Kardiologiya最新文献

Objective    To evaluate the impact of radiofrequency catheter ablation versus conservative medical therapy on long-term survival, cardiac function, and clinical outcomes in patients with heart failure (HF) and atrial fibrillation (AF).Material and methods    The records of 328 patients with HF and AF treated at our institution from January 2015 through December 2020 were retrospectively analyzed. Included were165 patients in a radiofrequency ablation group and 163 patients in a medical therapy group. The primary endpoint was all-cause mortality, and secondary endpoints included cardiovascular death, HF hospitalization, cardiac function improvement, and AF recurrence, among others. The median follow-up time was 45 mos (range 12-60 mos). Survival analysis was performed using the Kaplan-Meier method, and independent predictive factors were evaluated with Cox proportional hazards regression models.Results    The radiofrequency ablation group had higher 5 yr survival rates compared to the medical therapy group (p=0.021), with lower 5 yr cardiovascular mortality (p=0.024). The ablation group had a lower HF hospitalization rate (p=0.008). At 12 mos post-procedure, the ablation group had an increase in left ventricular ejection fraction (LVEF) of 8.3±6.4 % from baseline, while the medical therapy group increased only 0.4±4.2 % (p<0.001). In the ablation group, 72.7 % of the patients had an LVEF increase ≥5 %, compared to 28.2 % in the medical therapy group (p<0.001). The 60 mo AF-free rate was 68.5 % in the ablation group, higher than the 21.5 % in the medical therapy group (p<0.001). Multivariate analysis showed that radiofrequency ablation was an independent protective factor for all-cause mortality (p=0.031). Patients with paroxysmal AF had lower baseline LVEF than those with persistent AF (p=0.003), with AF duration, ventricular rate, concomitant coronary artery disease, and BNP concentrations as independent correlates.Conclusion    Radiofrequency catheter ablation can improve long-term survival, cardiac function, and quality of life in patients with HF and AF, while reducing HF hospitalization events. Radiofrequency ablation represents an important treatment option for this patient population.

Objective        This study aimed to investigate the effects of exercise snacking (ES) on body composition, carotid-femoral pulse wave velocity (cfPWV), and serum resistin in male and female obese college students.Material and methods    A total of 50 male and 50 female college students, each with a body mass index (BMI) ≥28 kg / m², were enrolled in the study. The male and female groups were each further divided into an exercise snacking group (ES group, n=25) and a moderate-intensity, continuous training group (MICT group, n=25). The ES group conducted two 5 min high-intensity interval training (HIIT) sessions and one 30 min session of aerobic exercise incorporating HIIT elements daily, while the MICT group performed 45 min of running at the maximal fat-burning intensity each day. All participants were tested for body composition, including body weight (BW), body mass index (BMI), body fat mass (BFM), trunk fat mass (TFM), skeletal muscle mass (SMM), arterial stiffness, and serum resistin concentrations before and after a 12 wk exercise program. Arterial stiffness was evaluated by measuring carotid-femoral pulse wave velocity (cfPWV).Results    After the exercise program, the ES and the MICT groups both had reduced BW, BMI, BFM, and TFM (p<0.01). Only in the ES group, were significant changes observed in SMM, cfPWV, and serum resistin, (p<0.01). Pearson correlation analysis revealed that for obese male students, changes in serum resistin correlated positively with cfPWV (r=0.67, p<0.01) and negatively with the increase in muscle mass (r=-0.68, p<0.01). For obese female students, changes in serum resistin tended to show a positive correlation with TFM, however, no statistically significant difference was observed (r=0.35, p=0.09). There was a positive correlation with cfPWV (r=0.44, p<0.05), and a negative correlation with the increase in muscle mass (r=-0.90, p<0.01).Conclusion    An ES protocol can serve as an effective exercise strategy to help obese college students significantly improve their body composition and cfPWV indicators of arterial stiffness.

Aim: To evaluate the clinical, functional and prognostic outcomes, including left ventricular (LV) reverse remodeling, of combining percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) in patients with ischemic cardiomyopathy (ICM) and reduced left ventricular ejection fraction (LVEF).

Material and methods: ICM with significantly reduced LVEF remains one of the severe forms of chronic heart failure (CHF), associated with a high risk of adverse outcomes. The choice of the optimal treatment strategy, coronary revascularization in addition to intensive medical therapy, is a subject of active discussion and requires further study, especially regarding its effect on LV reverse remodeling and long-term prognosis. This retrospective cohort study included 561 patients with ICM and LVEF <40%. The follow-up lasted from 2014 through 2024. 74% of the patients were men aged 61.4±8.7 years. Patients were divided into a revascularization group (PCI+OMT, n=281) and an OMT group (n=280). The structural and functional state of the heart was assessed using transthoracic echocardiography (ECHO) with standard protocols.

Results: The OMT group had a significantly higher EuroSCORE II surgical risk (4.0±1.9% vs. 3.0±1.5% in the PCI+OMT group; p<0.05), a greater prevalence of stage III or higher chronic kidney disease (35.7% vs. 17.8%; p<0.05), and more severe LV dilatation (LV end-diastolic volume 265±54 ml vs. 245±45 ml; p<0.05). The PCI+OMT group presented with significantly higher anatomical lesion complexity compared to the OMT group (SYNTAX Score 33.5±8.8 vs. 28.9±9.7, p<0.05). At the 24-month follow-up, the PCI+OMT group demonstrated a superior improvement in LVEF (+10.7±6.8% vs. +2.1±4.5%, p<0.001). The proportion of patients with severe mitral regurgitation (III+) was lower in the PCI+OMT group (5.3% vs. 16.1%, p<0.001), and overall mortality was 10.7% vs. 23.2% in the OMT group (p<0.001). The CHF-related hospitalization rate was also significantly lower in the PCI+OMT group than in the OMT group (17.8% vs. 33.9%; p<0.001).

Conclusion: The combination of PCI and OMT is associated with a pronounced recovery of myocardial contractility, reverse LV remodeling, and regression of functional mitral regurgitation. The structural changes in the myocardium achieved through the integrative approach translate into a significant reduction in overall mortality and hospitalizations rates due to decompensated CHF during mid-term follow-up.

Background    Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute myocardial infarction (AMI) in young women, with hormonal factors potentially playing a significant role.Case summary    A 32 year-old woman taking combined oral contraceptives for four months presented with acute chest pain and ST-segment elevation. Coronary angiography revealed diffuse LAD narrowing that improved after intracoronary nitroglycerin. Follow-up optical coherence tomography at 6 weeks confirmed intramural hematoma consistent with SCAD. Conservative management was pursued. At one-year follow-up, the patient had recovered with normalized left ventricular function.Conclusion    Clinicians should be highly suspicious of SCAD in young women with ACS or AMI, particularly those using oral contraceptives. Early identification with appropriate imaging can lead to favorable outcomes.

Aim: To evaluate the feasibility of stress echocardiography (stress-ECHO) with an extended protocol in the diagnosis of hemodynamically significant coronary artery disease (CAD) and in the differential diagnosis of different phenotypes of chronic coronary syndromes.

Material and methods: This observational study enrolled 454 patients (60.79% men, mean age 61.2±9.8 years) with established (n=191; 42.07%) or suspected (n=263; 57.93%) ischemic heart disease (IHD). The stress-ECHO protocol assessed left ventricular (LV) regional wall motion abnormalities (RWMA) (A), B-lines (B), contractile reserve (LVCR) (C), coronary flow reserve (CFR) (D), heart rate (HR) reserve (E), global longitudinal strain (GLS), and diastolic function. Based on multislice computed tomography/coronary angiography with fractional flow reserve (if necessary), patients were categorized into four phenotypes: Group 0, non-obstructive hemodynamically insignificant CAD (conditional normal; n=118; 26.0%); Group 1, non-obstructive hemodynamically significant CAD (microvascular IHD; n=84; 18.5%); Group 2, obstructive hemodynamically insignificant CAD (obstructive coronary atherosclerosis; n=107; 23.6%); and Group 3, obstructive hemodynamically significant CAD (obstructive IHD; n=145; 31.9%). Significance was set at p=0.05.

Results: The groups differed significantly in maximum CAD percentage (p<0.0001 for all) and number of CA with ≥50% stenosis (p<0.05 for all). Detection of hemodynamically significant CAD was associated with chest pain, ST segment depression, RWMA, reduced HR reserve, CFR, lower LV stroke volume, diastolic dysfunction, and higher total protocol scores. In multivariate regression analysis, RWMA (chi-square 92.75; p<0.0001) and CFR (chi-square 38.95; p<0.0001; sensitivity 95.2%, specificity 73.9%, diagnostic accuracy 85.4%) were included in the model as predictors of ischemia. The ABCDE stress ECHO protocol did not allow identifying patients with ischemia caused by obstructive lesions of the main coronary arteries among those with hemodynamically significant CA disease. Differentiation of patients based on the severity of coronary artery (macro- or microvascular) damage was only possible by LV GLS ≤17.5% at the peak of the test (AUC 0.66; 95% confidence interval 0.58-0.74; p<0.001).

Conclusion: The extended ABCDE stress-ECHO protocol in a modern cohort of individuals with chest pain reliably identifies hemodynamically significant CAD, but fails to differentiate between obstructive and non-obstructive lesions. Differentiation based on the severity of CA damage was only possible using a peak stress LV GLS.

Aim: To assess central arterial pressure (CAP) in young overweight women accounting for their arterial hypertension (AH) phenotype derived from 24-hour ambulatory blood pressure monitoring (ABPM) data.

Material and methods: The study included 145 women aged 18 to 35 years with excess (n=104) and normal (n=41) body weight (BW). All subjects underwent office blood pressure (BP) measurement and ABPM with an oscillometric sensor using a BPLab Vasotens device (Petr Telegin LLC, Nizhny Novgorod) with an additional diagnostic option for determining CAP. Group 1 consisted of normotensive women with normal body weight (n=41). Among women with overweight and obesity, the following comparison groups were formed based on ABPM results: Group 2, sustained normotension (n=30), Group 3, "white coat" hypertension (WCH, n=10), Group 4, masked hypertension (n=32), and Group 5, sustained AH (n=32). CAP was evaluated in these groups, including Group 1 of age-matched normotensives with normal body weight. This allowed identifying the following conditions: sustained combined normotension; isolated peripheral hypertension; isolated central hypertension (CH); combined CH with office AH; combined CH with ambulatory AH; and sustained combined hypertension.

Results: CH was detected in almost 10% of Group 1 normotensive women with normal body weight. In normotensive women but with overweight and obesity (Group 2), CH was found in almost half of the examined subjects. Elevated CAP incidence in overweight and obese young women varied by ABPM phenotype of AH appearing in practically a third of WCH cases, and nearly all cases of masked or sustained AH. In our sample, CH was detected in 2 out of 3 overweight women. Analysis of the prevalence of AH hemodynamic variants showed that among the examined women with and without overweight, women with isolated CH (comprising 13% of the cohort) were predominantly overweight (78%). Correlation analysis indicated that increased BMI and waist circumference significantly influenced intra-aortic pressure, linking metabolic risk factors with central and peripheral hemodynamicsConclusion: For young women with overweight or obesity, preventive strategies should include, in addition to measuring office and ambulatory BP, wider implementation of CAP assessment, even if they are initially normotensive, due to their high risk of elevated aortic pressure, despite their young age. Furthermore, CH may affect roughly 10% of normotensive, normal-weight peers. Consequently, this prevalence should be addressed during management of this patient group within primary healthcare settings, including health centers, student polyclinics, and prevention departments (offices).

Aim: To assess the incidence, severity, and predictors of functional atrial mitral regurgitation (FAMR) and its impact on outcomes in patients with heart failure with preserved ejection fraction (HFpEF) depending on the presence of atrial fibrillation (AF).

Material and methods: Data from 218 patients with HFpEF and FAMR hospitalized between 2020 and 2023 were analyzed retrospectively. The median follow-up period was 589 days.

Endpoints: rehospitalization for heart failure (HF), cardiovascular death (CVD), and the composite endpoint (CE).

Results: Moderate FAMR was detected in 53.3% of patients with AF, and severe FAMR in 15.3%, which was significantly higher than the incidence in patients with sinus rhythm (SR) (24.5% and 8.0%, respectively, p<0.001). In the subgroup with AF, severe FAMR was associated with a 4.1-fold increased risk of rehospitalization for HF (95% confidence interval (CI): 1.7-10.2, p=0.002) and a 2.6-fold increased risk of CE (95% CI: 1.4-4.9, p=0.002). In patients with SR, no statistically significant association between FAMR and clinical outcomes was found.

Conclusion: FAMR in AF is an independent predictor of poor prognosis in patients with HFpEF. This highlights the importance of rhythm control as a pathogenetic strategy for this patient category.

Aim: To evaluate the diagnostic significance of a microRNA panel (-21, -29a, -133a) in patients with hypertrophic cardiomyopathy (HCM) by comparing their expression levels to a group with moderate arterial hypertension (comparison group).

Material and methods: A comparative study was conducted involving 80 individuals: 40 patients with confirmed HCM and 40 sex- and age-matched controls (22 men, 18 women, mean age 55.3±13.3 years). All participants underwent a comprehensive examination at the cardiology department, including electrocardiography (ECG), echocardiography with full assessment of intracardiac hemodynamic parameters, Holter ECG monitoring, and laboratory tests. For molecular biological analysis, plasma expression levels of circulating microRNAs (-21, -29a, -133a) were determined for all participants using real-time polymerase chain reaction.

Results: Circulating microRNA levels differed significantly between patients with HCM and the comparison group. The analysis showed a significant increase in the microRNA-21 expression (4.07 vs. 2.03; p<0.001) and significant decreases in microRNA-29a (0.24 vs. 1.83; p<0.001) and microRNA-133a (0.02 vs. 6.34; p<0.001). ROC analysis demonstrated a high discriminatory ability of the studied microRNAs: microRNA-21 (AUC=0.887, sensitivity 89.7%, specificity 84.4%); microRNA-29a (AUC=0.884, sensitivity 92.3%, specificity 87.5%).

Conclusion: Increased expression of microRNA-21 and decreased expression of microRNA-29a are associated with myocardial fibrosis, while marked suppression of microRNA-133a reflects hypertrophic remodeling. These findings suggest that this microRNA panel holds promise as potential auxiliary markers for HCM, though clinical significance requires validation in larger, prospective studies.

Aim: To evaluate the effect of inclisiran therapy on the blood lipid profile 90 days post-injection and to describe the baseline structural and ultrasound characteristics of carotid and femoral plaques in high- and very high-risk patients who failed to achieve low-density lipoprotein cholesterol goals despite ongoing lipid-lowering treatment.

Material and methods: This prospective observational single-center study included 22 patients (mean age 50.9±8.6 years, 50% men) with dyslipidemia and atherosclerotic plaques in peripheral arteries narrowing the lumen by 25-49%. Familial hypercholesterolemia was diagnosed in 59% of patients, and statin intolerance in 36%. Duplex scanning of the carotid and femoral arteries was performed. The gray-scale median (GSM) method is currently used for the quantitative assessment of carotid artery (CA) plaque echogenicity. Inclisiran was administered on day 1, day 90, and then every six months. Blood lipid profiles, including low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), triglycerides, and lipoprotein (a) [Lp(a)], were assessed.

Results: At baseline, median concentrations were 3.7 [2.5; 5.4] mmol/l for LDL-C, 5.4 [4.4; 6.8] mmol/l for TC, and 22.0 [5.0; 108.0] mg/dl for Lp(a). Carotid artery evaluation showed a median of 4.0 [2.0; 4.0] plaques, total stenosis of 110% [63.8; 118.8], and a GSM of 38.6 [28.6; 52.4], with a predominance of heterogeneous plaques (59%). Femoral artery assessment revealed a median of 2.0 [2.0; 3.0] plaques, 75% [42.5; 111.3] total stenosis, and a minimum echogenicity of 41.5 [33.4; 57.4] gray-scale units, with 65% heterogeneous plaques. Ninety days post-initiation of inclisiran, LDL-C was reduced by 65% (to 1.3 [1.2; 2.9] mmol/L, p<0.01), TC by 30% (p<0.01), triglycerides by 35%, and Lp(a) by 33%.

Conclusion: Inclisiran demonstrated high efficacy in reducing LDL-C levels in patients at high and very high risk of cardiovascular disease who failed to reach targets with standard therapy. The identified plaque characteristics indicate a high risk of atherothrombosis in this cohort. The dynamics of these structural plaque changes will be assessed after completing the one-year follow-up.

Objective        To develop and validate an early diagnostic prediction model for acute coronary syndrome (ACS) in patients with chest pain; thus providing scientific evidence for clinical decision-making.Material and methods    A retrospective cohort study design was employed, including 480 chest pain patients who presented to the emergency department from January 2020 to January 2025. The patients were randomly divided into a modeling set (336 cases) and a validation set (144 cases) at a 7:3 ratio. Data collected included demographic characteristics, clinical symptoms and signs, medical history, laboratory tests, electrocardiogram, and imaging examinations. Univariate and multivariate logistic regression analyses were used to screen independent predictors and establish the prediction model. Model performance was evaluated through receiver operating characteristic (ROC) curves, Hosmer-Lemeshow test, and Bootstrap resampling, and a simplified risk scoring system was established.Results    Multivariate logistic regression analysis showed that elevated cTnI (OR=17.231), ST-segment changes (OR=8.451), typical chest pain (OR=4.047), age ≥60 years (OR=2.441), smoking history (OR=2.103), sweating (OR=1.931), male sex (OR=1.799), and pain duration >30 min (OR=1.689) were independent predictors of ACS (all p<0.05). The area under the curve (AUC) of the model in the modeling set and vali-dation set were 0.921 (95 %CI: 0.890-0.952) and 0.908 (95 %CI: 0.857-0.959), respectively, with sensitivities of 86.4 % and 82.9 %, and specificities of 89.7 % and 87.4 %, respectively. The Hosmer-Lemeshow test indicated good model calibration (modeling set p=0.609, validation set p=0.776). The established risk scoring system (0-20 points) classified patients into four risk stratifications: low risk (0-4 points, ACS incidence 3.8 %), moderate risk (5-8 points, 23.1 %), high risk (9-12 points, 62.2 %), and very high risk (13-20 points, 91.9 %), with an optimal cutoff value of 8 points (Youden index 0.716).Conclusion    The ACS early diagnostic prediction model established in this study incorporated eight readily accessible clinical variables and demonstrated good discrimination and calibration. The risk scoring system based on this model is simple and practical. This scoring system can effectively perform risk stratification and provide a valuable clinical tool for early diagnosis and risk assessment of chest pain patients.