗心律失常辅助的适应症清单中。我们无法在现有文献中找到与此病理相关的窦结功能障碍发展的临床描述。目前的临床报告提出了一个病例的检测和成功的治疗损害心血管系统表现为窦结功能障碍/病态窦综合征的变异型。采用射频导管消融、植入永久性起搏器、抗心律失常治疗以及运动感觉神经病变的药物和非药物治疗相结合的联合治疗方法,可恢复和长期维持窦性心律,并使患者的神经状态得到有益的改变。
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引用次数: 0
[Adherence of patients with atrial fibrillation after acute coronary syndrome to antithrombotic therapy at stage III of cardiac rehabilitation: data from the local register of the Kirov region]. [急性冠状动脉综合征后房颤患者心脏康复期抗血栓治疗的依从性:来自基洛夫地区当地登记的数据]。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1779
E. Tarlovskaya, J. Dorofeeva
Aim      To evaluate the quality of antithrombotic therapy (ATT) in patients with atrial fibrillation (AF) after acute coronary syndrome (ACS) at stage 3 of rehabilitation.Material and methods  The registry included 163 patients with AF (mean age, 65.0 [59.0; 72.0] years; 55.8 % men) undergoing rehabilitation after ACS (ACS <1 month ago) in the hospital of the Kirov State Medical University.Results Recommendations for 73.6 % of patients on ATT provided upon discharge from the hospital after stage 2 of rehabilitation were consistent with clinical guidelines (CG). During the entire stage 3, 25.8% of patients had acute cardiovascular complications (CVC) or urgent interventions (8.0% died). Furthermore, the ATT was actually consistent with CG only in 9.2 % of patients; in 21.5 %, errors in changing the ATT timing were detected; and in 84.1 %, various mistakes in the control of international normalized ratio were observed. On the whole, 3.6% of patients incorrectly adjusted their ATT independently, and for 15.3%, the attending physician made incorrect APT adjustments.Conclusion      In AF patients after ACS who were undergoing stage 3 of rehabilitation, the quality of the ATT was low despite the recommendations at discharge from the hospital, which depended not only on the patient but also on the attending physician.
目的评价急性冠脉综合征(ACS)后心房颤动(AF)患者康复3期抗血栓治疗(ATT)的质量。材料与方法纳入163例房颤患者(平均年龄65.0 [59.0;72.0)年;55.8%男性)在基洛夫国立医科大学医院接受ACS (ACS <1个月前)后的康复治疗。结果73.6%的患者在康复2期后出院时提供的ATT建议与临床指南(CG)一致。在整个3期,25.8%的患者出现急性心血管并发症(CVC)或紧急干预(8.0%死亡)。此外,只有9.2%的患者的ATT与CG一致;在21.5%中,检测到改变ATT定时的错误;84.1%的人在控制国际标准化比例时出现了各种错误。总体而言,3.6%的患者不正确地独立调整了他们的ATT, 15.3%的患者是主治医生做出了不正确的APT调整。结论ACS后房颤患者在进行3期康复治疗时,尽管出院时推荐房颤质量较低,但这不仅取决于患者,也取决于主治医师。
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引用次数: 0
[Clinical case: early connection of valsartan/sacubitril in the treatment of hypertension]. 【临床病例:缬沙坦/苏比特里早期联用治疗高血压】。
Pub Date : 2022-05-31 DOI: 10.18087/cardio.2022.5.n1977
N. G. Lozhkina, A. Spiridonov
Metabolic syndrome is a disease the World Health Organization has called a new pandemic of the 21st century. Arterial hypertension is one of the criteria for this diagnosis and a determinant of damage to major target organs. The present clinical case demonstrates an experience of treatment of arterial hypertension associated with metabolic syndrome with a valsartan/sacubitril molecular complex.
代谢综合征被世界卫生组织称为21世纪的新流行病。动脉高血压是诊断的标准之一,也是主要靶器官受损的决定因素。本临床病例展示了用缬沙坦/苏比里尔分子复合物治疗与代谢综合征相关的动脉高血压的经验。
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引用次数: 0
期刊
B''lgarska kardiologiia
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