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Patient Adherence and Duration of Continuous Treatment With Various Arbs in Patients With Uncomplicated Arterial Hypertension in the USA Based on The Analysis of the Truven Health Analytics MarketScan Database. 基于 Truven Health Analytics MarketScan 数据库分析的美国无并发症动脉高血压患者持续使用各种 Arbs 治疗的依从性和持续时间。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2689
Yu N Belenkov, M G Glezer, M V Kozhevnikova, K S Chernichka, N V Matveev

Aim: To discuss two aspects that can be used to improve the adherence to therapy in patients with arterial hypertension (AH): 1) which of the angiotensin II receptor blockers (ARBs) provides the highest adherence rates; 2) how various factors influence adherence rates.

Material and methods: An analysis of one of the world's largest clinical practice databases, Truven Health Analytics MarketScan (currently Merative MarketScan), was performed. The analysis included data on patients of both sexes aged 30 to 65 years who had been diagnosed with uncomplicated AH (at least once between March 1, 2012 and January 1, 2018) and prescribed monotherapy with one of ARBs. The exclusion criteria were heart failure and the treatment with two or more ARBs (simultaneously or sequentially) during the treatment period. Ultimately, the study included 717,099 patients with uncomplicated AH, who were divided into four groups based on the prescribed drug: azilsartan (n=4276), candesartan (n=6023), losartan (n=586,857), and valsartan (n=119,943). Adherence to treatment was evaluated by two parameters: duration of continuous therapy and medication possession ratio (MPR). The individual effect of each factor (specific ARB used for therapy, patient gender, age, initial ARB dose, patient co-payment per day of treatment) on the adherence to treatment was assessed using a regression analysis.

Results: The adherence to the ARB therapy was generally high. The MPR was the lowest in the azilsartan group and the highest in the candesartan group. However, the parameters that potentially influenced both the MPR and the duration of continuous therapy (patient's gender and age, initial ARB dose, co-payment size) differed significantly between the groups receiving different ARBs. The regression analysis showed that both adherence parameters and the duration of continuous therapy were higher in patients receiving candesartan than in patients receiving azilsartan, losartan or valsartan, when the effect on the adherence of other factors available for study (age, gender, initial dose of the drug, and the absolute size of co-payment for a day of therapy) was excluded. The lowest adherence to therapy was observed in the azilsartan treatment group (p<0.01).

Conclusion: The study provided data for comparing the adherence of patients with uncomplicated AH to the therapy with different ARBs. Further study of adherence to treatment will provide additional data that will allow an optimal selection of drugs for the treatment of AH in patients with potentially poor adherence.

目的:讨论可用于改善动脉高血压(AH)患者坚持治疗的两个方面:1)哪种血管紧张素 II 受体阻滞剂(ARB)的坚持治疗率最高;2)各种因素如何影响坚持治疗率:对全球最大的临床实践数据库之一 Truven Health Analytics MarketScan(现为 Merative MarketScan)进行了分析。分析包括年龄在 30 岁至 65 岁之间、被诊断为无并发症的急性心肌梗死(2012 年 3 月 1 日至 2018 年 1 月 1 日期间至少一次)并接受过一种 ARB 单药治疗的男女患者的数据。排除标准为心力衰竭以及在治疗期间(同时或先后)接受过两种或两种以上 ARBs 治疗。最终,研究纳入了717099名无并发症的AH患者,根据处方药物将其分为四组:阿齐沙坦(n=4276)、坎地沙坦(n=6023)、洛沙坦(n=586857)和缬沙坦(n=119943)。治疗依从性通过两个参数进行评估:持续治疗时间和药物持有率(MPR)。使用回归分析评估了各因素(治疗中使用的特定 ARB、患者性别、年龄、初始 ARB 剂量、患者每天治疗的自费部分)对坚持治疗的影响:结果:ARB 治疗的依从性普遍较高。阿齐沙坦组的MPR最低,坎地沙坦组最高。然而,对MPR和持续治疗时间有潜在影响的参数(患者的性别和年龄、初始ARB剂量、自费金额)在接受不同ARB治疗的组别之间存在显著差异。回归分析表明,在排除其他可研究因素(年龄、性别、药物初始剂量和一天治疗的自费金额绝对值)对治疗依从性的影响后,接受坎地沙坦治疗的患者的治疗依从性参数和持续治疗时间均高于接受阿齐沙坦、洛沙坦或缬沙坦治疗的患者。阿齐沙坦治疗组的治疗依从性最低(p<0.01):该研究为比较无并发症 AH 患者对不同 ARB 治疗的依从性提供了数据。对治疗依从性的进一步研究将提供更多数据,从而为依从性可能较差的急性心肌梗死患者选择最佳药物进行治疗。
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引用次数: 0
In Search of Optimal Criteria for Iron Deficiency in CHF Patients. Post-hoc Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)". 寻找慢性心力衰竭患者铁缺乏症的最佳标准。俄罗斯联邦慢性心力衰竭患者铁缺乏症患病率(ID-CHF-RF)"研究的事后分析。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2732
V Yu Mareev, Yu V Mareev, Zh D Kobalava, Yu L Begrambekova, L V Karapetyan, S A Galochkin, E R Kazakhmedov, A A Lapshin, A A Garganeeva, E A Kuzheleva, A A Efremushkina, E V Kiseleva, O L Barbarash, T B Pecherina, A S Galyavich, Z M Galeeva, L V Baleeva, N A Koziolova, A S Veclich, D V Duplyakov, M N Maksimova, S S Yakushin, E A Smirnova, E V Sedykh, I I Shaposhnik, N A Makarova, A A Zemlyanukhina, V V Skibitsky, A V Fendrikova, A V Skibitsky, N A Spiropoulos, E M Seredenina, Ya A Orlova, K A Eruslanova, Yu V Kotovskaya, O N Tkacheva, M A Fedin

Aim: Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 μmol/l.

Material and methods: An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 μg/l or ferritin from 100 to 299 μg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed.

Results: ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml).

Conclusion: Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 μg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

目的:比较分析根据AHA/ESC/RSC标准诊断的慢性心力衰竭(CHF)和缺铁(ID)患者,以及根据转铁蛋白饱和度(TSAT)下降≤19.8%或血清铁(Fe)≤13 μmol/l诊断为ID的CHF患者的临床、病史、实验室和仪器数据:对 ID-CHF-RF 研究进行了补充分析。分析对象包括 498 名 CHF 患者(198 名女性)。除了方案规定的ID标准(AHA/ESC/RSC标准:铁蛋白<100 μg/l或铁蛋白从100到299 μg/l和TSAT<20%)外,还评估了ID生物标志物的浓度,与骨髓形态学图像(TSAT<19.8%或铁≤13 μmol/l)相比,ID诊断的敏感性和特异性都很高。分析了仅根据AHA/ESC/RSC标准、仅根据TSAT≤19.8%和铁≤13 μmol/l标准以及同时根据这两种标准确定的ID患者亚组:结果:83.1%的患者根据 AHA/ESC/RSC 标准诊断为 ID。TSAT≤19.8%和Fe≤13 μmol/l标准显示有74.5%的患者患有ID。有 341 名患者(76.8%)同时使用这两种标准诊断出 ID。与根据 AHA/ESC/RKO 标准诊断的 ID 患者相比,根据 TSAT≤19.8% 和 Fe≤13 μmol/l 标准诊断的 ID 患者的 Fe 值低 50%(9.8 μmol/l 对 19.4 μmol/l),贫血(43.3% 对 23.3%)和糖尿病(DM)(36.7% 和 24.7%)发生率更高。此外,这些患者的体重指数(BMI)和NT-proBNP浓度(2317 [1305;9092] vs. 1691 [709;3856] pg/ml)较高,左心室EF值(41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%)较低。根据两个标准确定的 ID 患者的 CHF 病程最严重,与 ID 和贫血相关的实验室检查变化最大。该组患者年龄较大,体重指数较高,心房颤动发生率较高,NT-proBNP(4182 [1854;9341] pg/ml)也较高:结论:与低 TSAT 或低铁蛋白患者相比,孤立性低铁蛋白患者的临床和功能损害程度较轻。同时,铁蛋白高于 300 μg/l 且 TSAT 和/或铁偏低的患者具有非常严重的慢性心力衰竭和功能低下的特征,尽管这可能与 ID 无关。因此,使用基于铁蛋白的 ID 标准可能会导致一些患者被过度诊断为 ID,同时也会漏诊一些可能需要进行 ID 矫正的最 "严重 "患者。三项指标均下降的 ID 患者可能从补充铁元素中获益最多。最好对补充铁元素对这部分患者的病程和预后的影响进行更多的研究。
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引用次数: 0
Prospective Reassessment of the Association Between Pro-Inflammatory Factors and Prognosis After on-Pump Cardiac Surgery. 前瞻性地重新评估促炎因子与泵上心脏手术后预后之间的关系
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2682
Yingting Huang, Xunbei Huang, Liqin Ling, Chaonan Liu, Si Chen, Jing Zhou, Lei Du, Jiyue Xiong

Aim: Elevated levels of pro-inflammatory factors in plasma have been linked to worse prognosis after on-pump cardiac surgery, yet interventions that reduce the levels in patients have failed to improve prognosis. Therefore, we explored whether levels of pro-inflammatory factors are associated with prognosis of patients after valve surgery with cardiopulmonary bypass.

Material and methods: 244 patients were prospectively enrolled into observational study. Levels of tumor necrosis factor (TNF) - α, interleukin-8 and neutrophil elastase were measured once before and several times after cardiopulmonary bypass. The levels were compared between patients who experienced in-hospital adverse events or not, and between patients who experienced major adverse cardiac or cerebrovascular events (MACCEs) during three-year follow-up or not.

Results: Of the 244 patients enrolled, in-hospital adverse events occurred in 38 (15.6 %); of the 237 patients who completed follow-up, MACCEs occurred in 30 (12.7 %). Surgery led to significant increases in levels of all three pro-inflammatory factors, with levels returning to pre-bypass baseline on arrival in the intensive care unit (TNF-α), 4 h after arrival (interleukin-8) or 20 h after arrival (neutrophil elastase). However, pre- and post-bypass levels of all three factors did not differ significantly between patients who experienced adverse events in-hospital or not, or between patients who experienced MACCEs during follow-up or not.

Conclusions: Levels of TNF-α, interleukin-8 and neutrophil elastase may not be associated with poor prognosis after cardiopulmonary bypass. This may help explain why "cytokine clearance" strategies fail to improve clinical outcomes after on-pump cardiac surgery.

目的:血浆中促炎症因子水平升高与体外循环心脏手术后预后恶化有关,但降低患者体内促炎症因子水平的干预措施未能改善预后。因此,我们探讨了促炎因子水平是否与心肺旁路瓣膜手术后患者的预后有关。在心肺旁路术前和术后多次测量肿瘤坏死因子(TNF)-α、白细胞介素-8和中性粒细胞弹性蛋白酶的水平。对是否发生院内不良事件的患者以及是否在三年随访期间发生重大心脏或脑血管不良事件(MACCE)的患者进行了水平比较:在 244 名入选患者中,有 38 人(15.6%)发生了院内不良事件;在 237 名完成随访的患者中,有 30 人(12.7%)发生了重大心脑血管不良事件。手术导致所有三种促炎症因子的水平明显升高,在到达重症监护室(TNF-α)、到达重症监护室后 4 小时(白细胞介素-8)或到达重症监护室后 20 小时(中性粒细胞弹性蛋白酶),这三种促炎症因子的水平均恢复到搭桥前的基线。然而,这三种因子在搭桥前和搭桥后的水平在是否在院内发生不良事件的患者之间,或在是否在随访期间发生澳门巴黎人娱乐官网的患者之间并无显著差异:TNF-α、白细胞介素-8和中性粒细胞弹性蛋白酶的水平可能与心肺搭桥术后的不良预后无关。结论:TNF-α、白细胞介素-8和中性粒细胞弹性蛋白酶的水平可能与心肺旁路术后的不良预后无关,这可能有助于解释为什么 "细胞因子清除 "策略无法改善泵上心脏手术后的临床预后。
{"title":"Prospective Reassessment of the Association Between Pro-Inflammatory Factors and Prognosis After on-Pump Cardiac Surgery.","authors":"Yingting Huang, Xunbei Huang, Liqin Ling, Chaonan Liu, Si Chen, Jing Zhou, Lei Du, Jiyue Xiong","doi":"10.18087/cardio.2024.9.n2682","DOIUrl":"10.18087/cardio.2024.9.n2682","url":null,"abstract":"<p><strong>Aim: </strong>Elevated levels of pro-inflammatory factors in plasma have been linked to worse prognosis after on-pump cardiac surgery, yet interventions that reduce the levels in patients have failed to improve prognosis. Therefore, we explored whether levels of pro-inflammatory factors are associated with prognosis of patients after valve surgery with cardiopulmonary bypass.</p><p><strong>Material and methods: </strong>244 patients were prospectively enrolled into observational study. Levels of tumor necrosis factor (TNF) - α, interleukin-8 and neutrophil elastase were measured once before and several times after cardiopulmonary bypass. The levels were compared between patients who experienced in-hospital adverse events or not, and between patients who experienced major adverse cardiac or cerebrovascular events (MACCEs) during three-year follow-up or not.</p><p><strong>Results: </strong>Of the 244 patients enrolled, in-hospital adverse events occurred in 38 (15.6 %); of the 237 patients who completed follow-up, MACCEs occurred in 30 (12.7 %). Surgery led to significant increases in levels of all three pro-inflammatory factors, with levels returning to pre-bypass baseline on arrival in the intensive care unit (TNF-α), 4 h after arrival (interleukin-8) or 20 h after arrival (neutrophil elastase). However, pre- and post-bypass levels of all three factors did not differ significantly between patients who experienced adverse events in-hospital or not, or between patients who experienced MACCEs during follow-up or not.</p><p><strong>Conclusions: </strong>Levels of TNF-α, interleukin-8 and neutrophil elastase may not be associated with poor prognosis after cardiopulmonary bypass. This may help explain why \"cytokine clearance\" strategies fail to improve clinical outcomes after on-pump cardiac surgery.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 9","pages":"87-95"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401941","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
Effects of Ventricular Extrasystoles on Right Ventricle Functions (a Speckle Tracking Study). VES and RV Strain Imaging. 室性期外收缩对右心室功能的影响(斑点追踪研究)。VES 和右心室应变成像。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2673
Ahmet Özderya, Turhan Turan

Aim: The adverse effects of ventricular extrasystoles (VES) on the heart, such as induced dyssynchrony, irregular heart rate, and atrioventricular dissociation, have been demonstrated. The aim of this study was to investigate the effects of VES on the right ventricle (RV) using strain imaging.

Material and methods: Fifty patients with 5000 or more VES detected during 24hr Holterrhythm monitoring between April 2022 and September 2022 in the cardiology outpatient clinic were included in this study.A volunteer control group of 50 individuals matching the patients' age and demographic characteristics was selected. Right heart function parameters were compared echocardiographically between the two groups.

Results: In the VES group, both RV free wall strain (22.03±3.67, 29.52±3.01; p<0.001) and RV four-chamber strain (19.37±2.95, 22.34±2.11; p<0.001) were lower compared to the control groupIn the univariate regression analysis for decreased RV four-chamber strain, the presence of VES (p<0.001) was identified as a predictor, whereaas in the multivariate regression analysis, it was not considered to be an independent predictor. When evaluating the characteristics of the VES patients, the number of VES detected during Holter monitoring and delta QRS were observed as negative predictors of RV strain.

Conclusion: This study demonstrated the adverse effects of VES on the right ventricle, as it is on the left ventricle.Therefore, regular monitoring of RV function with echocardiography is important in the follow-up of patients with VES.

目的:室性期外收缩(VES)对心脏的不良影响已得到证实,如诱发不同步、心率不齐和房室解离。本研究旨在利用应变成像技术研究 VES 对右心室(RV)的影响:本研究纳入了 2022 年 4 月至 2022 年 9 月期间在心脏病学门诊进行 24 小时心律监测期间检测到 5000 或更多 VES 的 50 名患者。通过超声心动图比较了两组患者的右心功能参数:结果:在 VES 组中,RV 游离壁应变(22.03±3.67,29.52±3.01;p<0.001)和 RV 四腔应变(19.37±2.95,22.34±2.11;p<0.在 RV 四腔应变降低的单变量回归分析中,VES 的存在(p<0.001)被认为是一个预测因素,而在多变量回归分析中,它不被认为是一个独立的预测因素。在评估 VES 患者的特征时,Holter 监测中检测到的 VES 数量和 delta QRS 被认为是 RV 应变的负预测因子:因此,在对 VES 患者进行随访时,通过超声心动图定期监测 RV 功能非常重要。
{"title":"Effects of Ventricular Extrasystoles on Right Ventricle Functions (a Speckle Tracking Study). VES and RV Strain Imaging.","authors":"Ahmet Özderya, Turhan Turan","doi":"10.18087/cardio.2024.9.n2673","DOIUrl":"https://doi.org/10.18087/cardio.2024.9.n2673","url":null,"abstract":"<p><strong>Aim: </strong>The adverse effects of ventricular extrasystoles (VES) on the heart, such as induced dyssynchrony, irregular heart rate, and atrioventricular dissociation, have been demonstrated. The aim of this study was to investigate the effects of VES on the right ventricle (RV) using strain imaging.</p><p><strong>Material and methods: </strong>Fifty patients with 5000 or more VES detected during 24hr Holterrhythm monitoring between April 2022 and September 2022 in the cardiology outpatient clinic were included in this study.A volunteer control group of 50 individuals matching the patients' age and demographic characteristics was selected. Right heart function parameters were compared echocardiographically between the two groups.</p><p><strong>Results: </strong>In the VES group, both RV free wall strain (22.03±3.67, 29.52±3.01; p&lt;0.001) and RV four-chamber strain (19.37±2.95, 22.34±2.11; p&lt;0.001) were lower compared to the control groupIn the univariate regression analysis for decreased RV four-chamber strain, the presence of VES (p&lt;0.001) was identified as a predictor, whereaas in the multivariate regression analysis, it was not considered to be an independent predictor. When evaluating the characteristics of the VES patients, the number of VES detected during Holter monitoring and delta QRS were observed as negative predictors of RV strain.</p><p><strong>Conclusion: </strong>This study demonstrated the adverse effects of VES on the right ventricle, as it is on the left ventricle.Therefore, regular monitoring of RV function with echocardiography is important in the follow-up of patients with VES.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 9","pages":"80-86"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401919","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
Incremental Value of Radiomics Features of Epicardial Adipose Tissue for Detecting the Severity of COVID-19 Infection. 心外膜脂肪组织放射组学特征对检测 COVID-19 感染严重程度的增量价值
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2685
Ni Yao, Yanhui Tian, Daniel Gama das Neves, Chen Zhao, Claudio Tinoco Mesquita, Wolney de Andrade Martins, Alair Augusto Sarmet Moreira Damas Dos Santos, Yanting Li, Chuang Han, Fubao Zhu, Neng Dai, Weihua Zhou

Introduction: Epicardial adipose tissue (EAT) is known for its pro-inflammatory properties and association with Coronavirus Disease 2019 (COVID-19) severity. However, existing detection methods for COVID-19 severity assessment often lack consideration of organs and tissues other than the lungs, which limits the accuracy and reliability of these predictive models.

Material and methods: The retrospective study included data from 515 COVID-19 patients (Cohort 1, n=415; Cohort 2, n=100) from two centers (Shanghai Public Health Center and Brazil Niteroi Hospital) between January 2020 and July 2020. Firstly, a three-stage EAT segmentation method was proposed by combining object detection and segmentation networks. Lung and EAT radiomics features were then extracted, and feature selection was performed. Finally, a hybrid model, based on seven machine learning models, was built for detecting COVID-19 severity. The hybrid model's performance and uncertainty were evaluated in both internal and external validation cohorts.

Results: For EAT extraction, the Dice similarity coefficients (DSC) of the two centers were 0.972 (±0.011) and 0.968 (±0.005), respectively. For severity detection, the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI) of the hybrid model increased by 0.09 (p<0.001), 19.3 % (p<0.05), and 18.0 % (p<0.05) in the internal validation cohort, and by 0.06 (p<0.001), 18.0 % (p<0.05) and 18.0 % (p<0.05) in the external validation cohort, respectively. Uncertainty and radiomics features analysis confirmed the interpretability of increased certainty in case prediction after inclusion of EAT features.

Conclusion: This study proposed a novel three-stage EAT extraction method. We demonstrated that adding EAT radiomics features to a COVID-19 severity detection model results in increased accuracy and reduced uncertainty. The value of these features was also confirmed through feature importance ranking and visualization.

导言:心外膜脂肪组织(EAT)因其促炎特性和与冠状病毒疾病2019(COVID-19)严重程度相关而闻名。然而,现有的用于评估 COVID-19 严重程度的检测方法往往缺乏对肺部以外器官和组织的考虑,这限制了这些预测模型的准确性和可靠性:该回顾性研究纳入了2020年1月至2020年7月期间来自两个中心(上海公共卫生中心和巴西尼泰罗伊医院)的515名COVID-19患者(队列1,n=415;队列2,n=100)的数据。首先,结合物体检测和分割网络,提出了三阶段 EAT 分割方法。然后提取肺和 EAT 放射组学特征,并进行特征选择。最后,建立了一个基于七个机器学习模型的混合模型,用于检测 COVID-19 的严重程度。在内部和外部验证队列中对混合模型的性能和不确定性进行了评估:结果:在EAT提取方面,两个中心的Dice相似系数(DSC)分别为0.972(±0.011)和0.968(±0.005)。在严重程度检测方面,混合模型的接收者操作特征曲线下面积(AUC)、净再分类改进(NRI)和综合辨别改进(IDI)分别增加了 0.在内部验证队列中分别增加了 0.09 (p<0.001)、19.3 % (p<0.05) 和 18.0 % (p<0.05),在外部验证队列中分别增加了 0.06 (p<0.001)、18.0 % (p<0.05) 和 18.0 % (p<0.05)。不确定性和放射组学特征分析证实,纳入 EAT 特征后,病例预测的确定性增加了:本研究提出了一种新颖的三阶段 EAT 提取方法。我们证明,在 COVID-19 严重程度检测模型中加入 EAT 放射组学特征可提高准确性并降低不确定性。这些特征的价值还通过特征重要性排序和可视化得到了证实。
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引用次数: 0
Prediction of Cardiovascular Events and Structural and Functional Remodeling of the Heart in Patients With Severe Mitral Regurgitation of Various Genesis Underwent Transcatheter Mitral Valve Repair "Edge-To-Edge". 对接受经导管二尖瓣瓣膜 "边缘到边缘 "修复术的各种成因严重二尖瓣反流患者的心血管事件及心脏结构和功能重塑进行预测。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2699
M I Makeev, M A Saidova, A A Safiullina, A E Komlev, I V Kuchin, M M Kantemirova, T E Imaev
<p><strong>Aim: </strong>To search for predictors of adverse cardiovascular events after edge-to-edge transcatheter mitral valve repair (TMVR) in patients with severe mitral regurgitation (MR) of various origins with an assessment of structural and functional remodeling of the heart and left ventricular (LV) contractile function.</p><p><strong>Material and methods: </strong>The study included 73 patients (median age 71 [63; 80] years, 60.3% men) at a high surgical risk with severe MR of primary and secondary genesis, who underwent TMVR. The second-generation (58.9%) and fourth-generation (41.1%) clips were implanted. In addition to standard echocardiographic (EchoCG) indices, the parameters of left heart chamber longitudinal strain and LV myocardial function were assessed at baseline, on days 4-5, and at 6 and 12 months after the intervention. Also, the N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP) was assessed at baseline and on days 4-5 after TMVR.</p><p><strong>Results: </strong>A significant decrease in MR was achieved during 12 months of follow-up. In the group with primary mitral regurgitation (PMR), MR decreased from 4.0 [3.4; 4.0] to 2.0 [1.5; 2.5] at one year of follow-up (p<0.001). In the group with secondary mitral regurgitation (SMR), MR decreased from 3.5 [3.0; 3.9] to 2.0 [2.0; 2.5] at 12 months of follow-up (p<0.001). This effect was associated with volumetric unloading of the left heart chambers evident as a significant decrease in the volumetric indices of the left chambers and an increase in the cardiac index. In the early postoperative period, the LV function was impaired as shown by decreases in the ejection fraction (EF), global longitudinal strain (GLS), LV myocardial function parameters, and an associated increase in NT-proBNP. By 12 months of follow-up, statistically significant improvements in global constructive work (GCW) and global work index (GWI) relative to baseline values were noted in both groups without significant changes in EF and LV GLS. A strong correlation was found between LV EF and GCW (r=0.812, p<0.001) and GWI (r=0.749, p<0.001). The overall survival was 89%, not differing between groups (p=0.72); the absence of hospitalization for decompensated heart failure (HF) was 79.5%, also without significant differences between the groups (p=0.78). According to multivariate regression analysis, the baseline GCW value was the strongest predictor of rehospitalization for decompensated HF (relative risk (RR) 0.997; 95% confidence interval (CI) 0.995-1.000; p=0.021) and the composite endpoint (CEP) (hospitalization for decompensated HF + all-cause mortality) (RR 0.998; 95% CI 0.996-1.000; p=0.033) in the cohort with PMR. In the group with SMR, the initial degree of MR was related with rehospitalization and the CEP (OR 12.252; 95% CI 2.125-70.651; p=0.005 and OR 16.098; 95% CI 2.944-88.044; p=0.001, respectively). The most significant predictor of overall mortality in the study popul
目的:通过评估心脏结构和功能重塑情况以及左心室收缩功能,寻找各种原因导致的严重二尖瓣反流(MR)患者接受边缘对边缘经导管二尖瓣修复术(TMVR)后发生不良心血管事件的预测因素:研究纳入了73名接受TMVR的原发性和继发性重度MR高手术风险患者(中位年龄71 [63; 80]岁,60.3%为男性)。植入的是第二代(58.9%)和第四代(41.1%)夹子。除标准超声心动图(EchoCG)指标外,还在基线、介入治疗后第 4-5 天、6 个月和 12 个月评估了左心室纵向应变参数和左心室心肌功能。此外,还在基线和 TMVR 后第 4-5 天评估了前脑利钠肽 N 端片段(NT-proBNP):结果:在 12 个月的随访中,MR 明显下降。在原发性二尖瓣反流(PMR)组中,随访一年后,MR 从 4.0 [3.4; 4.0] 降至 2.0 [1.5; 2.5](p<0.001)。在继发性二尖瓣反流 (SMR) 组中,随访 12 个月时,MR 从 3.5 [3.0; 3.9] 降至 2.0 [2.0; 2.5](p<0.001)。这种效应与左心房的容积负荷减轻有关,左心房的容积指数显著下降,心脏指数上升。术后早期,左心室功能受损,表现为射血分数(EF)、整体纵向应变(GLS)和左心室心肌功能参数的下降,以及相关的 NT-proBNP 增加。随访 12 个月后,两组患者的全局建设性工作(GCW)和全局工作指数(GWI)与基线值相比均有统计学意义上的显著改善,但射血分数(EF)和左心室纵向应变(GLS)无明显变化。研究发现,左心室 EF 与 GCW(r=0.812,p<0.001)和 GWI(r=0.749,p<0.001)之间存在很强的相关性。总生存率为 89%,组间无显著差异(p=0.72);无失代偿性心衰(HF)住院率为 79.5%,组间也无显著差异(p=0.78)。根据多变量回归分析,在 PMR 组群中,基线 GCW 值是失代偿性 HF 再住院(相对风险 (RR) 0.997;95% 置信区间 (CI)0.995-1.000;p=0.021)和复合终点 (CEP) (失代偿性 HF 住院 + 全因死亡率)(RR 0.998;95% CI 0.996-1.000;p=0.033)的最强预测因子。在 SMR 组中,MR 的初始程度与再住院和 CEP 有关(OR 分别为 12.252;95% CI 2.125-70.651;p=0.005 和 OR 16.098;95% CI 2.944-88.044;p=0.001)。研究人群总死亡率的最重要预测因素是术前左心室搏出量(OR 0.824; 95% CI 0.750-0.906; p<0.001):边对边TMVR对PMR和SMR患者的预后、心脏结构和功能重塑有积极影响。心肌功能指数可能有助于评估各种原因导致的严重 MR 患者的左心室收缩功能。通过新的 EchoCG 技术等手段确定不良心血管事件的预测因素,有助于更好地对患者进行分层。
{"title":"Prediction of Cardiovascular Events and Structural and Functional Remodeling of the Heart in Patients With Severe Mitral Regurgitation of Various Genesis Underwent Transcatheter Mitral Valve Repair \"Edge-To-Edge\".","authors":"M I Makeev, M A Saidova, A A Safiullina, A E Komlev, I V Kuchin, M M Kantemirova, T E Imaev","doi":"10.18087/cardio.2024.9.n2699","DOIUrl":"https://doi.org/10.18087/cardio.2024.9.n2699","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To search for predictors of adverse cardiovascular events after edge-to-edge transcatheter mitral valve repair (TMVR) in patients with severe mitral regurgitation (MR) of various origins with an assessment of structural and functional remodeling of the heart and left ventricular (LV) contractile function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The study included 73 patients (median age 71 [63; 80] years, 60.3% men) at a high surgical risk with severe MR of primary and secondary genesis, who underwent TMVR. The second-generation (58.9%) and fourth-generation (41.1%) clips were implanted. In addition to standard echocardiographic (EchoCG) indices, the parameters of left heart chamber longitudinal strain and LV myocardial function were assessed at baseline, on days 4-5, and at 6 and 12 months after the intervention. Also, the N-terminal fragment of the pro-brain natriuretic peptide (NT-proBNP) was assessed at baseline and on days 4-5 after TMVR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A significant decrease in MR was achieved during 12 months of follow-up. In the group with primary mitral regurgitation (PMR), MR decreased from 4.0 [3.4; 4.0] to 2.0 [1.5; 2.5] at one year of follow-up (p&lt;0.001). In the group with secondary mitral regurgitation (SMR), MR decreased from 3.5 [3.0; 3.9] to 2.0 [2.0; 2.5] at 12 months of follow-up (p&lt;0.001). This effect was associated with volumetric unloading of the left heart chambers evident as a significant decrease in the volumetric indices of the left chambers and an increase in the cardiac index. In the early postoperative period, the LV function was impaired as shown by decreases in the ejection fraction (EF), global longitudinal strain (GLS), LV myocardial function parameters, and an associated increase in NT-proBNP. By 12 months of follow-up, statistically significant improvements in global constructive work (GCW) and global work index (GWI) relative to baseline values were noted in both groups without significant changes in EF and LV GLS. A strong correlation was found between LV EF and GCW (r=0.812, p&lt;0.001) and GWI (r=0.749, p&lt;0.001). The overall survival was 89%, not differing between groups (p=0.72); the absence of hospitalization for decompensated heart failure (HF) was 79.5%, also without significant differences between the groups (p=0.78). According to multivariate regression analysis, the baseline GCW value was the strongest predictor of rehospitalization for decompensated HF (relative risk (RR) 0.997; 95% confidence interval (CI) 0.995-1.000; p=0.021) and the composite endpoint (CEP) (hospitalization for decompensated HF + all-cause mortality) (RR 0.998; 95% CI 0.996-1.000; p=0.033) in the cohort with PMR. In the group with SMR, the initial degree of MR was related with rehospitalization and the CEP (OR 12.252; 95% CI 2.125-70.651; p=0.005 and OR 16.098; 95% CI 2.944-88.044; p=0.001, respectively). The most significant predictor of overall mortality in the study popul","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 9","pages":"3-15"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401924","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
Comparative Analysis of The Effectiveness of Antihypertensive Therapy Including Spironolactone and Eplerenone in Patients With Essential Hypertension and Atrial Fibrillation. 包括螺内酯和依普利酮在内的抗高血压疗法对重度高血压和心房颤动患者疗效的对比分析
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2712
G Zh Abdullaeva, G M Radzhabova, N H Sherbadalova, M T Pulatova, Z T Mashkurova, R B Alieva, M N Khatamova, N N Ibragimov
<p><strong>Aim: </strong>To perform a comparative analysis of the efficacy of antihypertensive therapy (AHT) containing spironolactone or eplerenone in patients with essential arterial hypertension (AH) and atrial fibrillation (AF).</p><p><strong>Material and methods: </strong>The study included 99 male and female patients with essential AH complicated by permanent AF, who were receiving the outpatient treatment at the National Specialized Scientific and Practical Medical Center of Cardiology (Tashkent). The patients aged 61.3±9.5 years, the mean duration of AH was 12.9±8.3 years. All patients were divided into two groups: Group 1, patients who completed a 6-month combination AHT containing spironolactone (n=51); Group 2, patients who completed a 6-month combination AHT containing eplerenone (n=48). AF was diagnosed by electrocardiogram (ECG) and/or 24-hour ECG monitoring according to standard diagnostic criteria. The ECG study was performed in compliance with the American Society of Echocardiography Guidelines in M- and B-modes. The degree of structural vascular alterations was determined by the intima-media thickness of the common carotid artery by duplex scanning and microalbuminuria in morning urine. The concentrations of sex hormones were measured by the enzyme immunoassay. The serum concentrations of lipids, glucose, creatinine, and uric acid were measured by the enzymatic method. The glomerular filtration rate (GFR) was calculated with the EPI formula. Results of all studies were considered statistically significant at p<0.05.</p><p><strong>Results: </strong>The proportion of patients who achieved the target diastolic blood pressure (BP) values was significantly greater in the eplerenone-containing treatment group than in the spironolactone-containing treatment group: 87.8% vs. 67.5% (p=0.043). The proportion of patients who simultaneously achieved the target systolic and diastolic BP values was slightly greater in the eplerenone-containing treatment group than in the spironolactone-containing group (100% vs. 92.1%, p=0.060). The best cardioprotective efficacy was observed in the group of combination AHT containing eplerenone. Specifically, in Group 2, the left ventricular ejection fraction (LVEF) was significantly improved compared to Group 1: from 55.4±10.6% at baseline to 52.6±9.1% in Group 1 (p>0.05) and from 54.8±8.8% at baseline to 58.2±6.4% in Group 2 (p<0.02). Only in Group 2, the left atrial volume index (LAVI) was significantly decreased compared to Group 1. Thus, in Group 1, the LAVI changed from 42.2±15.1 ml/m2 at baseline to 40.4±12.2 ml/m2 (p>0.05) and in Group 2, from 41.2±15.3 ml/m2 at baseline to 37.3±13.5 ml/m2 after the treatment (p<0.05); the ∆% LAVI in the eplerenone group was -5.9% vs. -0.36% in the spironolactone group. In men of Group 1, estradiol significantly increased from 13.9±12.6 pmol/l at baseline to 22.7±12.4 pmol/l (p<0.001).</p><p><strong>Conclusion: </strong>The good antihypertensive eff
目的:对使用螺内酯或依普利酮的降压疗法(AHT)治疗原发性动脉高血压(AH)合并心房颤动(AF)患者的疗效进行比较分析:研究对象包括在塔什干国家心脏病学专业科学实践医疗中心接受门诊治疗的99名男性和女性原发性动脉高血压并发永久性房颤患者。患者年龄为(61.3±9.5)岁,房颤平均持续时间为(12.9±8.3)年。所有患者分为两组:第一组,完成为期 6 个月的含螺内酯的联合 AHT 的患者(51 人);第二组,完成为期 6 个月的含依普利酮的联合 AHT 的患者(48 人)。房颤根据标准诊断标准通过心电图和/或 24 小时心电图监测进行诊断。心电图检查按照《美国超声心动图学会指南》以 M 型和 B 型进行。血管结构的改变程度是通过双工扫描颈总动脉内膜厚度和晨尿微量白蛋白尿来确定的。性激素的浓度是通过酶免疫测定法测定的。血脂、葡萄糖、肌酐和尿酸的血清浓度采用酶法测量。肾小球滤过率(GFR)用 EPI 公式计算。所有研究结果的统计学意义均为 p<0.05:结果:含依普利酮治疗组达到目标舒张压(BP)值的患者比例明显高于含螺内酯治疗组:87.8%对67.5%(P=0.043)。同时达到收缩压和舒张压目标值的患者比例,含依普利酮治疗组略高于含螺内酯治疗组(100% 对 92.1%,P=0.060)。含有依普利酮的联合 AHT 治疗组的心脏保护效果最佳。具体而言,与第 1 组相比,第 2 组的左室射血分数(LVEF)显著改善:从基线时的 55.4±10.6% 降至第 1 组的 52.6±9.1%(p>0.05),从基线时的 54.8±8.8% 降至第 2 组的 58.2±6.4%(p<0.02)。因此,第 1 组的左心房容积指数从基线时的 42.2±15.1 ml/m2 变为 40.4±12.2 ml/m2 (p>0.05),第 2 组从基线时的 54.8±8.8% 变为 58.2±6.4% (p<0.02)。05),第 2 组从基线时的 41.2±15.3 ml/m2 变为治疗后的 37.3±13.5 ml/m2 (p<0.05);依普利酮组的 LAVI ∆% 为-5.9%,而螺内酯组为-0.36%。第1组男性的雌二醇从基线的13.9±12.6 pmol/l显著升高至22.7±12.4 pmol/l(p<0.001):在达到目标血压值方面,为期6个月的含依普利酮联合疗法的良好降压效果明显优于螺内酯。与含有螺内酯的治疗相比,含有依普利酮的治疗能显著改善 LVEF 并降低 LAVI。在女性和男性中,含有依普利酮的 AHT 对性激素浓度都有有益影响的趋势。
{"title":"Comparative Analysis of The Effectiveness of Antihypertensive Therapy Including Spironolactone and Eplerenone in Patients With Essential Hypertension and Atrial Fibrillation.","authors":"G Zh Abdullaeva, G M Radzhabova, N H Sherbadalova, M T Pulatova, Z T Mashkurova, R B Alieva, M N Khatamova, N N Ibragimov","doi":"10.18087/cardio.2024.9.n2712","DOIUrl":"https://doi.org/10.18087/cardio.2024.9.n2712","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To perform a comparative analysis of the efficacy of antihypertensive therapy (AHT) containing spironolactone or eplerenone in patients with essential arterial hypertension (AH) and atrial fibrillation (AF).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;The study included 99 male and female patients with essential AH complicated by permanent AF, who were receiving the outpatient treatment at the National Specialized Scientific and Practical Medical Center of Cardiology (Tashkent). The patients aged 61.3±9.5 years, the mean duration of AH was 12.9±8.3 years. All patients were divided into two groups: Group 1, patients who completed a 6-month combination AHT containing spironolactone (n=51); Group 2, patients who completed a 6-month combination AHT containing eplerenone (n=48). AF was diagnosed by electrocardiogram (ECG) and/or 24-hour ECG monitoring according to standard diagnostic criteria. The ECG study was performed in compliance with the American Society of Echocardiography Guidelines in M- and B-modes. The degree of structural vascular alterations was determined by the intima-media thickness of the common carotid artery by duplex scanning and microalbuminuria in morning urine. The concentrations of sex hormones were measured by the enzyme immunoassay. The serum concentrations of lipids, glucose, creatinine, and uric acid were measured by the enzymatic method. The glomerular filtration rate (GFR) was calculated with the EPI formula. Results of all studies were considered statistically significant at p&lt;0.05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The proportion of patients who achieved the target diastolic blood pressure (BP) values was significantly greater in the eplerenone-containing treatment group than in the spironolactone-containing treatment group: 87.8% vs. 67.5% (p=0.043). The proportion of patients who simultaneously achieved the target systolic and diastolic BP values was slightly greater in the eplerenone-containing treatment group than in the spironolactone-containing group (100% vs. 92.1%, p=0.060). The best cardioprotective efficacy was observed in the group of combination AHT containing eplerenone. Specifically, in Group 2, the left ventricular ejection fraction (LVEF) was significantly improved compared to Group 1: from 55.4±10.6% at baseline to 52.6±9.1% in Group 1 (p&gt;0.05) and from 54.8±8.8% at baseline to 58.2±6.4% in Group 2 (p&lt;0.02). Only in Group 2, the left atrial volume index (LAVI) was significantly decreased compared to Group 1. Thus, in Group 1, the LAVI changed from 42.2±15.1 ml/m2 at baseline to 40.4±12.2 ml/m2 (p&gt;0.05) and in Group 2, from 41.2±15.3 ml/m2 at baseline to 37.3±13.5 ml/m2 after the treatment (p&lt;0.05); the ∆% LAVI in the eplerenone group was -5.9% vs. -0.36% in the spironolactone group. In men of Group 1, estradiol significantly increased from 13.9±12.6 pmol/l at baseline to 22.7±12.4 pmol/l (p&lt;0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The good antihypertensive eff","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 9","pages":"70-79"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401918","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
Assessment of Specific Biomarkers' Profile and Structural, Functional Parameters of the Left Ventricle in Patients With Lymphomas Undergoing Antitumor Therapy. 评估接受抗肿瘤治疗的淋巴瘤患者左心室的特定生物标记物特征及结构和功能参数
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2743
I Ya Sokolova, Sh M Murtuzaliev, S A Kardovskaya, A A Shchendrygina, P A Markin, S A Appolonova, T Yu Kulagina, O A Zhigulina, N V Khabarova, Yu N Belenkov, I S Ilgisonis

Aim: To evaluate the dynamics of specific biomarkers for cardiotoxicity, endothelial dysfunction, fibrosis, systemic inflammation, and morpho-functional alterations in the left ventricular (LV) myocardium in patients with newly diagnosed lymphomas during 6 courses of polychemotherapy (PCT).

Material and methods: The study included 30 patients with newly diagnosed lymphomas. All patients were evaluated for laboratory markers of cardiotoxicity at baseline and after 6 courses of chemotherapy (6 months), including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), endothelin-1 (ET-1), circulating cardiac biomarker ST-2, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and LV structural and functional echocardiographic (EchoCG) parameters.

Results: The changes in NT-proBNP and hsTnI concentrations during 6 courses of PCT were not statistically significant. Comparison of the baseline values with those after 6 courses of PCT showed increases in the median concentrations of ET-1 (3.38 and 5.5 pg/ml, respectively; p=0.438) and ST-2 (12.21 and 26.75 ng/ml, respectively; p=0.687). Markers of systemic inflammation were significantly decreased after 6 courses of PCT: the median CRP decreased from 15.2 to 0.72 mg/ml (p=0.006), and the median IL-6 decreased from 12.2 to 5.1 pg/ml (p=0.034). EchoCG data revealed a statistically significant impairment of the LV diastolic function parameters (E/A; E/e' lateral; E/e' average; left atrial volume index; isovolumic relaxation time). A moderate direct correlation was found between the ET-1 concentration and the isovolumic relaxation time at baseline and after 6 courses of PCT, respectively (r1 = 0.387, p=0.047 and r2 = 0.391, p=0.035). No changes in the LV systolic function were observed.

Conclusion: The study showed that patients with lymphoproliferative diseases had no signs of cardiotoxicity during PCT according to the accepted criteria. This study described and highlighted for the first time the interrelation of endothelial dysfunction, profibrotic status, and LV diastolic dysfunction as manifestations of cardiovascular toxicity in patients with lymphoproliferative diseases. It is advisable to supplement the integrated strategies for the prevention and monitoring of PCT cardiovascular toxicity with a thorough evaluation of instrumental parameters of diastolic dysfunction for timely initiation/correction of cardioprotective therapy.

目的:评估新诊断的淋巴瘤患者在接受6个疗程的多化学疗法(PCT)期间,心脏毒性、内皮功能障碍、纤维化、全身炎症和左心室(LV)心肌形态功能改变的特定生物标志物的动态变化:研究对象包括30名新确诊的淋巴瘤患者。所有患者均在基线和 6 个疗程化疗(6 个月)后接受了心脏毒性实验室指标评估,包括 N 端前脑钠肽 (NT-proBNP)、高敏肌钙蛋白 I (hsTnI)、内皮素-1 (ET-1)、内皮素-1(ET-1)、循环心脏生物标志物 ST-2、高敏 C 反应蛋白(hsCRP)、白细胞介素-6(IL-6)以及左心室结构和功能超声心动图(EchoCG)参数。结果在 PCT 的 6 个疗程中,NT-proBNP 和 hsTnI 浓度的变化无统计学意义。将基线值与 PCT 6 个疗程后的值进行比较后发现,ET-1(分别为 3.38 和 5.5 pg/ml;p=0.438)和 ST-2 的中位浓度均有所增加(分别为 12.21 和 26.75 ng/ml;p=0.687)。经过 6 个疗程的 PCT 治疗后,全身炎症指标明显降低:CRP 中位数从 15.2 毫克/毫升降至 0.72 毫克/毫升(p=0.006),IL-6 中位数从 12.2 pg/ml 降至 5.1 pg/ml(p=0.034)。EchoCG 数据显示,左心室舒张功能参数(E/A;E/e'侧值;E/e'平均值;左心房容积指数;等容舒张时间)出现了统计学意义上的显著损伤。在基线和 6 个疗程的 PCT 治疗后,发现 ET-1 浓度与等容舒张时间之间分别存在中等程度的直接相关性(r1 = 0.387,p=0.047;r2 = 0.391,p=0.035)。左心室收缩功能未见变化:研究表明,根据公认的标准,淋巴细胞增生性疾病患者在 PCT 期间没有心脏毒性的迹象。本研究首次描述并强调了淋巴细胞增殖性疾病患者的内皮功能障碍、组织坏死状态和左心室舒张功能障碍作为心血管毒性表现的相互关系。在预防和监测 PCT 心血管毒性的综合策略中,最好对舒张功能障碍的仪器参数进行全面评估,以便及时启动/纠正心血管保护疗法。
{"title":"Assessment of Specific Biomarkers' Profile and Structural, Functional Parameters of the Left Ventricle in Patients With Lymphomas Undergoing Antitumor Therapy.","authors":"I Ya Sokolova, Sh M Murtuzaliev, S A Kardovskaya, A A Shchendrygina, P A Markin, S A Appolonova, T Yu Kulagina, O A Zhigulina, N V Khabarova, Yu N Belenkov, I S Ilgisonis","doi":"10.18087/cardio.2024.9.n2743","DOIUrl":"https://doi.org/10.18087/cardio.2024.9.n2743","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the dynamics of specific biomarkers for cardiotoxicity, endothelial dysfunction, fibrosis, systemic inflammation, and morpho-functional alterations in the left ventricular (LV) myocardium in patients with newly diagnosed lymphomas during 6 courses of polychemotherapy (PCT).</p><p><strong>Material and methods: </strong>The study included 30 patients with newly diagnosed lymphomas. All patients were evaluated for laboratory markers of cardiotoxicity at baseline and after 6 courses of chemotherapy (6 months), including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), endothelin-1 (ET-1), circulating cardiac biomarker ST-2, high-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and LV structural and functional echocardiographic (EchoCG) parameters.</p><p><strong>Results: </strong>The changes in NT-proBNP and hsTnI concentrations during 6 courses of PCT were not statistically significant. Comparison of the baseline values with those after 6 courses of PCT showed increases in the median concentrations of ET-1 (3.38 and 5.5 pg/ml, respectively; p=0.438) and ST-2 (12.21 and 26.75 ng/ml, respectively; p=0.687). Markers of systemic inflammation were significantly decreased after 6 courses of PCT: the median CRP decreased from 15.2 to 0.72 mg/ml (p=0.006), and the median IL-6 decreased from 12.2 to 5.1 pg/ml (p=0.034). EchoCG data revealed a statistically significant impairment of the LV diastolic function parameters (E/A; E/e' lateral; E/e' average; left atrial volume index; isovolumic relaxation time). A moderate direct correlation was found between the ET-1 concentration and the isovolumic relaxation time at baseline and after 6 courses of PCT, respectively (r1 = 0.387, p=0.047 and r2 = 0.391, p=0.035). No changes in the LV systolic function were observed.</p><p><strong>Conclusion: </strong>The study showed that patients with lymphoproliferative diseases had no signs of cardiotoxicity during PCT according to the accepted criteria. This study described and highlighted for the first time the interrelation of endothelial dysfunction, profibrotic status, and LV diastolic dysfunction as manifestations of cardiovascular toxicity in patients with lymphoproliferative diseases. It is advisable to supplement the integrated strategies for the prevention and monitoring of PCT cardiovascular toxicity with a thorough evaluation of instrumental parameters of diastolic dysfunction for timely initiation/correction of cardioprotective therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 9","pages":"28-38"},"PeriodicalIF":0.5,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401917","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
Peculiarities of Hemostasis and Proteomics in Patients With Acute Myocardial Infarction and Healthy Volunteers After SARS-CоV-2 Infection. SARS-CоV-2 感染后急性心肌梗死患者和健康志愿者的止血和蛋白质组学特征
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-09-30 DOI: 10.18087/cardio.2024.9.n2752
A I Kalinskaya, A K Elizarova, A S Anisimova, D A Vorobyeva, G I Rusakovich, E V Maryukhnich, O A Dukhin, O I Ivanova, A E Bugrova, A G Brzhozovskiy, M I Indeykina, A S Kononikhin, E N Nikolaev, E Yu Vasilieva

Aim: To identify the features of plasma, platelet hemostasis, and proteomic composition of the blood plasma in patients with acute myocardial infarction (AMI) and healthy volunteers after COVID-19.

Material and methods: The study included patients with AMI who have recently had COVID-19 (AMI-post-COVID, n=56) and patients with AMI who have not recently had COVID-19 (AMI-control, n=141). Healthy volunteers constituted the control groups and were also divided into control-post-COVID (n=32) and control-control (n=71) groups. Previous SARS-CoV-2 infection was determined by anti-N IgG in the blood serum, the level of which persists for 6-10 months after the disease. Hemostasis was evaluated by thromboelastometry (on whole blood), thrombodynamics (on platelet-poor plasma), fibrinolysis, impedance aggregometry, and proteomic analysis.

Results: The AMI-post-COVID and AMI-control groups had higher values of thrombus growth rate, size and density based on the data of thromboelastometry and thrombodynamics, as well as increased concentrations of the complement system components, proteins regulating the state of the endothelium, and a number of acute-phase and procoagulant proteins compared to the control groups. Furthermore, in the AMI-post-COVID group, compared to the AMI-control group, the thrombus density was lower, and its lysis rates were higher when measured by the thrombodynamics method on platelet-poor plasma, while the platelet aggregation induced by ADP and thrombin was higher. Also, in the control-post-COVID group, compared to the control-control group, the thrombus formation rate was lower, whereas, in contrast, the thrombus size as measured by the thrombodynamics method and the platelet aggregation induced by arachidonic acid and thrombin were higher. In addition, in the AMI-post-COVID group, compared to the AMI-control group, the concentrations of proteins involved in inflammation and hemostasis were lower.

Conclusion: Patients with AMI who have recently had COVID-19 are characterized by a less pronounced activation of the immune response compared to patients with AMI who have not had COVID-19. This may be due to long-term chronic inflammation and depletion of components of the immune activation system after SARS-CoV-2 infection. Long-term activation of the hemostasis system in both patients with AMI and healthy volunteers after COVID-19 is primarily due to the platelet component of hemostasis.

目的:确定急性心肌梗死(AMI)患者和健康志愿者在接受COVID-19治疗后血浆、血小板止血和蛋白质组组成的特征:研究对象包括近期接受过COVID-19治疗的急性心肌梗死患者(AMI-后COVID,n=56)和近期未接受过COVID-19治疗的急性心肌梗死患者(AMI-对照组,n=141)。对照组由健康志愿者组成,也分为对照-COVID 后组(32 人)和对照-对照组(71 人)。通过血清中的抗 N IgG 来确定是否曾感染过 SARS-CoV-2,抗 N IgG 的水平在病后 6-10 个月内持续存在。通过血栓弹性测定(全血)、血栓动力学(贫血小板血浆)、纤溶、阻抗聚集测定和蛋白质组分析对止血情况进行了评估:结果:根据血栓弹力仪和血栓动力学的数据,AMI 后 COVID 组和 AMI 对照组的血栓生长速度、大小和密度均高于对照组,补体系统成分、调节内皮状态的蛋白质以及一些急性期和促凝血蛋白的浓度也高于对照组。此外,与 AMI 对照组相比,AMI 后 COVID 组的血栓密度较低,通过血栓动力学方法测量贫血小板血浆,血栓溶解率较高,而 ADP 和凝血酶诱导的血小板聚集率较高。同时,与对照-对照组相比,对照-COVID 后组的血栓形成率较低,而血栓动力学法测定的血栓大小以及花生四烯酸和凝血酶诱导的血小板聚集率则较高。此外,与急性心肌梗死对照组相比,急性心肌梗死后COVID组参与炎症和止血的蛋白质浓度较低:结论:与未接受过 COVID-19 治疗的 AMI 患者相比,近期接受过 COVID-19 治疗的 AMI 患者的免疫反应激活程度较低。这可能是由于感染 SARS-CoV-2 后长期慢性炎症和免疫激活系统成分耗竭所致。COVID-19对AMI患者和健康志愿者止血系统的长期激活主要是由于血小板的止血作用。
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引用次数: 0
The Structure of Left Ventricular Relaxation in Case of Ventriculography. 心室造影中左心室舒张的结构。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2640
V L Lakomkin, A A Abramov, A V Prosvirnin, A S Tereshchenko, G K Arutunan, A N Samko, V I Kapelko

Aim: To study the relaxation structure of the left ventricle (LV) in patients who underwent ventriculography.

Material and methods: LV ventriculography was performed in 37 patients. Before catheterization, echocardiography was performed in each patient. In 6 patients, the LV ejection fraction (EF) was below 40%; these patients with systolic dysfunction were not included in the study. In 31 patients, the LV EF was higher than 50%. In this group, 13 patients had NYHA functional class (FC) 2-3 chronic heart failure (CHF); the rest of the patients had FC 1 CHF. Eighteen of 31 patients had stable ischemic heart disease; 50% of these patients had a history of myocardial infarction; the rest of the patients had hypertension and atrial and ventricular arrhythmias. The dynamics of the LV pressure decrease was analyzed from the moment of the maximum rate of pressure drop, which usually coincides with the closure of the aortic valves. The pressure drop curve was logarithmized with natural logarithms and divided into 4-5 sections with different degrees of curve slope. The relaxation time constant was calculated for each section. Its inverse value characterizes the relaxation time constant (tau).

Results: In 31 patients with LV EF 52-60%, three types of the dynamics of the relaxation rate constant were identified during the pressure decrease in the isovolumic phase: in 9 patients, the isovolumic relaxation constant (IRC) steadily increased as the pressure decreased; in 13 patients, it continuously decreased; and in 9 patients, the dynamics of IRC change was intermediate, with an initial increase followed by a decrease.

Conclusion: In diastolic dysfunction, one group of patients had an adaptation type associated with an increase in the LV wall elasticity, while the other group had a different type of adaptation associated with its decrease. Each type has advantages and disadvantages. This is probably due to changes in the structure of the sarcomeric protein connectin (titin).

目的:研究接受心室造影术的患者左心室的松弛结构:37名患者接受了左心室造影术。材料:对 37 名患者进行了左心室造影检查,每位患者在导管插入术前都进行了超声心动图检查。6名患者的左心室射血分数(EF)低于40%,这些收缩功能障碍患者未纳入研究。31名患者的左心室射血分数高于50%。在这组患者中,13 名患者患有 NYHA 功能分级(FC)2-3 级慢性心力衰竭(CHF),其余患者患有 FC 1 级慢性心力衰竭。31名患者中有18名患有稳定的缺血性心脏病,其中50%有心肌梗死病史,其余患者患有高血压、房性和室性心律失常。左心室压力下降的动态分析是从压力下降速率最大的时刻开始的,而压力下降速率最大的时刻通常与主动脉瓣关闭的时间相吻合。用自然对数对压力下降曲线进行对数化处理,并将其分为 4-5 段,每段的曲线斜率各不相同。计算每个部分的松弛时间常数。其倒数表示松弛时间常数(tau):在 31 例左心室 EF 值为 52-60% 的患者中,发现等容阶段压力下降时松弛率常数的动态变化有三种类型:9 例患者的等容松弛常数(IRC)随压力下降而稳步上升;13 例患者的等容松弛常数持续下降;9 例患者的等容松弛常数的动态变化处于中间状态,最初上升,随后下降:结论:在舒张功能障碍患者中,一组患者的适应类型与左心室壁弹性增加有关,而另一组患者的适应类型与左心室壁弹性降低有关。两种类型各有利弊。这可能是由于肉瘤蛋白连接蛋白(titin)的结构发生了变化。
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引用次数: 0
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Kardiologiya
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