Kardiologiya最新文献

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.

An important objective of the creation of the Society of Experts in Heart Failure (SEHF) was to assess the level of diagnostics and approaches to the treatment of chronic heart failure (CHF) in the Russian Federation (RF), without which it was impossible to bring clinical practice to the optimal level and in consistency with the existing clinical guidelines. Thus, along with the development of Guidelines for the diagnosis and treatment of CHF, a series of registries and multicenter clinical trials (MCTs) was conducted to bring the indexes of real practice closer to the developed Guidelines. Numerous MCTs organized during the 25 years of the SEHF existence have significantly improved the substantiated and recommended therapy for CHF administered by practicing physicians in the Russian Federation. This article overviews the most important registries and MCTs that were conducted during the 25 years of the SEHF work and their effect on CHF diagnostics and treatment in the clinical practice in the RF.

Aim    To evaluate the risks of all-cause death (ACD), cardiovascular death (CVD), death from recurrent acute decompensated heart failure (ADHF), and a composite index of CVD and death from recurrent ADHF in patients with chronic heart failure (CHF) after the first hospitalization for ADHF during a long-term, five-year follow-up in the conditions of specialized medical care and in real clinical practice.Material and methods    This prospective cohort observational study included 942 patients after ADHF. Group 1 consisted of 510 patients who continued the outpatient follow-up at a specialized center for the treatment of CHF (cCHF); group 2 consisted of 432 patients followed up at outpatient and polyclinic institutions (OPI) at the place of residence. During the five-year follow-up, the causes of death were determined based on the medical records of inpatients, postmortem examinations, or the conclusion in the medical records of outpatients. Rates of ACD, CVD, death from recurrent ADHF, and the composite index (CVD and death from ADHF) were analyzed. Statistical analysis was performed with a R statistical package.Results    ACD was 32.3% and 53.5% in groups 1 and 2, respectively (p<0.001). Based on the results of Cox proportional hazards models, it was shown that the follow-up in group 1, regardless of other factors, was associated with a decrease in the ACD risk (HR 2.07; 95% CI 1.68-2.54; p<0.001), CVD (HR 1.94; 95% CI 1.26-2.97; p=0.002), death from recurrent ADHF (HR 2.4; 95% CI 1.66-3.42; p<0.001) and the composite mortality index (HR 2.2; 95% CI 1.65-2.85; p<0.001) compared to group 2. The risks of death in CHF patients with moderately reduced left ventricular ejection fraction (LVEF) (HFmrEF) were consistent with the death rates in CHF patients with low LVEF (HFrEF) and were significantly higher than in CHF patients with preserved LVEF (HFpEF). The prognosis of life worsened with an increase in the Clinical Condition Assessment Scale score and age. The prognosis of life was better in women, as well as with higher values of systolic blood pressure (BP) and 6-minute walk test. In the structure of death in both groups, death from ADHF and sudden cardiac death (SCD) prevailed.Conclusion    The absence of specialized follow-up at an outpatient CHF center increases the risks of ACD, CVD, death from recurrent ADHF, and the composite endpoint at a depth of five-year observation. The leading causes of death were recurrent ADHF and SCD.

During the 25 years of the existence of the Russian Society of Experts in Heart Failure, it has become the most numerous and authoritative medical association. The Society has representative offices in 52 regions of Russia, and its active members amount to more than 4,000 various specialists. More than 200 Schools, regional conferences, and annual Congresses have been held annually. Dozens of clinical studies have been performed under the auspices of the Society, and the Cardiology journal has been published. This article also outlines the following new promising areas for the development of the Society: widespread introduction of modern clinical guidelines into clinical practice; transition to personalized medicine based on phenotyping of patients with heart failure; acceleration of heart failure diagnostics and earlier initiation of treatment with recommended doses; transition to remote follow-up of heart failure outpatients.

Pericarditis as an inflammatory heart disease is rarely discussed in the cardiology community. The latest European guidelines on pericarditis were published in 2015, and Russian clinical guidelines are dated 2022. However, in recent years, a number of publications have appeared that have forced the scientific community to take a fresh look at this problem. This is mainly due to a change in the paradigm of the treatment of idiopathic recurrent pericarditis (IRP) registered in the Russian Federation as a rare (orphan) disease. According to most experts, IRP is an underestimated cardiac disease, which, due to the lack of specific symptoms and the physicians' alertness regarding the IRP diagnostics, is rarely the subject of scientific discussions. The issues of diagnosis and therapy of IRP in light of the latest reports became the matter under discussion for a group of leading Russian experts chaired by Corresponding Member of the Russian Academy of Sciences, Professor G.P. Arutyunov.

The article discusses long-term safety of drug-eluting stents in emergent coronary revascularization.

The article presents a clinical case of perioperative non-ST-segment elevation myocardial infarction in a patient with primary metasynchronous cancer of the rectum, stomach and bladder, which developed during simultaneous surgical intervention in the volume of proximal gastrectomy and abdominoperineal extirpation of the rectum. Fluctuations in blood pressure and imbalance in the hemostasis system at the stages of anesthesia and surgery in a patient with severe systemic atherosclerosis caused the development of myocardial ischemia in the area of significant coronary stenosis. Emergency coronary angiography detected subtotal stenosis of the anterior descending artery; stenting of the affected area of the coronary artery was performed. Monitoring of hemodynamic parameters and changes in the hemostasis system during the optimal antianginal therapy allowed to bring the patient out of critical condition and discharge him from the hospital on the 18th day.

Aim: To analyze the relationship between the occurrence of atrial fibrillation (AF) and thyroid dysfunction caused by low concentrations of free triiodothyronine (FT3), free triiodothyronine and free thyroxine (FT3 and FT4), and high concentrations of free thyroxine (FT4) with normal values of thyroid-stimulating hormone (TSH) in experiments on outbred rats.

Material and methods: The pathogenesis of AF with low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 was studied in an experiment on 146 outbred rats. In the experiment, hypothyroidism, euthyroidism, and thyrotoxicosis were modeled by changing the concentrations of thyroid hormones, and the effect of these conditions on ECG and the incidence of AF was evaluated.

Results: The types of the hypothalamic-pituitary-thyroid system response to the L-thyroxine administration in experimental hypothyroidism were identified. A relationship was determined between AF paroxysms and threshold values of thyroid hormones at low concentrations of FT3, FT3 and FT4, and a high concentration of FT4 with normal TSH values. It was shown that achieving the euthyroid status did not reduce the incidence of AF paroxysms by more than 70.0%.

Conclusion: In AF with low FT3, low FT3 and FT4, and high FT4, the dose of L-thyroxine must be adjusted.

Objective: To explore the role and mechanism of metformin (MET) in regulating myocardial injury caused by cardiac ischemia-reperfusion.

Material and methods: A rat model of myocardial ischemia-reperfusion injury was established by ligation of the anterior descending branch of the left coronary artery. The myocardial area at risk and the infarction size were measured by Evans blue and 2,3,5‑triphenyltetrazole chloride (TTC) staining, respectively. Terminal Deoxynucleotidyl Transferase-Mediated dUTP Nick End Labeling (TUNEL) staining was used to detect apoptosis of cardiomyocytes. The expression of 4‑hydroxynonenal (4‑HNE) was detected by immunohistochemical staining. Real-time quantitative polymerase chain reaction (RT-PCR) and Western blot were used to detect mRNA and expression of the Adenosine 5'-monophosphate-activated protein kinase (AMPK) - 3‑hydroxy-3‑methylglutaryl-CoA reductase (HMGCR) signaling pathway, respectively.

Results: MET treatment decreased the infarct size and the activity of the myocardial enzyme profile, thus demonstrating protection of ischemic myocardium. The number of TUNEL positive cells significantly decreased. Immunohistochemical results showed that MET decreased the expression of 4‑HNE in myocardial tissue and the content of malondialdehyde (MDA) in myocardial cells. Further experimental results showed that MET decreased HMGCR transcription and protein expression, and increased AMPK phosphorylation. In the model of hypoxia and reoxygenation injury of cardiomyocytes, MET increased the viability of cardiomyocytes, decreased the activity of lactic dehydrogenase (LDH), decreased malondialdehyde content and intracellular reactive oxygen species (ROS) concentrations, and regulate the AMPK-HMGCR signaling pathway through coenzyme C (ComC).

Conclusion: MET inhibits the expression of HMGCR by activating AMPK, reduces oxidative damage and apoptosis of cardiomyocytes, and alleviates myocardial ischemia-reperfusion injury.

With the advent of new diagnostic and therapeutic methods, the management of pericarditis has not become an easier task. The well-studied, but currently rare tuberculosis, bacterial and malignant forms have been joined by pericarditis associated with infection or vaccination against SARS-CoV-2. While 2-3 years ago, cardiologists had to recall the schedule of managing acute viral pericarditis, today its complications are often encountered, including chronic, recurrent, effusive or constrictive pericarditis. The European guidelines were updated 10 years ago and are expected to be issued within the next year. We posed the most pressing questions on the management of pericarditis to the coordinator of the 2015 European Society of Cardiology (ESC) guidelines [1], who will also chair the 2025 ESC guidelines on myocarditis and pericarditis, one of the most cited scientists in the field of inflammatory diseases of the pericardium, Massimo Imazio. He is a Professor in the Department of Cardiology and Anatomy at the University of Turin, runs a school on pericarditis, and has initiated fundamental research of this pathology. We presented his answers with comments of the co-author in the form of a short interview.