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Clinical, Anamnestic, and Demographic Characteristics of Patients with Myocardial Infarction in Russian Federation According to the Russian Registry of Acute Myocardial Infarction - REGION-IM. 根据俄罗斯急性心肌梗死登记处 - REGION-IM 统计的俄罗斯联邦心肌梗死患者的临床、病理和人口特征。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2625
S A Boytsov, R M Shakhnovich, S N Tereschenko, A D Erlikh, D V Pevsner, Yu K Rytova, R G Gulyan, I A Markov, L V Shchepinova, M A Fomina, A S Kletkina, T V Grigoreva, V I Dagaeva, L S Devyatova, L Yu Chesnokova, E S Semenova, Ya A Kamenetz

Aim: Based on data from the Russian REGION-MI registry, to characterize patients with myocardial infarction (MI) hospitalized in Russian hospitals, describe their historical, demographic, and clinical characteristics, and compare the results with the data of previous Russian and international registries of acute coronary syndrome.

Material and methods: REGION-MI is a multicenter prospective observational study. The follow-up period was divided into three stages: during the hospital stay, at 6 and 12 months after the inclusion in the registry. Demographic and historic data and information about the present case of MI were entered into the patient's individual record card.

Results: The median age of all patients was 63 years; 68% of patients were men. The mean age of women was older than that of men. Among all MI cases, 70% were ST-segment elevation myocardial infarction (STEMI). Patients with non-ST-segment elevation myocardial infarction (NSTEMI) were older and had more comorbidities than patients with STEMI. The median time from the first symptoms to ECG recording was two hours, and from the first symptoms to CAG 7 hours. CAG was performed in 91% of patients with STEMI and 84% of patients with NSTEMI. Stenting was performed in 69% of patients. Although many patients had a complicated cardiovascular history, at the time of admission only 31.5% of patients were taking at least one drug from the groups of antiplatelets, oral anticoagulants, statins, and beta-blockers.

Conclusion: Patients with MI in the Russian Federation are younger than patients with MI in European countries. Among the clinical and historical characteristics, conspicuous is the presence of modifiable risk factors in many patients, as well as the presence of a previous diagnosis of ischemic heart disease. Furthermore, a small proportion of patients took statins, antiplatelet agents or anticoagulants at the outpatient stage, which indicates a great reserve of both primary and secondary prevention of cardiovascular diseases in the Russian Federation. The delayed seeking medical help is also noticeable, which indicates the need for increasing the public awareness of the symptoms of MI and the importance of timely hospitalization.

目的:根据俄罗斯REGION-MI登记处的数据,描述在俄罗斯医院住院的心肌梗死(MI)患者的特征,描述他们的历史、人口统计学和临床特征,并将结果与之前俄罗斯和国际急性冠状动脉综合征登记处的数据进行比较:REGION-MI 是一项多中心前瞻性观察研究。随访期分为三个阶段:住院期间、纳入登记册后的 6 个月和 12 个月。人口统计学数据、历史数据和本次心肌梗死病例的相关信息都被输入了患者的个人记录卡:所有患者的中位年龄为 63 岁,68% 的患者为男性。女性的平均年龄大于男性。在所有心肌梗死病例中,70%为ST段抬高型心肌梗死(STEMI)。与 STEMI 患者相比,非 ST 段抬高型心肌梗死(NSTEMI)患者年龄更大,合并症更多。从首发症状到心电图记录的中位时间为两小时,从首发症状到CAG的中位时间为7小时。91%的STEMI患者和84%的NSTEMI患者接受了CAG治疗。69%的患者接受了支架植入术。虽然许多患者有复杂的心血管病史,但入院时只有31.5%的患者至少服用了一种抗血小板药物、口服抗凝剂、他汀类药物和β-受体阻滞剂:结论:俄罗斯联邦的心肌梗死患者比欧洲国家的心肌梗死患者更年轻。在临床和病史特征方面,许多患者存在可改变的风险因素,以及曾被诊断为缺血性心脏病。此外,一小部分患者在门诊阶段服用了他汀类药物、抗血小板药物或抗凝剂,这表明俄罗斯联邦在心血管疾病的一级和二级预防方面都有很大的储备。延迟就医的现象也很明显,这表明有必要提高公众对心肌梗死症状的认识以及及时住院治疗的重要性。
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引用次数: 0
[Features of the Course of Arterial Hypertension in the Era of the COVID-19 Pandemic: Common Pathogenetic Links Between Hypertension and SARS-CoV-2]. [COVID-19大流行时期动脉高血压的病程特点:高血压与 SARS-CoV-2 之间的共同病原学联系]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2525
S A Berns, M S Leontyeva, E V Tavlueva, V S Bashnyak, O M Drapkina

The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.

本综述旨在介绍严重急性呼吸系统综合征相关冠状病毒-2(SARS-CoV-2)的感染机制及其对动脉高血压病程可能产生的影响。另一个目的是评估肾素-血管紧张素-醛固酮系统与 SARS-CoV-2 病毒感染致病阶段的关系。
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引用次数: 0
Hemodynamic Changes in Intrarenal Blood Flow are Associated With Poor Prognosis in Patients With Acute Decompensated Heart Failure. 肾内血流的血流动力学变化与急性失代偿性心力衰竭患者的不良预后有关。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-04-30 DOI: 10.18087/cardio.2024.4.n2575
S A Sovetova, T A Nikiforova, K V Charaya, D Yu Shchekochikhin, V M Kulikov, A M Dubovitsky, S A Suchkova, A A Bogdanova, N A Ananicheva, D A Andreev

Aim: To evaluate a potential role of different patterns of intrarenal blood flow using Doppler ultrasound as a part of determining the severity of venous congestion, predicting impairment of renal function and an unfavorable prognosis in patients with acute decompensated chronic heart failure (ADCHF).

Material and methods: This prospective observational single-site study included 75 patients admitted in the intensive care unit for ADCHF. Upon admission all patients underwent bedside renal venous Doppler ultrasound to determine the blood flow pattern (continuous, biphasic, monophasic). In one hour after the initiation of intravenous diuretic therapy, sodium concentration was measured in a urine sample. The primary endpoint was the development of acute kidney injury (AKI). The secondary endpoints were the development of diuretic resistance (a need to increase the furosemide daily dose by more than 2 times compared with the baseline), decreased natriuretic response (defined as urine sodium concentration less than 50-70 mmol/l), and in-hospital death.

Results: According to the data of Doppler ultrasound, normal renal blood flow was observed in 40 (53%) patients, biphasic in 21 (28%) patients, and monophasic in 14 (19%) patients. The monophasic pattern of intrarenal blood flow was associated with the highest incidence of AKI: among 14 patients in this group, AKI developed in 100% of cases (OR 3.8, 95% CI: 2.5-5.8, p<0.01), while among patients with normal and moderate impairment of renal blood flow, there was no significant increase in the risk of developing AKI. The odds of in-hospital death were increased 25.77 times in patients with monophasic renal blood flow (95% CI: 5.35-123.99, p<0.001). Patients with a monophasic intrarenal blood flow pattern were also more likely to develop diuretic resistance compared to patients with other blood flow patterns (p<0.001) and had a decreased sodium concentration to less than 50 mmol/l (p<0.001) in a spot urine test obtained one hour after the initiation of furosemide administration.

Conclusion: Patients with monophasic intrarenal blood flow are at a higher risk of developing AKI, diuretic resistance with decreased natriuretic response, and in-hospital death.

目的:评估使用多普勒超声检查肾内血流的不同模式在确定静脉充血严重程度、预测急性失代偿性慢性心力衰竭(ADCHF)患者肾功能损害和不利预后方面的潜在作用:这项前瞻性单点观察研究纳入了 75 名因慢性心力衰竭急性失代偿期而入住重症监护室的患者。所有患者入院时均接受了床旁肾静脉多普勒超声检查,以确定血流模式(连续、双相、单相)。在开始静脉利尿治疗一小时后,测量尿样中的钠浓度。主要终点是急性肾损伤(AKI)的发生。次要终点是出现利尿剂抵抗(需要将呋塞米的日剂量增加到基线的 2 倍以上)、利钠反应减弱(定义为尿钠浓度低于 50-70 毫摩尔/升)和院内死亡:多普勒超声数据显示,40 例(53%)患者的肾血流量正常,21 例(28%)患者的肾血流量呈双相型,14 例(19%)患者的肾血流量呈单相型。肾内血流的单相模式与最高的 AKI 发生率相关:在这一组的 14 名患者中,100% 的病例发生了 AKI(OR 3.8,95% CI:2.5-5.8,p<0.01),而在肾血流正常和中度受损的患者中,发生 AKI 的风险没有显著增加。单相肾血流患者的院内死亡几率增加了 25.77 倍(95% CI:5.35-123.99,p<0.001)。与其他血流模式的患者相比,单相肾内血流模式的患者也更容易出现利尿药抵抗(p<0.001),并且在开始服用呋塞米一小时后进行的尿液定点检测中,钠浓度降至 50 毫摩尔/升以下(p<0.001):结论:单相肾内血流的患者发生 AKI、利尿抵抗和钠尿肽反应降低以及院内死亡的风险较高。
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引用次数: 0
Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region. 萨马拉地区慢性心力衰竭终末期形式的简短登记。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2323
O A Rubanenko, I V Skripnik, K V Matuchina, A O Rubanenko, I L Davydkin, A S Benyan, D V Duplyakov

Aim: To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.

Material and methods: A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.

Results: 591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction <40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.

Conclusion: Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.

目的:研究符合姑息治疗计划标准的功能分级(FC)III-IV级慢性心力衰竭(CHF)患者的临床特征和预后:萨马拉地区的 60 家门诊和住院诊所对重症慢性心力衰竭患者进行了为期一个月(2022 年 5 月 16 日至 2022 年 6 月 15 日)的短期登记。登记对象包括在此期间就医的 FC III-IV 型慢性心力衰竭患者。使用死亡率信息和分析系统对纳入登记册后 90 天的死亡结果进行评估:共登记了 591 名患者(中位年龄为 71.0 [64.0; 80.0]岁),包括 339 名男性(57.4%),其中 149 名(24.1%)处于工作年龄(65 岁以下)。导致慢性心力衰竭的主要原因是缺血性心脏病(64.5%)。229名(38.7%)患者的左心室射血分数为40%。在过去一年中,513 名(86.8%)患者至少有一次因慢性心力衰竭失代偿而住院治疗。45.7%的患者有胸水,11.3%的患者有腹水。超过 25% 的患者收缩压偏低;14.2% 的患者需要院内肌力支持;9.1% 的患者在门诊接受肌力支持。4.2%的患者在门诊接受氧气支持,0.8%的患者需要使用麻醉镇痛药。12(1.9%)名患者正在等待心脏移植。在这项研究中,室性心动过速和/或左束支传导阻滞(LBBB)患者中植入心脏再同步治疗设备(CRTD)或植入式心脏除颤器(ICD)的人数不一致,共有19名患者(11名患者植入CRTD,8名患者植入ICD),而58名(9.8%)患者有植入CRTD/ICD的适应症。在纳入登记册后的 90 天内,59 名患者(10.0%)死亡。根据二元逻辑回归分析,存在LBBB、胸腔积水、需要门诊氧支持和心脏手术史的患者死亡风险较高:重症慢性心力衰竭患者不仅需要适当的药物治疗,还需要动态的临床观察,辅以旨在改善生活质量的姑息治疗,包括共同决策和预先护理计划的伦理原则,以确定患者在护理方面的优先事项和目标。
{"title":"Short Registry of Terminal Forms of Chronic Heart Failure in the Samara Region.","authors":"O A Rubanenko, I V Skripnik, K V Matuchina, A O Rubanenko, I L Davydkin, A S Benyan, D V Duplyakov","doi":"10.18087/cardio.2024.3.n2323","DOIUrl":"https://doi.org/10.18087/cardio.2024.3.n2323","url":null,"abstract":"<p><strong>Aim: </strong>To study the clinical characteristics and prognosis of patients with functional class (FC) III-IV chronic heart failure (CHF) who meet the criteria for inclusion in the palliative care program.</p><p><strong>Material and methods: </strong>A short registry of severe CHF forms was conducted at 60 outpatient and inpatient clinics in the Samara region for one month (16.05.2022-15.06.2022). The registry included patients with FC III-IV CHF who sought medical help during that period. Lethal outcomes were assessed at 90 days after the inclusion in the registry using the Mortality Information and Analytics system.</p><p><strong>Results: </strong>591 patients (median age, 71.0 [64.0; 80.0] years were enrolled, including 339 (57.4%) men, of which 149 (24.1%) were of working age (under 65 years). The main cause of CHF was ischemic heart disease (64.5%). 229 (38.7%) patients had left ventricular ejection fraction &lt;40%. During the past year, 513 (86.8%) patients had at least one hospitalization for decompensated CHF. 45.7% of patients had hydrothorax, and 11.3% of patients had ascites. Low systolic blood pressure was observed in more than 25% of patients; 14.2% required in-hospital inotropic support; and 9.1% received it on the outpatient basis. 4.2% of patients received outpatient oxygen support and 0.8% required the administration of narcotic analgesics. 12 (1.9%) patients were on the waiting list for heart transplantation. In this study, there was an inconsistency in the number of patients with ventricular tachycardia and/or left bundle branch block (LBBB) who were implanted with cardiac resynchronization therapy devices (CRTD) or an implantable cardioverter defibrillator (ICD), a total of 19 patients (11 patients with CRTD and 8 patients with ICD), while 58 (9.8%) patients had indications for CRTD/ICD implantation. Within 90 days from inclusion in the registry, 59 (10.0%) patients died. According to binary logistic regression analysis, the presence of LBBB, hydrothorax, the requirement for outpatient oxygen support, and a history of cardiac surgery were associated with a high risk of death.</p><p><strong>Conclusion: </strong>Patients with severe forms of CHF require not only adequate drug therapy, but also dynamic clinical observation supplemented with palliative care aimed at improving the quality of life, including the ethical principles of shared decision-making and advance care planning to identify the priorities and goals of patients in relation to their care.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140860298","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
[Stress-Echocardiography in Low-risk Acute Coronary Syndrome Without Persistent ST-segment Elevation Diagnostic Algorithm]. [无持续 ST 段抬高的低危急性冠状动脉综合征的负荷超声心动图诊断算法]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2430
E E Abramenko, T R Ryabova, V V Ryabov, A A Boshchenko, R S Karpov

This review addresses the capabilities of stress EchoCG as a simple, non-invasive, non-radiation method for diagnosing occult disorders of coronary blood flow in patients with non-ST-elevation acute coronary syndrome on a low-risk electrocardiogram. The capabilities of the enhanced stress EchoCG protocol are based on supplementing the standard detection of transient disturbances of local contractility, generally associated with coronary artery obstruction, with an assessment of the heart rate reserve, coronary reserve and other parameters. This approach is considered promising for a more complete characterization of heart function during exercise and an accurate prognosis of the clinical case, which allows determining the tactics for patient management not limited to selection for myocardial revascularization.

本综述探讨了应激 EchoCG 作为一种简单、无创、无辐射的方法,在低风险心电图上诊断非 ST 段抬高急性冠状动脉综合征患者冠状动脉血流隐性紊乱的功能。增强型应激 EchoCG 方案的功能基于对心率储备、冠状动脉储备和其他参数的评估,对通常与冠状动脉阻塞有关的局部收缩力短暂紊乱的标准检测进行补充。这种方法有望更全面地描述运动时的心脏功能,并对临床病例进行准确预后,从而确定患者管理策略,而不仅限于选择心肌血管重建。
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引用次数: 0
An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension. 运动时左心房容积的增加与动脉高血压患者舒张压测试的阳性结果有关。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2643
E S Mazur, V V Mazur, N D Bazhenov, O V Nilova, T O Nikolaeva, D V Alekseev

Aim: To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH).

Material and methods: The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15.

Results: A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV >1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%.

Conclusion: In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion >15 in 94.5% of cases.

目的:研究动脉高血压(AH)患者运动时左心房容积(LAV)的变化与舒张压力试验(DST)结果之间的关系:研究对象包括219名无缺血性心脏病和心房颤动的动脉高血压患者。在运动前后进行的 DST 期间,测定了二尖瓣口血流速度与二尖瓣瓣环速度之比(E/e')、左心房贮血期整体纵向应变(贮血应变)和 LAV。DST 阳性的标准是 E/e' 增加≥15:90例(41.1%)患者的DST结果为阳性。DST 阳性的患者年龄较大(65.0 岁和 59.0 岁);其中男性较少(24.4% 和 41.1%),但肥胖(66.7% 和 40.3%)和糖尿病(36.7% 和 8.5%)患者较多。静息时,DST 阳性患者的 E/e' 比值(11.5 和 8.8)、肺动脉收缩压(29.0 和 27.0 毫米汞柱)和 LAV(60.0 和 52.0 毫升)较高,但左心房储压应变(20.0 和 24.0%)较低。DST 阳性和阴性患者在运动时,E/e'分别增加了 5.46 和 0.47 个单位。这两组患者运动时 LAV 和储腔应变的变化方向不同。在 DST 阳性的患者中,左心房储压应变降低了 1.0 个百分点(pp),而在 DST 阴性的患者中,左心房储压应变增加了 8.0 个百分点。在运动过程中,DST 阳性患者的左心房储血量增加了 10.0 毫升,而替代组患者的左心房储血量减少了 8.5 毫升。作为 DST 阳性指标的 LAV 变化的 AUC 为 0.987,而静息左心房储库应变的 AUC 为 0.938。以 LAV 增加 1 毫升作为 DST 阳性指标的敏感性为 96.9%,特异性为 95.1%:在AH患者中,左心室充盈压的变化与LAV的单向变化有关。运动时左心室充盈压增加超过 1 毫升可作为 DST 阳性结果的标准。在 94.5% 的病例中,这一评估结果与根据 E/e' 标准 >15 评估的 DST 结果一致。
{"title":"An Increase in the Left Atrium Volume During Exercise is Associated With a Positive Result of a Diastolic Stress Test in Patients With Arterial Hypertension.","authors":"E S Mazur, V V Mazur, N D Bazhenov, O V Nilova, T O Nikolaeva, D V Alekseev","doi":"10.18087/cardio.2024.3.n2643","DOIUrl":"https://doi.org/10.18087/cardio.2024.3.n2643","url":null,"abstract":"<p><strong>Aim: </strong>To study the relationship between changes in left atrial volume (LAV) during exercise and the result of a diastolic stress test (DST) in patients with arterial hypertension (AH).</p><p><strong>Material and methods: </strong>The study included 219 patients with AH without ischemic heart disease and atrial fibrillation. During the DST performed before and after exercise, the ratio of transmitral flow velocity to mitral annular velocity (E/e'), the left atrial global longitudinal strain in the reservoir phase (reservoir strain), and LAV were determined. The criterion for a positive DST was an increase in E/e' ≥15.</p><p><strong>Results: </strong>A positive result of DST was observed in 90 (41.1%) patients. Patients with positive DST were older (65.0 and 59.0 years); among them, there were fewer men (24.4 and 41.1%), but more patients with obesity (66.7 and 40.3%) and diabetes mellitus (36.7 and 8.5%). At rest, patients with positive DST had higher E/e' ratio (11.5 and 8.8), pulmonary artery systolic pressure (29.0 and 27.0 mm Hg), and LAV (60.0 and 52.0 ml), but a lower left atrial reservoir strain (20.0 and 24.0%). During exercise in patients with positive and negative DST, E/e' increased by 5.46 and 0.47 units, respectively. Changes in the LAV and reservoir strain during exercise in these groups were directed differently. In patients with positive DST, the left atrial reservoir strain decreased by 1.0 percentage points (pp) whereas in patients with negative DST, it increased by 8.0 pp. During exercise, the LAV increased by 10.0 ml in patients with a positive DST, whereas in the alternative group, the LAV decreased by 8.5 ml. The AUC for changes in LAV as an indicator of a positive DST was 0.987 while the AUC for the resting left atrial reservoir strain was 0.938. An increase in LAV &gt;1 ml, as an indicator of a positive DST has a sensitivity of 96.9% and a specificity of 95.1%.</p><p><strong>Conclusion: </strong>In AH patients, changes in left ventricular filling pressure are associated with a unidirectional change in LAV. An increase in LAV during exercise by more than 1 ml can serve as a criterion for a positive DST result. This assessment was consistent with the assessment of the DST result by the E/e' criterion &gt;15 in 94.5% of cases.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140854461","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
Determining The Risk of Atrial Fibrillation Paroxysm in Patients With Chronic Heart Failure With Intact and Reduced Ejection Fraction. 确定射血分数完整和降低的慢性心力衰竭患者心房颤动阵发性发作的风险。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2466
I P Zakharov, P Sh Chomakhidze, F Yu Kopylov, E A Sultygova, D F Mesitskaya, E A Lyubimova, D A Andreev

Aim: To determine predictors for the development of atrial fibrillation (AF) in patients with chronic heart failure (CHF) with preserved and reduced ejection fraction by echocardiography (EchoCG) according to an extended protocol with determination of diastolic function and left atrial global strain.

Material and methods: Data of 168 patients with stage I-III CHF without a history of AF were analyzed. All patients underwent echocardiography according to an extended protocol with the determination of diastolic dysfunction (DD), left atrial ejection fraction (LA EF), and left atrial global strain (LA GS). Tissue Doppler imaging (TDI) was used to evaluate the early (E) and late (A) LV filling velocity and the early (E') and late (A') diastolic mitral annular velocity. In all patients, Holter ECG monitoring (HM ECG) of heart rhythm was performed for 3 days, and ECG monitoring with telemedicine technologies was performed for 7 days, 3 times a day for 3 minutes. The follow-up period was 3 months or until an AF episode.

Results: During the study, paroxysmal AF (pAF) was detected in 41 (24.4%) patients using various methods of heart rhythm monitoring. Complaints of palpitations were noted for 10 (24.4%) patients during pAF, which was recorded using a CardioQVARK® device, HM ECG or a 12-lead ECG. In 5 (12.2%) patients, daily ECG monitoring revealed pAF without associated complaints. HM ECG detected 8, 2, 4 (19.5%, 4.8%, and 9.7%) cases during 24, 48 and 72 hours, respectively; a single-channel CardioQVARK® detected 30 (73.2%) cases when used 3 times a day for 7 days. These results showed that AF frequently develops in CHF without accompanying symptoms. The method for detecting pAF with CardioQVARK® showed good results: it was twice more effective than HM ECG and three times more effective than 12-lead ECG. Also, according to ultrasound data, significant changes in the following parameters were noted in patients with AF: LA EF <36% (OR 1.04, 95% CI: 1.02-1.08), p=0.003; LA GS <9.9% (OR 1.16, 95% CI: 1.02-1.38), p<0.001; TDI E med <5.7 cm/s (OR 0.97, 95% CI: 0.94-1.00), p=0.026. Grade 2 DD did not show statistically significant results (OR 1.1, 95% CI: 0.7-1.5, p=0.54). However, it was detected more frequently in patients with AF, in 34% of cases, compared to 29% of cases in patients without AF, which requires further study on a larger patient sample.

Conclusion: Patients with CHF have a high risk of developing pAF (24.4%). 75% of patients with AF do not feel the development of paroxysm. All CHF patients should undergo EchoCG with assessment of LA EF, TDI E med and LA GS to identify a group at risk for the development of AF. Heart rhythm remote monitoring with CardioQVARK® devices can be considered a reliable method for early detection of pAF and timely initiation of anticoagulant therapy in patients with CHF.

目的:通过超声心动图(EchoCG)确定射血分数保留和降低的慢性心力衰竭(CHF)患者发生心房颤动(AF)的预测因素:分析了 168 例无房颤病史的 I-III 期 CHF 患者的数据。所有患者均按照扩展方案接受了超声心动图检查,以确定舒张功能障碍(DD)、左心房射血分数(LA EF)和左心房整体应变(LA GS)。组织多普勒成像(TDI)用于评估左心室早期(E)和晚期(A)充盈速度以及二尖瓣瓣环舒张早期(E')和晚期(A')速度。对所有患者进行了为期 3 天的心律 Holter ECG 监测(HM ECG),并利用远程医疗技术进行了为期 7 天的 ECG 监测,每天 3 次,每次 3 分钟。随访期为 3 个月或直至房颤发作:研究期间,使用各种心律监测方法检测到 41 名(24.4%)患者出现阵发性房颤(pAF)。有 10 名(24.4%)患者在阵发性房颤期间出现心悸症状,心悸症状是通过 CardioQVARK® 设备、HM 心电图或 12 导联心电图记录的。5名患者(12.2%)在日常心电图监测中发现心房颤动,但无相关主诉。在 24、48 和 72 小时内,HM ECG 分别检测到 8、2 和 4 个病例(19.5%、4.8% 和 9.7%);单通道 CardioQVARK® 在连续 7 天每天使用 3 次的情况下,检测到 30 个病例(73.2%)。这些结果表明,心房颤动经常发生在无伴随症状的慢性心力衰竭患者身上。使用 CardioQVARK® 检测心房颤动的方法显示出良好的效果:它比 HM 心电图有效两倍,比 12 导联心电图有效三倍。此外,根据超声数据,房颤患者的以下参数发生了显著变化:LA EF <36%(OR 1.04,95% CI:1.02-1.08),p=0.003;LA GS <9.9%(OR 1.16,95% CI:1.02-1.38),p<0.001;TDI E med <5.7cm/s(OR 0.97,95% CI:0.94-1.00),p=0.026。2 级 DD 的结果没有统计学意义(OR 1.1,95% CI:0.7-1.5,P=0.54)。然而,在心房颤动患者中,DD的检出率更高,占34%,而在非心房颤动患者中,DD的检出率仅为29%:结论:慢性心力衰竭患者罹患心房颤动的风险很高(24.4%)。75%的房颤患者感觉不到阵发性心房颤动的发生。所有慢性阻塞性肺病患者都应接受 EchoCG 检查,同时评估 LA EF、TDI E med 和 LA GS,以确定心房颤动的高危人群。使用 CardioQVARK® 设备进行心律远程监测是一种可靠的方法,可用于早期发现心房颤动,并及时为慢性阻塞性肺病患者启动抗凝治疗。
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引用次数: 0
Limitations of Diagnosis of Ischemic Left Ventricular Dysfunction Using the Values of Strain, Twist and Untwist in Patients With Myocardial Infarction of Various Localization. 使用应变值、扭转值和非扭转值诊断不同部位心肌梗死患者缺血性左心室功能障碍的局限性
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2253
D A Shvets, S V Povetkin

Aim: To compare capabilities for diagnosing regional and global myocardial dysfunction using the values of longitudinal and circular strain, left ventricular (LV) torsion and untwisting in patients with myocardial infarction (MI) of various locations.

Material and methods: Patients included in the study (n=121) were divided into three groups: patients with unstable angina (n=30), patients with anterior MI (n=45), and patients with inferior MI (n=46). Clinical, laboratory and instrumental test were performed, including echocardiography. For a quantitative analysis of LV contractility, the maximum systolic peaks of regional and global longitudinal and circular strain, systolic and diastolic rotation, LV torsion and untwisting were measured.

Results: Anterior MI was characterized by injury of the LV apical segments, while inferior MI was characterized by injury of the basal segments. In anterior MI, the longitudinal strain was reduced less than 14.5% and circular strain less than 19.3% in the apical segment of the LV anteroseptal wall (ASW). In akinesia of the LV ASW apical segment, longitudinal and circular strains were reduced less than 10%. The magnitude of the circular strain of the LV ASW apical segment (diagnostic threshold 19.3%, sensitivity (Se) 87%, specificity (Sp) 90%) was superior to that of the longitudinal strain as a diagnostic marker for regional ischemic dysfunction in anterior MI. The magnitude of the circular strain of the basal segment of the LV inferior wall in inferior MI has a greater diagnostic value for identifying regional systolic dysfunction than the value of the longitudinal strain of this LV segment. The diagnostic threshold was 17.3%, Se 79%, Sp 80%.

Conclusion: A decrease in the circular strain of the LV ASW less than 19.3% in the LV apical segment is more specific (Sp 90%) for diagnosing regional systolic dysfunction in anterior MI than a decrease in longitudinal strain. A circular strain value of less than 17.3% in the basal segment of the LV inferior wall is more specific (Sp 80%) than the longitudinal strain of this segment for diagnosing regional systolic dysfunction in inferior MI. Predominant injury to the LV apex in anterior MI can cause systolic and diastolic myocardial dysfunction, which is manifested by a decrease in LV circular deformation, torsion and untwisting.

目的:比较不同部位心肌梗死(MI)患者使用纵向和环向应变、左心室扭转和解旋值诊断区域和整体心肌功能障碍的能力:参与研究的患者(121 人)分为三组:不稳定型心绞痛患者(30 人)、前心肌梗死患者(45 人)和下心肌梗死患者(46 人)。他们接受了临床、实验室和仪器检查,包括超声心动图检查。为了对左心室收缩力进行定量分析,测量了区域和整体纵向和环向应变的最大收缩期峰值、收缩期和舒张期旋转、左心室扭转和解旋:结果:前心肌梗死的特征是左心室心尖段受损,而下心肌梗死的特征是基底段受损。在前壁心肌梗死中,左心室前隔壁(ASW)心尖段的纵向应变降低了不到14.5%,环向应变降低了不到19.3%。在左心室前隔壁心尖段出现运动障碍时,纵向应变和环向应变的降低幅度均小于 10%。作为前壁心肌梗死区域缺血性功能障碍的诊断指标,左心室ASW心尖段的环向应变(诊断阈值19.3%,敏感性(Se)87%,特异性(Sp)90%)优于纵向应变。在下壁心肌梗死中,左心室下壁基底段的环向应变比左心室该段的纵向应变在鉴别区域收缩功能障碍方面具有更大的诊断价值。诊断阈值分别为 17.3%、Se 79%、Sp 80%:结论:在诊断前壁心肌梗死的区域收缩功能障碍时,左心室心尖段ASW环形应变的下降小于19.3%比纵向应变的下降更具特异性(Sp 90%)。在诊断下壁心肌梗死时,左心室下壁基底段的环向应变值小于 17.3% 比该段的纵向应变更具特异性(Sp 80%)。在前壁心肌梗死中,左心室心尖的主要损伤可导致收缩和舒张性心肌功能障碍,表现为左心室环形变形、扭转和解旋的减少。
{"title":"Limitations of Diagnosis of Ischemic Left Ventricular Dysfunction Using the Values of Strain, Twist and Untwist in Patients With Myocardial Infarction of Various Localization.","authors":"D A Shvets, S V Povetkin","doi":"10.18087/cardio.2024.3.n2253","DOIUrl":"https://doi.org/10.18087/cardio.2024.3.n2253","url":null,"abstract":"<p><strong>Aim: </strong>To compare capabilities for diagnosing regional and global myocardial dysfunction using the values of longitudinal and circular strain, left ventricular (LV) torsion and untwisting in patients with myocardial infarction (MI) of various locations.</p><p><strong>Material and methods: </strong>Patients included in the study (n=121) were divided into three groups: patients with unstable angina (n=30), patients with anterior MI (n=45), and patients with inferior MI (n=46). Clinical, laboratory and instrumental test were performed, including echocardiography. For a quantitative analysis of LV contractility, the maximum systolic peaks of regional and global longitudinal and circular strain, systolic and diastolic rotation, LV torsion and untwisting were measured.</p><p><strong>Results: </strong>Anterior MI was characterized by injury of the LV apical segments, while inferior MI was characterized by injury of the basal segments. In anterior MI, the longitudinal strain was reduced less than 14.5% and circular strain less than 19.3% in the apical segment of the LV anteroseptal wall (ASW). In akinesia of the LV ASW apical segment, longitudinal and circular strains were reduced less than 10%. The magnitude of the circular strain of the LV ASW apical segment (diagnostic threshold 19.3%, sensitivity (Se) 87%, specificity (Sp) 90%) was superior to that of the longitudinal strain as a diagnostic marker for regional ischemic dysfunction in anterior MI. The magnitude of the circular strain of the basal segment of the LV inferior wall in inferior MI has a greater diagnostic value for identifying regional systolic dysfunction than the value of the longitudinal strain of this LV segment. The diagnostic threshold was 17.3%, Se 79%, Sp 80%.</p><p><strong>Conclusion: </strong>A decrease in the circular strain of the LV ASW less than 19.3% in the LV apical segment is more specific (Sp 90%) for diagnosing regional systolic dysfunction in anterior MI than a decrease in longitudinal strain. A circular strain value of less than 17.3% in the basal segment of the LV inferior wall is more specific (Sp 80%) than the longitudinal strain of this segment for diagnosing regional systolic dysfunction in inferior MI. Predominant injury to the LV apex in anterior MI can cause systolic and diastolic myocardial dysfunction, which is manifested by a decrease in LV circular deformation, torsion and untwisting.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140856717","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
Chronic Heart Failure in Patients Hospitalized in 2002 and 2021: Comparative Analysis of Prevalence, Clinical Course and Drug Therapy. 2002 年和 2021 年住院患者中的慢性心力衰竭:发病率、临床病程和药物治疗的对比分析。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2595
A A Garganeeva, O V Tukish, K N Vitt, Yu V Mareev, E A Kuzheleva, V V Ryabov, M Yu Kondratiev, E E Syromyatnikova, B B Dorzhieva, V Yu Mareev

Aim: Comparative analysis of the prevalence of chronic heart failure (CHF), clinical and medical history data, and drug therapy of patients admitted to a cardiology hospital in 2002 and 2021.

Material and methods: The study analyzed the medical records of patients with a confirmed diagnosis of CHF who were admitted in 2002 (n=210) and 2021 (n=381) to a specialized cardiology hospital.

Results: According to medical records of 2021, the proportion of patients with a confirmed diagnosis of CHF (87.6%) in the cohort of patients admitted to a cardiology hospital was twice as high as in 2002 (46.4%; p<0.001). The majority of patients with CHF in the study sample were patients with preserved left ventricular ejection fraction (HFpEF). The proportion of such patients significantly increased to reach 75.9% in 2021 compared to 58.6% in 2002 (p<0.001). At the same time, the number of severe forms of CHF (NYHA functional class (FC) IV) decreased by 10% and was 13.2% in 2002 and 1.3% in 2021 (p<0.001). In the majority of patients, ischemic heart disease (98.1 and 91.1% in 2002 and 2021, respectively, p<0.001) and hypertension (80.5 and 98.2%, respectively, p<0.001) were diagnosed as the cause for CHF. Furthermore, the incidence of comorbidity increased significantly: atrial fibrillation was detected in 12.3% of patients in 2002 and 26.4% in 2021 (p < 0.001); type 2 diabetes mellitus, in 14.3 and 32% of patients (p <0.001); and obesity, in 33.3 and 43.7% of patients, respectively (p=0.018). The frequency of using the major groups of drugs increased during the analyzed period: renin-angiotensin-aldosterone system blockers were administered to 71.9% of patients in 2002 and to 87.7% in 2021 (p<0.001); beta-blockers were administered to 53.3 and 82.4% of patients (p<0.001); and mineralocorticoid receptor antagonists, to 1.9 and 18.6% of patients, respectively (p=0.004).

Conclusion: In 2021, the proportion of patients with a confirmed diagnosis of CHF in the patient cohort admitted to a cardiology hospital was twice as high as in 2002; the phenotype with preserved left ventricular ejection fraction predominated in the CHF structure. During the analyzed twenty-year period, the prevalence of comorbidities increased among CHF patients. The prescription frequency of pathogenetic evidence-based therapy has significantly increased by 2021, however, it remains insufficient even in patients with CHF with reduced left ventricular ejection fraction.

目的:比较分析一家心脏病专科医院2002年和2021年收治的慢性心力衰竭(CHF)患者的患病率、临床和病史资料以及药物治疗情况:研究分析了一家心脏病专科医院 2002 年(210 人)和 2021 年(381 人)收治的确诊为慢性心力衰竭患者的病历:根据 2021 年的医疗记录,心脏专科医院收治的确诊为慢性阻塞性肺病的患者比例(87.6%)是 2002 年(46.4%;p<0.001)的两倍。在研究样本中,大多数慢性心力衰竭患者都是左心室射血分数保留(HFpEF)患者。与 2002 年的 58.6% 相比,2021 年此类患者的比例大幅上升至 75.9%(p<0.001)。与此同时,重度 CHF(NYHA 功能分级(FC)IV)的人数减少了 10%,2002 年为 13.2%,2021 年为 1.3%(p<0.001)。在大多数患者中,缺血性心脏病(2002 年为 98.1%,2021 年为 91.1%,p<0.001)和高血压(2002 年为 80.5%,2021 年为 98.2%,p<0.001)被诊断为导致慢性心力衰竭的原因。此外,合并症的发生率也显著增加:2002 年发现心房颤动的患者占 12.3%,2021 年占 26.4%(p<0.001);发现 2 型糖尿病的患者分别占 14.3% 和 32%(p<0.001);发现肥胖的患者分别占 33.3% 和 43.7%(p=0.018)。在分析期间,使用主要药物组的频率有所增加:2002 年,71.9% 的患者使用肾素-血管紧张素-醛固酮系统阻断剂,2021 年,87.7% 的患者使用(p<0.001);53.3% 的患者使用β-受体阻断剂,82.4% 的患者使用(p<0.001);1.9% 的患者使用矿物质皮质激素受体拮抗剂,18.6% 的患者使用(p=0.004):2021年,在心脏病医院住院的患者队列中,确诊为慢性心力衰竭的患者比例是2002年的两倍;在慢性心力衰竭结构中,左心室射血分数保留的表型占主导地位。在分析的二十年间,CHF 患者的合并症发病率有所增加。到2021年,病因循证疗法的处方频率显著增加,但即使是左心室射血分数降低的慢性阻塞性肺病患者,其处方频率仍然不足。
{"title":"Chronic Heart Failure in Patients Hospitalized in 2002 and 2021: Comparative Analysis of Prevalence, Clinical Course and Drug Therapy.","authors":"A A Garganeeva, O V Tukish, K N Vitt, Yu V Mareev, E A Kuzheleva, V V Ryabov, M Yu Kondratiev, E E Syromyatnikova, B B Dorzhieva, V Yu Mareev","doi":"10.18087/cardio.2024.3.n2595","DOIUrl":"https://doi.org/10.18087/cardio.2024.3.n2595","url":null,"abstract":"<p><strong>Aim: </strong>Comparative analysis of the prevalence of chronic heart failure (CHF), clinical and medical history data, and drug therapy of patients admitted to a cardiology hospital in 2002 and 2021.</p><p><strong>Material and methods: </strong>The study analyzed the medical records of patients with a confirmed diagnosis of CHF who were admitted in 2002 (n=210) and 2021 (n=381) to a specialized cardiology hospital.</p><p><strong>Results: </strong>According to medical records of 2021, the proportion of patients with a confirmed diagnosis of CHF (87.6%) in the cohort of patients admitted to a cardiology hospital was twice as high as in 2002 (46.4%; p&lt;0.001). The majority of patients with CHF in the study sample were patients with preserved left ventricular ejection fraction (HFpEF). The proportion of such patients significantly increased to reach 75.9% in 2021 compared to 58.6% in 2002 (p&lt;0.001). At the same time, the number of severe forms of CHF (NYHA functional class (FC) IV) decreased by 10% and was 13.2% in 2002 and 1.3% in 2021 (p&lt;0.001). In the majority of patients, ischemic heart disease (98.1 and 91.1% in 2002 and 2021, respectively, p&lt;0.001) and hypertension (80.5 and 98.2%, respectively, p&lt;0.001) were diagnosed as the cause for CHF. Furthermore, the incidence of comorbidity increased significantly: atrial fibrillation was detected in 12.3% of patients in 2002 and 26.4% in 2021 (p &lt; 0.001); type 2 diabetes mellitus, in 14.3 and 32% of patients (p &lt;0.001); and obesity, in 33.3 and 43.7% of patients, respectively (p=0.018). The frequency of using the major groups of drugs increased during the analyzed period: renin-angiotensin-aldosterone system blockers were administered to 71.9% of patients in 2002 and to 87.7% in 2021 (p&lt;0.001); beta-blockers were administered to 53.3 and 82.4% of patients (p&lt;0.001); and mineralocorticoid receptor antagonists, to 1.9 and 18.6% of patients, respectively (p=0.004).</p><p><strong>Conclusion: </strong>In 2021, the proportion of patients with a confirmed diagnosis of CHF in the patient cohort admitted to a cardiology hospital was twice as high as in 2002; the phenotype with preserved left ventricular ejection fraction predominated in the CHF structure. During the analyzed twenty-year period, the prevalence of comorbidities increased among CHF patients. The prescription frequency of pathogenetic evidence-based therapy has significantly increased by 2021, however, it remains insufficient even in patients with CHF with reduced left ventricular ejection fraction.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871462","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
Associations of ECG Signs of Ischemic and Non-Specific Signs of Metabolic Changes in the Myocardium With Unfavorable Cardiovascular Prognosis in a 7-Year Prospective Follow-Up of Young People Under 45 Years. 在对 45 岁以下年轻人进行的为期 7 年的前瞻性随访中,心肌缺血和非特异性代谢变化的心电图迹象与心血管预后不良之间的关系。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2571
N A Kuzminykh, L V Shcherbakova, V V Gafarov, D V Denisova, V S Shramko, Yu I Ragino

Aim: To study ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium and to determine their relationship with unfavorable cardiovascular prognosis in a 7-year prospective observation of young people under 45 years of age.

Material and methods: A cross-sectional population survey of a random sample aged 25-44 years (n=1363) was conducted in Novosibirsk. The survey program used the standardized epidemiological Rose questionnaire. Biochemical tests were used to measure blood concentrations of total cholesterol (C), triglycerides (TG), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), and fasting blood plasma glucose. Systolic and diastolic BP (SBP, DBP), the presence of arterial hypertension (AH), body mass index (BMI), waist circumference (WC), and smoking status were assessed. ECG was recorded at rest in 12 standard leads followed by interpretation according to the Minnesota Code. The presence of ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium was determined. Subjects with ECG signs of ischemic changes in the myocardium were selected for long-term follow-up and additional examination by cardiologists. Then the whole cohort was monitored for 7 years, and cardiovascular events were recorded, including using data from the WHO Myocardial Infarction Registry in Novosibirsk. For statistical analysis of the results, cardiovascular events were combined into a composite endpoint.

Results: During 7 years, 40 people (27 men and 13 women) had an unfavorable cardiovascular prognosis. Multivariate regression analysis showed that a 7-year unfavorable cardiovascular prognosis in people younger than 45 years was associated with signs of ischemic myocardial alterations identified on the background ECG (OR 5.319, 95% CI: 1.543-18.342, p=0.008) and nonspecific ECG signs of metabolic changes in the myocardium (OR 2.978, 95% CI: 1.216-7.216, p=0.017) regardless of age, gender, the presence of arterial hypertension (AH) and type 2 diabetes mellitus (DM2).

Conclusion: In young people under 45 years of age, not only ECG signs of ischemic changes in the myocardium, but also nonspecific ECG signs of metabolic changes in the myocardium are associated with an unfavorable cardiovascular prognosis, directly and independently on age and gender, in a long-term, 7-year period.

目的:通过对 45 岁以下年轻人进行为期 7 年的前瞻性观察,研究心肌缺血和/或非特异性代谢变化的心电图征兆,并确定其与心血管预后不良的关系:在新西伯利亚对 25-44 岁的随机样本(n=1363)进行了横断面人口调查。调查方案使用了标准化的流行病学罗斯问卷。生化检验用于测量血液中总胆固醇(C)、甘油三酯(TG)、低密度和高密度脂蛋白胆固醇(LDL-C、HDL-C)以及空腹血浆葡萄糖的浓度。还评估了收缩压和舒张压(SBP、DBP)、动脉高血压(AH)、体重指数(BMI)、腰围(WC)和吸烟状况。在静息状态下记录 12 个标准导联的心电图,然后根据明尼苏达规范进行判读。确定心肌是否存在缺血性和/或非特异性代谢变化的心电图征象。挑选出心电图显示心肌缺血变化的受试者进行长期随访,并由心脏病专家进行额外检查。然后,对整个组群进行为期 7 年的监测,并记录心血管事件,包括使用新西伯利亚世界卫生组织心肌梗死登记处的数据。在对结果进行统计分析时,将心血管事件合并为一个综合终点:7年间,有40人(27名男性和13名女性)心血管预后不良。多变量回归分析表明,45 岁以下人群的 7 年心血管预后不良与背景心电图中发现的缺血性心肌改变迹象有关(OR 5.319,95% CI:1.P=0.008)和心肌代谢变化的非特异性心电图征象(OR 2.978,95% CI:1.216-7.216,P=0.017)相关,与年龄、性别、是否存在动脉高血压(AH)和2型糖尿病(DM2)无关:结论:对于 45 岁以下的年轻人,在 7 年的长期研究中,不仅心肌缺血变化的心电图征象,而且心肌代谢变化的非特异性心电图征象都与心血管疾病的不良预后直接相关,且与年龄和性别无关。
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引用次数: 0
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Kardiologiya
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