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Factors that Determined a Positive Response to Resynchronization Therapy in Patients With Chronic Heart Failure and Cardiac Dyssynchrony. One Center Experience. 决定慢性心力衰竭和心脏不同步患者对再同步化疗法做出积极响应的因素。一个中心的经验。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2627
A S Postol, N M Neminushchiy, G N Antipov, A V Ivanchenko, V V Lyashenko, D A Kalinin, S N Kotov, A B Vygovsky, Yu A Shneider

Aim: To evaluate the efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) associated with cardiac dyssynchrony and to identify the factors that influence the CRT efficacy.

Material and methods: This retrospective study included 155 patients after implantation of CRT devices. The CRT devices with a built-in cardioverter-defibrillator (CRT-D) and without it (CRT-P) were implanted in 139 (89.7%) and 16 (10.3%) patients, respectively. The follow-up period was 52.37±35.94 months. Based on the study results, two groups of patients were formed depending on the presence of a clinical response to CRT, responders and non-responders. The factors that influenced the clinical response to CRT were studied. The effect of the baseline state of patients on the effect of therapy was assessed. The need for CRT optimization and a possibility of using electrocardiographic criteria for that purpose were studied. Modern devices and leads for CRT, their functional capabilities and their influence on the CRT efficacy were characterized. Statistical analysis was performed with an IBM SPSS Statistics 21.0 (Chicago, USA) package.

Results: CRT implantation with the left ventricular lead placement according to the traditional technique, through the coronary sinus, was successful in 130 (87.9%) patients. Difficulties with the left ventricular lead placement were noted in 13 (8.3%) patients when other techniques were used. After 6 months, a hemodynamic and clinical response was observed in 112 (72.2%) patients, and no positive response in 43 (27.8%). The increase in left ventricular ejection fraction in the responder group was more than 21.8±3.7%, which was associated with an improvement of the 6-minute walk test results. Th clinical response was significantly influenced by the possibility of stimulation from the basal parts of the heart; the use of more modern devices for CRT and quadripolar left ventricular leads; timely CRT optimization; and persistent dyssynchrony in non-responders. During the follow-up period, 34 (21.9%) patients died. The death rate in the non-responder group was significantly higher than in the responder group, 18 (41.3%) vs. 16 (14.3%), p=0.001. The main cause of death in the group of non-responders was CHF. Heart transplantation was performed in 3 (1.9%) patients.

Conclusion: CRT increases the life span and improves the quality of life in patients with CHF and cardiac dyssynchrony. There was a group of patients with no benefit from CRT in this study. Modern devices allow increasing the number of patients who benefit from CRT. Periodic optimization of CRT is necessary. When optimizing CRT, it is possible to use electrocardiographic criteria of effectiveness: duration of the QRS complex and changes in the position of the electrical axis of the heart.

目的:评估心脏再同步化疗法(CRT)对伴有心脏不同步的慢性心力衰竭(CHF)患者的疗效,并找出影响CRT疗效的因素:这项回顾性研究包括155名植入CRT设备的患者。植入内置心律转复除颤器(CRT-D)和不植入内置心律转复除颤器(CRT-P)的 CRT 装置的患者分别为 139 人(89.7%)和 16 人(10.3%)。随访时间为(52.37±35.94)个月。根据研究结果,根据患者对 CRT 是否有临床反应分为两组,即有反应者和无反应者。研究了影响 CRT 临床反应的因素。评估了患者基线状态对治疗效果的影响。研究了优化 CRT 的必要性以及为此使用心电图标准的可能性。对用于 CRT 的现代设备和导线、其功能能力及其对 CRT 疗效的影响进行了描述。统计分析采用 IBM SPSS Statistics 21.0(美国芝加哥)软件包进行:130例(87.9%)患者按照传统技术通过冠状窦植入左心室导线,成功进行了CRT植入。使用其他技术时,有 13 例(8.3%)患者在左心室导联置入时遇到困难。6 个月后,112 名患者(72.2%)出现了血液动力学和临床反应,43 名患者(27.8%)未出现积极反应。应答组的左心室射血分数增加了 21.8±3.7% 以上,这与 6 分钟步行测试结果的改善有关。临床反应明显受到以下因素的影响:从心脏基底部位进行刺激的可能性;使用更先进的 CRT 设备和四极左心室导联;及时进行 CRT 优化;以及无反应者持续的不同步。在随访期间,34 名(21.9%)患者死亡。非应答组的死亡率明显高于应答组,分别为 18 例(41.3%)和 16 例(14.3%),P=0.001。无应答组患者的主要死因是慢性心力衰竭。3名(1.9%)患者接受了心脏移植手术:CRT延长了CHF和心脏不同步患者的寿命,改善了他们的生活质量。在这项研究中,有一部分患者没有从 CRT 中获益。现代设备能让更多患者从 CRT 中获益。定期优化 CRT 是必要的。在优化 CRT 时,可以使用心电图的有效性标准:QRS 波群的持续时间和心脏电轴位置的变化。
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引用次数: 0
Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. 冠状动脉非阻塞性心肌梗死患者的患病率、临床特征、治疗和预后。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2526
T H Hoang, V V Maiskov, I A Merai, Zh D Kobalava

Aim: To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA).

Material and methods: This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years.

Results: MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042).

Conclusion: The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.

目的:与冠状动脉阻塞性心肌梗死(MIOCA)患者相比,研究冠状动脉非阻塞性心肌梗死(MINOCA)患者的临床和人口统计学特征、治疗方案和临床结果:这项单中心前瞻性观察研究共纳入了 712 名连续确诊为急性心肌梗死(MI)的患者,这些患者均常规接受了直接冠状动脉造影术。根据是否存在狭窄性冠状动脉粥样硬化,患者被分为两组:MIOCA组(冠状动脉狭窄≥50%)和MINOCA组(冠状动脉狭窄<50%,无其他原因)。临床结果包括院内死亡率、长期总死亡率和心血管再住院率。中位随访时间为 1.5 年:73例(10.3%)患者被诊断为MINOCA,其中37例(50%)为女性。MINOCA 患者的中位年龄为 61 岁,MIOCA 组患者的中位年龄为 65 岁。MINOCA 和 MIOCA 患者的心血管风险因素无明显差异。在 53.4% 的病例中,MINOCA 的病因是心肌供氧和需氧之间的差异,而在 35.6% 的病例中,病因是高血压危象和肺水肿。与 MINOCA 相关的因素包括年龄小于 58 岁、女性、无 ST 段抬高、无局部收缩力受损区域、存在主动脉瓣狭窄和支气管肺部感染。MINOCA患者接受乙酰水杨酸、P2Y12抑制剂、双重抗血小板疗法、β-受体阻滞剂和他汀类药物治疗的可能性较低(p<0.05)。87.5%的患者(n=623)获得了长期预后数据。在院内死亡率(1.5% 对 6.2%;P=0.161)和长期总死亡率(6.1% 对 14.7%;P=0.059)方面,MIOCA 患者的预后相当。MINOCA组的心血管疾病再住院率更高(33.3% vs. 21.5%;P=0.042):结论:在我们的研究中,急性心肌梗死患者中MINOCA的发病率为10.3%。MINOCA患者与MIOCA患者具有相似的公认心血管风险因素。MINOCA患者的院内死亡率和长期死亡率与MIOCA患者相当,但需要心血管再住院的情况更多。
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引用次数: 0
[Evaluation of the Functional Reserve and Exercise Tolerance in Patients with CHF in Clinical Trials (Consent Document of the Editorial board of the Journal of Cardiology, the Board of the Society of Specialists in Heart Failure (SSHF) and Working Group "Non-drug treatment methods" of SSHF)]. [在临床试验中评估慢性心力衰竭患者的功能储备和运动耐量(《心脏病学杂志》编辑委员会、心力衰竭专家协会(SSHF)委员会和 SSHF "非药物治疗方法 "工作组的同意文件)]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2637
Yu L Begrambekova, G P Arutynov, M G Glezer, N A Karanadze, E A Kolesnikova, T A Lelyavina, A S Lishuta, Ya A Orlova, Yu N Belenkov

Assessing the functional capacity and exercise tolerance is an important and widely used research tool in patients with heart failure. It is used not only in cardiac rehabilitation and physical therapy, but also for inclusion criteria and outcome measures in studies of drug interventions. This document outlines the scope, guidelines for the implementation and interpretation, and limitations of the methods for assessing the functional capacity and exercise tolerance in clinical trials in patients with heart failure.

对心力衰竭患者进行功能能力和运动耐量评估是一项重要且广泛使用的研究工具。它不仅用于心脏康复和物理治疗,还用于药物干预研究的纳入标准和结果测量。本文件概述了心衰患者临床试验中功能能力和运动耐量评估方法的范围、实施和解释指南以及局限性。
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引用次数: 0
[The effect of sodium-glucose cotransporter type 2 inhibitors on left ventricular diastolic function: current status and prospects]. [钠-葡萄糖共转运体 2 型抑制剂对左心室舒张功能的影响:现状与前景]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2545
E V Borisova, A V Barsukov, S A Glebova, A V Airapetyan

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) or gliflozins, are a new class of cardiovascular drugs with a proven clinical efficacy and a beneficial effect on prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Impaired left ventricular (LV) diastolic function (DF) is an important element in the pathogenesis of HFpEF. Experimental studies have found intracellular mechanisms for the so-called diastolic effects in gliflozins. Studies using laboratory models of experimental HFpEF have demonstrated a positive effect of dapagliflozin and empagliflozin on the elastic properties of cardiomyocyte myofilaments, the dynamics of myocardial fibrosis, and intracellular sodium and calcium homeostasis. The significance of anti-inflammatory, antioxidant properties of gliflozins in improving the cardiomyocyte DF has been experimentally established. The effect of SGLT2 inhibitors on LV DF in patients at high risk for cardiovascular diseases and their complications, that has been demonstrated in relatively small clinical studies, is due to primary cardiac and secondary effects. Results of individual studies confirmed the protective (in relation to myocardial relaxation) properties of gliflozins in the conditions of a diastolic stress test. The regression of LV diastolic dysfunction associated with the SGLT2 inhibitor treatment found in small observational studies is important in the context of the significant beneficial effect of empagliflozin and dapagliflozin on the prognosis of cardiovascular diseases that has been demonstrated in large randomized clinical trials in patients with HFpEF.

钠-葡萄糖共转运体-2抑制剂(SGLT2抑制剂)或格列酮类药物是一类新型心血管药物,其临床疗效已得到证实,并对射血分数保留型心力衰竭(HFpEF)患者的预后产生有利影响。左心室舒张功能(DF)受损是 HFpEF 发病机制中的一个重要因素。实验研究发现了格列酮类药物所谓的舒张效应的细胞内机制。使用实验性 HFpEF 实验室模型进行的研究表明,达帕格列净和恩格列净对心肌细胞肌丝的弹性特性、心肌纤维化的动态变化以及细胞内钠和钙的平衡均有积极影响。实验证实,格列酮嗪类药物的抗炎和抗氧化特性对改善心肌细胞DF具有重要意义。SGLT2 抑制剂对心血管疾病及其并发症高危患者左心室 DF 的影响已在相对较小的临床研究中得到证实,这种影响是由原发性心脏效应和继发性效应引起的。个别研究结果证实,在舒张压力测试条件下,格列酮类具有保护性(与心肌松弛有关)。小型观察性研究中发现的与 SGLT2 抑制剂治疗相关的左心室舒张功能障碍的消退非常重要,因为在针对高频血栓性心力衰竭(HFpEF)患者的大型随机临床试验中,empagliflozin 和 dapagliflozin 对心血管疾病的预后产生了显著的有利影响。
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引用次数: 0
Inflammatory Biomarkers in Patients With Type 2 Diabetes Mellitus and Heart Failure With Preserved Ejection Faction. 2 型糖尿病合并保留射血分数的心力衰竭患者的炎症生物标志物
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2562
T S Sveklina, S B Shustov, S N Kolyubaeva, A N Kuchmin, V A Kozlov, P D Oktysyuk, V V Konyaev

Aim: To verify the relationship between gene polymorphisms of tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) with inflammation markers and codependent metabolic variables in patients with type 2 diabetes mellitus and chronic heart failure (CHF).

Material and methods: This study included 154 patients (mean age, 69.1±3.2 years). The control group consisted of 47 patients with metabolic syndrome (MS) without CHF; the 2nd group included 56 patients with CHF with preserved ejection fraction (CHFpEF); and the 3rd group consisted of 51 patients with CHF with reduced ejection fraction (CHFrEF). The rs1800629 polymorphism of the TNF-α gene (TNF-α: G308A) was studied in real time by the polymerase chain reaction (PCR) method and the rs1800795 polymorphism of the IL-6 gene (IL-6: 174 G>C) was studied by PCR with the electrophoretic detection. The frequencies of polymorphic alleles were compared with the clinical blood test results, plasma concentrations of C-reactive protein (CRP), TNF-α, leptin, and fibrinogen. Differences between the groups were determined using the F test. Relationships between individual studied parameters were identified using the regression analysis.

Results: In most patients, the occurrence of gene polymorphisms was eident as increased plasma concentrations of biomarkers. An association was found between the TNF-α gene polymorphism (G308A) and an increase in plasma TNF-α and between the IL-6 gene polymorphism (174 C>G) and an increase in plasma CRP. In the CHFpEF group, the rs1800629 gene polymorphism was observed in 55% of patients, among whom 93% had increased TNF-α. The rs1800795 gene polymorphism was observed in 82% of CHFpEF patients, among whom 21% had increased CRP. In the CHFrEF group, the G308A transition in the TNF-α gene was observed in 53% of patients; an increase in the respective cytokine was noted in 67% of patients; the IL-6 gene polymorphism 174 C>G was found in 78%, however, only 14% of patients with this polymorphism had also increased CRP. In the control group, the TNF-α G308A gene polymorphism was found in 30% of patients, while an increase in free TNF-α was associated with this polymorphism in 50% of patients; the IL-6 174 C>G gene polymorphism was detected in 78%, while no increase in the CRP level was observed in this group. This demonstrates a high probability of the TNF-α G308A gene polymorphism occurrence in patients with CHF.

Conclusion: Inflammatory markers are important predictors of CHF. The most significant predictor was the TNF-α G308A gene polymorphism, which was observed in more than 50% of patients, the majority of whom had an increase in plasma TNF-α.

目的:验证肿瘤坏死因子α(TNF-α)和白细胞介素-6(IL-6)的基因多态性与2型糖尿病和慢性心力衰竭(CHF)患者的炎症标志物和代谢变量之间的关系:本研究包括 154 名患者(平均年龄为 69.1±3.2 岁)。对照组包括 47 名无 CHF 的代谢综合征(MS)患者;第二组包括 56 名射血分数保留型 CHF(CHFpEF)患者;第三组包括 51 名射血分数降低型 CHF(CHFrEF)患者。研究采用聚合酶链式反应(PCR)方法实时检测 TNF-α 基因的 rs1800629 多态性(TNF-α:G308A),采用 PCR 结合电泳检测法检测 IL-6 基因的 rs1800795 多态性(IL-6:174 G>C)。多态等位基因的频率与临床血液检测结果、血浆中 C 反应蛋白 (CRP)、TNF-α、瘦素和纤维蛋白原的浓度进行了比较。组间差异采用 F 检验。使用回归分析确定了各研究参数之间的关系:结果:大多数患者的基因多态性表现为血浆中生物标志物浓度的升高。结果发现,TNF-α基因多态性(G308A)与血浆TNF-α浓度升高有关,IL-6基因多态性(174 C>G)与血浆CRP浓度升高有关。在CHFpEF组中,55%的患者出现rs1800629基因多态性,其中93%的患者TNF-α升高。在82%的CHFpEF患者中发现了rs1800795基因多态性,其中21%的患者CRP升高。在CHFrEF组中,53%的患者观察到TNF-α基因的G308A转变;67%的患者注意到相应的细胞因子增加;78%的患者发现IL-6基因多态性174 C>G,然而,只有14%的患者的CRP也增加了。在对照组中,30% 的患者发现了 TNF-α G308A 基因多态性,50% 的患者游离 TNF-α 的增加与该多态性有关;78% 的患者发现了 IL-6 174 C>G 基因多态性,而该组患者的 CRP 水平未见增加。这表明,TNF-α G308A 基因多态性在慢性心力衰竭患者中发生的概率很高:结论:炎症标志物是CHF的重要预测指标。最重要的预测指标是 TNF-α G308A 基因多态性,50% 以上的患者存在该基因多态性,其中大多数患者的血浆 TNF-α 增高。
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引用次数: 0
Utility of Point-of-Care Diagnosis of Chronic Heart Failure Using an Express Test for Semi-Quantitative Determination of NT-proBNP Levels. 使用半定量检测 NT-proBNP 水平的快速检验对慢性心力衰竭进行护理点诊断的实用性。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2647
A V Iosifov, O A Shtegman

Aim: To evaluate the accuracy of a rapid test for semi-quantitative determination of NT-proBNP levels in the diagnosis of CHF in comparison with quantitative assessment; to study the strength of the association of the results of this NT-proBNP test with indicators of the CHF severity.

Material and methods: The concentration of NT-proBNP was determined in 44 patients at bedside both semi-quantitatively using an express test (BioTest, Novosibirsk) and quantitatively in a laboratory. In 11 patients, the severity of CHF was assessed with the CHF Clinical Status Scale (CSS). Echocardiography was performed in all patients.

Results: The sensitivity of the quantitative and semi-quantitative tests coincided and was 95%. The specificity of the quantitative test was 100% in our study, whereas the semi-quantitative test showed a specificity of 92%. The negative predictive value of either test was 96%. The diagnostic accuracy was 98% and 93%, respectively. In patients with significantly high NT-proBNP concentrations, the semi-quantitative test demonstrated a reduced ability to verify values above 1800 pg/ml; in patients with threshold concentrations, the semi-quantitative test showed an increased subthreshold sensitivity. Increases in the NT-proBNP concentration correlated with the severity of CHF according to the stage of the disease.

Conclusion: Due to the sufficiently high sensitivity, specificity, ease of use, and speed of obtaining results, the rapid test for semi-quantitative measuring NT-proBNP is promising for outpatient screening bedside diagnosis of CHF and in the emergency room to confirm or exclude CHF. When determining the dynamics of NT-proBNP during the treatment of CHF, the use of the semi-quantitative rapid test with visual assessment of the results may produce an error compared to the quantitative assessment, which will probably not allow tracking the effect of therapy or predicting exacerbation of the disease.

目的:与定量评估相比,评估半定量测定 NT-proBNP 水平的快速检测方法在诊断慢性心力衰竭中的准确性;研究 NT-proBNP 检测结果与慢性心力衰竭严重程度指标之间的关联强度:44名患者的NT-proBNP浓度是在床边用快速检测仪(BioTest,新西伯利亚)进行半定量检测和在实验室进行定量检测的。用 CHF 临床状态量表 (CSS) 评估了 11 名患者 CHF 的严重程度。所有患者均进行了超声心动图检查:定量检测和半定量检测的灵敏度一致,均为 95%。在我们的研究中,定量检测的特异性为 100%,而半定量检测的特异性为 92%。两种检测方法的阴性预测值均为 96%。诊断准确率分别为 98% 和 93%。在 NT-proBNP 浓度明显偏高的患者中,半定量检测验证数值超过 1800 pg/ml 的能力有所下降;而在浓度达到阈值的患者中,半定量检测对阈值以下的敏感性有所提高。根据疾病的分期,NT-proBNP 浓度的增加与 CHF 的严重程度相关:由于半定量检测 NT-proBNP 具有足够高的灵敏度、特异性、易用性和获得结果的速度,因此该快速检测方法有望用于门诊筛查床旁诊断 CHF,以及急诊室确诊或排除 CHF。在确定 CHF 治疗期间 NT-proBNP 的动态变化时,与定量评估相比,使用目测结果的半定量快速检测可能会产生误差,这很可能无法跟踪治疗效果或预测疾病的恶化。
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引用次数: 0
[A Case of Successful Treatment of Severe Hyperlipidemia After Heart Transplantation With Inclisiran]. [英克利西兰成功治疗心脏移植术后严重高脂血症病例]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2679
Z G Tatarintseva, L K Tkhatl, K O Barbuhatti, E D Kosmacheva

The prognosis after heart transplantation continues to improve. Therefore, the prevention of chronic post-transplant sequelae, such as chronic kidney disease, allograft vasculopathy, and malignancies is becoming increasingly important. Everolimus, an inhibitor of the mammalian target of rapamycin (mTOR), is increasingly used for immunosuppression after heart transplantation. However, everolimus may cause a characteristic complex of adverse effects, including dyslipidemia. Currently there are no guidelines for the long-term screening and treatment of dyslipidemia in heart transplant recipients treated with everolimus. This article presents a clinical case of hypercholesterolemia that developed after the start of the everolimus treatment in a heart recipient. The patient was a 39-year-old man who underwent orthotopic heart transplantation for ischemic cardiomyopathy in 2012 (at the age of 27). In 2019, the patient's immunosuppressive therapy was converted from mycophenolate mofetil to everolimus due to the development of cardiac allograft vasculopathy. The change in the immunosuppressive therapy was associated with increases in total cholesterol and low-density lipoprotein cholesterol, which were not reversed with a combined lipid-lowering therapy (maximum doses of rosuvastatin, ezetimibe, fenofibrate). A decrease in lipid levels was achieved with a blocker of hepatic proprotein convertase subtilisin/kexin type 9 synthesis at the level of microribonucleic acid (inclisiran). This case demonstrates the difficulties in correcting dyslipidemia in patients with cardiac allograft, since the treatment with the immunosuppressant everolimus worsens existing dyslipidemia. However, the combination lipid-lowering therapy, that affects various elements of the pathogenesis (specifically, the combined inhibition of hydroxymethylglutaryl-CoA reductase with a statin, cholesterol absorption from the small intestine with ezetimibe, and PCSK9 messenger RNA with inclisiran), provides an effective control of blood lipids and minimizing the adverse effects of immunosuppressive therapy, such as cardiac allograft vasculopathy.

心脏移植后的预后不断改善。因此,预防移植后慢性后遗症(如慢性肾病、异体移植血管病变和恶性肿瘤)变得越来越重要。依维莫司是哺乳动物雷帕霉素靶点(mTOR)的抑制剂,越来越多地被用于心脏移植后的免疫抑制。然而,依维莫司可能会引起一系列特有的不良反应,包括血脂异常。目前还没有关于接受依维莫司治疗的心脏移植受者血脂异常的长期筛查和治疗指南。本文介绍了一例心脏受者在开始接受依维莫司治疗后出现高胆固醇血症的临床病例。患者是一名 39 岁的男性,2012 年(27 岁)因缺血性心肌病接受了正位心脏移植手术。2019年,由于出现心脏同种异体移植血管病变,患者的免疫抑制疗法从霉酚酸酯(mycophenolate mofetil)改为依维莫司(everolimus)。免疫抑制疗法的改变导致总胆固醇和低密度脂蛋白胆固醇升高,而联合降脂疗法(最大剂量的洛伐他汀、依折麦布和非诺贝特)无法逆转这种情况。通过在微核糖核酸水平上阻断肝脏 9 型枯草蛋白酶/kexin 的合成(clinisiran),血脂水平有所下降。该病例表明,纠正心脏同种异体移植患者的血脂异常非常困难,因为使用免疫抑制剂依维莫司治疗会加重现有的血脂异常。然而,联合降脂疗法可影响发病机制的各种因素(特别是他汀类药物对羟甲基戊二酰-CoA 还原酶的联合抑制作用、依折麦布对小肠胆固醇吸收的抑制作用以及 inclisiran 对 PCSK9 信使 RNA 的抑制作用),从而有效控制血脂,并将免疫抑制疗法的不良反应(如心脏同种异体移植血管病变)降至最低。
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引用次数: 0
[Heparin-Induced Thrombocytopenia]. [肝素诱发血小板减少症]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2186
A B Sugraliyev

The extensive use of therapeutic doses of heparin to prevent thrombosis in critically ill patients with COVID-19 during the pandemic has led to an increased incidence of bleeding and heparin-induced thrombocytopenia (HIT). In addition, the introduction of the AstraZeneca and Johnson&Johnson vaccines against COVID-19 into clinical practice was associated with the development of a rare but very severe, adverse thrombotic complication, vaccine-induced immune thrombotic thrombocytopenia (VITT). Thrombotic complications of VITT turned out to be similar to HIT both clinically and pathophysiologically. HIT is a potentially fatal immune-mediated adverse drug response that results in emergence of antibodies that activate platelets in the presence of heparin. HIT is characterized by a high incidence of venous and arterial thromboses, often with fatal outcomes. Currently, there are clearly defined international guidelines for the diagnosis, treatment and prevention of HIT. In case of thrombotic complications, non-heparin anticoagulants should be used.

大流行期间,COVID-19 重症患者广泛使用治疗剂量的肝素来预防血栓形成,导致出血和肝素诱发血小板减少症 (HIT) 的发病率增加。此外,阿斯利康和强生的 COVID-19 疫苗被引入临床实践后,出现了一种罕见但非常严重的血栓形成不良并发症--疫苗诱导的免疫性血小板减少症(VITT)。VITT 的血栓并发症在临床和病理生理学上与 HIT 相似。HIT 是一种可能致命的免疫介导的不良药物反应,在肝素存在的情况下,抗体会激活血小板。HIT 的特点是静脉和动脉血栓的高发病率,通常会造成致命后果。目前,国际上已有明确的 HIT 诊断、治疗和预防指南。如果出现血栓并发症,应使用非肝素抗凝剂。
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引用次数: 0
WNT Signaling Cascade Proteins and LRP6 in the Formation of Various Types of Coronary Lesions in Patients With Coronary Artery Disease. 冠状动脉疾病患者各种冠状动脉病变形成过程中的 WNT 信号级联蛋白和 LRP6。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2626
Yu N Belenkov, A O Iusupova, O A Slepova, N N Pakhtusov, L V Popova, A S Lishuta, A V Krivova, N V Khabarova, M Yu Abidaev, E V Privalova

Aim: Assessment of WNT1, WNT3a, and LRP6 concentrations in patients with ischemic heart disease (IHD) and obstructive and non-obstructive coronary artery (CA) disease.

Material and methods: This cross-sectional observational study included 50 IHD patients (verified by coronary angiography, CAG), of which 25 (50%) were men, mean age 64.9±8.1 years; 20 patients had non-obstructive CA disease (stenosis <50%), and 30 patients had hemodynamically significant stenosis. Concentrations of WNT1, WNT3a and LRP6 were measured in all patients.

Results: The concentrations of WNT1 and WNT3a proteins were significantly higher in patients with IHD and obstructive CA disease (p < 0.001), while the concentration of LRP6 was higher in the group with non-obstructive CA disease (p = 0.016). Data analysis of the group with obstructive CA disease showed a moderate correlation between WNT1 and LRP6 (ρ=0.374; p=0.042). Correlation analysis of all groups of patients with CA disease revealed a moderate association between the concentrations of WNT1 and uric acid (ρ=0.416; p=0.007). Regression analysis showed that risk factors for the development of IHD, such as increased body mass index, age, smoking, dyslipidemia, and hypertension, did not significantly influence the type of CA disease in IHD patients. According to ROC analysis, the obstructive form of IHD was predicted by a WNT3a concentration higher than 0.155 ng/ml and a LRP6 concentration lower than 12.94 ng/ml.

Conclusion: IHD patients with non-obstructive CA disease had the greatest increase in LRP6, while patients with obstructive CA disease had significantly higher concentrations of the canonical WNT cascade proteins, WNT1 and WNT3a. According to the ROC analysis, a WNT3a concentration >0.155 ng/ml can serve as a predictor for the presence of hemodynamically significant CA stenosis in IHD patients (sensitivity 96.7%; specificity 70%), whereas a LRP6 concentration >12.94 ng/ml can predict the development of non-obstructive CA disease (sensitivity 76.7%; specificity 65%).

目的:评估缺血性心脏病(IHD)以及阻塞性和非阻塞性冠状动脉(CA)疾病患者体内WNT1、WNT3a和LRP6的浓度:这项横断面观察性研究纳入了 50 名 IHD 患者(经冠状动脉造影证实,CAG),其中 25 名(50%)为男性,平均年龄(64.9±8.1)岁;20 名患者患有非阻塞性 CA 病(狭窄 <50%),30 名患者患有血流动力学意义上的狭窄。对所有患者的 WNT1、WNT3a 和 LRP6 的浓度进行了测量:IHD和阻塞性CA疾病患者的WNT1和WNT3a蛋白浓度明显更高(p <0.001),而非阻塞性CA疾病组的LRP6浓度更高(p = 0.016)。对阻塞性 CA 疾病组的数据分析显示,WNT1 和 LRP6 之间存在中度相关性(ρ=0.374;p=0.042)。对各组 CA 疾病患者进行的相关性分析显示,WNT1 的浓度与尿酸之间存在中度相关性(ρ=0.416;p=0.007)。回归分析表明,发生心肌梗死的危险因素,如体重指数增加、年龄、吸烟、血脂异常和高血压,对心肌梗死患者的 CA 疾病类型没有显著影响。根据ROC分析,WNT3a浓度高于0.155纳克/毫升和LRP6浓度低于12.94纳克/毫升可预测IHD的阻塞型:结论:患有非阻塞性CA疾病的IHD患者LRP6的升高幅度最大,而患有阻塞性CA疾病的患者WNT级联蛋白WNT1和WNT3a的浓度明显更高。根据ROC分析,WNT3a浓度为0.155纳克/毫升时,可预测IHD患者是否存在血流动力学意义上的CA狭窄(灵敏度为96.7%;特异度为70%),而LRP6浓度为12.94纳克/毫升时,可预测非阻塞性CA疾病的发生(灵敏度为76.7%;特异度为65%)。
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引用次数: 0
[Cardiac Dysfunction and Arterial Hypertension as Manifestations of Cardiovasculotoxicity of iVEGF-Containing Chemotherapy. Clinical Case]. [心功能障碍和动脉高血压是含 iVEGF 化疗心血管毒性的表现。临床病例]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-05-31 DOI: 10.18087/cardio.2024.5.n2661
Yu Yu Kirichenko, T Yu Kulagina, O A Zhigulina, I S Ilgisonis, Yu N Belenkov

Significant advances in timely diagnosis and modern antitumor therapy have led to a considerable increase in the survival rate of cancer patients. On the other hand, the incidence of cardiovascular (CV) diseases and their complications is increasingly growing, including due to side effects of anticancer drugs. CV complications are the most common cause of non-oncological death of cancer patients. The development of polychemotherapy-induced arterial hypertension (AH) is closely associated with the use of certain groups of drugs, for example, inhibitors of vascular endothelial growth factor (iVEGF). Such AH is generally dose-dependent and reversible after interruption or termination of treatment. However, systemic AH, regardless of its genesis, is one of the key risk factors for many CV events (myocardial infarction, stroke, heart failure, arrhythmias) and kidney disease. Therefore, thorough blood pressure monitoring and its timely and adequate correction if needed are indicated when using certain groups of chemotherapy drugs. This article describes a clinical follow-up of a patient with induced AH associated with the iVEGF antitumor therapy for advanced uterine cancer with a rapid development of left ventricular myocardial dysfunction.

及时诊断和现代抗肿瘤疗法的重大进步使癌症患者的生存率大幅提高。另一方面,心血管(CV)疾病及其并发症的发病率也在日益增长,其中包括抗癌药物的副作用。心血管并发症是导致癌症患者非肿瘤性死亡的最常见原因。多化疗诱发动脉高血压(AH)的发生与使用某些药物组密切相关,例如血管内皮生长因子抑制剂(iVEGF)。这种动脉高压一般是剂量依赖性的,并且在中断或终止治疗后是可逆的。然而,全身性 AH 无论其成因如何,都是导致许多心血管事件(心肌梗死、中风、心力衰竭、心律失常)和肾脏疾病的关键风险因素之一。因此,在使用某类化疗药物时,应进行全面的血压监测,并在必要时及时、充分地纠正血压。本文描述了对一名因接受 iVEGF 抗肿瘤治疗而诱发 AH 的晚期子宫癌患者的临床随访,该患者的左心室心肌功能障碍发展迅速。
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引用次数: 0
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Kardiologiya
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