Kardiologiya最新文献

It has been proven and widely accepted that comprehensive cardiac rehabilitation that underlies secondary prevention reduces morbidity, disability, and mortality from cardiovascular diseases and their complications, improves quality of life, and minimizes economic losses to the healthcare system and the state as a whole. Unfortunately, despite the recognized benefits of cardiac rehabilitation, it remains underutilized or inadequately utilized. In addition to the common barriers to participation in rehabilitation that occur in most countries, the Russian Federation faces a number of limiting factors related to discrepancies between current regulations and clinical guidelines on cardiac rehabilitation, which critically impacts the rehabilitation of cardiac patients. To address this issue, it would be appropriate to separate cardiac rehabilitation from the "medical rehabilitation of patients with somatic diseases." This situation requires cardiologists to create a consensus document on cardiac rehabilitation, which should address organizational issues, routing, a description of cardiac rehabilitation programs with proven effectiveness, and criteria of the rehabilitation effectiveness specific to cardiac patients. Therefore, this should be a document aimed at reducing mortality, complications, disability, and increasing the life expectancy of cardiac patients, which is the primary goal of healthcare.

Despite significant advances in pharmacological, interventional, and surgical treatments for cardiovascular diseases (CVDs) in recent decades, it appeared that the effectiveness of standard treatments has reached a ceiling, and growing attention has been paid to the regulation of inflammation. Immune inflammation is a key component in the pathogenesis of atherosclerosis and its complications, cardiac arrhythmias, and heart failure, but it is also an integral part of tissue regeneration. Consistently, the indiscriminate use of various anti-inflammatory agents with pronounced immunosuppressive properties has failed to demonstrate benefits in heart disease. Numerous studies, including long-term ones, have demonstrated that colchicine remains an anti-inflammatory drug that is not associated with the development of iatrogenic immunodeficiency or increased cardiovascular mortality. Considering this, as well as the effects of colchicine on the immune system components involved in the pathophysiology of CVD, its short half-life, its century-long history of use in rheumatology, and the fact that colchicine is "familiar" to cardiologists from the experience of treatment of pericarditis, colchicine appears the most promising and safe for use in common cardiology practice. However, the use of immunomodulators requires a better understanding of the pathophysiology of inflammation, differentiating physiological and excessive inflammation, and the risks associated with impaired endogenous defense. Therefore, colchicine and other immunosuppressants, as distinct from acetylsalicylic acid, cannot be prescribed for formal indications. To define more clearly the patient groups most likely to benefit from colchicine, further research, new diagnostic methods, and the opinion of a cardiologist are needed. This review includes clinical studies, abstracts, and meta-analyses published online with no publication date restrictions up to July 2025. The PubMed, ScienceDirect, Google Scholar, and CENTRAL databases were used, in which 520 literature sources were reviewed describing the clinical efficacy of colchicine drugs and the heterogeneity of its effects in different treatment regimens for various CVDs.

Aim    The incidence of ischemic heart disease (IHD) and risk factors for its development in rural residents of the Novosibirsk Region (NSR).Material and methods     A cross-sectional survey (2023) was conducted among the rural population registered with the Central District Hospitals of the Ordynsky and Kochenevsky Districts of the Novosibirsk Region: 600 rural residents aged 35-79 years, with 51.2% men and 48.8% women. The survey included a standard questionnaire, anthropometric measurements, blood sampling for lipid and glucose tests, and electrocardiography (ECG). IHD was diagnosed using the Rose Angina Questionnaire and functional ECG criteria with interpretation by the Minnesota Code. All individuals were divided into subgroups: no IHD, probable IHD, and definite IHD.Results        The incidence of definite IHD in rural residents of the Novosibirsk Region was 30.5%, with 27.0% in men and 34.1% in women. Individuals with definite IHD were older (62.0 [56.0; 68.0] years) than those without IHD (60.0 [49.0; 66.0] years; p=0.004). Individuals with definite IHD were more likely to have hyperglycemia ≥7.0 mmol/L (p=0.008) and higher systolic blood pressure (SBP) (p=0.048) than those without IHD. In definite IHD, prevalence of arterial hypertension was by 9.3% higher (p=0.004), type 2 diabetes mellitus by 9.9% higher (p=0.004), obesity (p=0.012) determined by body mass index by 11.5% higher, and abdominal obesity by 7.0% higher (p=0.001). Compared with men, women were more likely to have obesity, including abdominal obesity, either in the absence or presence of any form of IHD.Conclusion    A high incidence of definite IHD was found among rural residents of the Novosibirsk Region. Cardiometabolic risk factors were more common in individuals with definite IHD than in those without it.

The aim is to present expert-agreed guidelines for the primary prevention of cardiovasculotoxicity of anticancer therapy as part of the Cardioprotection 2025 Consensus of the Russian Society of Cardiology, the Society of Heart Failure Specialists, the Russian Association of Oncologists, and the Eurasian Association of Cardio-Oncologists. The second part of the Consensus focuses on strategies for protecting the myocardium and blood vessels before or at early stages of anticancer treatment. The document addresses the key principles of primary prevention of cardiovasculotoxicity: interdisciplinary collaboration between cardiologists and oncologists at the stage of treatment scheduling, the possibility of managing modifiable risk factors, pharmacological cardioprotection, approaches to preventive screening (including clinical evaluation, biomarkers, and imaging), non-pharmacological prevention (physical activity, nutritional status correction, artificial intelligence, and digital monitoring management), and specific features of prophylaxis in the treatment with key anticancer drug classes (anthracyclines, HER2-targeted agents, tyrosine kinase inhibitors, anti-VEGF agents, immune checkpoint inhibitors). This document aims to optimize patient management to reduce the risk of cardiovascular complications during anticancer therapy.

Background    Coronary computed tomographic angiography (CTA) provides valuable anatomical and functional information before and during chronic total occlusion (CTO) - percutaneous coronary intervention (PCI). Although several studies have suggested that pre-procedural CTA may improve procedural planning and success rates, its impact has not been consistently demonstrated, particularly in real-world settings and in patients with complex lesions. This retrospective study aims to evaluate the effect of preoperative coronary CTA on the success rates of PCI in patients with CTO.Material and methods    In this single-center retrospective study, we included CTO patients who underwent PCI from January 2020 to September 2023. Participants were divided into two groups based on whether they received preoperative coronary CTA: the CTA-guided group and a angiography-guided group. The primary endpoint was the success rate of recanalization, defined as a final TIMI flow grade ≥2 and residual stenosis ≤30 %.Results    A total of 400 CTO patients were included, with 200 in the CTA-guided group and 200 in the angiography-guided group. The success rate of recanalization was significantly higher (93.5 %) in the CTA-guided group compared to in the angiography-guided group (84.0 %, p=0.003). In high-difficulty CTO cases (based on the Japanese CTO score system J-CTO score ≥2), the advantage of the CTA-guided group was more pronounced (82.0 %, p < 0.001). Regarding perioperative complications, the incidence of myocardial infarction within 24 hrs was 2.5 % in the CTA-guided group compared with 5.0 % in the angiography-guided group (p=0.047), and coronary perforation occurred in 1.0 % vs. 3.5 % of patients, respectively (p=0.035). However, At the 1 yr follow-up, there was no significant difference in major adverse cardiac events between the two groups (CTA-guided 4.5 % vs. angiography-guided 7.0 %, p=0.11), including cardiac death (1.0 % vs. 2.0 %, p=0.10) and recurrent myocardial infarction (2.0 % vs. 3.5 %, p=0.15).Conclusion    The use of preoperative coronary CTA in CTO-PCI is associated with higher success rates, particularly in high-difficulty CTO cases. Additionally, CTA-guided PCI was associated with a reduction in perioperative complications such as myocardial infarction and coronary perforation. Further multicenter, randomized studies are warranted to evaluate its impact on long-term cardiovascular outcomes.

Aim: A systematic review and meta-analysis to determine the prognostic value of left atrial (LA) myocardial strain assessed with speckle tracking echocardiography (stEchoCG) for prediction of new-onset atrial fibrillation (AF) according to population-based studies.

Material and methods:     The PubMed (Medline) and Google Scholar databases were searched for studies. In all studies, the included patients met the following criteria: general population screening; age over 18 years; absence of AF and history of stroke; availability of 2D echocardiography results obtained in accordance with standard protocols. In all included studies, the endpoint was the development of AF. To determine the difference in the average weighted LA strain values, LA strain values were analyzed in the reservoir phase (peak atrial longitudinal strain, PALS), conduit phase (left atrial conduit strain, LACS), and contraction phase (left atrial contractile strain, LACtS). Adjusted odds ratio (OR) values were obtained from multivariable models.Results     The analysis included 7 studies with a total of 12,161 patients, with 5,326 (43.8%) men. According to the meta-analysis, patients with new-onset AF had significantly lower values of LA longitudinal strain in the reservoir phase (PALS) and contraction phase (LACtS) compared with patients without AF: the weighted mean difference was -3.30% (95% confidence interval (CI): -5.58 to -1.01; p=0.005) and -2.51% (95% CI: -4.12 to -0.89; p=0.002), respectively. No statistically significant differences were found in the conduit phase strain (LACS) (-0.63%; 95% CI: -1.37 to 0.11%; p=0.10). The decreases in PALS and LACtS were associated with an increased risk of AF (OR 1.05 for every 1% of PALS; 95% CI: 1.03-1.07; p<0.0001 and OR 1.08 for every 1% of LACtS; 95% CI: 1.04-1.12; p<0.0001), whereas no association was found between LACS and the risk of AF (OR 1.01; 95% CI: 0.99-1.04; p=0.21).Conclusion    Decreased left atrial strain values in the reservoir phase (PALS) and contraction phase (LACtS) determined by stEchoCG are associated with an increased risk of a first AF episode, according to population studies.

Aim    Evaluation of epicardial fat thickness (EFT) and concentrations of biochemical markers in overweight patients after coronary artery bypass grafting (CABG) at different stages of the rehabilitation period.Material and methods    The study included 155 patients aged 35 to 65 years with left main coronary artery disease who underwent CABG. Patients were divided into 3 groups. The main group (Group 1) consisted of 85 overweight (OW) patients (48 men and 37 women) after CABG (CABG+OW+) with body mass index (BMI) 28.0 ± 0.9 kg/m2). Group 2 included 70 patients (39 men and 31 women) with normal body weight (BMI 23.3 ± 1.1 kg/m2) after CABG (CABG+OW-). The control group (Group 3) consisted of 30 healthy age-matched volunteers without acute or chronic disease (BMI 20.4±0.7 kg/m2).Results    A trend toward increased EFT and concentrations of acid-soluble blood fraction (ASBF) and deoxyribonucleic acid (DNA) in blood was observed in Group 1 at the third stage of rehabilitation. Concentrations of neutrophil extracellular traps (NETs) were significantly (p<0.05) higher in Group 1 at all stages of rehabilitation, with a trend toward an increase at the third stage of rehabilitation compared to Group 2.Conclusion    In OW patients after CABG, the EFT and the DNA concentration were significantly increased 1.8 times (p<0.05), the ASFB was 2.1 times higher, and the NET concentration was 1.9 times higher than in patients with normal body weight. In OW patients after CABG, the EFT and the concentrations of cell-free nucleic acids (ASBF, DNA) and NETs were significantly increased (p<0.05) at the third stage of rehabilitation compared to patients with normal body weight. Strong direct correlations were found between EFT and ASBF (r=0.705; p<0.001) at the second stage of rehabilitation and between EFT and DNA (r=0.825; p<0.001) at the third stage of rehabilitation.

Aim     To assess circulating levels of interleukin 1 (IL-1), soluble IL-1 receptor type II (sIL-1R2) and IL-1 receptor antagonist (IL-1Ra) in patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) in acute decompensated heart failure (ADHF) and in stable condition.Material and methods            The study included 42 patients with HFpEF and 117 patients with HFrEF admitted for ADHF. After 12 months of follow-up, 31 patients with HFpEF and 84 patients with HFrEF were re-examined. Their condition was assessed as clinically stable. Plasma concentrations of IL-1, IL-1R2, and IL-1Ra were measured in all patients.Results            In ADHF, IL-1R2 and IL-1Ra concentrations were higher than in stable condition, with IL-1Ra concentrations increasing markedly (3.5 times). Depending on the left ventricular ejection fraction, IL-1 was lower in patients with HFpEF, while IL-1R2 and IL-1Ra were higher than in patients with HFrEF. IL-1 was not detected in stable condition, and differences in IL-1R2 and IL-1Ra concentrations between fractions subsided.Conclusion     In ADHF, the differences in the concentrations of IL-1 and endogenous inhibitors of IL-1 signaling, IL-1R2 and IL-1βRa, in patients with HFpEF and HFrEF indicated different severity of the inflammatory response in these fractions and more intense neutralization of IL-1 in patients with HFpEF compared to patients with HFrEF, which should be taken into account in the therapeutic blockade of IL-1.

Aim        To study the concentrations of routine markers of systemic inflammation (erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen) and assess their correlation with the vascular morpho-functional parameters in patients with hemoblastosis before the start of polychemotherapy.Material and methods    The study included 32 patients with a newly diagnosed oncohematological disease, with 18 (56.25%) men aged 56.87±17.06 years (95% confidence interval (CI): 50.50-63.24). For all patients, ESR, CRP, and fibrinogen concentrations were measured, and digital photoplethysmography and ultrasonic duplex scanning of the brachiocephalic arteries were performed.Results  Increases in systemic inflammatory (SI) markers were found: median ESR was 25 [4.00; 45.00] mm/h (N<20), CRP was 7.5 [1.30; 17.10] mg/l (N<5), and fibrinogen was 4.30 [1.30; 8.30] g/l (N 1.8-4.0). Vascular remodeling was detected. In the large arteries: the median alternative large artery stiffness index (aSI) was 8.30 [6.10; 15.80] (N<8), phase shift (PS) value was 8.38±3.36 (95% CI: 7.10-9.66) ms (N>10), intima-media thickness (IMT) was 0.92 [0.85; 1.30] mm (N<0.90), and carotid-femoral pulse wave velocity (cfPWV) was 9.26±1.59 (95% CI: 8.49-10.59) m/s (N<10). In the microcirculation, the median occlusion index (OI) was 1.50 [0.90; 2.80] (N>1.8). According to the rank correlation analysis (Spearman rank correlation coefficient), significant direct corrlations were found between CRP and aSI (ρ=0.575; p=0.001), IMT (ρ=0.497; p=0.005); fibrinogen and aSI (ρ=0.662; p=0.001), IMT (ρ=0.678; p=0.001). Also, aSI and IMT were significantly worse in the groups with elevated CRP (ρ=0.001; p=0.042) and in patients with a more advanced tumor process according to the Ann-Abor staging system (ρ=0.002; p=0.001). However, the severity of SI and vascular remodeling did not differ in patients with different cardio-oncological risks.Conclusion         Patients with hemoblastosis before the start of polychemotherapy have morpho-functional changes in blood vessels associated with cancer severity and SI intensity. These results may indicate the potential prognostic value of routine SI markers and evaluation of baseline vascular status for stratification of cardio-oncological risk. Further studies in larger patient samples and assessment of long-term outcomes are needed to clarify these findings.

Menopausal symptoms can disrupt women's well-being at the peak of their careers and family life. Currently, the most effective treatment for these symptoms is menopausal hormone therapy (MHT). The presence of cardiovascular and metabolic diseases does not preclude the use of MHT to relieve menopausal symptoms and improve quality of life. However, physicians' concerns about causing more harm than benefits often hinder the use of this type of hormone therapy. Caution is especially important for women with comorbidities. Moreover, it should be acknowledged that high-quality studies of the MHT safety in major chronic noncommunicable diseases and common comorbidities are insufficient. This consensus document analyzes all currently available data from clinical trials of various designs and develops a set of eligibility criteria for prescribing MHT to women with cardiovascular and metabolic comorbidities. Based on this document, physicians of various specialties who provide menopause care to women will receive an accessible algorithm that will allow them to avoid potentially dangerous situations and appropriately prescribe MHT in clinical practice.