Kardiologiya最新文献

Enhanced cancer treatment efficacy has resulted in a significant increase in the number of cancer survivors after the cure of malignant tumors. However, cardiovascular morbidity, including chronic heart failure, has become the leading cause of death and decreased life expectancy among cancer survivors. This is due, in particular, to the cardiotoxic effects of anticancer drugs and associated factors. Cardioprotective approaches aim to reduce the incidence and severity of cardiotoxicity through the use of cardioprotective agents (e.g., dexrazoxane), liposomal drug delivery systems (e.g., liposomal doxorubicin), and optimization of drug administration schedules. Reducing the cardiotoxicity of cancer treatments is a clinically important goal. Phosphocreatine-based therapy represents a potentially valuable new strategy in this area. In this regard, the study "Multicenter prospective observational study to investigate the experience of using phosphocreatine in combination therapy for heart failure caused by cancer treatment" was initiated. This publication presents the protocol of the observational non-interventional NEOCARD study.

Aim    To compare the effects of two combined antihypertensive therapies on indices of the structural and functional state of the left ventricular (LV) myocardium and intrarenal vascular resistance in patients with arterial hypertension (AH) and prediabetes.Material and methods    The study included 80 patients with poorly controlled AH and prediabetes who were randomized into two groups: patients in group 1 (n=40) received perindopril at a starting dose of 5 mg/day, sustained-release indapamide 1.5 mg/day, and metformin 1000 mg/day; patients in group 2 (n=40) received perindopril 5 mg/day, moxonidine at a starting dose of 0.2 mg/day, and metformin 1000 mg/day. Subsequently, if necessary, the doses of perindopril and moxonidine were titrated to the maximum permissible ones. Prediabetes was diagnosed based on the results of an oral glucose tolerance test. Ultrasound examination of the heart and renal arteries was performed with a SIEMENS ACUSON X 300 ultrasound apparatus (Korea). Statistical analysis was performed using the Statistica 12.0 software (StatSoft Inc., USA).Results    In both groups after 24 weeks of pharmacotherapy, patients who achieved the target blood pressure had statistically significant and comparable improvements in all studied parameters of the structural and functional state of the LV myocardium and intrarenal vascular resistance. In a comparable number of patients in both groups, the treatment was associated with normalization of the LV myocardial geometry and diastolic function. The combination including moxonidine was associated with a significant decrease in fasting plasma insulin that was more pronounced than with the diuretic treatment.Conclusion    In patients with AH and prediabetes, the combination therapy including perindopril, metformin and moxonidine provided a significant improvement in the structural and functional state of the LV myocardium and intrarenal vascular resistance comparable to the improvement produced by a combination of perindopril, metformin and sustained-release indapamide. The combination of an ACE inhibitor, biguanide and moxonidine may in some cases be a preferred pharmacotherapy option for patients with AH and early carbohydrate metabolism disorders due to the observed significant metabolic benefits.

Ischemic heart disease, including previous myocardial infarction (MI), is one of the main causes for the development and progression of heart failure (HF). The presence of HF before MI or the development of HF in the setting of acute coronary catastrophe is an extremely unfavorable prognostic factor leading to a multiple increase in the risk of death and rehospitalization due to HF in the post-infarction period. In 2024, the results of two randomized clinical trials (RCTs) (DAPA-MI and EMPACT-MI) were published, which assessed the effect of sodium-glucose co-transporter type 2 inhibitors (SGLT2i) on clinical outcomes in patients with acute MI. In both studies, the predetermined primary composite endpoint was not achieved. At the same time, it was shown that SGLT2i significantly reduced the risk of hospitalization for HF (empagliflozin) and contributed to the improvement of metabolic outcomes (dapagliflozin). Also, the safety of early initiation of SGLT2i in the acute period of MI was demonstrated. Based on the available results of randomized and observational clinical studies, the working group has substantiated the need for implementing these RCT results into clinical practice and proposed an algorithm for administering SGLT2 to patients with acute MI. Thus, in the presence of compelling anamnestic criteria for the diagnosis or previously diagnosed type 2 diabetes mellitus, and/or chronic kidney disease, and/or HF, continuation or timely initiation of SGLT2i during the hospitalization for index MI is recommended to improve cardiovascular and renal outcomes. Based on the results of RCTs in patients with acute MI and taking into account individual risk factors for the development of HF, the initiation of SGLT2i before discharge may be considered in order to reduce the risk of hospitalization for HF.

Aim      To evaluate the concentration of the WNT signaling cascade proteins (WNT1, -3a, -4, -5a) and the state of the vasculature by photoplethysmography (PPG) in patients with different phenotypes of stable ischemic heart disease (IHD), with obstructive and non-obstructive coronary artery disease (CAD).Material and methods  This cross-sectional observational study included 80 patients (45-75 years old) with a verified diagnosis of stable IHD. Based on the results of coronary angiography or multislice spiral computed tomography coronary angiography, the patients were divided into two equal groups (n=40), with obstructive IHD (oIHD), and ischemia with no obstructive CAD or angina with no obstructive CAD (INOCA/ANOCA). In the oIHD group, men prevailed (67.5%) while in the INOCA/ANOCA group, women prevailed (57.5%). Noninvasive PPG evaluation of the vasculature was performed, and WNT1, -3a, -4, and -5a concentrations were measured by ELISA in all patients.Results Higher concentrations of the WNT1 and WNT3a proteins were found in patients with oIHD (p<0.001) while the INOCA/ANOCA group had a significantly higher concentration of WNT5a (p=0.001). According to the PPG data, the arterial stiffness index (aSI) significantly differed between the INOCA/ANOCA (7.6 m/s [6.6; 9.35]) and oIHD (9.25 m/s [7.88; 10.33]) groups, p=0.048). The correlation analysis revealed a relationship between WNT1 and the reflectance index RI (ρ=0.359; p=0.014) in IHD patients (oIHD+INOCA/ANOCA). According to the ROC analysis, the curve for WNT3a turned out to be diagnostically significant (sensitivity and specificity of the model were 85.7 and 87.0%, respectively). The cut-off value of WNT3a was 0.183 pg/ml.Conclusion      The results of the study showed that the activation of the canonical WNT cascade (WNT1 and WNT3a) was observed in patients with oIHD, while the non-canonical cascade (WNT5a) was activated in patients with INOCA/ANOCA. The obstructive IHD phenotype can be predicted with a WNT3a value ≥0.183 pg/ml.

Abstracts of the National Congress with international participation "Heart Failure 2024". Moscow, 07.12.2024 - 09.12.2024.

Aim      To study the role of early blood tests using the polymerase chain reaction (PCR) (before or at initial stages of antibacterial therapy, within the first 24-48 hours after diagnosis) for the diagnosis of infective endocarditis (IE) and improvement of the etiological algorithm.Material and methods  The study included 154 patients with confirmed IE (DUKE, 2015) who underwent standard microbiological (culture) blood tests with a simultaneous molecular biological test (PCR study/sequencing) on the same type of biological material at the stage of primary diagnosis.Results In 117 (76.0%) examined patients, the etiologic agent was determined in blood samples by any of the methods used. Concordant results were obtained in 43 (36.8%) patients and discordant in 4 (3.4%) patients. In 29 (24.8%) patients, the causative agent of IE was determined only by the microbiological (cultural) examination of blood samples, and in 25 (21.4%) patients, only by the PCR study, including 3 cases of Bartonella spр. 23 patients had results of the microbiological (culture) blood tests that required clarification (70% CoNS, 26% gram-negative bacteria, one case of Enterococcus faecalis); 16 (69.6%) of 23 were not confirmed by the molecular biological method and were interpreted as contamination. In 1/3 of patients, the PCR blood study allowed increasing the accuracy of determining the causative agent of IE. Based on the integrated approach to the etiological diagnosis of IE, criteria for determining the causative pathogen were developed. This allowed reclassifying 9 (5.9%) diagnoses into the category of confirmed IE and to de-escalate the antibacterial therapy in every third examined patient. The microbiological and PCR studies of blood demonstrated comparable indexes of sensitivity, specificity and diagnostic accuracy [79.0, 86.0, 81.0% and 67.0, 93.0, 74.0%, respectively]. The PCR study of blood at the early stages of IE diagnosis (before or during the initial antibacterial therapy, within the first 24-48 hours after the IE diagnosis) is proposed as a control for Streptococcus spp., Staphylococcus aureus, CoNS, Enterococcus spр., and at the later stages of laboratory examination, especially in IE with an unspecified pathogen, as a priority method.Conclusion      The PCR study of blood samples is a highly informative method for the etiological diagnosis of IE that allows increasing the accuracy of the pathogen identification in every third patient and, thus, prescribing an effective antibacterial therapy.

Aim    To evaluate the efficacy of the I NEED HELP scale in determining the six-month prognosis for patients on the heart transplant waiting list (HTWL) of the Almazov National Medical Research Center of the Russian Ministry of Health.Material and methods    This retrospective study included 42 patients from the HTWL. The patients' survival for more than 6 months was assessed. The composite end point (CEP) of adverse outcome was all-cause death, heart transplantation (HT) due to the increased urgency of surgical intervention according to UNOS within 6 months after the inclusion in the HTWL. Patients were evaluated using the I NEED HELP scale. Statistical analysis was performed by nonparametric methods.Results    The median I NEED HELP score was 4 [from 1 to 7]. The increase in score was positively correlated with the incidence of adverse outcomes (r=0.5; p=0.0007). The group of patients with an unfavorable outcome had a median score higher by one than for the survivors (score 5 vs. 4, respectively; p=0.001). The greatest effect on the prognosis was exerted by low systolic blood pressure (SBP) (p=0.003); the failure to increase or the necessity to decrease the doses of disease-modifying drugs (p=0.039); and target organ dysfunction (p=0.039). The sensitivity and specificity of the scale at a score 5 or higher were 100% and 84%, respectively.Conclusion    This pilot study demonstrated the efficacy of the I NEED HELP scale in a patient population from a specialized center HTWL with high sensitivity and specificity at the determined threshold score 5 for an unfavorable outcome. It is appropriate to continue the study with an expanded sample and validation of the scale on patient cohorts from hospitals of various healthcare system levels.

Aim      To identify predictors for the risk of in-hospital death and to develop a prognostic scale for individual risk of death in patients with acute coronary syndrome (ACS) at the hospital stage of treatment.Material and methods  A sequential retrospective analysis was conducted, including 225 patients with ACS (n=101, main group of patients who died in hospital; n=124, control group) hospitalized in the Regional Vascular Center #2 of the Semashko Nizhny Novgorod Regional Clinical Hospital from January, 2021 through July, 2022. Clinical, demographic, laboratory and instrumental characteristics of patients were studied. Statistical analysis was performed using the Statistica version 10.0 and MedCalc version 20.0 software. The cutoff threshold for quantitative variables was determined by ROC analysis. Potential outcome predictors were identified by a univariate logical regression analysis followed by the construction of a multivariate model for predicting in-hospital mortality using the stepwise analysis with backward inclusion. The prognostic degree of a predictor was expressed as an odds ratio (OR) with a 95% confidence interval (CI). Differences were considered statistically significant at p<0.05. For each variable of the multivariate regression model, an individual score was calculated using a linear transformation of the beta coefficients of each variable.Results Seven independent predictors of hospital death were identified in patients with ACS: Killip class II or higher acute heart failure (AHF) (OR 5.96; 95% CI 1.82-19.48; p=0.0031), low hemoglobin ≤127 g/l (OR 3.75; 95% CI 1.39-10.07; p=0.0087), elevated blood glucose on admission ≥9.7 mmol/l (OR 4.86; 95% CI 1.55-15.21; p=0.0065), high body mass index (BMI) ≥32 kg/m2 (OR 7.18; 95% CI 2.65-19.42; p=0.0001), high pulmonary artery systolic pressure (PASP) ≥38 mmHg (OR 3.95; 95% CI 1.48-10.51; p=0.0059), reduced left ventricular ejection fraction (LVEF) according to Simpson (%) ≤42% (OR 5.80; 95% CI 2.15-15.68; p=0.0005), reduced glomerular filtration rate (GFR) according to CKD-EPI ≤55 ml/min (OR 5.75; 95% CI 2.16-15.28; p=0.0005). An individual score was calculated for each predictor. The total score of all predictors formed a scale that was ranged from score 0 to 43 with a cutoff threshold of 14, where a result >14 indicated a high probability of in-hospital death. This scale has a high prognostic potential with the sensitivity 93.07%, specificity 86.29%, and the area under the curve (AUC) 0.957.Conclusion      Based on the obtained multifactorial model that included 7 major predictors, a scale (scoring system) was developed for predicting the risk of death for ACS patients at the hospital stage of treatment. This scale allows fast identification of patients with a high risk of in-hospital death with a high prognostic accuracy in real clinical practice.

Artificial intelligence (AI) has an enormous potential for improving the quality of medical care, diagnostic methods, and treatments. AI allows taking scientific research to a fundamentally new level. The article addresses the most important areas of using AI in cardiology. AI can be used to accelerate making clinical decisions, remote patient monitoring, tomographic image analysis, patient phenotyping, including metabolomic analysis, to assess the risk of complications and many other areas.

Background    The quality of life of the patient is diminished by chronic heart failure (CHF), which also costs the healthcare system. This study examined the benefits of individualized nutritional support provided by a specialized nursing team on the nutritional status and cardiac function of elderly patients with CHF.Material and methods    This study included 102 elderly, hospitalized CHF patients. The patients were randomly assigned to two groups of 51 each. During the study protocol, the control group received regular nursing care, while the experimental group received individualized nutritional support by a specialized nursing team. Nutritional-related and cardiac function indicators, inflammatory factors, and life quality scores measured before and after the protocol were compared.Results    There was a significant increase in total albumin, hemoglobin, and protein in both groups during the protocol, but the final concentrations were significantly higher in the experimental group (p<0.05). In both groups, the left ventricular ejection fraction was increased after the protocol, while the left ventricular end-systolic dimension and the left ventricular end-diastolic dimension significantly decreased. The improvements in these variables were greater in the experimental group (p<0.05). The experimental group also exhibited significantly reduced tumor necrosis factor-α, interleukin-6, and high sensitivity C-reactive protein (p<0.05), and the experimental group reported higher quality of life (p<0.05) and nursing satisfaction (p<0.05).Conclusion    Nutritional support of elderly CHF patients administered by a specialized nursing team improved nutrition, cardiac function, inflammatory status, and quality of life compared to standard nutrition and regular nursing care.