Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2709
A V Susekov
HMG-CoA reductase inhibitors (statins) were discovered in the early 1970s in Japan and were originally used to treat patients with hereditary hyperlipidemia. In the late 1990s and early 2000s, clinical trials using statins for primary and secondary prevention showed the possibility of reducing cardiovascular (CV) and, in some cases, all-cause mortality. Intensive statin therapy (atorvastatin 80 mg/day and rosuvastatin 40 mg/day) compared to initial doses provides an additional 16% reduction in CV complications. Regression studies with the original rosuvastatin using intracoronary ultrasound and other modern methods have shown the possibility of stabilization and regression of atherosclerosis in the carotid and coronary arteries. High-dose statin therapy is generally well tolerated; the incidence of clinically significant adverse liver reactions does not exceed 2-3 per 100,000 people, and the incidence of myopathies with increased creatine kinase over 10 upper limits of normal is not higher than 1 per 10,000 people per year. Long-term statin treatment does not increase the risk of dementia and, in some studies, reduced the risk of Alzheimer's disease. Achieving target levels of low-density lipoprotein cholesterol (LDL-C) in routine practice does not exceed 5-11%; one of the main reasons for that is the rare (2-3%) prescription of high doses of statins. Increasing statin doses in routine clinical practice will optimize the treatment of patients with high CV risk and will contribute to further reduction of mortality in our country.
{"title":"[Rationale for Increasing Doses of Statins in Everyday Clinical Practice].","authors":"A V Susekov","doi":"10.18087/cardio.2024.8.n2709","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2709","url":null,"abstract":"<p><p>HMG-CoA reductase inhibitors (statins) were discovered in the early 1970s in Japan and were originally used to treat patients with hereditary hyperlipidemia. In the late 1990s and early 2000s, clinical trials using statins for primary and secondary prevention showed the possibility of reducing cardiovascular (CV) and, in some cases, all-cause mortality. Intensive statin therapy (atorvastatin 80 mg/day and rosuvastatin 40 mg/day) compared to initial doses provides an additional 16% reduction in CV complications. Regression studies with the original rosuvastatin using intracoronary ultrasound and other modern methods have shown the possibility of stabilization and regression of atherosclerosis in the carotid and coronary arteries. High-dose statin therapy is generally well tolerated; the incidence of clinically significant adverse liver reactions does not exceed 2-3 per 100,000 people, and the incidence of myopathies with increased creatine kinase over 10 upper limits of normal is not higher than 1 per 10,000 people per year. Long-term statin treatment does not increase the risk of dementia and, in some studies, reduced the risk of Alzheimer's disease. Achieving target levels of low-density lipoprotein cholesterol (LDL-C) in routine practice does not exceed 5-11%; one of the main reasons for that is the rare (2-3%) prescription of high doses of statins. Increasing statin doses in routine clinical practice will optimize the treatment of patients with high CV risk and will contribute to further reduction of mortality in our country.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301224","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2731
V V Skibitskiy, A V Fendrikova, A V Skibitskiy, D V Sirotenko, O V Timofeeva
Aim: To compare the efficacy of adding original moxonidine and its generics to previous ineffective antihypertensive therapy in patients with poorly controlled arterial hypertension (AH).
Results: After 4 weeks of therapy, the BP target was achieved significantly more frequently in group 1 (63% of patients) compared to groups 2 (36.7% of patients), 3 (16.7% of patients), and 4 (16.7% of patients) (p<0.05). At 12 weeks, office SBP, DBP, and HR were significantly decreased in all groups, but the decrease was significantly greater in group 1. The therapy was associated with a more pronounced decrease in all studied 24-h BPM parameters in the Physiotens group than in other groups, as well as with a significantly more frequent normalization of the 24-h BP profile, in 66.7% of patients vs. 46.7%, 33.4%, and 23.2% of patients in groups 2, 3, and 4, respectively.
Conclusion: The treatment with original moxonidine demonstrated advantages over generic drugs in terms of achieving the BP goal, reducing office BP and HR, and improving 24-h BPM parameters.
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2634
E V Garbuzova, Ya V Polonskaya, E V Kashtanova, E M Stakhneva, V S Shramko, I S Murashov, A V Kurguzov, A M Chernyavsky, Yu I Ragino
Aim: To study metabolic molecules (adiponectin, adipsin, resistin, glucagon-like peptide-1 (GLP-1), glucagon, secretin) of adipose tissue in atherosclerotic plaques (AP) and their associations with AP instability in men with coronary atherosclerosis.
Material and methods: Metabolic molecules (adipocytokines and metabolic hormones) of adipose tissue can act as enzymes, hormones or growth factors in modulating insulin resistance and lipid and glucose metabolism and indirectly influence the course of the atherosclerotic process. This study included 48 men from whom 139 coronary artery (CA) samples were collected during coronary artery bypass grafting, after obtaining the informed consent. According to the histological conclusion, 84 (60.4%) CA plaques were stable, 44 (31.7%) were unstable, and 11 histological samples had a conditionally unchanged CA intima (7.9%). The concentrations of adiponectin, adipsin, resistin, GLP-1, glucagon, and secretin were measured in AP homogenates by multiplex analysis using the Human Metabolic Hormone V3 panel (MILLIPLEX, Germany). During the study, demographic and anthropometric characteristics, medical history, and presence of chronic diseases were recorded.
Results: The glucagon concentration in the conditionally unchanged intima was 16.7% lower and in the fragments of unstable atherosclerotic plaques 41.2% lower than in fragments of stable APs. However, the glucagon concentration in stable APs was 28% higher than in unstable APs. The secretin concentration in the conditionally unchanged intima was also lower than in stable APs by 41.2%, while in stable APs, the secretin concentration was 20% higher than in unstable APs. The adiponectin concentrations were directly correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations (r=0.286; p=0.002), while the secretin concentrations were inversely correlated with serum HDL-C concentrations (r= -0.199; p=0.038). The probability of having an unstable AP (in relation to conditionally unchanged intima) increases by 35.8% with an increase in the AP glucagon concentration by 1 pg/mg protein. The probability of having a stable AP (in relation to unchanged intima) increases by 29.4% with an increase in the AP glucagon concentration by 1 pg/mg protein and by 10.1% with an increase in the AP secretin concentration by 1 pg/mg protein.
Conclusion: The AP adiponectin concentration directly correlates and the AP secretin concentration inversely correlates with the serum concentration of HDL-C. The presence of both stable and unstable APs is directly associated with the AP glucagon concentration in men with coronary atherosclerosis. The AP secretin concentration is directly associated with plaque stability in men with coronary atherosclerosis. Further thorough study of the identified markers in atherosclerotic lesions will allow using them as potential targets for therapy.
目的:研究冠状动脉粥样硬化男性患者动脉粥样硬化斑块(AP)中脂肪组织的代谢分子(脂肪连素、脂肪素、抵抗素、胰高血糖素样肽-1(GLP-1)、胰高血糖素、胰泌素)及其与动脉粥样硬化斑块不稳定性的关系:脂肪组织的代谢分子(脂肪细胞因子和代谢激素)可作为酶、激素或生长因子调节胰岛素抵抗、脂质和葡萄糖代谢,并间接影响动脉粥样硬化过程。这项研究包括 48 名男性,在获得知情同意后,收集了他们在冠状动脉搭桥术期间的 139 个冠状动脉(CA)样本。根据组织学结论,84 个(60.4%)冠状动脉斑块是稳定的,44 个(31.7%)是不稳定的,11 个组织学样本的冠状动脉内膜有条件性变化(7.9%)。通过使用人类代谢激素 V3 面板(德国 MILLIPLEX 公司)进行多重分析,测量了 AP 匀浆中的脂肪连素、脂肪素、抵抗素、GLP-1、胰高血糖素和胰泌素的浓度。研究期间记录了人口统计学和人体测量特征、病史和是否患有慢性疾病:结果:与稳定的动脉粥样硬化斑块碎片相比,条件不变的内膜中的胰高血糖素浓度低 16.7%,不稳定的动脉粥样硬化斑块碎片中的胰高血糖素浓度低 41.2%。然而,稳定 AP 中的胰高血糖素浓度比不稳定 AP 高 28%。在条件不变的内膜中,胰泌素浓度也比稳定型 AP 低 41.2%,而在稳定型 AP 中,胰泌素浓度比不稳定型 AP 高 20%。脂联素浓度与血清高密度脂蛋白胆固醇(HDL-C)浓度直接相关(r=0.286;p=0.002),而分泌素浓度与血清高密度脂蛋白胆固醇浓度成反比(r=-0.199;p=0.038)。当 AP 胰高血糖素浓度增加 1 pg/mg 蛋白时,出现不稳定 AP(与条件不变的内膜有关)的概率增加 35.8%。AP胰高血糖素浓度增加1 pg/mg蛋白,出现稳定AP(相对于未改变的内膜)的概率增加29.4%;AP胰泌素浓度增加1 pg/mg蛋白,出现稳定AP的概率增加10.1%:结论:胰高血糖素浓度与血清高密度脂蛋白胆固醇浓度直接相关,而胰高血糖素浓度与血清高密度脂蛋白胆固醇浓度成反比。在冠状动脉粥样硬化男性患者中,稳定和不稳定AP的存在与AP胰高血糖素浓度直接相关。在冠状动脉粥样硬化男性患者中,AP 分泌素浓度与斑块稳定性直接相关。对动脉粥样硬化病变中已确定的标记物进行进一步深入研究,可将其作为潜在的治疗目标。
{"title":"Biomolecules of Adipose Tissue in Atherosclerotic Plaques of Men With Coronary Atherosclerosis.","authors":"E V Garbuzova, Ya V Polonskaya, E V Kashtanova, E M Stakhneva, V S Shramko, I S Murashov, A V Kurguzov, A M Chernyavsky, Yu I Ragino","doi":"10.18087/cardio.2024.8.n2634","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2634","url":null,"abstract":"<p><strong>Aim: </strong>To study metabolic molecules (adiponectin, adipsin, resistin, glucagon-like peptide-1 (GLP-1), glucagon, secretin) of adipose tissue in atherosclerotic plaques (AP) and their associations with AP instability in men with coronary atherosclerosis.</p><p><strong>Material and methods: </strong>Metabolic molecules (adipocytokines and metabolic hormones) of adipose tissue can act as enzymes, hormones or growth factors in modulating insulin resistance and lipid and glucose metabolism and indirectly influence the course of the atherosclerotic process. This study included 48 men from whom 139 coronary artery (CA) samples were collected during coronary artery bypass grafting, after obtaining the informed consent. According to the histological conclusion, 84 (60.4%) CA plaques were stable, 44 (31.7%) were unstable, and 11 histological samples had a conditionally unchanged CA intima (7.9%). The concentrations of adiponectin, adipsin, resistin, GLP-1, glucagon, and secretin were measured in AP homogenates by multiplex analysis using the Human Metabolic Hormone V3 panel (MILLIPLEX, Germany). During the study, demographic and anthropometric characteristics, medical history, and presence of chronic diseases were recorded.</p><p><strong>Results: </strong>The glucagon concentration in the conditionally unchanged intima was 16.7% lower and in the fragments of unstable atherosclerotic plaques 41.2% lower than in fragments of stable APs. However, the glucagon concentration in stable APs was 28% higher than in unstable APs. The secretin concentration in the conditionally unchanged intima was also lower than in stable APs by 41.2%, while in stable APs, the secretin concentration was 20% higher than in unstable APs. The adiponectin concentrations were directly correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations (r=0.286; p=0.002), while the secretin concentrations were inversely correlated with serum HDL-C concentrations (r= -0.199; p=0.038). The probability of having an unstable AP (in relation to conditionally unchanged intima) increases by 35.8% with an increase in the AP glucagon concentration by 1 pg/mg protein. The probability of having a stable AP (in relation to unchanged intima) increases by 29.4% with an increase in the AP glucagon concentration by 1 pg/mg protein and by 10.1% with an increase in the AP secretin concentration by 1 pg/mg protein.</p><p><strong>Conclusion: </strong>The AP adiponectin concentration directly correlates and the AP secretin concentration inversely correlates with the serum concentration of HDL-C. The presence of both stable and unstable APs is directly associated with the AP glucagon concentration in men with coronary atherosclerosis. The AP secretin concentration is directly associated with plaque stability in men with coronary atherosclerosis. Further thorough study of the identified markers in atherosclerotic lesions will allow using them as potential targets for therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301225","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2720
N G Vinogradova, V S Berestovskaya, Z N Blankova, T V Vavilova, N V Gomyranova, V P Masenko, V Yu Mareev, A A Skvortsov, N A Sorokina, S N Tereshchenko
The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.
{"title":"[Laboratory Aspects of Using the Results of NT-Probnp Concentration Immunochemical Determination in the Management of Patients With Heart Failure: Support For Clinical Decision-Making].","authors":"N G Vinogradova, V S Berestovskaya, Z N Blankova, T V Vavilova, N V Gomyranova, V P Masenko, V Yu Mareev, A A Skvortsov, N A Sorokina, S N Tereshchenko","doi":"10.18087/cardio.2024.8.n2720","DOIUrl":"10.18087/cardio.2024.8.n2720","url":null,"abstract":"<p><p>The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301223","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2728
G E Gendlin, A M Baimukanov, E I Emelina, D A Paegle, I G Nikitin
In relation with the published article "Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation", we have issued a comment. The authors of the article addressed a widely discussed topic of "Short episodes of fast arrhythmias initially detected in records on implantable devices". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.
{"title":"Editorial on the article «Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation».","authors":"G E Gendlin, A M Baimukanov, E I Emelina, D A Paegle, I G Nikitin","doi":"10.18087/cardio.2024.8.n2728","DOIUrl":"10.18087/cardio.2024.8.n2728","url":null,"abstract":"<p><p>In relation with the published article \"Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation\", we have issued a comment. The authors of the article addressed a widely discussed topic of \"Short episodes of fast arrhythmias initially detected in records on implantable devices\". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301227","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2753
Yu N Belenkov, I S Ilgisonis, N V Khabarova, Yu Yu Kirichenko Yu Yu
The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.
{"title":"Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity.","authors":"Yu N Belenkov, I S Ilgisonis, N V Khabarova, Yu Yu Kirichenko Yu Yu","doi":"10.18087/cardio.2024.8.n2753","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2753","url":null,"abstract":"<p><p>The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301228","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2602
B I Geltser, K I Shahgeldyan, I G Domzhalov, N S Kuksin, V N Kotelnikov, E A Kokarev
Aim: Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods.
Material and methods: A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups.
Results: Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (<0.3%), medium (0.3-9%), high (9-17%), and very high (>17%) risk groups.
Conclusion: The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.
{"title":"Comparative Analysis of the Effectiveness of Riskometer Scales in Predicting the Risk of in-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention.","authors":"B I Geltser, K I Shahgeldyan, I G Domzhalov, N S Kuksin, V N Kotelnikov, E A Kokarev","doi":"10.18087/cardio.2024.8.n2602","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2602","url":null,"abstract":"<p><strong>Aim: </strong>Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods.</p><p><strong>Material and methods: </strong>A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups.</p><p><strong>Results: </strong>Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (<0.3%), medium (0.3-9%), high (9-17%), and very high (>17%) risk groups.</p><p><strong>Conclusion: </strong>The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301226","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2683
G P Arutyunov, E I Tarlovskaya, A G Arutyunov, T I Batluk, N A Koziolova, A I Chesnikova, A Yu Vaskin, D S Tokmin, I G Bakulin, O L Barbarash, N Yu Grigoryeva, I V Gubareva, N V Izmozherova, U K Kamilova, S G Kechedzhieva, Z F Kim, N A Koriagina, S V Mironova, N P Mitkovskaya, S V Nemirova, L M Nurieva, M M Petrova, E A Polyanskaya, A P Rebrov, A V Svarovskaya, E A Smirnova, A B Sugraliev, Ya B Khovaeva, G V Shavkuta, I I Shaposhnik, M Yu K Alieva, A B Almukhanova, A V Aparkina, R A Bashkinov, L N Belousova, E I Blokhina, V O Bochkareva, V M Buianova, F Yu Valikulova, A D Vende, A S Galyavich, V V Genkel, E V Gorbunova, E D Gordeychuk, E A Grigorenko, E V Grigoryeva, I L Davydkin, D S Evdokimov, A N Ermilova, Sh B Zhangelova, N V Zhdankina, E I Zheleznyak, N S Ilyanok, D A Kapsultanova, N A Karoli, E A Kartashova, A S Kuznetsova, A T Kumaritova, N A Magdeeva, S A Makarov, E S Melnikov, M V Novikova, I A Obukhova, E V Ponomarenko, A O Rubanenko, O A Rubanenko, F E Rustamova, V A Safronenko, E I Suchkova, A I Sycheva, D R Tagaeva, M A Trubnikova, T P Trunina, A G Frolov, V V Khatlamadzhiyan, Yu I Khokhlova, A I Chernyavina, O Yu Chizhova, M A O Shambatov, T V Shnyukova, Yu V Shchukin
Aim: To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.
Material and methods: The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).
Results: A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.
Conclusion: IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.
{"title":"Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).","authors":"G P Arutyunov, E I Tarlovskaya, A G Arutyunov, T I Batluk, N A Koziolova, A I Chesnikova, A Yu Vaskin, D S Tokmin, I G Bakulin, O L Barbarash, N Yu Grigoryeva, I V Gubareva, N V Izmozherova, U K Kamilova, S G Kechedzhieva, Z F Kim, N A Koriagina, S V Mironova, N P Mitkovskaya, S V Nemirova, L M Nurieva, M M Petrova, E A Polyanskaya, A P Rebrov, A V Svarovskaya, E A Smirnova, A B Sugraliev, Ya B Khovaeva, G V Shavkuta, I I Shaposhnik, M Yu K Alieva, A B Almukhanova, A V Aparkina, R A Bashkinov, L N Belousova, E I Blokhina, V O Bochkareva, V M Buianova, F Yu Valikulova, A D Vende, A S Galyavich, V V Genkel, E V Gorbunova, E D Gordeychuk, E A Grigorenko, E V Grigoryeva, I L Davydkin, D S Evdokimov, A N Ermilova, Sh B Zhangelova, N V Zhdankina, E I Zheleznyak, N S Ilyanok, D A Kapsultanova, N A Karoli, E A Kartashova, A S Kuznetsova, A T Kumaritova, N A Magdeeva, S A Makarov, E S Melnikov, M V Novikova, I A Obukhova, E V Ponomarenko, A O Rubanenko, O A Rubanenko, F E Rustamova, V A Safronenko, E I Suchkova, A I Sycheva, D R Tagaeva, M A Trubnikova, T P Trunina, A G Frolov, V V Khatlamadzhiyan, Yu I Khokhlova, A I Chernyavina, O Yu Chizhova, M A O Shambatov, T V Shnyukova, Yu V Shchukin","doi":"10.18087/cardio.2024.8.n2683","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2683","url":null,"abstract":"<p><strong>Aim: </strong>To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.</p><p><strong>Material and methods: </strong>The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).</p><p><strong>Results: </strong>A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.</p><p><strong>Conclusion: </strong>IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the \"aggressiveness\" of therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301231","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}
Pub Date : 2024-08-31DOI: 10.18087/cardio.2024.8.n2633
Hüseyin Aykaç, Cihan Aydın, Aykut Demirkıran, Nurullah Uslu, Şeref Alpsoy
Aim: Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF.
Material and methods: The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24‑hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of ≥5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared.
Results: N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml, p<0.001; 13±11.4 ng / dl vs. 4.4±2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113±10.2 ms vs. 98±10.4 ms; p<0.001), minimum P wave duration (Pmin) (73.8±5.5 ms vs.70±6.3 ms; p<0.001) and P wave dispersion (PWD) (39.1±7.9 ms vs.28±7.6 ms; p<0.001) were longer in the micro-AF group.
Conclusions: Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.
目的:心房颤动(AF)是一种心律失常,其特点是心房源性电激活非常快且无序,心房收缩不协调。极短时间的房颤样活动(微房颤)可能是未被发现的无声房颤发作的前兆。在此,我们研究了微房颤患者体内钠尿肽浓度与超声心动图结果之间的关系:用 24 小时 Holter 监护仪记录心悸患者的心电图,并将患者连续纳入研究。微心房颤动的定义是持续时间少于 30 秒的突发性不规则房性心动过速,发作次数≥5 次连续室上性去极化,且绝对没有 p 波。经过 G 功率测试后,患者被连续纳入研究:微 AF 组和对照组各 45 名患者。两组患者的实验室指标、心电图和超声心动图结果进行了比较:结果:微 AF 组 N 端 Pro B 型钠尿肽(Pro-BNP)和血清肌钙蛋白 T 浓度更高(分别为 375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml,p<0.001;13±11.4 ng / dl vs. 4.4±2.4 ng / dl,p<0.001)。血清 Pro-BNP 每增加 1 pg / ml,微 AF 风险增加 1.8%。在 ROC 分析中,Pro-BNP 诊断微小心房颤动的临界值为 63.4 pg /ml,敏感性为 91.1%,特异性为 73.3%。微 AF 组的心房电动力学延迟时间明显较长。要预测微 AF,心房间平面机电延迟时间(心房间平面 AEMD)的临界值为 18.5 秒,灵敏度为 93.3%,特异度为 91.1%。左心房内平面机电延迟时间(心房内 AEMD LEFT)的临界值为 11.5 秒,灵敏度为 95.6%,特异度为 75.6%。在心电图评估中,微 AF 组的最大 P 波持续时间(Pmax)(113±10.2 毫秒 vs. 98±10.4 毫秒;p<0.001)、最小 P 波持续时间(Pmin)(73.8±5.5 毫秒 vs. 70±6.3 毫秒;p<0.001)和 P 波弥散(PWD)(39.1±7.9 毫秒 vs. 28±7.6 毫秒;p<0.001)更长:结论:通过评估心电图、超声心动图和血清钠尿肽数据可预测患者的微AF。
{"title":"Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation.","authors":"Hüseyin Aykaç, Cihan Aydın, Aykut Demirkıran, Nurullah Uslu, Şeref Alpsoy","doi":"10.18087/cardio.2024.8.n2633","DOIUrl":"10.18087/cardio.2024.8.n2633","url":null,"abstract":"<p><strong>Aim: </strong>Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF.</p><p><strong>Material and methods: </strong>The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24‑hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of ≥5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared.</p><p><strong>Results: </strong>N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml, p<0.001; 13±11.4 ng / dl vs. 4.4±2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113±10.2 ms vs. 98±10.4 ms; p<0.001), minimum P wave duration (Pmin) (73.8±5.5 ms vs.70±6.3 ms; p<0.001) and P wave dispersion (PWD) (39.1±7.9 ms vs.28±7.6 ms; p<0.001) were longer in the micro-AF group.</p><p><strong>Conclusions: </strong>Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301229","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}
Pub Date : 2024-07-31DOI: 10.18087/cardio.2024.7.n2671
A M Kochergina, O L Barbarash
Aim: To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM).
Material and methods: The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured.
Results: During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p<0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1.
Conclusion: This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.
{"title":"Possibilities of Azilsartan Medoxomil for Preparation for Planned Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus.","authors":"A M Kochergina, O L Barbarash","doi":"10.18087/cardio.2024.7.n2671","DOIUrl":"https://doi.org/10.18087/cardio.2024.7.n2671","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM).</p><p><strong>Material and methods: </strong>The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured.</p><p><strong>Results: </strong>During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p<0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1.</p><p><strong>Conclusion: </strong>This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894907","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}