Kardiologiya最新文献

Objective: To assess the prevalence of risk factors  of cardiovascular disease (CV RF) development and awareness of them among young people studing at University.

Material and methods: Сross-sectional study study included 1182 young men and women studying at Lomonosov Moscow State University (age 18-44 years), with no history of chronic non-infectious diseases, who underwent a screening  in April-June 2022. All participants filled out the standard "Questionnaire for citizens under the age of 65 years to identify chronic non-communicable diseases, risk factors for their development, and the use of narcotic drugs and psychotropic substances without prescription", a specially designed questionnaire on socio-demographic characteristics and risk factors for CVD development, and a questionnaire on nighttime sleep status. Results. In young men, the most common FRs were low fruit and vegetable intake (46.8%). Sleep disturbances were reported by 28.8% of men and 34.5% of women. Low physical activity was present in 1 in 5 young people. Obesity was found in 5.0% of the study participants. Young women in general showed greater awareness of CV RF. The most frequent factor mentioned in the questionnaire was smoking. More than 60% of respondents mentioned low physical activity and  nutritional factors , while obesity and overweight were mentioned by only 16% of respondents.More CV RFs were named by natural science students, and more smokers were identified among them.

Conclusion: The obtained data allow us to speak about the high prevalence of behavioral CV RFs  and insufficient awareness of their adverse health effects in young people, even with a high level of education. The effectiveness of preventive measures can be largely determined by their precise targeting. Raising awareness of the need for greater consumption of fruits and vegetables, sleep norms, the dangers of arterial hypertension, hypodynamia and obesity, in our opinion, is an important component of preventive work among students in universities.

Aim    To evaluate the cumulative incidence and prognostic value of rehospitalizations in patients with heart failure (HF) within one year after discharge.Material and methods    The data of patients with HF hospitalized for the first time (code I50.x in the diagnosis) for the period from January 01, 2022 through February 13, 2024 were selected from the St. Petersburg Chronic Heart Failure Registry. Age and gender characteristics, comorbidities, risk of rehospitalization and death after discharge from the hospital depending on the number of rehospitalizations were analyzed. Descriptive statistics methods, Kaplan-Meier survival analysis, and the Fine and Gray competing risks model were used. P<0.001 was considered significant.Results    The study included 43,143 patients with HF who were hospitalized for the first time. During a median observation time of 242 days, 6,395 (14.8%) patients were readmitted, most often once (78.4%). A greater number of rehospitalizations was typical for men, patients with HF of ischemic genesis, atrial fibrillation, diabetes mellitus, obstructive pulmonary diseases, and a history of COVID-19. The cumulative incidence of rehospitalizations for HF during 1, 3, 6, and 12 months was 3.2%, 7.0%, 10.8%, and 17.2%, respectively, taking into account the competing risk of death. With an increasing number of hospitalizations, the median time to the next hospitalization decreased, and the risk of readmission increased (p<0.001). The probability of death within a year of the index hospitalization was 14.9% (95% confidence interval [CI]: 14.5%-15.3%). The all-cause death rate was 30, 44, and 54 cases per 100 patient-years for patients with one, two, and at least three readmissions vs. 19 cases per 100 patient-years for those without readmissions. Readmitted patients were characterized by an increased risk of death: the adjusted hazard ratios of death in patients with one, two, and at least three readmissions were 1.47 (95% CI: 1.36-1.59), 1.97 (95% CI: 1.69-2.30), and 2.24 (95% CI: 1.81-2.78), respectively.Conclusion    In patients hospitalized with HF for the first time, the cumulative one-year HF readmission rate adjusted for the competing risk of death was 17.2%. Increased readmission rates were independently associated with increased odds of readmission and death.

Aim      To identify metabolomic and structure and function markers of remote left ventricular (LV) remodeling in patients with chronic heart failure (CHF) of ischemic etiology and LV ejection fraction (EF) <50%.Material and methods  This prospective study included 56 patients with 3-4 NYHA functional class CHF of ischemic etiology (mean age, 66±7 years) and 50 patients with ischemic heart disease (IHD) without signs of CHF (69 [64; 73.7] years). Concentration of 19 amino acids, 11 products of kynurenine catabolism of tryptophan, 30 acylcarnitines with different chain lengths were measured in all participants. The metabolites that showed statistical differences between the comparison groups were then used for the analysis. Echocardiography was used to assess LV cavity remodeling at the time of the CHF patient inclusion in the study and after 6 months of follow-up. Predictors of long-term LV cavity remodeling were assessed for this cohort taking into account statistically significant echocardiographic parameters and metabolites.Results Patients with CHF of ischemic etiology, predominantly (81%) had pathological calculated types of LV remodeling (concentric and eccentric hypertrophy, 46 and 35%, respectively). However, this classification had limitations in describing this cohort. In addition, in this group, the concentrations of alanine, proline, asparagine, glycine, arginine, histidine, lysine, valine, indolyl-3-acetic acid, indolyl-3-propionic acid, C16-1-OH, and C16-OH were significantly (p<0.05) lower, and the concentrations of most medium- and long-chain acylcarnitines were higher than in patients with IHD without signs of CHF. The long-term (6 months) reverse remodeling of the LV cavity in CHF of ischemic etiology was influenced by changes in the interventricular septum thickness (hazard ratio, HR, 19.07; 95% confidence interval, CI, 1.76-206.8; p=0.006) and concentrations of anthranilic acid (HR 19.8; 95% CI 1.01-387.8; p=0.019) and asparagine (HR 8.76; 95% CI 1.07-71.4; p=0.031).Conclusion      The presence of an interventricular septum thickness of more than 13.5 mm, anthranilic acid concentrations of higher than 0.235 μM/l, or an asparagine concentration of less than 135.2 μM/l in patients with CHF of ischemic etiology after 6 months of follow-up affects their achievement of LV cavity reverse remodeling.

Left atrial dysfunction (left atrial myopathy) is not only a consequence of impaired left ventricular diastolic function but also plays a central role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left atrial myopathy in HFpEF is associated with a more severe course of heart failure and an unfavorable prognosis, and the choice of treatment largely depends on its severity. Echocardiography allows an accurate assessment of the left atrial condition, while the parameters of left atrial myocardial strain are sensitive to early functional disorders to help diagnosing HFpEF and determining the prognosis. This article discusses the participation of the left atrium in the left ventricular filling, its status at different stages of left ventricular diastolic dysfunction, the major mechanisms of atrial myopathy in HFpEF, and therapeutic approaches to its restriction and reversion.

These guidelines combine the key provisions for the management of patients with chronic heart failure (CHF) at the outpatient stage based on current data from clinical studies, new 2024 clinical guidelines of the Russian Society of Cardiology for the management of CHF patients, and the provisions of the current order of the Ministry of Health of the Russian Federation on the procedure for conducting dispensary observation. CHF is a progressive disease characterized by a high risk of death, rehospitalizations, and disability. Reducing the risk of CHF decompensation and improving the prognosis is possible only with regular monitoring of the patient's condition and timely correction of therapy. The priority task of the outpatient unit is to expand the coverage of dispensary follow-up of CHF patients, preventive counseling, and telemedicine monitoring for timely identification of the patients at a high risk of CHF progression, improving their quality of life, and prolonging their life duration.

Aim    To analyze the results of myocardial revascularization in the Russian Federation (RF) for ACS in 2023 compared to previous years.Material and methods    The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), myocardial revascularization in the above-listed ACS forms, the number of fatal outcomes depending on the ACS form and the revascularization method used. The data for this analysis were obtained from the 2023 Ministry of Health of Russia monitoring in the section of revascularization in ACS and were compared with the data for the past 8 years.Results, conclusion   In 2023, 438,315 patients were hospitalized for ACS in the Russian Federation: 309,158 with NSTE-ACS and 148,729 with STEMI. The total number of hospitalizations for ACS per 1 million of the Russian population was 2,982: 1,011 with STEMI and 2,103 with NSTE-ACS. The availability of primary PCI in 2023 reached its maximum of 55.3% compared to previous years; the total number of PCI for STEMI was 75.7%, and the mortality rate in the whole STEMI group was a minimum of 10.7% for the past 8 years. In 2023, the maximum number of PCIs for NSTE-ACS for the past 8 years was recorded, both in absolute values (120,990) and in relative values (39.1%). In the whole NSTE-ACS group, mortality was 2.5%, which was also the lowest for the past 8 years.

Aim    To analyze the main reasons for the impairment of the life prognosis of patients with chronic heart failure (CHF) in real clinical practice of the Russian Federation.Material and methods    Representative samples of the population of the Nizhny Novgorod region (1998, n=1,922) and the European part of Russia followed from 2002 through 2017 (n=19,276), as well as randomly selected medical records of outpatients under the dispensary monitoring for CHF from 19 therapeutic and preventive medical institutions of three constituent entities of the Russian Federation (n=177, 2022) were analyzed for the adherence to therapy and the effectiveness of treatment. In addition, the prevalence, etiology, and prognosis of life of patients with CHF and acute decompensated heart failure (ADHF) were determined as a part of the EPOCH study.Results    The EPOCH-CHF study for the first time determined the true prevalence of CHF in the European part of the Russian Federation (8.2% by soft criteria) and 3.1% (by strict criteria). Furthermore, the prevalence of heart failure with reduced ejection fraction (EF) was 0.8%, moderately reduced EF was 0.9%, and heart failure with preserved EF was 1.4% of all studied patients in whom HF was defined by strict criteria. The EPOCH-CHF and EPOCH-Hospital Stage studies confirmed that a long-term exposure of the body to arterial hypertension and ischemic heart disease significantly influenced the development of CHF. At the same time, acute myocardial infarction, diabetes mellitus and uncorrected heart defects can induce severe CHF within a short period. The life prognosis of patients both after ADHF and with stable CHF in the Russian Federation is very poor. Within 4 years, 55.2% of patients after ADHF die; no patient with III-IV FC CHF survives longer than 10 years; and patients with I-II FC CHF are at a 75% risk to die after 16 years of follow-up. This is related with an ineffective use of basic drugs and uncoordinated follow-up of patients.Conclusion    The analysis of three studies showed a high level of coverage of CHF patients with therapy but a low level of compliance with national guidelines, which is reflected in the use of low doses of drugs, the lack of effective hemodynamic control and, as a consequence, a poor prognosis for CHF patients with CHF, regardless of its stable course or acute decompensation.

Aim      The article presents the principal results and conclusions of the study "SCHool and outpAtient moNitoring of patients with Cardiac failurE (CHANCE)", organized by the Society of Experts in Heart Failure.Material and methods  CHANCE was a multicenter randomized study. Patients in the intervention group (IG) received the Structured Education and Flexible Outpatient Control Model, that included telephone contacts plus an additional visit if necessary. The planned visits for the IG and control group (CG) were scheduled at 3, 6, and 12 months. 360 IG patients and 385 CG patients were included in the analysis. In the main analysis of the CHANCE study, the efficacy was assessed by the impact on the hard endpoints (mortality and rehospitalizations), clinical condition, functional capabilities, quality of life, anxiety and depressive symptoms, and cost-effectiveness. Also, a comprehensive assessment was performed of the prevalence, structure, and dynamics of anxiety and depressive symptoms depending on the changes in the clinical condition.Results Mortality significantly differed between the groups: 30 (8.3%) patients died in the IG and 50 (13.0%) in the CG. The relative risk of death was 0.68, 95% confidence interval 0.42-0.99, p = 0.044. To prevent one death, it was necessary to educate and monitor 21 patients with clinically evident chronic heart failure (CHF) according to the principles of the CHANCE program. According to the dynamics of the Clinical Condition Assessment Scale (SCAS), the score difference between the groups was 1.7 (p<0.001) after 12 months of follow-up in favor of the IG group. In 12 months, the increase in the 6-minute walk test distance was 98.7 m in the IG and 42.9 m in the CG (p<0.001). The change from baseline in the Minnesota questionnaire total score was 15.3 ± 16.3 in the IG (p<0.001) and 6.2 ± 15.3 in the CG (p<0.001). The odds of developing depressive symptoms increased with each SCAS point by 19% (p = 0.0002). The odds of developing anxiety symptoms increased with each SCAS point by 12% (p = 0.02). The odds of developing the most unfavorable combination of anxiety and depressive symptoms increased with each SCAS point by 41% (p = 0.000002). The participation of patients in the study increased the odds of reducing the anxiety and depressive symptoms in patients with CHF by 2.35 times (p<0.0001), to a greater extent in women.Conclusion      The CHANCE study that included 42 centers in 23 cities of Russia became the forerunner of the first initiatives in organizing the outpatient follow-up of patients in real clinical practice and serves as a vivid example of the importance of national research programs. Their implementation allows obtaining results that can be scaled up throughout the country to make an important contribution to the improvement of medical care for patients with CHF.

This review focuses on the sex-related differences of patients in etiological factors, clinical picture, and objective laboratory and instrumental signs of heart failure. The authors performed an analysis of the effectiveness of drug and non-drug treatments depending on the gender of patients with low and preserved left ventricular ejection fraction, which should improve the quality of medical care and outcomes in patients with heart failure.