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[Rationale for Increasing Doses of Statins in Everyday Clinical Practice]. [在日常临床实践中增加他汀类药物剂量的理由]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2709
A V Susekov

HMG-CoA reductase inhibitors (statins) were discovered in the early 1970s in Japan and were originally used to treat patients with hereditary hyperlipidemia. In the late 1990s and early 2000s, clinical trials using statins for primary and secondary prevention showed the possibility of reducing cardiovascular (CV) and, in some cases, all-cause mortality. Intensive statin therapy (atorvastatin 80 mg/day and rosuvastatin 40 mg/day) compared to initial doses provides an additional 16% reduction in CV complications. Regression studies with the original rosuvastatin using intracoronary ultrasound and other modern methods have shown the possibility of stabilization and regression of atherosclerosis in the carotid and coronary arteries. High-dose statin therapy is generally well tolerated; the incidence of clinically significant adverse liver reactions does not exceed 2-3 per 100,000 people, and the incidence of myopathies with increased creatine kinase over 10 upper limits of normal is not higher than 1 per 10,000 people per year. Long-term statin treatment does not increase the risk of dementia and, in some studies, reduced the risk of Alzheimer's disease. Achieving target levels of low-density lipoprotein cholesterol (LDL-C) in routine practice does not exceed 5-11%; one of the main reasons for that is the rare (2-3%) prescription of high doses of statins. Increasing statin doses in routine clinical practice will optimize the treatment of patients with high CV risk and will contribute to further reduction of mortality in our country.

HMG-CoA 还原酶抑制剂(他汀类药物)于 20 世纪 70 年代初在日本发现,最初用于治疗遗传性高脂血症患者。20 世纪 90 年代末和 21 世纪初,使用他汀类药物进行一级和二级预防的临床试验显示,该药物可降低心血管疾病(CV)死亡率,在某些情况下还可降低全因死亡率。与初始剂量相比,他汀类药物的强化治疗(阿托伐他汀 80 毫克/天和罗苏伐他汀 40 毫克/天)可将心血管并发症的发生率额外降低 16%。利用冠状动脉内超声波和其他现代方法对最初的罗伐他汀进行的回归研究表明,颈动脉和冠状动脉的动脉粥样硬化有可能稳定和回归。大剂量他汀类药物治疗的耐受性普遍良好;临床上显著的肝脏不良反应发生率不超过每 10 万人中 2-3 例,肌酸激酶升高超过正常值上限 10 的肌病发生率不高于每年每 1 万人中 1 例。长期他汀类药物治疗不会增加痴呆症的风险,在一些研究中还降低了阿尔茨海默病的风险。在常规治疗中,低密度脂蛋白胆固醇(LDL-C)达到目标水平的比例不超过 5-11%;其中一个主要原因是很少(2-3%)使用大剂量他汀类药物。在常规临床实践中增加他汀类药物的剂量将优化对高心血管风险患者的治疗,并有助于进一步降低我国的死亡率。
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引用次数: 0
Original Moxonidine and Generics: Where is the Edge of Difference? 原研药莫索尼定和仿制药:差异的边缘在哪里?
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2731
V V Skibitskiy, A V Fendrikova, A V Skibitskiy, D V Sirotenko, O V Timofeeva

Aim: To compare the efficacy of adding original moxonidine and its generics to previous ineffective antihypertensive therapy in patients with poorly controlled arterial hypertension (AH).

Material and methods: This observational prospective non-randomized study included 120 patients with poorly controlled blood pressure on the previous antihypertensive therapy. All patients underwent clinical evaluation, including anthropometric and laboratory indexes, and 24-hour blood pressure monitoring (24-h BPM) at baseline and after 12 weeks of observation. Office systolic and diastolic blood pressure (SBP and DBP) and heart rate (HR) were recorded after 4 and 12 weeks of treatment. During the observation period, 4 equal groups were formed: group 1, Physiotens was added to the treatment; group 2, Moxonitex; group 3, Moxonidine SZ; and group 4, Moxonidine Canon. Statistical analysis was performed with the StatTech v.4.2.7 software (© OOO StatTech, Russia).

Results: After 4 weeks of therapy, the BP target was achieved significantly more frequently in group 1 (63% of patients) compared to groups 2 (36.7% of patients), 3 (16.7% of patients), and 4 (16.7% of patients) (p<0.05). At 12 weeks, office SBP, DBP, and HR were significantly decreased in all groups, but the decrease was significantly greater in group 1. The therapy was associated with a more pronounced decrease in all studied 24-h BPM parameters in the Physiotens group than in other groups, as well as with a significantly more frequent normalization of the 24-h BP profile, in 66.7% of patients vs. 46.7%, 33.4%, and 23.2% of patients in groups 2, 3, and 4, respectively.

Conclusion: The treatment with original moxonidine demonstrated advantages over generic drugs in terms of achieving the BP goal, reducing office BP and HR, and improving 24-h BPM parameters.

目的:比较动脉高血压(AH)控制不佳患者在既往无效的降压治疗基础上加用原研莫索尼定及其仿制药的疗效:这项观察性前瞻性非随机研究纳入了120名之前接受降压治疗但血压控制不佳的患者。所有患者均接受了临床评估,包括人体测量和实验室指标,以及基线和 12 周后的 24 小时血压监测(24-h BPM)。治疗 4 周和 12 周后,记录办公室收缩压和舒张压(SBP 和 DBP)以及心率(HR)。在观察期间,分为 4 组:第 1 组,在治疗过程中添加 Physiotens;第 2 组,使用 Moxonitex;第 3 组,使用 Moxonidine SZ;第 4 组,使用 Moxonidine Canonidine。统计分析使用 StatTech v.4.2.7 软件(© OOO StatTech,俄罗斯)进行:治疗 4 周后,与第 2 组(36.7% 的患者)、第 3 组(16.7% 的患者)和第 4 组(16.7% 的患者)相比,第 1 组(63% 的患者)达到血压目标的频率明显更高(p<0.05)。12周时,所有组的诊室SBP、DBP和心率均显著下降,但第1组的降幅明显更大。与其他组相比,Physiotens组所有研究的24小时BPM参数均有更明显的下降,而且24小时血压曲线正常化的频率也明显更高,66.7%的患者与第2、3和4组的46.7%、33.4%和23.2%的患者相比,均有更高的血压曲线正常化率:在实现降压目标、降低诊室血压和心率以及改善 24 小时血压参数方面,使用原研莫索尼定治疗比使用普通药物更具优势。
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引用次数: 0
[Laboratory Aspects of Using the Results of NT-Probnp Concentration Immunochemical Determination in the Management of Patients With Heart Failure: Support For Clinical Decision-Making]. [在心力衰竭患者管理中使用 NT-Probnp 浓度免疫化学测定结果的实验室方面:支持临床决策]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2720
N G Vinogradova, V S Berestovskaya, Z N Blankova, T V Vavilova, N V Gomyranova, V P Masenko, V Yu Mareev, A A Skvortsov, N A Sorokina, S N Tereshchenko

The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.

近几十年来,全球心力衰竭(HF)的负担日益加重。根据门诊测量的钠尿肽(NP)浓度对心力衰竭进行早期诊断,可以及时开始治疗并降低心力衰竭不良后果的发生率。遗憾的是,全世界进行 NP 检测的频率仍然很低。在 2024 年 3 月 15 日举行的在线专家会议上,与会专家讨论了 N 端前脑钠尿肽(NT-proBNP)检测试剂盒(罗氏 Elecsys proBNP)的特点,以及检测结果的解释和实验室报告中结果的呈现。专家们讨论了 Elecsys proBNP 检测在各种临床情况(慢性和急性心房颤动)下用于疑似心房颤动患者的特点。根据不同的临床情况,确定了 NT-proBNP 检测的临床决策范围。讨论了 Elecsys proBNP 检测结果随合并症的变化。专家们提出了在俄罗斯联邦优化 Elecsys proBNP 检测结果报告格式的方法,这将加快该检测在临床实践中的应用,并优化对心房颤动患者的管理。
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引用次数: 0
Biomolecules of Adipose Tissue in Atherosclerotic Plaques of Men With Coronary Atherosclerosis. 男性冠状动脉粥样硬化斑块中的脂肪组织生物大分子
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2634
E V Garbuzova, Ya V Polonskaya, E V Kashtanova, E M Stakhneva, V S Shramko, I S Murashov, A V Kurguzov, A M Chernyavsky, Yu I Ragino

Aim: To study metabolic molecules (adiponectin, adipsin, resistin, glucagon-like peptide-1 (GLP-1), glucagon, secretin) of adipose tissue in atherosclerotic plaques (AP) and their associations with AP instability in men with coronary atherosclerosis.

Material and methods: Metabolic molecules (adipocytokines and metabolic hormones) of adipose tissue can act as enzymes, hormones or growth factors in modulating insulin resistance and lipid and glucose metabolism and indirectly influence the course of the atherosclerotic process. This study included 48 men from whom 139 coronary artery (CA) samples were collected during coronary artery bypass grafting, after obtaining the informed consent. According to the histological conclusion, 84 (60.4%) CA plaques were stable, 44 (31.7%) were unstable, and 11 histological samples had a conditionally unchanged CA intima (7.9%). The concentrations of adiponectin, adipsin, resistin, GLP-1, glucagon, and secretin were measured in AP homogenates by multiplex analysis using the Human Metabolic Hormone V3 panel (MILLIPLEX, Germany). During the study, demographic and anthropometric characteristics, medical history, and presence of chronic diseases were recorded.

Results: The glucagon concentration in the conditionally unchanged intima was 16.7% lower and in the fragments of unstable atherosclerotic plaques 41.2% lower than in fragments of stable APs. However, the glucagon concentration in stable APs was 28% higher than in unstable APs. The secretin concentration in the conditionally unchanged intima was also lower than in stable APs by 41.2%, while in stable APs, the secretin concentration was 20% higher than in unstable APs. The adiponectin concentrations were directly correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations (r=0.286; p=0.002), while the secretin concentrations were inversely correlated with serum HDL-C concentrations (r= -0.199; p=0.038). The probability of having an unstable AP (in relation to conditionally unchanged intima) increases by 35.8% with an increase in the AP glucagon concentration by 1 pg/mg protein. The probability of having a stable AP (in relation to unchanged intima) increases by 29.4% with an increase in the AP glucagon concentration by 1 pg/mg protein and by 10.1% with an increase in the AP secretin concentration by 1 pg/mg protein.

Conclusion: The AP adiponectin concentration directly correlates and the AP secretin concentration inversely correlates with the serum concentration of HDL-C. The presence of both stable and unstable APs is directly associated with the AP glucagon concentration in men with coronary atherosclerosis. The AP secretin concentration is directly associated with plaque stability in men with coronary atherosclerosis. Further thorough study of the identified markers in atherosclerotic lesions will allow using them as potential targets for therapy.

目的:研究冠状动脉粥样硬化男性患者动脉粥样硬化斑块(AP)中脂肪组织的代谢分子(脂肪连素、脂肪素、抵抗素、胰高血糖素样肽-1(GLP-1)、胰高血糖素、胰泌素)及其与动脉粥样硬化斑块不稳定性的关系:脂肪组织的代谢分子(脂肪细胞因子和代谢激素)可作为酶、激素或生长因子调节胰岛素抵抗、脂质和葡萄糖代谢,并间接影响动脉粥样硬化过程。这项研究包括 48 名男性,在获得知情同意后,收集了他们在冠状动脉搭桥术期间的 139 个冠状动脉(CA)样本。根据组织学结论,84 个(60.4%)冠状动脉斑块是稳定的,44 个(31.7%)是不稳定的,11 个组织学样本的冠状动脉内膜有条件性变化(7.9%)。通过使用人类代谢激素 V3 面板(德国 MILLIPLEX 公司)进行多重分析,测量了 AP 匀浆中的脂肪连素、脂肪素、抵抗素、GLP-1、胰高血糖素和胰泌素的浓度。研究期间记录了人口统计学和人体测量特征、病史和是否患有慢性疾病:结果:与稳定的动脉粥样硬化斑块碎片相比,条件不变的内膜中的胰高血糖素浓度低 16.7%,不稳定的动脉粥样硬化斑块碎片中的胰高血糖素浓度低 41.2%。然而,稳定 AP 中的胰高血糖素浓度比不稳定 AP 高 28%。在条件不变的内膜中,胰泌素浓度也比稳定型 AP 低 41.2%,而在稳定型 AP 中,胰泌素浓度比不稳定型 AP 高 20%。脂联素浓度与血清高密度脂蛋白胆固醇(HDL-C)浓度直接相关(r=0.286;p=0.002),而分泌素浓度与血清高密度脂蛋白胆固醇浓度成反比(r=-0.199;p=0.038)。当 AP 胰高血糖素浓度增加 1 pg/mg 蛋白时,出现不稳定 AP(与条件不变的内膜有关)的概率增加 35.8%。AP胰高血糖素浓度增加1 pg/mg蛋白,出现稳定AP(相对于未改变的内膜)的概率增加29.4%;AP胰泌素浓度增加1 pg/mg蛋白,出现稳定AP的概率增加10.1%:结论:胰高血糖素浓度与血清高密度脂蛋白胆固醇浓度直接相关,而胰高血糖素浓度与血清高密度脂蛋白胆固醇浓度成反比。在冠状动脉粥样硬化男性患者中,稳定和不稳定AP的存在与AP胰高血糖素浓度直接相关。在冠状动脉粥样硬化男性患者中,AP 分泌素浓度与斑块稳定性直接相关。对动脉粥样硬化病变中已确定的标记物进行进一步深入研究,可将其作为潜在的治疗目标。
{"title":"Biomolecules of Adipose Tissue in Atherosclerotic Plaques of Men With Coronary Atherosclerosis.","authors":"E V Garbuzova, Ya V Polonskaya, E V Kashtanova, E M Stakhneva, V S Shramko, I S Murashov, A V Kurguzov, A M Chernyavsky, Yu I Ragino","doi":"10.18087/cardio.2024.8.n2634","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2634","url":null,"abstract":"<p><strong>Aim: </strong>To study metabolic molecules (adiponectin, adipsin, resistin, glucagon-like peptide-1 (GLP-1), glucagon, secretin) of adipose tissue in atherosclerotic plaques (AP) and their associations with AP instability in men with coronary atherosclerosis.</p><p><strong>Material and methods: </strong>Metabolic molecules (adipocytokines and metabolic hormones) of adipose tissue can act as enzymes, hormones or growth factors in modulating insulin resistance and lipid and glucose metabolism and indirectly influence the course of the atherosclerotic process. This study included 48 men from whom 139 coronary artery (CA) samples were collected during coronary artery bypass grafting, after obtaining the informed consent. According to the histological conclusion, 84 (60.4%) CA plaques were stable, 44 (31.7%) were unstable, and 11 histological samples had a conditionally unchanged CA intima (7.9%). The concentrations of adiponectin, adipsin, resistin, GLP-1, glucagon, and secretin were measured in AP homogenates by multiplex analysis using the Human Metabolic Hormone V3 panel (MILLIPLEX, Germany). During the study, demographic and anthropometric characteristics, medical history, and presence of chronic diseases were recorded.</p><p><strong>Results: </strong>The glucagon concentration in the conditionally unchanged intima was 16.7% lower and in the fragments of unstable atherosclerotic plaques 41.2% lower than in fragments of stable APs. However, the glucagon concentration in stable APs was 28% higher than in unstable APs. The secretin concentration in the conditionally unchanged intima was also lower than in stable APs by 41.2%, while in stable APs, the secretin concentration was 20% higher than in unstable APs. The adiponectin concentrations were directly correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations (r=0.286; p=0.002), while the secretin concentrations were inversely correlated with serum HDL-C concentrations (r= -0.199; p=0.038). The probability of having an unstable AP (in relation to conditionally unchanged intima) increases by 35.8% with an increase in the AP glucagon concentration by 1 pg/mg protein. The probability of having a stable AP (in relation to unchanged intima) increases by 29.4% with an increase in the AP glucagon concentration by 1 pg/mg protein and by 10.1% with an increase in the AP secretin concentration by 1 pg/mg protein.</p><p><strong>Conclusion: </strong>The AP adiponectin concentration directly correlates and the AP secretin concentration inversely correlates with the serum concentration of HDL-C. The presence of both stable and unstable APs is directly associated with the AP glucagon concentration in men with coronary atherosclerosis. The AP secretin concentration is directly associated with plaque stability in men with coronary atherosclerosis. Further thorough study of the identified markers in atherosclerotic lesions will allow using them as potential targets for therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"39-47"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Editorial on the article «Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation». 关于文章 "微心房颤动患者的 Natriuretic Peptide 浓度和超声心动图检查结果 "的社论。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2728
G E Gendlin, A M Baimukanov, E I Emelina, D A Paegle, I G Nikitin

In relation with the published article "Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation", we have issued a comment. The authors of the article addressed a widely discussed topic of "Short episodes of fast arrhythmias initially detected in records on implantable devices". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.

关于已发表的文章《微小房颤患者的 Natriuretic Peptide 浓度和超声心动图检查结果》,我们发表了评论。这篇文章的作者探讨了一个被广泛讨论的话题,即 "最初在植入式设备记录中检测到的快速心律失常的短暂发作"。此外,已经通过不同持续时间的 Holter 监测对这些发作进行了研究,并评估了其临床意义。这就是引用文章的主题和我们的评论。
{"title":"Editorial on the article «Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation».","authors":"G E Gendlin, A M Baimukanov, E I Emelina, D A Paegle, I G Nikitin","doi":"10.18087/cardio.2024.8.n2728","DOIUrl":"10.18087/cardio.2024.8.n2728","url":null,"abstract":"<p><p>In relation with the published article \"Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation\", we have issued a comment. The authors of the article addressed a widely discussed topic of \"Short episodes of fast arrhythmias initially detected in records on implantable devices\". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"64-67"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparative Analysis of the Effectiveness of Riskometer Scales in Predicting the Risk of in-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention. 经皮冠状动脉介入术后 ST 段抬高型心肌梗死患者院内死亡风险的风险量表预测效果对比分析。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2602
B I Geltser, K I Shahgeldyan, I G Domzhalov, N S Kuksin, V N Kotelnikov, E A Kokarev

Aim: Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods.

Material and methods: A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups.

Results: Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (<0.3%), medium (0.3-9%), high (9-17%), and very high (>17%) risk groups.

Conclusion: The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.

目的:比较评估风险量表在预测经皮冠状动脉介入治疗(PCI)后ST段抬高型心肌梗死(STEMI)患者院内死亡(IHD)方面的有效性,并开发基于机器学习方法的新模型:我们利用 4,675 份 STEMI 患者(3,202 名男性和 1,473 名女性)的电子病历数据开展了一项单中心队列回顾性研究,这些患者接受了急诊 PCI,中位年龄为 63 岁。其中分为两组:第一组包括 318 名(6.8%)在医院死亡的患者;第二组包括 4359 名(93.2%)预后良好的患者。GRACE、CADILLAC、TIMI-STe、PAMI和RECORD量表用于评估IHD风险。利用单变量和多变量逻辑回归、随机梯度提升和人工神经网络(ANN)建立了由这些量表得分之和预测的 IHD 预后模型。根据人工神经网络模型数据,通过计算比较组的 IHD 预测概率中值,对不良事件风险进行分层:对 STEMI 患者各量表预后价值的比较分析表明,PCI 后 IHD 风险分层的质量存在差异。GRACE量表的预后准确性最高,而PAMI量表的准确性最低。CADILLAC量表和TIMI-STe量表的预后能力可以接受且不相上下,而RECORD量表则显示出相当比例的假阳性结果。综合 ANN 模型的预测因子是 5 个量表的评分,其预测准确性优于单变量和多变量逻辑回归算法以及随机梯度提升算法。根据 ANN 模型的数据,IHD 的概率被分为低(0.3%)、中(0.3%-9%)、高(9%-17%)和极高(17%)风险组:结论:GRACE、CADILLAC 和 TIMI-STe 量表与 PAMI 和 RECORD 量表相比,在对 PCI 后 STEMI 患者进行 IHD 风险分层的准确性方面具有优势。综合了五个分析量表的预后资源的集成 ANN 模型具有更好的质量标准,基于该模型数据的分层算法的特点是能准确识别 STEMI 患者在 PCI 术后发生 IHD 的高风险和极高风险。
{"title":"Comparative Analysis of the Effectiveness of Riskometer Scales in Predicting the Risk of in-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention.","authors":"B I Geltser, K I Shahgeldyan, I G Domzhalov, N S Kuksin, V N Kotelnikov, E A Kokarev","doi":"10.18087/cardio.2024.8.n2602","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2602","url":null,"abstract":"<p><strong>Aim: </strong>Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods.</p><p><strong>Material and methods: </strong>A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups.</p><p><strong>Results: </strong>Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (&lt;0.3%), medium (0.3-9%), high (9-17%), and very high (&gt;17%) risk groups.</p><p><strong>Conclusion: </strong>The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"48-55"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity. 现代抗肿瘤疗法诊断和风险评估仪器心血管毒性。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2753
Yu N Belenkov, I S Ilgisonis, N V Khabarova, Yu Yu Kirichenko Yu Yu

The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.

心肿瘤学最重要的组成部分是评估抗肿瘤治疗心血管毒性的发生风险和诊断,其检测主要基于心血管系统的可视化。文章根据 2022 年欧洲心脏病学会心肿瘤学临床指南,介绍了心脏和血管无创可视化的最新方法。此外,文章还讨论了尚未纳入指南的有前景的心血管成像技术:使用多层计算机断层扫描评估冠状动脉钙化,以及使用18F标记的2-脱氧-2-氟-d-葡萄糖进行正电子发射计算机断层扫描。
{"title":"Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity.","authors":"Yu N Belenkov, I S Ilgisonis, N V Khabarova, Yu Yu Kirichenko Yu Yu","doi":"10.18087/cardio.2024.8.n2753","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2753","url":null,"abstract":"<p><p>The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"3-12"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries). 非结构性冠状动脉疾病和多血管疾病患者。KAMMA (俄罗斯联邦和欧亚国家多血管疾病患者临床登记处)真实世界登记处子分析。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2683
G P Arutyunov, E I Tarlovskaya, A G Arutyunov, T I Batluk, N A Koziolova, A I Chesnikova, A Yu Vaskin, D S Tokmin, I G Bakulin, O L Barbarash, N Yu Grigoryeva, I V Gubareva, N V Izmozherova, U K Kamilova, S G Kechedzhieva, Z F Kim, N A Koriagina, S V Mironova, N P Mitkovskaya, S V Nemirova, L M Nurieva, M M Petrova, E A Polyanskaya, A P Rebrov, A V Svarovskaya, E A Smirnova, A B Sugraliev, Ya B Khovaeva, G V Shavkuta, I I Shaposhnik, M Yu K Alieva, A B Almukhanova, A V Aparkina, R A Bashkinov, L N Belousova, E I Blokhina, V O Bochkareva, V M Buianova, F Yu Valikulova, A D Vende, A S Galyavich, V V Genkel, E V Gorbunova, E D Gordeychuk, E A Grigorenko, E V Grigoryeva, I L Davydkin, D S Evdokimov, A N Ermilova, Sh B Zhangelova, N V Zhdankina, E I Zheleznyak, N S Ilyanok, D A Kapsultanova, N A Karoli, E A Kartashova, A S Kuznetsova, A T Kumaritova, N A Magdeeva, S A Makarov, E S Melnikov, M V Novikova, I A Obukhova, E V Ponomarenko, A O Rubanenko, O A Rubanenko, F E Rustamova, V A Safronenko, E I Suchkova, A I Sycheva, D R Tagaeva, M A Trubnikova, T P Trunina, A G Frolov, V V Khatlamadzhiyan, Yu I Khokhlova, A I Chernyavina, O Yu Chizhova, M A O Shambatov, T V Shnyukova, Yu V Shchukin

Aim: To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.

Material and methods: The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%).

Results: A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.

Conclusion: IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

目的:研究KAMMA登记中的非梗阻性缺血性心脏病(IHD)和多灶性动脉粥样硬化(MFA)患者的临床状况以及实验室和仪器检查数据:子分析包括 1,893 名接受冠状动脉造影术 (CAG) 和外周动脉超声波检查的 IHD 患者。根据冠状动脉造影数据,患者被分为两组:第一组,阻塞性冠状动脉粥样硬化(CA)患者(最大狭窄≥50%和/或有经皮冠状动脉介入治疗/冠状动脉旁路移植史,n=1728;91.3%);第二组,非阻塞性CA患者(最大狭窄<50%,n=165;8.7%):根据 KAMMA 登记中已确诊的 IHD 患者的冠状动脉阻塞程度进行的比较分析表明,8.7% 的患者冠状动脉狭窄程度小于 50%。绝大多数非阻塞性 CA 患者的肱动脉受 MFA 影响的比例为 94.3%,下肢动脉受影响的比例为 40.2%。在非阻塞性 IHD 患者中,女性居多;与阻塞性 IHD 组相比,该组患者中吸烟和 2 型糖尿病等风险因素的发生率较低。与阻塞性心肌梗死患者相比,非阻塞性心肌梗死患者更常见血脂异常病史;总胆固醇和非高密度脂蛋白胆固醇更高;更常接受中等强度的他汀类药物治疗(55.8% 对 34.5%)。非阻塞性 CA 患者的特征是不太严重的 IHD 和较少的急性冠状动脉综合征病史。然而,中风、外周动脉血栓和下肢慢性动脉功能不全的发生率在第一组和第二组中没有差异,而阵发性心房颤动的发生率在非阻塞性 IHD 组中较高:结论:无冠状动脉阻塞的 IHD 患者也需要评估外周动脉状况,因为他们可能患有晚期 MFA,在选择治疗的 "积极性 "时应考虑到这一点。
{"title":"Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).","authors":"G P Arutyunov, E I Tarlovskaya, A G Arutyunov, T I Batluk, N A Koziolova, A I Chesnikova, A Yu Vaskin, D S Tokmin, I G Bakulin, O L Barbarash, N Yu Grigoryeva, I V Gubareva, N V Izmozherova, U K Kamilova, S G Kechedzhieva, Z F Kim, N A Koriagina, S V Mironova, N P Mitkovskaya, S V Nemirova, L M Nurieva, M M Petrova, E A Polyanskaya, A P Rebrov, A V Svarovskaya, E A Smirnova, A B Sugraliev, Ya B Khovaeva, G V Shavkuta, I I Shaposhnik, M Yu K Alieva, A B Almukhanova, A V Aparkina, R A Bashkinov, L N Belousova, E I Blokhina, V O Bochkareva, V M Buianova, F Yu Valikulova, A D Vende, A S Galyavich, V V Genkel, E V Gorbunova, E D Gordeychuk, E A Grigorenko, E V Grigoryeva, I L Davydkin, D S Evdokimov, A N Ermilova, Sh B Zhangelova, N V Zhdankina, E I Zheleznyak, N S Ilyanok, D A Kapsultanova, N A Karoli, E A Kartashova, A S Kuznetsova, A T Kumaritova, N A Magdeeva, S A Makarov, E S Melnikov, M V Novikova, I A Obukhova, E V Ponomarenko, A O Rubanenko, O A Rubanenko, F E Rustamova, V A Safronenko, E I Suchkova, A I Sycheva, D R Tagaeva, M A Trubnikova, T P Trunina, A G Frolov, V V Khatlamadzhiyan, Yu I Khokhlova, A I Chernyavina, O Yu Chizhova, M A O Shambatov, T V Shnyukova, Yu V Shchukin","doi":"10.18087/cardio.2024.8.n2683","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2683","url":null,"abstract":"<p><strong>Aim: </strong>To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.</p><p><strong>Material and methods: </strong>The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis &lt;50%, n = 165; 8.7%).</p><p><strong>Results: </strong>A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.</p><p><strong>Conclusion: </strong>IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the \"aggressiveness\" of therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"13-23"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation. 微心房颤动患者的钠尿肽浓度和超声心动图检查结果
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-08-31 DOI: 10.18087/cardio.2024.8.n2633
Hüseyin Aykaç, Cihan Aydın, Aykut Demirkıran, Nurullah Uslu, Şeref Alpsoy

Aim: Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF.

Material and methods: The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24‑hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of ≥5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared.

Results: N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml, p<0.001; 13±11.4 ng / dl vs. 4.4±2.4 ng / dl, p<0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113±10.2 ms vs. 98±10.4 ms; p<0.001), minimum P wave duration (Pmin) (73.8±5.5 ms vs.70±6.3 ms; p<0.001) and P wave dispersion (PWD) (39.1±7.9 ms vs.28±7.6 ms; p<0.001) were longer in the micro-AF group.

Conclusions: Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.

目的:心房颤动(AF)是一种心律失常,其特点是心房源性电激活非常快且无序,心房收缩不协调。极短时间的房颤样活动(微房颤)可能是未被发现的无声房颤发作的前兆。在此,我们研究了微房颤患者体内钠尿肽浓度与超声心动图结果之间的关系:用 24 小时 Holter 监护仪记录心悸患者的心电图,并将患者连续纳入研究。微心房颤动的定义是持续时间少于 30 秒的突发性不规则房性心动过速,发作次数≥5 次连续室上性去极化,且绝对没有 p 波。经过 G 功率测试后,患者被连续纳入研究:微 AF 组和对照组各 45 名患者。两组患者的实验室指标、心电图和超声心动图结果进行了比较:结果:微 AF 组 N 端 Pro B 型钠尿肽(Pro-BNP)和血清肌钙蛋白 T 浓度更高(分别为 375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml,p<0.001;13±11.4 ng / dl vs. 4.4±2.4 ng / dl,p<0.001)。血清 Pro-BNP 每增加 1 pg / ml,微 AF 风险增加 1.8%。在 ROC 分析中,Pro-BNP 诊断微小心房颤动的临界值为 63.4 pg /ml,敏感性为 91.1%,特异性为 73.3%。微 AF 组的心房电动力学延迟时间明显较长。要预测微 AF,心房间平面机电延迟时间(心房间平面 AEMD)的临界值为 18.5 秒,灵敏度为 93.3%,特异度为 91.1%。左心房内平面机电延迟时间(心房内 AEMD LEFT)的临界值为 11.5 秒,灵敏度为 95.6%,特异度为 75.6%。在心电图评估中,微 AF 组的最大 P 波持续时间(Pmax)(113±10.2 毫秒 vs. 98±10.4 毫秒;p<0.001)、最小 P 波持续时间(Pmin)(73.8±5.5 毫秒 vs. 70±6.3 毫秒;p<0.001)和 P 波弥散(PWD)(39.1±7.9 毫秒 vs. 28±7.6 毫秒;p<0.001)更长:结论:通过评估心电图、超声心动图和血清钠尿肽数据可预测患者的微AF。
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引用次数: 0
Possibilities of Azilsartan Medoxomil for Preparation for Planned Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus. 阿齐沙坦美多米用于 2 型糖尿病患者经皮冠状动脉介入治疗前准备的可能性
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-07-31 DOI: 10.18087/cardio.2024.7.n2671
A M Kochergina, O L Barbarash

Aim: To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM).

Material and methods: The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured.

Results: During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p<0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1.

Conclusion: This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.

目的:评估阿齐沙坦酯用于缺血性心脏病(IHD)、动脉高血压(AH)和2型糖尿病(DM)患者术前准备和改善择期经皮冠状动脉介入治疗(PCI)长期预后的有效性和安全性:研究样本包括转诊择期PCI的2型糖尿病患者,根据24小时血压监测(24-BPM),这些患者的血压(BP)控制不佳(日平均收缩压≥130 mmHg,日平均舒张压≥80 mmHg)。数据收集时间为 2018 年至 2020 年。研究共纳入75名患者,并通过简单随机的方式将其分为两组:第1组(主要组,人数=37)接受阿齐沙坦酯甲钴胺作为降压药物,剂量为40毫克/天(之前处方的血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂(ARB)停用);第2组(对照组,人数=38)继续之前的降压治疗。随访期为 6 个月。在连续5次随访中,每次都对患者进行检查,记录24-BPM,并测量肾功能不全的尿液指标(肾小球滤过率,GFR;中性粒细胞明胶酶相关脂质钙蛋白,NGAL;尿白蛋白-肌酐比值,UACR;肾损伤分子,KIM-1;白细胞介素-18,IL-18):结果:阿齐沙坦治疗期间,肾小球滤过率下降了 7.4%,而对照组下降了 18.9%(p<0.001)。随访 6 个月,主要治疗组的 NGAL 浓度没有变化,而对照组的 NGAL 浓度增加了 12.9%。服用阿齐沙坦后,尿液中的 IL-18 浓度下降了 16.9%,而对照组患者的 IL-18 浓度上升了 7.14%。两组患者都出现了蛋白尿,这在患有糖尿病的情况下是可以预料到的;但是,接受阿齐沙坦治疗的患者的 UACR 值增加了 37.5%,而对照组患者的 UACR 值增加了 96.15%。这些差异具有统计学意义。胱抑素 C 和 KIM-1 的浓度在统计学上没有明显差异:这项研究证明了两个重要事实:使用新的、更敏感的肾脏损伤标记物诊断造影剂诱发的急性肾损伤(CI-AKI)的可能性,这对评估预防效果非常重要;使用 ARBs,尤其是阿齐沙坦,预防合并有 AH 和 DM 的 IHD 患者发生 CI-AKI 的可能性。
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引用次数: 0
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