Kardiologiya最新文献

Aim    To evaluate the safety and efficacy of sodium-glucose cotransporter-2 inhibitor (SGLT-2i) inhibitor therapy in kidney transplant recipients (KTRs) with and without post-transplant diabetes mellitus (PTDM).Material and methods     KTRs (n=2146, with PTDM n=303, or 14%) who had undergone transplantation more than one year ago, with stable graft function (estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m2), after excluding patients with combined kidney and pancreas transplantation (n=57), type 1 diabetes mellitus (DM) (n=124), and type 2 DM diagnosed before kidney allotransplantation (KAT) (n=74), were prescribed SGLT-2i (empagliflozin 25 mg/day or dapagliflozin 10 mg/day; n=107), the rest of the KTRs (n=1784) did not receive SGLT-2i. After pseudo-randomization, two groups were formed and included in an open, single-center prospective study: an experimental group with SGLT-2i (n=78; with PTDM n=45) and a control group, without SGLT-2i (n=78; n=45 with PTDM). The groups were comparable in the PTDM duration and the period from KAT to inclusion in the study, as well as in clinical characteristics, including gender, age, history of acute myocardial infarction (AMI) before KAT, levels of glycated hemoglobin (HbA1c), systolic blood pressure (SBP) and diastolic blood pressure (DBP), GFR, microalbuminuria (MAU), blood uric acid concentration, blood lipid profile (total cholesterol (TC), low-density lipoproteins (LDL)), basal blood concentration (C0) of calcineurin inhibitors (CNI), and therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), statins, and metformin (p >0.05).Results     The relative risk (RR) of all-cause death in the experimental group was reduced by 60% compared with the control group (RR 0.40; 95% confidence interval (CI) 0.17-0.98 vs. RR 2.44; 95% CI 1.01-5.86; p=0.04). The RR of adverse coronary outcomes in the experimental group was reduced by 75% compared with the control group (RR 0.25; 95% CI 0.06-0.89 vs. 4.0; 95% CI 1.11-14.42; p=0.03). The RR of adverse renal outcomes in the experimental group was reduced by 72% compared with the control group (RR 0.28; 95% CI 0.09-0.85 vs. 3.50; 95% CI 1.16-10.49; p=0.02). In addition, in the experimental group, compared to the control group, the GFR decline was slower (-1.29±0.763 ml/min/1.73 m2/year vs. -3.33±0.767 ml/min/1.73 m2/year; p=0.047). Also, a pronounced advantage in the dynamic decline in GFR was observed throughout the entire study period (-3.10±1.73 ml/min/1.73 m2 vs. -7.87±1.87 ml/min/1.73 m2; p=0.040).Conclusion SGLT2i effectively reduce cardiovascular and renal mortality, the risk of adverse renal and coronary outcomes, and slow the progression of chronic kidney disease in KTRs, regardless of the presence of PTDM. A large-scale study evaluating the efficacy of SGLT2i in KTRs is warranted to formulate appropriate clinical recommendations.

Aim    Chronic heart failure with preserved left ventricular ejection fraction (CHFpEF) is characterized by high prevalence, clinical heterogeneity, and insufficient understanding of its mechanisms compared to other CHF types. One approach to improving the patient group stratification is the identification of subphenotypes based on clinical and functional data and biomarker assessment. The aim of this study was to identify the clinical, laboratory, and instrumental characteristics of patients with CHFpEF and ischemic heart disease based on left ventricular ejection fraction (LVEF).Material and methods     This study included 145 patients with CHFpEF who were scheduled for coronary artery bypass grafting. Inclusion criteria were NYHA class ≥2 symptomatic heart failure, preserved LVEF ≥50%, and a HFA-PEFF algorithm total score ≥3, which helps diagnose CHFpEF. Patients were divided into a group with LVEF 50-60% (group 1; n=53) and a group with LVEF >60% (group 2; n=92). Before surgery, echocardiography, standard laboratory tests, and measurements of plasma biomarkers (N-terminal pre-brain natriuretic peptide (NT-proBNP), vascular endothelial growth factor (VEGF), heart fatty acid binding protein (H-FABP), interleukin receptor ST2, vascular endothelial cell adhesion molecule (VCAM), plasminogen activator inhibitor type 1 (PAI-1), neuropilin-1 (NRP-1) were performed in all patients.Conclusion    CHFpEF subphenotypes have different clinical and laboratory characteristics. Higher neuropilin-1 concentrations were associated with lower LVEF in CHFpEF.

Aim        To study a possibility of using serum concentrations of cystatin C (CYS) in early diagnosis and prediction of acute kidney injury (AKI) and associated in-hospital mortality and 30-day risk of death in pulmonary embolism (PE).Materials and methods        This study included 98 patients with suspected PE, of whom 63 had a confirmed diagnosis and formed the study group; the rest were excluded. CYS was measured on admission. The difference (CYSdiff) between the measured CYS and the estimated CYS corresponding to the glomerular filtration rate (GFR) of 75 ml/min/1.73 m2 was calculated using the reversed 2012 CKD-EPI Cystatin C formula. The estimated GFR was calculated as the difference between the CYS-based GFR (2012 CKD-EPI Cystatin C) and the creatinine-based GFR (2009 CKD-EPI). The 30-day mortality risk was assessed according to the ESC/ERS Guidelines for the diagnosis and treatment of acute PE in effect at the time of hospitalization.Results    AKI was diagnosed in 13 (21%) of 63 patients with PE aged 67±12 years, of whom 36 (57%) were men. In 7 (54%) cases, AKI was associated with chronic kidney disease (CKD), and in 6 (46%) cases, AKI developed for the first time. The measurement of the CYS concentration ensured early diagnosis and prediction of AKI with AUC=0.70 (95% confidence interval (CI) 0.57-0.81; p=0.009), optimal cutoff point (OP) >2.55 μg/ml (sensitivity 70%, specificity 62%), and AKI associated with CKD with AUC=0.78 (95% CI 0.65-0.88; p=0.001), OP >2.55 μg/ml (sensitivity 86%, specificity 62%). Similar predictive value for AKI was determined for CYSdiff: AUC = 0.70 (95% CI 0.57-0.81; p=0.009), OP >1.62 μg/ml with a sensitivity of 69% and specificity of 68%. Five patients (9%) died in hospital. The death rate was higher in AKI (χ2 = 5.8; p=0.018). CYS and CYSdiff levels did not predict in-hospital mortality (p >0.05 for both). The predictive value of eGFRdiff was unsatisfactory for either AKI or mortality (p >0.05 for both). It was found that CYS (AUC=0.76; 95% CI 0.63-0.85; p<0.001; OP>2.17 μg/ml) with a sensitivity of 70%, specificity of 70%, and CYSdiff (AUC=0.77; 95% CI 0.64-0.86; p<0.001; OP>1.22 μg/ml) with a sensitivity of 70%, and specificity of 70%, but not eGFRdiff were associated with a high 30-day risk of death (p=0.804).Conclusion            The study results confirm the effectiveness of CYS assessment in the early diagnosis and prediction of AKI, including cases associated with CKD. Prediction accuracy can be improved using CYSdiff. CYS levels do not predict in-hospital mortality but are associated with a high 30-day risk of death in patients with PE.

Objective This research investigated the application of real-time, three-dimensional speckle tracking imaging (RT-3D-STI) to evaluate left atrial (LA) function in individuals suffering from hypertensive heart disease (HHD) and heart failure with preserved ejection fraction (HFpEF).Material and methods This retrospective study included 100 patients with HHD and HFpEF hospitalized from August 2023to June 2024 (HFpEF group). 100 healthy individuals undergoing physical examinations comprised the control group. Patient data were collected, and echocardiography was performed to measure LA diameter (LAD), left ventricular end diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular outflow tract diameter (LVOTd), early diastolic maximum velocity of mitral valve inflow (MVE), late diastolic maximum velocity of mitral valve inflow (MVA), early diastolic and late diastolic velocities of mitral annulus measured by tissue Doppler ultrasound (e' and a'), tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF). The LA images were analyzed using GE software, and the following parameters were measured: L emptying fraction (LAEF), LA emptying volume (LAEV), LAvolume at the onset of contraction (LAVpreA), minimum LA volume (LAVmin), maximum LA volume (LAVmax), LA strain during the reservoir phase (LASr), LA strain during the contraction phase (LASct), and LA strain during the conduit phase (LAScd). ROC curves were adopted to evaluate the diagnostic value of LA parameters for HFpEF, and a Pearson correlation analysis examined the relationship between these parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP).Results Compared with the control group, the blood pressure in the HFpEF group was significantly higher (p<0.05). In the HFpEF group, NT-proBNP concentrations were significantly greater than those observed in the control group (p<0.05). No statistically significant variances were detected in LVEF, LVEDD, LVOTd, TAPSE, MVE, MVA, ratio of E wave velocity to A wave velocity (E / A), a', LAEV, LAVmin, or LAVpreA between the two groups (p>0.05). Compared to the control group, the HFpEF group had dramatically higher LAD, IVST, and LVPWT (p<0.05). The HFpEF group also had lower e', LAEF, LASr, LAScd, and LASct, while E / e', maximum LA volume index (LAV Imax), and LAVmax were higher (p<0.05). LASr was negatively associated with NT-proBNP (r=-0.255, p=0.016), whereas no significant correlation was found among LAScd, LASct, and NT-proBNP (P>0.05).Conclusion LA strain parameters can serve as a non-invasive method for quantitatively assessing LA dysfunction in patients with HFpEF.

Atrial fibrillation (AF) is the most common form of cardiac arrhythmia, the prevalence of which increases with age. Slowing down senescence is one of the urgent challenges of modern science. Therefore, it is important to identify individuals with markers of premature cellular senescence for further development of pharmacological agents capable of slowing it. Assuming that in AF, signs of cellular senescence emerge earlier than in individuals without AF we performed search, analysis and systematization of studies of the relationship between markers of cellular senescence, including the leukocyte telomere length (LTL) and the plasma concentration of galectin-3 in patients with AF. In most of the reviewed studies, the concentration of galectin-3 was significantly higher in patients with AF than in practically healthy individuals, while the LTL did not differ significantly between these groups. Accordingly, the signs of cellular senescence appeared earlier in patients with AF than in practically healthy individuals. Further clinical studies of cellular senescence markers in patients with AF are promising and call for large multicenter studies with a uniform design and methodology.

Fulminant myocarditis is characterized by an extremely severe course and remains a life-threatening disease. Only isolated cases of diffuse myocardial calcification in myocarditis have been reported. For this reason, the process of natural evolution of myocardial structural changes and their impact on the cardiovascular system have not yet been sufficiently studied. A clinical case of a 37-year-old patient with morphologically proven fulminant lymphocytic myocarditis and extensive myocardial calcification was selected for the analysis. This article analyzes the course of the disease, an algorithm for diagnosis and selection of a treatment method, and provides a review of previously published studies.

A middle-aged female presenting with progressive heart failure was admitted to the emergency department. She had a history of mitral and aortic valve replacement and a reoperation involving the Konno procedure. Echocardiography suggested a possible paraprosthetic leakage, which was confirmed during surgery. Additionally, severe infection, evidenced by an abscess near the great arteries, was discovered intraoperatively, despite the absence of fever or any prior signs of infection. This case underscores the importance of accurate diagnosis and thorough intraoperative exploration in identifying the underlying causes of the current condition and complications of previous cardiac surgeries. These are crucial for planning and performing a safe and effective reoperation.

Aim        To identify non-pharmacological factors associated with ineffective blood pressure (BP) control among individuals with arterial hypertension (AH) in a Siberian urban population sample.Material and methods          A considerable proportion of individuals with AH does not achieve BP goals. BP control is influenced by a number of non-drug determinants, including non-modifiable and multiple modifiable factors. In a population sample (men/women, 55-84 years old, n=3,898, 2015-2018, HAPIEE project, Novosibirsk), a category of individuals with AH receiving antihypertensive therapy (AHT) (n=2,449) was selected and two groups with adequate and inadequate BP control (ABPC and IABPC, respectively) were identified. We evaluated associations of IABPC and a series of potentially related factors, including gender, age, AH duration, type 2 diabetes mellitus, cardiovascular diseases (CVD), anthropometric and biochemical parameters, behavioral (smoking, alcohol consumption, physical activity (PA)) and socioeconomic factors (education, marital status, economic activity, material deprivation).Results    In a sample of 55-84-year-old individuals with AH taking AHT, ABPC was 30.7%. In the multivariate logistic model, IABPC was directly associated with male gender (odds ratio (OR) 1.72; 95% confidence interval (CI) 1.28-2.31), AH duration longer than 10 years (OR 2.55; 95% CI 2.07-3.14), alcohol consumption 1-3 times a month (OR 1.36; 95% CI 1.02-1.81) and 1-4 times a week (OR 1.91; 95% CI 1.26-2.89) and was inversely associated with moderate PA (OR 0.78; 95% CI 0.62-0.98). In men, IABPC was additionally inversely associated with history of CVD (OR 0.62; 95% CI 0.42-0.92). In women, IABPC was additionally associated with economically inactive status (OR 1.39; 95% CI 1.03-1.86) and inversely associated with smoking (OR 0.51; 95% CI 0.29-0.87).Conclusion            In a Siberian population sample of 55-84-year-olds, one third of individuals with AH receiving AHT adequately controlled their BP. Inadequate BP control was directly associated with male gender, long history of AH, frequent alcohol consumption, and economically inactive status (in women), and was inversely associated with moderate PA, CVD (in men), and smoking (in women). Attention to non-pharmacological determinants may help optimize BP control.

Aim    To analyze the efficacy and cost-effectiveness of various options of antithrombotic therapy in patients with type 2 diabetes mellitus (T2DM) after acute coronary syndrome (ACS), based on the results of a one-year follow-up.Material and methods    The article presents features of various antithrombotic therapies in patients with T2DM after ACS from the standpoint of efficacy and cost-effectiveness in real clinical practice based on the materials of the ORACLE II open prospective observational study (2014-2017). The data of 368 patients were divided into three groups based on the selected antithrombotic therapy. Due to the identified significant differences in the clinical characteristics among these groups, the propensity score matching was used to reach a balance between the groups by key differing indicators: gender, age, hemoglobin concentration upon admission, and the frequency of percutaneous coronary intervention during the index hospitalization. Results    Based on adjusted data, it was noted that the patients taking ticagrelor had fewer adverse cardiovascular outcomes during the observation period after the index event: 9 (17.6%) vs. 21 (41.2%) and 14 (27.5%) in patients taking clopidogrel or during de-escalation of the antithrombotic therapy, respectively (p=0.031). The pharmacoeconomic analysis assessed the cost-effectiveness of each type of antithrombotic therapy. The costs of drugs during the follow-up period were higher in patients taking ticagrelor: 2,723,703.45 vs. 445,880.76 in those taking clopidogrel. Nevertheless, in the conditions of real clinical practice in the Russian Federation, an economic advantage of the ticagrelor treatment during long-term follow-up was a subsequent decrease in the number of hospitalizations and, consequently, a reduction in direct medical costs of the care covered by the compulsory medical insurance. The total costs of subsequent hospitalizations due to adverse cardiovascular events for one year of follow-up were 755,773.47 for patients taking ticagrelor and 2,209,545.53 for those taking clopidogrel. Thus, the total costs per person for one year of follow-up after the index event were 14,819.09 in the ticagrelor group and 43,324.42 in the clopidogrel group. Conclusion    In the conditions of real clinical practice in the Russian Federation, ticagrelor is currently a more effective antiplatelet drug than clopidogrel both in terms of preventing further adverse cardiovascular events and economic feasibility in patients with acute coronary syndrome and type 2 diabetes mellitus.