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[Management Strategy for Patients With Idiopathic Recurrent Pericarditis. Position Statement of the Experts of the Russian Society оf Cardiology and Eurasian Association of Therapists]. [特发性复发性心包炎患者的管理策略。俄罗斯心脏病学会和欧亚治疗师协会专家立场声明]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2766
G P Arutyunov, O L Barbarash, N N Vezikova, A S Galyavich, I V Zhirov, S K Zyryanov, N A Koziolova, O M Moiseeva, Ya A Orlova, M M Petrova, N G Poteshkina, E I Tarlovskaya, S N Tereshchenko, A I Chesnikova

Pericarditis as an inflammatory heart disease is rarely discussed in the cardiology community. The latest European guidelines on pericarditis were published in 2015, and Russian clinical guidelines are dated 2022. However, in recent years, a number of publications have appeared that have forced the scientific community to take a fresh look at this problem. This is mainly due to a change in the paradigm of the treatment of idiopathic recurrent pericarditis (IRP) registered in the Russian Federation as a rare (orphan) disease. According to most experts, IRP is an underestimated cardiac disease, which, due to the lack of specific symptoms and the physicians' alertness regarding the IRP diagnostics, is rarely the subject of scientific discussions. The issues of diagnosis and therapy of IRP in light of the latest reports became the matter under discussion for a group of leading Russian experts chaired by Corresponding Member of the Russian Academy of Sciences, Professor G.P. Arutyunov.

心包炎作为一种炎症性心脏病,在心脏病学界鲜有讨论。欧洲关于心包炎的最新指南发布于 2015 年,而俄罗斯的临床指南发布于 2022 年。然而,近年来出现的一些出版物迫使科学界重新审视这一问题。这主要是由于在俄罗斯联邦登记为罕见病(孤儿病)的特发性复发性心包炎(IRP)的治疗模式发生了变化。大多数专家认为,特发性复发性心包炎是一种被低估的心脏疾病,由于缺乏特异性症状和医生对特发性复发性心包炎诊断的警觉性,这种疾病很少成为科学讨论的主题。在俄罗斯科学院通讯院士 G.P. Arutyunov 教授的主持下,俄罗斯著名专家小组讨论了根据最新报告对 IRP 进行诊断和治疗的问题。
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引用次数: 0
[Drug-Eluting Stents - a Panacea for Everyone or Not? Commentary on the Paper «Perioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder Cancer»]. [药物洗脱支架--是否人人适用?原发性中晚期直肠癌、胃癌和膀胱癌患者围手术期心肌梗死和成功血管再通》一文的评论。]
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2772
I V Pershukov

The article discusses long-term safety of drug-eluting stents in emergent coronary revascularization.

文章讨论了药物洗脱支架在紧急冠状动脉血运重建中的长期安全性。
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引用次数: 0
[Perioperative Myocardial Infarction and Successful Revascularization in Patient With Primary Metasynchronic Rectal, Gastric and Bladder Cancer]. [原发性中晚期直肠癌、胃癌和膀胱癌患者围手术期心肌梗死和成功的血管再通]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2659
V I Potievskaya, V E Choronenko, V B Loenko, A G Rerberg, E R Bagiyan

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.

文章介绍了一例直肠癌、胃癌和膀胱癌原发同步癌患者围手术期非ST段抬高型心肌梗死的临床病例,该病例是在近端胃切除术和腹会阴直肠切除术同时进行的外科手术中发生的。一名患有严重系统性动脉粥样硬化的患者在麻醉和手术阶段出现血压波动和止血系统失衡,导致冠状动脉明显狭窄部位心肌缺血。急诊冠状动脉造影检查发现前降支动脉次完全狭窄,于是对冠状动脉受影响区域进行了支架植入手术。在最佳抗心绞痛治疗期间,对血流动力学参数和止血系统变化的监测使患者脱离了危险状态,并于第18天出院。
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引用次数: 0
[Changes of the Heart Rhythm in Imbalance of Thyroid Gland Hormones and its Morphology in Outbred Rats]. [近交系大鼠甲状腺激素失衡时心律的变化及其形态学]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2675
R F Rakhmatullov, K P Kondratieva, A E Sheina, R E Dementieva, F K Rakhmatullov

Aim: To analyze the relationship between the occurrence of atrial fibrillation (AF) and thyroid dysfunction caused by low concentrations of free triiodothyronine (FT3), free triiodothyronine and free thyroxine (FT3 and FT4), and high concentrations of free thyroxine (FT4) with normal values of thyroid-stimulating hormone (TSH) in experiments on outbred rats.

Material and methods: The pathogenesis of AF with low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 was studied in an experiment on 146 outbred rats. In the experiment, hypothyroidism, euthyroidism, and thyrotoxicosis were modeled by changing the concentrations of thyroid hormones, and the effect of these conditions on ECG and the incidence of AF was evaluated.

Results: The types of the hypothalamic-pituitary-thyroid system response to the L-thyroxine administration in experimental hypothyroidism were identified. A relationship was determined between AF paroxysms and threshold values of thyroid hormones at low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 with normal TSH values. It was shown that achieving the euthyroid status did not reduce the incidence of AF paroxysms by more than 70.0%.

Conclusion: In AF with low FT3, low FT3 and FT4, and high FT4, the dose of L-thyroxine must be adjusted.

摘要:目的:通过对纯种大鼠的实验,分析低浓度游离三碘甲状腺原氨酸(FT3)、游离三碘甲状腺原氨酸和游离甲状腺素(FT3和FT4)以及高浓度游离甲状腺素(FT4)引起的心房颤动(AF)的发生与甲状腺功能障碍之间的关系:以146只近交系大鼠为实验对象,研究了低浓度FT3、FT3和FT4以及高浓度FT4甲状腺功能减退症的发病机制。在实验中,通过改变甲状腺激素的浓度来模拟甲状腺功能减退症、甲状腺功能亢进症和甲状腺毒症,并评估这些情况对心电图和房颤发病率的影响:结果:确定了实验性甲状腺功能减退症患者下丘脑-垂体-甲状腺系统对服用左旋甲状腺素的反应类型。在低浓度FT3、FT3和FT4以及高浓度FT4与正常促甲状腺激素值之间,确定了房颤阵发性与甲状腺激素阈值之间的关系。结果表明,达到甲状腺功能正常状态并不能将房颤阵发性发作的发生率降低 70.0% 以上:结论:对于低FT3、低FT3和FT4以及高FT4的房颤患者,必须调整左旋甲状腺素的剂量。
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引用次数: 0
Metformin Attenuates Myocardial Ischemia-Reperfusion Injury through the AMPK-HMGCR-ROS Signaling Axis. 二甲双胍通过 AMPK-HMGCR-ROS 信号轴减轻心肌缺血再灌注损伤
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2739
He Zhu, Tao Zhu, Dubiao Dubiao, Xinmei Zhang

Objective: To explore the role and mechanism of metformin (MET) in regulating myocardial injury caused by cardiac ischemia-reperfusion.

Material and methods: A rat model of myocardial ischemia-reperfusion injury was established by ligation of the anterior descending branch of the left coronary artery. The myocardial area at risk and the infarction size were measured by Evans blue and 2,3,5‑triphenyltetrazole chloride (TTC) staining, respectively. Terminal Deoxynucleotidyl Transferase-Mediated dUTP Nick End Labeling (TUNEL) staining was used to detect apoptosis of cardiomyocytes. The expression of 4‑hydroxynonenal (4‑HNE) was detected by immunohistochemical staining. Real-time quantitative polymerase chain reaction (RT-PCR) and Western blot were used to detect mRNA and expression of the Adenosine 5'-monophosphate-activated protein kinase (AMPK) - 3‑hydroxy-3‑methylglutaryl-CoA reductase (HMGCR) signaling pathway, respectively.

Results: MET treatment decreased the infarct size and the activity of the myocardial enzyme profile, thus demonstrating protection of ischemic myocardium. The number of TUNEL positive cells significantly decreased. Immunohistochemical results showed that MET decreased the expression of 4‑HNE in myocardial tissue and the content of malondialdehyde (MDA) in myocardial cells. Further experimental results showed that MET decreased HMGCR transcription and protein expression, and increased AMPK phosphorylation. In the model of hypoxia and reoxygenation injury of cardiomyocytes, MET increased the viability of cardiomyocytes, decreased the activity of lactic dehydrogenase (LDH), decreased malondialdehyde content and intracellular reactive oxygen species (ROS) concentrations, and regulate the AMPK-HMGCR signaling pathway through coenzyme C (ComC).

Conclusion: MET inhibits the expression of HMGCR by activating AMPK, reduces oxidative damage and apoptosis of cardiomyocytes, and alleviates myocardial ischemia-reperfusion injury.

目的材料与方法:通过结扎左冠状动脉前降支,建立大鼠心肌缺血再灌注损伤模型:通过结扎左冠状动脉前降支,建立大鼠心肌缺血再灌注损伤模型。用伊文思蓝和 2,3,5-三苯基氯化四氮唑(TTC)染色法分别测量心肌危险面积和梗死面积。末端脱氧核苷酸转移酶介导的 dUTP 镍端标记(TUNEL)染色用于检测心肌细胞的凋亡。免疫组化染色法检测4-羟基壬烯醛(4-HNE)的表达。实时定量聚合酶链反应(RT-PCR)和 Western 印迹分别用于检测腺苷-5'-单磷酸激活蛋白激酶(AMPK)-3-羟基-3-甲基戊二酰-CoA 还原酶(HMGCR)信号通路的 mRNA 和表达:MET治疗缩小了心肌梗死面积,降低了心肌酶谱的活性,从而显示出对缺血心肌的保护作用。TUNEL阳性细胞数量明显减少。免疫组化结果显示,MET 降低了心肌组织中 4-HNE 的表达和心肌细胞中丙二醛(MDA)的含量。进一步的实验结果表明,MET能降低HMGCR的转录和蛋白表达,增加AMPK的磷酸化。在心肌细胞缺氧和再氧损伤模型中,MET可提高心肌细胞的活力,降低乳酸脱氢酶(LDH)的活性,减少丙二醛含量和细胞内活性氧(ROS)浓度,并通过辅酶C(ComC)调节AMPK-HMGCR信号通路:结论:MET通过激活AMPK抑制HMGCR的表达,减少心肌细胞的氧化损伤和凋亡,减轻心肌缺血再灌注损伤。
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引用次数: 0
[Complex Issues in the Management of Pericarditis. In Anticipation of the Release of Updated Recommendations of the European Society of Cardiology]. [心包炎治疗中的复杂问题。在欧洲心脏病学会发布最新建议之前]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2738
M Imazio, Z N Sukmarova, E L Nasonov

With the advent of new diagnostic and therapeutic methods, the management of pericarditis has not become an easier task. The well-studied, but currently rare tuberculosis, bacterial and malignant forms have been joined by pericarditis associated with infection or vaccination against SARS-CoV-2. While 2-3 years ago, cardiologists had to recall the schedule of managing acute viral pericarditis, today its complications are often encountered, including chronic, recurrent, effusive or constrictive pericarditis. The European guidelines were updated 10 years ago and are expected to be issued within the next year. We posed the most pressing questions on the management of pericarditis to the coordinator of the 2015 European Society of Cardiology (ESC) guidelines [1], who will also chair the 2025 ESC guidelines on myocarditis and pericarditis, one of the most cited scientists in the field of inflammatory diseases of the pericardium, Massimo Imazio. He is a Professor in the Department of Cardiology and Anatomy at the University of Turin, runs a school on pericarditis, and has initiated fundamental research of this pathology. We presented his answers with comments of the co-author in the form of a short interview.

随着新诊断和治疗方法的出现,心包炎的治疗也变得越来越容易。与感染或接种 SARS-CoV-2 疫苗相关的心包炎已经加入了结核病、细菌性心包炎和恶性心包炎的行列。两三年前,心脏病学家们还必须重新制定急性病毒性心包炎的治疗计划,而如今却经常会遇到其并发症,包括慢性、复发性、渗出性或收缩性心包炎。欧洲指南已于 10 年前更新,预计将于明年发布。我们向 2015 年欧洲心脏病学会(ESC)指南[1]的协调人、同时也是 2025 年ESC心肌炎和心包炎指南的主席、心包炎症性疾病领域引用率最高的科学家之一马西莫-伊马奇奥(Massimo Imazio)提出了有关心包炎治疗的最迫切问题。他是都灵大学(University of Turin)心脏病学和解剖学系教授,开办了一所心包炎学校,并发起了对这一病理学的基础研究。我们以简短访谈的形式介绍了他的回答以及合著者的评论。
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引用次数: 0
[Free Immunoglobulin Light Chains in Patients With Myocarditis: a New Biomarker of Inflammation and Heart Failure]. [心肌炎患者体内的游离免疫球蛋白轻链:炎症和心力衰竭的新生物标记物]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2700
O V Blagova, Yu A Lutokhina, M V Kozhevnikova, E A Zheleznykh, A Yu Fedorova, E A Kogan

Aim: To study the concentration of immunoglobulin free light chains (FLCs) in patients with myocarditis in comparison with non-inflammatory heart diseases, their relationship with inflammatory markers and the severity of chronic heart failure (CHF).

Material and methods: This study included 77 patients (31 women, mean age 54.1±13.3 years): 41 patients with myocarditis verified by myocardial biopsy (n=18) or using a noninvasive diagnostic algorithm, 31 patients with noninflammatory CHF (comparison group), and 5 patients with monoclonal gammopathy identified during the study (4 of them were diagnosed with AL amyloidosis with heart damage). In the myocarditis group, CHF was diagnosed in 29 patients, mean stage IIA, functional class (FC) 2-3, with a mean left ventricular ejection fraction 43%. In the comparison group, patients had predominantly IIA stage, FC 2-3 CHF without systolic dysfunction. The blood concentration of kappa and lambda FLC types was measured with Cloneus S-FLC-K TIA Kit and Cloneus S-FLC-L TIA Kit. Concentrations were considered normal at FLC-kappa 4.84-14.20 mg/l, FLC-lambda 7.03-22.50 mg/l, and the FLC-kappa/lambda ratio 0.426-1.050.

Results: Increased FLC concentrations were found in 58% of patients with myocarditis and in 77% of patients in the comparison group. The FLC-lambda concentration was significantly higher in the comparison group; there were no significant differences between the groups in FLC-kappa and their ratio. The closest significant correlations in both groups and the entire cohort were noted between FLCs of either type and CHF, as well as the requirement for loop diuretics (correlation coefficients, 0.60-0.90), independent on the severity of systolic dysfunction. Myocarditis patients also showed correlations of FLCs with the titer of antibodies to cardiomyocyte nuclear antigens, levels of C-reactive protein, leukocytes, neutrophils, erythrocyte sedimentation rate, and the concentration of N-terminal fragment of brain natriuretic peptide. In a subgroup of 10 myocarditis patients who were treated with immunosuppressants, FLCs of both types were significantly lower than in the comparison group; only with the persistence of severe CHF was an increase in FLCs noted.

Conclusion: An increased FLC concentration can be considered as an important pathogenesis component that reflects both the specific mechanisms of myocarditis and the severity of CHF. In the absence of a statistically significant increase in general inflammatory markers in the blood of myocarditis patients, the measurement of FLCs can be used as an additional diagnostic marker and predictor of the decompensated variant of the course of myocarditis. However, the diagnostic and prognostic significance of FLC concentration in patients without CHF requires a further study.

目的:研究心肌炎患者免疫球蛋白游离轻链(FLCs)的浓度与非炎症性心脏病的比较,以及它们与炎症标志物和慢性心力衰竭(CHF)严重程度的关系:本研究包括 77 名患者(31 名女性,平均年龄(54.1±13.3)岁):材料: 该研究纳入了 77 名患者(31 名女性,平均年龄(54.1±13.3)岁):41 名通过心肌活检(18 名)或使用无创诊断算法验证的心肌炎患者、31 名非炎症性 CHF 患者(对比组)以及 5 名在研究过程中发现的单克隆丙种球蛋白病患者(其中 4 名被诊断为伴有心脏损伤的 AL 淀粉样变性)。在心肌炎组中,29 名患者被确诊为 CHF,平均为 IIA 期,功能分级(FC)为 2-3,平均左室射血分数为 43%。对比组患者主要为 IIA 期、FC 2-3 级 CHF,无收缩功能障碍。使用 Cloneus S-FLC-K TIA Kit 和 Cloneus S-FLC-L TIA Kit 检测血液中 kappa 和 lambda 型 FLC 的浓度。FLC-kappa浓度为4.84-14.20毫克/升,FLC-lambda浓度为7.03-22.50毫克/升,FLC-kappa/lambda比值为0.426-1.050,即为正常:结果:58%的心肌炎患者和77%的对比组患者发现FLC浓度升高。对比组的FLC-lambda浓度明显较高;各组间的FLC-kappa及其比值无明显差异。在两组和整个队列中,任何一种类型的 FLC 与 CHF 以及对襻利尿剂的需求(相关系数,0.60-0.90)之间都存在最密切的相关性,与收缩功能障碍的严重程度无关。心肌炎患者的 FLCs 与心肌细胞核抗原抗体滴度、C 反应蛋白水平、白细胞、中性粒细胞、红细胞沉降率和脑钠肽 N 端片段浓度也有相关性。在接受免疫抑制剂治疗的 10 例心肌炎患者分组中,两种类型的 FLCs 均显著低于对比组;只有当严重慢性心力衰竭持续存在时,FLCs 才会升高:结论:FLC浓度升高可被视为一个重要的发病机制,它同时反映了心肌炎的特殊机制和CHF的严重程度。在心肌炎患者血液中一般炎症标记物未出现统计学意义上的显著增加的情况下,FLCs 的测量可作为心肌炎病程失代偿变异的额外诊断标记物和预测指标。然而,FLC 浓度对无 CHF 患者的诊断和预后意义还需要进一步研究。
{"title":"[Free Immunoglobulin Light Chains in Patients With Myocarditis: a New Biomarker of Inflammation and Heart Failure].","authors":"O V Blagova, Yu A Lutokhina, M V Kozhevnikova, E A Zheleznykh, A Yu Fedorova, E A Kogan","doi":"10.18087/cardio.2024.10.n2700","DOIUrl":"https://doi.org/10.18087/cardio.2024.10.n2700","url":null,"abstract":"<p><strong>Aim: </strong>To study the concentration of immunoglobulin free light chains (FLCs) in patients with myocarditis in comparison with non-inflammatory heart diseases, their relationship with inflammatory markers and the severity of chronic heart failure (CHF).</p><p><strong>Material and methods: </strong>This study included 77 patients (31 women, mean age 54.1±13.3 years): 41 patients with myocarditis verified by myocardial biopsy (n=18) or using a noninvasive diagnostic algorithm, 31 patients with noninflammatory CHF (comparison group), and 5 patients with monoclonal gammopathy identified during the study (4 of them were diagnosed with AL amyloidosis with heart damage). In the myocarditis group, CHF was diagnosed in 29 patients, mean stage IIA, functional class (FC) 2-3, with a mean left ventricular ejection fraction 43%. In the comparison group, patients had predominantly IIA stage, FC 2-3 CHF without systolic dysfunction. The blood concentration of kappa and lambda FLC types was measured with Cloneus S-FLC-K TIA Kit and Cloneus S-FLC-L TIA Kit. Concentrations were considered normal at FLC-kappa 4.84-14.20 mg/l, FLC-lambda 7.03-22.50 mg/l, and the FLC-kappa/lambda ratio 0.426-1.050.</p><p><strong>Results: </strong>Increased FLC concentrations were found in 58% of patients with myocarditis and in 77% of patients in the comparison group. The FLC-lambda concentration was significantly higher in the comparison group; there were no significant differences between the groups in FLC-kappa and their ratio. The closest significant correlations in both groups and the entire cohort were noted between FLCs of either type and CHF, as well as the requirement for loop diuretics (correlation coefficients, 0.60-0.90), independent on the severity of systolic dysfunction. Myocarditis patients also showed correlations of FLCs with the titer of antibodies to cardiomyocyte nuclear antigens, levels of C-reactive protein, leukocytes, neutrophils, erythrocyte sedimentation rate, and the concentration of N-terminal fragment of brain natriuretic peptide. In a subgroup of 10 myocarditis patients who were treated with immunosuppressants, FLCs of both types were significantly lower than in the comparison group; only with the persistence of severe CHF was an increase in FLCs noted.</p><p><strong>Conclusion: </strong>An increased FLC concentration can be considered as an important pathogenesis component that reflects both the specific mechanisms of myocarditis and the severity of CHF. In the absence of a statistically significant increase in general inflammatory markers in the blood of myocarditis patients, the measurement of FLCs can be used as an additional diagnostic marker and predictor of the decompensated variant of the course of myocarditis. However, the diagnostic and prognostic significance of FLC concentration in patients without CHF requires a further study.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 10","pages":"12-23"},"PeriodicalIF":0.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Percutaneous Coronary Intervention in High-Risk Patients]. [高危患者的经皮冠状动脉介入治疗]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2660
B G Alekyan, Yu M Navaliev

Ischemic heart disease (IHD) with severe coronary artery disease (SYNTAX score >22 points) in combination with various comorbidities is often a reason for refusal of coronary artery bypass grafting in such patients. Thus, a new term has emerged, "high-risk percutaneous coronary intervention"; however, the criteria, indications and results of these interventions have not yet been sufficiently studied. Therefore, according to current clinical guidelines, the treatment tactics for this patient cohort is determined by the decision of a council, the so-called Heart Team. This analytical review summarizes the criteria for high-risk percutaneous coronary interventions based on the literature, and describes the effect of various comorbidities on the results of direct myocardial revascularization.

缺血性心脏病(IHD)伴有严重冠状动脉病变(SYNTAX评分22分),并合并各种并发症,这往往是此类患者拒绝接受冠状动脉旁路移植术的原因。因此,"高风险经皮冠状动脉介入治疗 "这一新术语应运而生;然而,人们对这些介入治疗的标准、适应症和效果尚未进行充分研究。因此,根据目前的临床指南,这类患者的治疗策略由一个委员会(即所谓的心脏小组)决定。这篇分析性综述根据文献总结了高风险经皮冠状动脉介入治疗的标准,并描述了各种合并症对直接心肌血运重建结果的影响。
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引用次数: 0
[4‑Year Experience of the Cardio-Oncology Center of Sechenov University: Single-Center Epidemiological Study]. [谢切诺夫大学心脏肿瘤中心的 4 年经验:单中心流行病学研究]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2768
Yu Yu Kirichenko, I S Ilgisonis, A D Chernichkina, A V Palienko, O I Buduscheva, N N Pakhtusov, N V Khabarova, Yu N Belenkov

Aim: To present the four-year experience and the accomplishments of the Scientific and Practical Cardio-Oncology Center of the Sechenov University.

Material and methods: The records of patients referred for cardio-oncology consultation from January 2020 through March 2024 were retrospectively analyzed. The patients' cardiovascular (CV) status was assessed at baseline and after optimizing the cardiac therapy during the antitumor treatment. The endpoints were the completion of all antitumor therapy courses and the level of overall and CV mortality.

Results: Among 233 enrolled patients (66% women), a considerable part belonged to the group of high/very high cardio-oncological risk (n=134, 57%). Various cardiovascular toxicities were observed in 22% of patients. At baseline, these patients significantly more frequently had heart failure and ischemic heart disease as well as previous radiation and chemotherapy. After the optimization of cardiac therapy, 88% of patients successfully completed all scheduled treatments. The overall mortality, including the CV mortality, was 14% (n=7).

Conclusion: Creation of cardio-oncological services allows considerably reducing the probability of adverse CV events during the antitumor therapy and successfully completing all scheduled treatments in most patients..

目的:介绍谢切诺夫大学科学实践心脏肿瘤中心四年来的经验和成就:回顾性分析了 2020 年 1 月至 2024 年 3 月期间转诊的肿瘤心脏病患者的病历。对患者的心血管(CV)状况进行了基线评估和抗肿瘤治疗期间优化心脏治疗后的评估。终点是所有抗肿瘤治疗疗程的完成情况以及总死亡率和心血管死亡率:在233名入选患者(66%为女性)中,相当一部分属于心血管肿瘤高危/极高危人群(134人,57%)。22%的患者出现了各种心血管毒性反应。基线时,这些患者中患有心力衰竭和缺血性心脏病以及接受过放疗和化疗的人数明显增多。在优化心脏治疗后,88% 的患者成功完成了所有预定治疗。包括心血管疾病在内的总死亡率为14%(7人):结论:建立心脏肿瘤服务可大大降低抗肿瘤治疗期间发生不良心血管事件的概率,并使大多数患者成功完成所有预定治疗。
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引用次数: 0
[Predictors of New-Onset Atrial Fibrillation in Patients With Chronic Coronary Artery Disease After Coronary Artery Bypass Grafting: a Prospective, Observational, Single-Centre, Non-Randomized Study]. [冠状动脉旁路移植术后慢性冠状动脉疾病患者新发心房颤动的预测因素:一项前瞻性、观察性、单中心、非随机研究]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-10-31 DOI: 10.18087/cardio.2024.10.n2511
N Yu Sokolova, E A Savelyeva, K A Martynova, A D Makhauri, S R Medzhidov

Aim: To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG).

Material and methods: This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death).

Results: Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness >10.5 mm (p=0.015), indexed LA volume >33 ml/m2 (p<0.001), LV myocardial mass index >115 g/m2 (p=0.042), left main coronary artery disease >50% (p=0.043), duration of cardiopulmonary bypass during CABG >60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) <3.6 mmol/l (p<0.001), and pericardial effusion volume in the early postoperative period >88 ml (p<0.001).

Conclusion: Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.

目的:研究冠状动脉旁路移植术(CABG)后慢性缺血性心脏病(IHD)患者术后心房颤动(POAF)发生的影响因素:这项单中心前瞻性非随机观察研究纳入了152名慢性缺血性心脏病患者。患者平均年龄为(64.4±5.9)岁。根据术后早期心房颤动(AF)的发生情况,将所有接受过 CABG 手术的患者分为两组:第一组,有 POAF(43 人;28.3%);第二组,无 POAF(109 人;71.7%)。主要研究终点是 CABG 术后早期(住院)新发 POAF。次要研究终点是院内术后并发症(非致命/致命急性冠状动脉综合征(ACS)、非致命/致命中风、大出血、死亡):与保留窦性心律的患者相比,POAF患者在CABG术后的心脏结构和功能变化更为明显:左心室(LV)容积增大,左心室心肌质量增加,左心室收缩功能参数降低,舒张功能受损,左心房(LA)腔增大。对院内并发症的分析表明,各组在发生 POAF 方面没有任何差异。POAF的危险因素如下:年龄大于65岁(p=0.022)、体重指数≥30.5 kg/m2(p=0.020)、心外膜脂肪组织厚度>10.5 mm(p=0.015)、LA容积指数>33 ml/m2(p<0.001)、左心室心肌质量指数>115 g/m2(p=0.042)、左主冠状动脉疾病>50%(p=0.043)、CABG术中心肺旁路时间>60 min(p=0.019)、CABG术后早期(第一天)血钾浓度<3.6 mmol/l(p<0.001)、术后早期心包积液量>88 ml(p<0.001):结论:确定发生 POAF 的风险非常重要,对于术后密切监测慢性心肌缺血患者非常必要。
{"title":"[Predictors of New-Onset Atrial Fibrillation in Patients With Chronic Coronary Artery Disease After Coronary Artery Bypass Grafting: a Prospective, Observational, Single-Centre, Non-Randomized Study].","authors":"N Yu Sokolova, E A Savelyeva, K A Martynova, A D Makhauri, S R Medzhidov","doi":"10.18087/cardio.2024.10.n2511","DOIUrl":"https://doi.org/10.18087/cardio.2024.10.n2511","url":null,"abstract":"<p><strong>Aim: </strong>To study the factors that influence the occurrence of postoperative atrial fibrillation (POAF) in patients with chronic ischemic heart disease (IHD) after coronary artery bypass grafting (CABG).</p><p><strong>Material and methods: </strong>This single-center prospective observational non-randomized study included 152 patients with chronic IHD. Mean age of patients was 64.4±5.9 years. All patients after CABG were divided into two groups based on the occurrence of atrial fibrillation (AF) in the early postoperative period: group 1, with POAF (n=43; 28.3%) and group 2, without POAF (n=109; 71.7%). The primary study endpoint was new-onset POAF in the early postoperative (hospital) period after CABG. The secondary study endpoint was in-hospital postoperative complications (non-fatal/fatal acute coronary syndrome (ACS), non-fatal/fatal stroke, major bleeding, death).</p><p><strong>Results: </strong>Patients with POAF had significantly more pronounced structural and functional changes in the heart than patients with preserved sinus rhythm after CABG: larger left ventricular (LV) volume, greater LV myocardial mass, lower LV systolic function parameters and impaired diastolic function, and an enlarged left atrial (LA) cavity. Analysis of in-hospital complications did not show any differences between the groups associated with the development of POAF. The following risk factors for POAF were identified: age older than 65 years (p=0.022), body mass index ≥30.5 kg/m2 (p=0.020), epicardial adipose tissue thickness &gt;10.5 mm (p=0.015), indexed LA volume &gt;33 ml/m2 (p&lt;0.001), LV myocardial mass index &gt;115 g/m2 (p=0.042), left main coronary artery disease &gt;50% (p=0.043), duration of cardiopulmonary bypass during CABG &gt;60 min (p=0.019), blood potassium concentration in the early postoperative period after CABG (on the first day) &lt;3.6 mmol/l (p&lt;0.001), and pericardial effusion volume in the early postoperative period &gt;88 ml (p&lt;0.001).</p><p><strong>Conclusion: </strong>Determining the risk of developing POAF is important and necessary for the closest monitoring of a patient with chronic IHD in the postoperative period.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 10","pages":"40-47"},"PeriodicalIF":0.5,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Kardiologiya
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