Kardiologiya最新文献

Background    Cardioembolism in stroke and transient ischemic attack (TIA) patients is highly influenced by atrial fibrillation (AF). The best timing, duration, location (outpatient or inpatient), and procedure for diagnosing paroxysmal atrial fibrillation (PAF) after stroke / TIA are unknown. We investigated the use of smart devices in the detection of PAF during the index event hospitalization.Material and methods    Stroke and TIA patients hospitalized in the neurology service were evaluated. Patients with AF detected on the ECG at emergency department admission and patients with known AF were excluded from the study. Smartphone-based apps were given to 342 other patients to utilize the mobile app on smart devices during follow-up. Three cardiologists reviewed all smart device rhythm electrographs and identified patients with AF. On the basis of concurrent 24-72 h Holter rhythm monitoring, the patients were separated into those who had PAF (n=85; group 1) and those who did not have PAF (n=245; group 2).Results    Left atrium size (LA), arterial hypertension, lowest and highest heart rate on the smart device and episodes of AF on the smart device differed between patients with and without PAFas noted on the 24-72 h Holter rhythm recordings. Detection of AF on the smart device was found to be an independent predictor of PAF as observed on the Holter rhythm recording (p=0.017). An AF episode identified on the smart device predicted the detection of PAF on the Holter 24-72 h rhythm recording with 58 % sensitivity and 87 % specificity. (AUC=0.723, 95 % CI=0.569-0.876, p=0.007)Conclusion    The detection of PAF following acute ischemic stroke or TIA may be significantly improved during hospitalization by continuously monitoring cardiac rhythm with smart devices.

The growing burden of chronic heart failure (CHF) and arterial hypertension (AH) requires improved secondary prevention with the consideration of recent advances in drug therapy. Since 2015, angiotensin II receptor antagonists in combination with other drugs (valsartan + sacubitril) have been recommended for patients with CHF and reduced left ventricular ejection fraction (LVEF) due to the positive effect of these drugs on prognosis. Currently, the indications for the use of valsartan + sacubitril have been expanded to include not only essential AH but also CHF with any LVEF in order to improve survival and reduce the frequency of hospitalizations. This article discusses current advances in the combination therapy in multimorbid patients with CHF and AH to achieve target blood pressure and reduce the risk of cardiovascular complications when using these drugs, their advantages, efficacy, tolerability, and safety profile.

Objective        This study aimed to investigate the role of the triglyceride to high-density lipoprotein cholesterol (TG / HDL-C) ratio for the prediction of major adverse cardiovascular events (MACEs) in non-diabetic individuals.Material and methods    In total 88946 non-diabetic individuals were enrolled in the study. These individuals were divided into four groups according to the TG / HDL-C ratios. The clinical endpoints were composite MACEs and their subtypes, myocardial infarction and stroke. Cox proportional hazards regression models and restricted cubic spline (RCS) analysis were conducted to explore the relationship between the TG / HDL-C ratio and MACEs.Results    Multivariable Cox proportional hazards analyses showed that a higher TG / HDL-C ratio was associated with an elevated risk of MACEs. Kaplan-Meier survival curve showed that participants in higher quartiles of TG / HDL-C ratio had a higher cumulative incidence of composite MACEs (p<0.0001). In addition, RCS analysis indicated that the TG / HDL-C ratio and composite MACEs followed a non-linear relationship (p<0.0001).Conclusions    The TG / HDL-C ratio can serve as a prognostic marker of MACEs in non-diabetic individuals.

Aim        To study morphological features of lung tissue and pulmonary vessels in patients with pulmonary hypertension (PH) associated with acquired mitral valve (MV) defects, with indications for surgical treatment.Material and methods          This cross-sectional study included 105 patients with acquired MV defect of non-infectious origin (median age 60.0 [51.0; 66.0] years, 55.24% men) who underwent corrective surgery under cardiopulmonary bypass between 2024 through March 2025. PH was verified by right heart catheterization before defect correction. In 26 patients with MV defect and PH and 12 patients without PH, intraoperative lung tissue puncture biopsy samples were collected to assess changes in the lung parenchyma and microvasculature.Results    In patients with MV defect and PH, the condition of arterioles was characterized by a larger area of intimal hyperplasia and predominantly the presence of thrombosis (34.6%). In patients with MV defect without PH, partial thrombosis of arterioles was more often found (41.66%), and plethoric arterioles were observed in 41.66%. During morphometry of pulmonary vessels, it was noted that the a calculated systolic pressure in the pulmonary artery of >38 mm Hg according to preoperative echocardiography (EchoCG) had a moderate inverse correlation with the area of the vascular wall (Kendall's rank correlation coefficient tau (τ) = -0.34; p=0.01) and a moderate direct association with the greatest thickness at the site of arteriolar intimal hyperplasia (τ = 0.39; p = 0.04). A moderate inverse correlation was found between the systolic excursion of the tricuspid valve annulus (1.7 cm or more) and the greatest thickness at the site of arteriolar intimal hyperplasia (τ= -0.47; p=0.04). MV stenosis was associated with the presence of thrombosed capillaries (odds ratio (OR) 8.75; 95% confidence interval (CI) 1.1-69.5; p=0.029) and focal interstitial fibrosis (OR 10.66; 95% CI 0.89-126.78; p=0.046). The presence of mitral stenosis had a moderate correlation with perivascular fibrosis (τ=0.41; p=0.005). A body mass index of >25 kg/m2 was associated with reduced odds of arteriolar media thickening (OR 0.15; 95% CI 0.02-1.01; p=0.03).Conclusion            The severity of PH and right ventricular dysfunction, as determined by EchoCG before MV defect correction, may reflect morphometric changes in the pulmonary vessels. The nature of MV lesion, based on its stenosis type, is associated with a more than 8-fold increase in the odds of thrombosed capillaries and a 10-fold increase in the odds of focal interstitial fibrosis. Being overweight or obese was associated with an 85% reduction in the odds of arteriolar media thickening, as determined by pulmonary vascular morphometry.

Aim    To study the pharmacokinetics and safety and to prove the bioequivalence of Akrivario* (valsartan + sacubitril) film-coated tablets, at two dosages, 200 mg and 100 mg, compared to Uperio** (valsartan + sacubitril) film-coated tablets, at similar dosages, 200 mg and 100 mg (Studies 1 and 2, respectively), after oral administration to fasted healthy volunteers.Material and methods    Two four-period, crossover-design bioequivalence studies were conducted. In each study, fasted healthy volunteers (Study 1: n=60; Study 2: n=59) received a single dose of the drugs. The interval between drug administrations was 7 days. Analyte concentrations in blood samples were measured by validated high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS). Pharmacokinetic parameters were determined for both valsartan and sacubitril in both studies.Results    The 90% confidence intervals for the Ln-transformed ratios of all assessed pharmacokinetic parameters (Cmax and AUC0-t for valsartan and sacubitril) were in the range of 80-125%. Both study drugs were well tolerated; all adverse events (AEs) were mild and did not require additional therapy. No clinically significant AEs were observed during the study.Conclusion: The study demonstrated bioequivalence of Akrivario (valsartan + sacubitril) to the reference drug Uperio (valsartan + sacubitril).

The purpose of this document is to provide updated, evidence-based recommendations for the prevention of cardiovascular toxicity associated with anticancer therapy (anthracyclines, HER2-targeted therapy, tyrosine kinase inhibitors, anti-VEGF agents, fluoropyrimidines, and immune checkpoint inhibitors). The consensus covers risk stratification, screening and monitoring (biomarkers and imaging), pharmacological and non-pharmacological cardioprotection, and patient management algorithms for the detection of subclinical and clinically significant damage to the cardiovascular system. The recommendations are structured by recommendation classes (I, IIa, IIb, III) and levels of evidence (A, B, C), and are adapted for Russian and Eurasian clinical practice.

Aim    To determine factors associated with an increased risk of thrombotic complications during antiplatelet therapy in patients with acute myocardial infarction (AMI) based on a study of the parameters of hemostasis functional activity, as well as the proteomic composition of blood plasma and platelets.Material and methods    A single-center prospective clinical study assessed hemostasis parameters and quantified the plasma and platelet proteome before and after dual antiplatelet therapy (DAPT) in 98 AMI patients. Clinical data on thrombotic complications that occurred during the follow-up period were collected for 12 months after the inclusion into the study. A statistical analysis of the collected data was performed, and the proteins were identified whose concentrations were associated with an increased risk of late thrombotic complications.Results    The comparative analysis of patient groups with and without thrombotic complications revealed statistically significant differences in the concentrations of several proteins. The univariate regression analysis identified proteins associated with an increased risk of thrombotic complications in the long term. Statistically significant factors with a 95% confidence interval different from 0 were the concentrations of platelet proteins, including von Willebrand factor, complement component C8 β-chain, and cation-independent mannose-6 phosphate receptor.Conclusion    The study identified proteins whose concentrations were associated with an increased risk of thrombotic complications in AMI patients taking DAPT. Before implementing these findings in clinical practice, a randomized prospective study should be performed for validation of the study results.

Background Cardiac arrest is a severe medical emergency with poor prognosis. This study aimed to analyze the clinical characteristics of cardiac arrest patients and explore the key factors influencing their outcomes. Additionally, we applied machine learning methods to evaluate the performance of different models in predicting return of spontaneous circulation (ROSC), with the goal of optimizing strategies for managing cardiac arrest.Material and methods We comprehensively assessed the demographic characteristics, physiological parameters, and laboratory results of 748 cardiac arrest patients, and compared the differences between the ROSC and non-ROSC groups. We applied LASSO regression analysis to identify the key variables predictive of ROSC. Furthermore, we evaluated the performance of various machine learning models, including GBDT and LGBM, in ROSC prediction, including calibration, decision curve analysis, and ROC curves.Results Patients in the ROSC group were younger and predominately male. They had more normal blood pressure, temperature, and oxygen saturation, as well as less severe organ dysfunction, LASSO regression analysis identified age, WBC, and lactate as key predictors of ROSC. Among the machine learning models, GBDT and LGBM exhibited the best performance, with superior alibration, decision curve analysis, and ROC curves compared.Conclusions This study identified key clinical factors influencing the prognosis of cardiac arrest patients, and it identified machine learning models that were superior for predicting ROSC.

Chronic heart failure with preserved ejection fraction (CHFpEF) is a common syndrome that leads to adverse outcomes. The syndrome is quite heterogeneous and, according to multiple clinical, genetic, molecular, proteomic, and other studies, varies significantly depending on the predominant pathophysiological mechanism. Currently, modern research methods, such as those for studying proteome, genome, and epicardial regulation, allow a more precise identification of phenotypes. This review focuses on existing concepts on phenotypes in CHFpEF, specifically, aseptic inflammation, myocardial fibrosis, dysmetabolism, and others. Data were searched using the PubMed search by keywords in the 2010-2025 time range using the following tags: HFpEF, phenotypes, proteome, metabolome, inflammation, fibrosis. Currently, a limited number of drugs is available for the treatment of CHFpEF. Potentially, identifying phenotypes in each individual patient will facilitate personalized therapy, such as anti-inflammatory therapy for those with a predominantly inflammatory component, antifibrotic therapy for those with a fibrotic phenotype, etc.

Aim        To study the immediate outcome of an interventional method for the treatment of mitral regurgitation (MR) using the MitraClip system (Abbott Vascular) in the context of the etiological factor.Material and methods         This was a prospective, single-center study. A total of 89 patients treated in 2023-2024 were included in the analysis. Most patients belonged to an older age group (67.6 ± 9.3 years) where males predominated (57.3%). Echocardiography (EchoCG) was performed on a Philips EPIQ CVx ultrasound system using X5-1 and X8 t transducers. The severity of MR was assessed by multiparametric EchoCG. Quantitative measurements were performed in accordance with current Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE and EACVI, 2015).Results    In 19.1% of cases, the cause of MR was mitral valve leaflet chordae prolapse or rupture (primary mitral regurgitation (PMR) group, group 1). In 80.9% of cases, MR was secondary: in 29.2%, MR was atrial functional mitral regurgitation (a-FMR, group 2) and in 51.7%, MR was ventricular FMR (v-FMR, group 3). Comparative analysis of EchoCG data showed that with a comparable MR degree, the left ventricular systolic function was significantly lower in the v-FMR group than in the PMR group, and was also inferior to that in the a-FMR group (42.7±10.2% vs. 53.5±8.5 and 49.2±10.7%, respectively; p1-3<0.001, p2-3=0.029). The effectiveness of the procedure evident in a reduction of the MR degree was achieved in 93.2% of patients (grade <1 in 64% of them). The maximum reduction in MR to grade I and less was noted in the v-FMR group (71.7%); this proportion was higher compared to other groups (a-FMR, 57.7%; PMR, 52.9%). All groups had improvements in symptoms and in the NYHA chronic heart failure (CHF) functional class (FC). The v-FMR group achieved a more pronounced symptomatic improvement and a reduction in FC (95.7% of patients with FC II).Conclusion            Transcatheter edge-to-edge mitral valve reconstructive procedures using the MitraClip system achieved significant immediate reductions in MR, regardless of its etiology. Long-term follow-up is essential to assess the result sustainability.