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[Decompensation of Heart Failure in "Fragile" Patients: Clinical Features and Approaches to Therapy]. ["脆弱 "患者的心衰失代偿:临床特征和治疗方法]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2554
A A Senichkina, N M Savina, N V Lomakin

Aim: To evaluate the impact of frailty syndrome (FS) on the course of acute decompensated heart failure (ADHF) and the quality of drug therapy before discharge from the hospital in patients with reduced and moderately reduced left ventricular ejection fraction (LVEF).

Material and methods: This open prospective study included 101 patients older than 75 years with reduced and mid-range LVEF hospitalized for decompensated chronic heart failure (CHF). FS was detected during the outpatient follow-up and identified using the Age is Not a Hindrance questionnaire, the chair rise test, and the One Leg Test. The "fragile" group consisted of 54 patients and the group without FS included 47 patients. Clinical characteristics of patients were compared, and the prescribing rate of the main drugs for the treatment of CHF was assessed upon admission to the hospital. The sacubitril/valsartan or dapagliflozin therapy was initiated in the hospital; prescribing rate of the quadruple therapy was assessed upon discharge from the hospital. Patients with reduced LVEF were followed up for 30 days, and LVEF was re-evaluated to reveal possible improvement due to optimization of therapy during hospitalization. Statistical analysis was performed with the SPSS 23.0 software.

Results: The main causes for decompensation did not differ in patients of the compared groups. According to the correlation analysis, FS was associated with anemia (r=0.154; p=0.035), heart rate ≥90 bpm (r=0.185; p=0.020), shortness of breath at rest (r =0.224; p=0.002), moist rales in the lungs (r=0.153; p=0.036), ascites (r=0.223; p=0.002), increased levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP) (r= 0.316; p<0.001), hemoglobin concentration <120 g / l (r=0.183; p=0.012), and total protein <65 g / l (r=0.153; p=0.035) as measured by lab blood tests. Among patients with LVEF ≤40 % in the FS group (n=33) and without FS (n=33), the quadruple therapy was a part of the treatment regimen at discharge from the hospital in 27.3 and 3.0 % of patients, respectively (p=0.006). According to the 30-day follow-up data, improvement of LVEF was detected in 18.2% of patients with LVEF ≤40% in the FS group and 12.1% of patients with LVEF ≤40% in the FS-free group (p=0.020). In patients with LVEF 41-49 % in the FS (n=21) and FS-free (n=14) groups, the prescribing rate of the optimal therapy, including sacubitril/valsartan, sodium-glucose cotransporter 2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists, no statistically significant differences were detected (14.3 and 7.1 %, respectively; p=0.515) at discharge from the hospital.

Conclusion: Patients with ADHF and FS showed more pronounced clinical manifestations of decompensation, anemia, heart rate ≥90 beats/min, and higher levels of NT-proBNP upon admission. The inpatient therapy with sacubitril/valsartan or dapagliflozin was more int

目的:评估虚弱综合征(FS)对左心室射血分数(LVEF)降低和中度降低的急性失代偿性心力衰竭(ADHF)病程和出院前药物治疗质量的影响:这项开放性前瞻性研究纳入了101名因慢性心力衰竭(CHF)失代偿住院的75岁以上左室射血分数降低和中度降低的患者。FS是在门诊随访期间发现的,并通过年龄不是障碍问卷、椅子起立测试和单腿测试进行鉴定。脆弱 "组有 54 名患者,无 FS 组有 47 名患者。比较了患者的临床特征,并评估了入院时治疗慢性心力衰竭的主要药物的处方率。在医院开始使用沙库比特利/缬沙坦或达帕利嗪治疗;出院时评估四联疗法的处方率。对 LVEF 下降的患者随访 30 天,并重新评估 LVEF,以揭示住院期间优化治疗可能带来的改善。统计分析使用 SPSS 23.0 软件进行:结果:两组患者失代偿的主要原因没有差异。根据相关性分析,FS 与贫血(r=0.154;p=0.035)、心率≥90 bpm(r=0.185;p=0.020)、休息时气短(r=0.224;p=0.002)、肺部湿啰音(r=0.153;p=0.036)、腹水(r=0.223;p=0.002)、血液化验室检测的N末端前脑钠尿肽(NT-proBNP)水平升高(r= 0.316; p<0.001)、血红蛋白浓度<120 g / l(r=0.183; p=0.012)和总蛋白<65 g / l(r=0.153; p=0.035)。在LVEF≤40%的FS组(33人)和非FS组(33人)患者中,分别有27.3%和3.0%的患者在出院时将四联疗法作为治疗方案的一部分(P=0.006)。根据 30 天的随访数据,在 FS 组 LVEF ≤40% 的患者中,18.2% 的患者 LVEF 有所改善,在无 FS 组 LVEF ≤40% 的患者中,12.1% 的患者 LVEF 有所改善(P=0.020)。在LVEF为41-49%的FS组(21人)和无FS组(14人)患者中,出院时最佳疗法的处方率,包括沙库比曲利/缬沙坦、钠-葡萄糖共转运体2抑制剂、β受体阻滞剂和矿化皮质激素受体拮抗剂,未发现有显著统计学差异(分别为14.3%和7.1%;P=0.515):结论:ADHF 和 FS 患者入院时表现出更明显的失代偿、贫血、心率≥90 次/分和更高的 NT-proBNP 水平。在 LVEF 降低的 FS 患者中,住院治疗中更多地使用了沙库比特利/缬沙坦或达帕格列净。个体化治疗方法使萨库比特利/缬沙坦的处方率达到39.4%,达帕格列净的处方率达到39.4%,出院时四联疗法的处方率达到27.3%。
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引用次数: 0
[Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction - REGION-IM]. [根据俄罗斯急性心肌梗死登记--REGION-IM,ST 段抬高型心肌梗死再灌注疗法的特点]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2601
S A Boytsov, R M Shakhnovich, S N Tereschenko, A D Erlikh, D V Pevsner, R G Gulyan, Yu K Rytova, N Yu Dmitrieva, Ya M Voznyuk, N A Musikhina, O A Nazarova, N A Pogorelova, G K Sanabasova, A V Sviridova, I V Sukhareva, A S Filinova, Yu V Shylko, G A Shirikova

Aim: Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice.

Material and methods: REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT).

Results: Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients.

Conclusion: The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.

目的:基于俄罗斯REGION-IM登记处的数据,研究ST段抬高型心肌梗死(STEMI)患者再灌注治疗在实际临床实践中的特点:REGION-IM是一项多中心前瞻性观察研究。观察期分为三个阶段:住院期间、纳入登记册后的 6 个月和 12 个月。患者的病历包括人口统计学和病史数据、本次心肌梗死病例的信息,包括首次出现症状的时间、首次与医务人员接触的时间和入院时间、冠状动脉造影(CAG)数据、经皮冠状动脉介入治疗(PCI)数据和溶栓治疗(TLT)信息:88.9%的 STEMI 患者接受了再灌注治疗。60.6%的患者进行了初级PCI(pPCI)治疗。从出现症状到进行 pPCI 的中位时间为 315 分钟 [195; 720]。从心电图到 pPCI 的中位时间为 110 分钟 [84;150]。7.4%的病例进行了孤立 TLT,20.9%的病例采用了药物介入治疗策略。从心电图到 TLT(院前和院内)的中位时间为 30 分钟 [10;59],而从心电图到院前 TLT 的中位时间为 18 分钟 [10;39],63% 的患者在诊断后 10 分钟以上才进行 TLT。73%的患者在TLT后进行了PCI治疗:结论:近年来,俄罗斯联邦 STEMI 再灌注治疗的频率显著增加。pPCI 的高频率值得注意,但 pPCI 的时机并不总是符合临床指南。本次登记的结果证实,在现实的临床实践中,对药物介入策略的需求很高。考虑到地理和后勤特点,及时实施心肌再灌注需要院前 TLT。然而,尽管 TLT 已被证实能在发现急性心肌梗死后的最短时间内发挥最大疗效,但在俄罗斯联邦,TLT 的使用频率仍然不足。
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引用次数: 0
[Biomarkers of Inflammation in Predicting the Outcomes of Heart Failure of Ischemic Etiology: the Results of Factor Analysis]. [预测缺血性心力衰竭预后的炎症生物标志物:因子分析结果]。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2465
A A Garganeeva, E A Kuzheleva, O V Tukish, M Yu Kondratiev, K N Vitt, S L Andreev, O N Ogurkova

Aim: To study the prognostic significance of inflammatory biomarkers in patients with chronic heart failure (CHF) and stenotic multivessel coronary atherosclerosis, with determination of the biomarker separate set that reflects subclinical inflammation and is associated with the development of cardiovascular complications during prospective observation.

Material and methods: A prospective observational study was conducted that included 80 patients with CHF and ischemic heart disease who were scheduled for coronary artery bypass grafting (CABG) during their current hospitalization. In addition to routine clinical laboratory tests, coagulation parameters were evaluated and the following inflammatory biomarkers were determined: neutrophil gelatinase-associated lipocalin (NGAL), growth/differentiation factor 15 (GDF-15), fibroblast growth factor 23 (FGF-23), transforming growth factor beta-1 (TGF-β1), and high-sensitivity C-reactive protein. Also, the calculated neutrophil-to-lymphocyte ratio (N LR) was included in the analysis. Follow-up duration was at least 12 months (median 16 [13, 22] months). Statistical analysis of the data was performed with the IBM SPSS Statistics 21 software.

Results: The study presented results of a factor analysis of 10 inflammatory biomarkers in patients who were scheduled for CABG. One of the factors identified by the analysis included the levels of NGAL and GDF-15, N LR, and the level of fibrinogen in the blood in CHF patients with stenotic coronary atherosclerosis and was significantly associated with the death rate during prospective observation. Furthermore, this association remained significant even after adjustments for age, glomerular filtration rate, severity of heart and coronary insufficiency, and the presence of diabetes mellitus.

Conclusion: In patients with CHF and stenotic coronary atherosclerosis, a set of inflammatory markers, including blood NGAL, GDF-15, N LR, and fibrinogen, can be combined into one factor reflecting subclinical inflammation. The value of this factor can be used to predict cardiovascular death in the long term after surgical myocardial revascularization.

目的:研究慢性心力衰竭(CHF)和狭窄性多血管冠状动脉粥样硬化患者炎症生物标志物的预后意义,并确定在前瞻性观察期间反映亚临床炎症并与心血管并发症发展相关的生物标志物独立集:该研究纳入了80名患有慢性心力衰竭和缺血性心脏病并计划在住院期间接受冠状动脉旁路移植术(CABG)的患者。除常规临床实验室检查外,还评估了凝血参数,并测定了以下炎症生物标志物:中性粒细胞明胶酶相关脂质体(NGAL)、生长/分化因子 15(GDF-15)、成纤维细胞生长因子 23(FGF-23)、转化生长因子β-1(TGF-β1)和高敏 C 反应蛋白。此外,计算得出的中性粒细胞与淋巴细胞比率(N LR)也被纳入分析范围。随访时间至少为 12 个月(中位数为 16 [13, 22] 个月)。数据统计分析采用 IBM SPSS Statistics 21 软件进行:结果:该研究对计划接受心血管造影术的患者的 10 种炎症生物标志物进行了因子分析。分析确定的因素之一包括冠状动脉粥样硬化狭窄的 CHF 患者血液中的 NGAL 和 GDF-15 水平、N LR 和纤维蛋白原水平,并且与前瞻性观察期间的死亡率显著相关。此外,即使对年龄、肾小球滤过率、心脏和冠状动脉功能不全的严重程度以及是否患有糖尿病等因素进行调整后,这种相关性仍然显著:结论:在慢性心力衰竭合并冠状动脉狭窄的患者中,一组炎症标志物(包括血液中的 NGAL、GDF-15、N LR 和纤维蛋白原)可合并成一个反映亚临床炎症的因子。该因子的值可用于预测外科心肌血运重建术后的长期心血管死亡。
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引用次数: 0
Modification of Cardiovascular Risk Factors and the Evolution of The Cardiovascular Phenotype of Liver Transplant Recipients in the Long -Term Postoperative Period. 肝移植受者术后长期心血管风险因素的改变和心血管表型的演变
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2612
E A Grigorenko, K Yu Antyukh, O O Rummo, N P Mitkovskaya

Aim: To evaluate the contribution of traditional and additional cardiovascular risk factors (CVRFs) to the development of chronic ischemic heart disease (CIHD) in liver transplant recipients during the long-term postoperative period.

Material and methods: A single-center prospective cohort study was conducted. The study included 740 patients with chronic end-stage liver disease (CESLD) and cirrhotic cardiomyopathy (CCMP). During the observation period (5.4±2.29 years), patients were divided into two groups: liver transplant recipients (n=420) and patients with CESLD on the waiting list who did not receive a donor organ (n=320). In patients enrolled to the study upon inclusion in the waiting list, CVRFs, history, clinical and laboratory and instrumental data were studied at all stages of the hepato-cardiac continuum.

Results: During the long-term postoperative period, liver transplant recipients belonged to the group of high cardiovascular risk: over a 5-year observation period, 35.7% (n=150) of them developed metabolic syndrome (MS), 9.8% developed verified CIHD associated with MS. The incidence of traditional CVRFs was high (arterial hypertension, 88.6%; obesity, 36.6%; hypercholesterolemia, 77.8%; hypertriglyceridemia, 43.6%; reduced concentration of high-density lipoprotein cholesterol, 35.4%; increased concentrations of low-density lipoprotein cholesterol, 66.8% and very low-density lipoprotein cholesterol, 51.2%; increased atherogenic index, 61.5%). During the long-term postoperative period as compared to the period when patients were on the waiting list, additional CVRFs appeared: increases in body mass index, calcium index, nitric oxide metabolites, endothelin-1, homocysteine, intercellular adhesion molecules VCAM-1 and ICAM-1, and decreases in endothelium-dependent vasodilation and glomerular filtration rate to less than 60 ml/min/1.73 m2. A model for the development of CIHD was created. The model uses a complex of independent risk factors and demonstrates a predictive accuracy of 84.6%.

Conclusion: The study results indicate a modification of CVRFs and a dynamic change in the cardiovascular phenotype of liver transplant recipients: progression of CCMP during their stay on the waiting list, regression of CCMP manifestations during the first 12 months after orthotopic liver transplantation, and increases in the total cardiovascular risk and likelihood of CIHD in the long-term postoperative period.

目的:评估肝移植受者术后长期慢性缺血性心脏病(CIHD)发生的传统和额外心血管风险因素(CVRFs)的作用:进行了一项单中心前瞻性队列研究。研究纳入了 740 名慢性终末期肝病(CESLD)和肝硬化性心肌病(CCMP)患者。在观察期间(5.4±2.29 年),患者被分为两组:肝移植受者(420 人)和等待名单中未接受器官捐献的 CESLD 患者(320 人)。研究人员对列入候选名单的患者进行了CVRFs、病史、临床、实验室和仪器数据的研究,这些数据涵盖了肝-心连续过程的所有阶段:在术后长期观察期间,肝移植受者属于心血管高危人群:在5年的观察期内,35.7%的受者(n=150)出现了代谢综合征(MS),9.8%的受者出现了与MS相关的经证实的CIHD。传统的 CVRF 发生率很高(动脉高血压 88.6%;肥胖 36.6%;高胆固醇血症 77.8%;高甘油三酯血症 43.6%;高密度脂蛋白胆固醇浓度降低 35.4%;低密度脂蛋白胆固醇浓度升高 66.8%,极低密度脂蛋白胆固醇升高 51.2%;致动脉粥样硬化指数升高 61.5%)。在术后长期观察期间,与患者在候诊期间相比,出现了更多的 CVRFs:体重指数、钙指数、一氧化氮代谢物、内皮素-1、同型半胱氨酸、细胞间粘附分子 VCAM-1 和 ICAM-1,以及内皮依赖性血管舒张和肾小球滤过率下降至低于 60 ml/min/1.73 m2。我们创建了一个 CIHD 发病模型。该模型使用了一系列独立的风险因素,预测准确率达 84.6%:研究结果表明,CVRFs发生了改变,肝移植受者的心血管表型也发生了动态变化:CCMP在候选名单中不断发展,CCMP表现在正位肝移植后的前12个月中逐渐消失,而在术后长期,总的心血管风险和CIHD的可能性都在增加。
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引用次数: 0
Cardiology Service of Kazakhstan Today: Acute Coronary Syndrome, Chronic Heart Failure, Atherosclerosis. 今日哈萨克斯坦心脏科:急性冠状动脉综合症、慢性心力衰竭、动脉粥样硬化。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2580
M S Bekbossynova, T V Ivanova-Razumova, S K Dzhetybayeva, Z O Oralbekova

The article focuses on the prevalence of circulatory diseases, organization and implementation of new programs in the system of cardiological care services in the Republic of Kazakhstan. Currently, three key programs are functioning at the republican level: "Acute coronary syndrome", "Chronic heart failure", and "Atherosclerosis and dyslipoproteinemia". The National Scientific Cardiac Surgery Center (Astana) is the coordinator of all these programs.

文章主要介绍了循环系统疾病的发病率、哈萨克斯坦共和国心脏病治疗服务系统新方案的组织和实施情况。目前,在共和国一级有三个主要方案在运作:"急性冠状动脉综合征"、"慢性心力衰竭 "和 "动脉粥样硬化和脂蛋白血症"。国家心脏外科科学中心(阿斯塔纳)是所有这些方案的协调机构。
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引用次数: 0
Early Detection and Control of Risk Factors for Cardiovascular Diseases in the Aral Region: Experience of Uzbekistan. 咸海地区心血管疾病风险因素的早期发现和控制:乌兹别克斯坦的经验。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2614
H G Fozilov, H H Ataniyazov, G A Khamidullaeva, S Ya Abdullaeva, R B Alieva

Aim: To analyze the results of screening of the population older than 40 years for early detection of risk factors for cardiovascular diseases in real clinical practice of family clinics in the Aral Sea region.

Material and methods: The results of screening of the population older than 40 years were analyzed for a total of 2,430 respondents from family clinics of the district (Republic of Uzbekistan, Republic of Karakalpakstan, Ellikkala district) according to the modified WHO PEN protocol. 1,020 of the respondents with blood pressure ≥140/90 mm Hg were included in the study (mean age, 57.68±8.06 years; women, 61.4%; men, 38.6%). Additionally, the following parameters were determined: salt-taste threshold using the R. Henkin method, echocardiography, ultrasonography of the brachiocephalic arteries, blood lipid spectrum, microalbuminuria, serum creatinine and uric acid. Statistical data are presented as mean±SD. The prevalence of signs in the study group was assessed using the Pearson's chi-square test, and the Pearson correlation coefficient was used.

Results: Among the patients with elevated blood pressure included in the study, 24 (2.4%) were younger than 40 years, 847 (81%) were 40-65 years old, and 169 (16.6%) were older than 65 years. Low cardiovascular risk was twice more common among women compared to men: 11.3% vs. 5.6% (χ²=8.990; p=0.003); almost 75% fewer patients with ischemic heart disease, 7.4% vs. 28.9% (χ²=14.939; p=0.0001); however, the incidence of type 2 diabetes mellitus was twice higher, 13.7% vs. 7.4% (χ²=9.205; p=0.002); the female group had significantly fewer cases of postinfarction cardiosclerosis (PICS) (χ²=5.313; p=0.021). Among women, there were no tobacco users or regular alcohol drinkers whereas among men these risk factors were identified in 59.4% (χ²=178.848; p=0.0001) and 35% (χ²=82.238; p=0.0001), respectively. 85.6% of the respondents had a high salt-taste threshold, 96% had left ventricular hypertrophy, 76% had microalbuminuria, 21% had proteinuria, and 92% of both men and women had a common carotid artery intima-media thickening >0.9 mm.

Conclusion: The study showed a broad prevalence of cardiovascular risk factors in the population of hypertensive patients in the Aral region, a high salt-taste threshold, and significant damages to target organs, which differed from other regions of Uzbekistan. Among hypertensive men, there was a significant prevalence of tobacco and alcohol use, and a significantly more frequent detection of ischemic heart disease, PICS and hyperuricemia compared to women; in the female population, the prevalence of type 2 diabetes mellitus was significantly greater.

目的:分析咸海地区家庭诊所为早期发现心血管疾病风险因素而对 40 岁以上人口进行筛查的结果:根据修改后的世界卫生组织 PEN 方案,对该地区(乌兹别克斯坦共和国,卡拉卡尔帕克斯坦共和国,埃利卡拉地区)家庭诊所的 2430 名 40 岁以上人口的筛查结果进行了分析。其中血压≥140/90 mm Hg 的 1020 名受访者被纳入研究范围(平均年龄为 57.68±8.06 岁;女性占 61.4%;男性占 38.6%)。此外,还测定了以下参数:采用 R. Henkin 法测定的盐味阈值、超声心动图、肱动脉超声造影、血脂谱、微量白蛋白尿、血清肌酐和尿酸。统计数据以均数±SD 表示。采用皮尔逊卡方检验评估研究组体征的流行情况,并使用皮尔逊相关系数:在纳入研究的血压升高患者中,24 人(2.4%)小于 40 岁,847 人(81%)40-65 岁,169 人(16.6%)大于 65 岁。与男性相比,低心血管风险在女性中的发生率高出一倍:11.3% 对 5.6% (χ²=8.990; p=0.003);缺血性心脏病患者减少了近 75%,为 7.4% 对 28.9% (χ²=14.939; p=0.0001);然而,2 型糖尿病的发病率却高出一倍,为 13.7% 对 7.4% (χ²=9.205;P=0.002);女性组的梗死后心脏硬化(PICS)病例明显较少(χ²=5.313;P=0.021)。女性中没有吸烟者或经常饮酒者,而男性中分别有 59.4% (χ²=178.848; p=0.0001)和 35% (χ²=82.238; p=0.0001)的人存在这些危险因素。85.6%的受访者盐味阈值较高,96%的受访者左心室肥厚,76%的受访者有微量白蛋白尿,21%的受访者有蛋白尿,92%的男性和女性受访者颈总动脉内膜中层增厚为0.9 mm:研究表明,咸海地区高血压患者的心血管危险因素普遍存在,盐味阈值高,靶器官受损严重,这与乌兹别克斯坦其他地区有所不同。在男性高血压患者中,吸烟和酗酒的发病率很高,与女性相比,缺血性心脏病、PICS 和高尿酸血症的发病率明显更高;在女性人群中,2 型糖尿病的发病率明显更高。
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引用次数: 0
Prediction of Cardiovascular Diseases in Women With Rheumatoid Arthritis. 类风湿关节炎女性患者的心血管疾病预测。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2616
I V Osipova, Y N Starodubova

Aim: To develop prognostic models for arterial hypertension (AH) and atherosclerosis based on studying the totality and significance of traditional and disease-mediated risk factors (RFs) in women with rheumatoid arthritis (RA).

Material and methods: 223 female patients with RA aged 54.9±2.1 years were evaluated at the premises of the polyclinic of the Gulla Municipal Hospital #4 (Barnaul), the "Health Center", the City Rheumatology Department of the polyclinic, and the Hospital Department in 2016-2019. Statistical analysis was performed using Excel Microsoft Office 2007, Statistica 6.0 and 10.0, and SigmaPlot 12.5 software packages. Multivariate regression analysis was used for studying the attributes influencing the development of AH and atherosclerosis in RA and for constructing predictive models. ROC analysis was used to determine the quality of the developed models. Differences were considered statistically significant at p<0.05.

Results: The following RFs predominating in the onset of disease were identified: traditional (hyperglycemia, obesity, increased diastolic BP (DBP), tachycardia, dyslipidemia); disease-mediated (ESR, fibrinogen, C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies, moderate and high DAS-28 activity), and psychosocial (stress, anxiety, depression, sleep disorders). The highest RF incidence and their combinations were determined with a RA duration of more than a year: traditional (obesity, hyperglycemia, increased systolic BP (SBP)), and decreased glomerular filtration rate; and disease-mediated (prednisolone treatment). A highly sensitive model for AH screening was developed that included a combination of RFs: disease-mediated (RA duration, CRP); traditional (improper diet, low physical activity, history of early cardiovascular diseases, increased SBP and DBP, preeclampsia and/or eclampsia, early menopause, older age, dyslipidemia); psychosocial (anxiety, depression), and a high salt-taste threshold. A highly sensitive model was developed for probable prediction of multifocal atherosclerosis in RA in women. The model includes a complex of risk factors: disease-mediated (RA activity by DAS-28, CRP, fibrinogen, ESR, dose-dependent prednisolone treatment); traditional (AH, SBP, waist circumference, heart rate, early menopause, preeclampsia and/or eclampsia, age 55 years and older, dyslipidemia); and psychosocial (sleep disorders, depression).

Conclusion: Algorithms for early prevention of AH and atherosclerosis were developed with consideration of identified predictors and proposed prediction models for women with RA.

目的:在研究类风湿性关节炎(RA)女性患者的传统和疾病介导风险因素(RFs)的整体性和重要性的基础上,建立动脉高血压(AH)和动脉粥样硬化的预后模型。材料与方法:2016-2019年,在古拉市第四医院综合诊所(巴尔瑙尔)、"健康中心"、综合诊所市风湿病科和医院部对223名年龄为(54.9±2.1)岁的女性RA患者进行了评估。统计分析使用 Excel Microsoft Office 2007、Statistica 6.0 和 10.0 以及 SigmaPlot 12.5 软件包进行。多变量回归分析用于研究影响RA发生AH和动脉粥样硬化的属性,并构建预测模型。ROC分析用于确定所建模型的质量。结果显示,P<0.05时差异具有统计学意义:结果:确定了以下在发病中占主导地位的RF因素:传统因素(高血糖、肥胖、舒张压(DBP)升高、心动过速、血脂异常);疾病介导因素(血沉、纤维蛋白原、C反应蛋白(CRP)、类风湿因子、环瓜氨酸肽抗体、中度和高度DAS-28活性)和社会心理因素(压力、焦虑、抑郁、睡眠障碍)。在类风湿持续时间超过一年的情况下,RF 发生率最高的因素及其组合是:传统因素(肥胖、高血糖、收缩压(SBP)升高)和肾小球滤过率降低;疾病介导因素(泼尼松龙治疗)。为 AH 筛查建立了一个高灵敏度模型,该模型包括以下 RFs 组合:疾病介导(RA 持续时间、CRP);传统(饮食不当、体力活动少、早期心血管疾病史、SBP 和 DBP 升高、子痫前期和/或子痫、更年期提前、年龄偏大、血脂异常);社会心理(焦虑、抑郁)和高盐味阈值。为预测女性 RA 多灶性动脉粥样硬化建立了一个高度敏感的模型。该模型包括一系列风险因素:疾病介导因素(通过 DAS-28、CRP、纤维蛋白原、血沉、剂量依赖性泼尼松龙治疗得出的 RA 活性);传统因素(AH、SBP、腰围、心率、早期绝经、先兆子痫和/或子痫、55 岁及以上、血脂异常);以及社会心理因素(睡眠障碍、抑郁):考虑到已确定的预测因素和针对 RA 女性提出的预测模型,制定了早期预防 AH 和动脉粥样硬化的方案。
{"title":"Prediction of Cardiovascular Diseases in Women With Rheumatoid Arthritis.","authors":"I V Osipova, Y N Starodubova","doi":"10.18087/cardio.2024.1.n2616","DOIUrl":"10.18087/cardio.2024.1.n2616","url":null,"abstract":"<p><strong>Aim: </strong>To develop prognostic models for arterial hypertension (AH) and atherosclerosis based on studying the totality and significance of traditional and disease-mediated risk factors (RFs) in women with rheumatoid arthritis (RA).</p><p><strong>Material and methods: </strong>223 female patients with RA aged 54.9±2.1 years were evaluated at the premises of the polyclinic of the Gulla Municipal Hospital #4 (Barnaul), the \"Health Center\", the City Rheumatology Department of the polyclinic, and the Hospital Department in 2016-2019. Statistical analysis was performed using Excel Microsoft Office 2007, Statistica 6.0 and 10.0, and SigmaPlot 12.5 software packages. Multivariate regression analysis was used for studying the attributes influencing the development of AH and atherosclerosis in RA and for constructing predictive models. ROC analysis was used to determine the quality of the developed models. Differences were considered statistically significant at p&lt;0.05.</p><p><strong>Results: </strong>The following RFs predominating in the onset of disease were identified: traditional (hyperglycemia, obesity, increased diastolic BP (DBP), tachycardia, dyslipidemia); disease-mediated (ESR, fibrinogen, C-reactive protein (CRP), rheumatoid factor, cyclic citrullinated peptide antibodies, moderate and high DAS-28 activity), and psychosocial (stress, anxiety, depression, sleep disorders). The highest RF incidence and their combinations were determined with a RA duration of more than a year: traditional (obesity, hyperglycemia, increased systolic BP (SBP)), and decreased glomerular filtration rate; and disease-mediated (prednisolone treatment). A highly sensitive model for AH screening was developed that included a combination of RFs: disease-mediated (RA duration, CRP); traditional (improper diet, low physical activity, history of early cardiovascular diseases, increased SBP and DBP, preeclampsia and/or eclampsia, early menopause, older age, dyslipidemia); psychosocial (anxiety, depression), and a high salt-taste threshold. A highly sensitive model was developed for probable prediction of multifocal atherosclerosis in RA in women. The model includes a complex of risk factors: disease-mediated (RA activity by DAS-28, CRP, fibrinogen, ESR, dose-dependent prednisolone treatment); traditional (AH, SBP, waist circumference, heart rate, early menopause, preeclampsia and/or eclampsia, age 55 years and older, dyslipidemia); and psychosocial (sleep disorders, depression).</p><p><strong>Conclusion: </strong>Algorithms for early prevention of AH and atherosclerosis were developed with consideration of identified predictors and proposed prediction models for women with RA.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698897","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
Preventive Cardiology 2024: State of Problem Perspectives of Development. 预防心脏病学 2024:问题现状 发展前景。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2636
N V Pogosova, S A Boytsov

This article presents the current relevance of preventive cardiology, substantiates the increasing importance of the prevention of cardiovascular diseases (CVD) to reduce mortality and the burden of CVD, including in the era of widespread use of modern high-tech methods and effective drug therapy for treating CVD in clinical practice. The article also addresses effectiveness of secondary prevention of CVD and approaches to its improvement. Particular attention is paid to the high importance of introducing into practice comprehensive programs for secondary prevention of CVD and cardiac rehabilitation. The principles of organizing such programs and their most important components are presented in detail.

本文介绍了预防心脏病学的现实意义,证实了预防心血管疾病(CVD)对降低死亡率和减轻心血管疾病负担的日益重要性,包括在临床实践中广泛使用现代高科技方法和有效药物治疗心血管疾病的时代。文章还论述了心血管疾病二级预防的有效性及其改进方法。文章特别强调了在实践中引入心血管疾病二级预防和心脏康复综合计划的重要性。文章详细介绍了此类计划的组织原则及其最重要的组成部分。
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引用次数: 0
The EXCEL Study: Long-term Observation of the Effectiveness of Drug and Non-drug Rehabilitation in Patients with Ischemic Heart Failure. EXCEL 研究:缺血性心力衰竭患者药物和非药物康复疗效的长期观察。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2615
Yu N Belenkov, A S Lishuta, O A Slepova, N S Nikolaeva, N V Khabarova, G M Dadashova, E V Privalova

Aim: To study the long-term effect of enhanced external counterpulsation (EECP) therapy on exercise tolerance, quality of life (QoL), and indicators of the structural and functional state of the cardiovascular system in patients with stable ischemic heart disease (IHD) complicated by chronic heart failure (CHF).

Material and methods: This open randomized EXCEL study included 120 patients with verified IHD complicated by NYHA II-III functional class CHF with reduced or mid-range left ventricular (LV) ejection fraction. Patients were randomized into group 1 (n=40), optimal drug therapy (ODT) and EECP (35 hours, 2 courses per year); group 2 (n=40), ODT and EECP (35 hours, 1 course per year); and group 3 (control; n=40), ODT and placebo counterpulsation (35 h, 1 course per year). All patients underwent a 6-minute walk test (6MWT), evaluation of clinical status, QoL with the MLHFQ and SF-36 questionnaires, structural and functional state of large blood vessels and microvasculature, measurement of brain natriuretic peptide precursor (NT-proBNP), and echocardiography at baseline and after 12 months.

Results: In groups 1 and 2 after 12 months, the 6MWT distance increased statistically significantly (44.5 and 24.9%, respectively) and the following indexes improved: QoL (SF-36, MLHFQ), the condition of large blood vessels (phase shift, radial augmentation index, central aortic systolic pressure (CASP)) and microvasculature (occlusion index, percentage of perfused capillaries, percentage of capillary recovery), and the LV systolic function (from 40.6±7.5 to 47.5±10.2% and from 41.3± 6.8 to 43.9±10.3%, respectively). The proportion of patients with a >20% increase in the 6MWT at 12 months was 97.5, 72.5, and 7.7%, respectively. A statistically significant decrease in NT-proBNP was observed in all groups. In group 3, the incidence of hospitalizations for CHF and the risk of the composite endpoint were significantly higher.

Conclusion: For the 12-month study period, the effects of EECP in patients with IHD complicated by CHF included improvements in exercise tolerance, QoL, vascular and cardiac functional parameters, and a decrease in the incidence of adverse outcomes.

目的:研究增强体外反搏(EECP)疗法对稳定型缺血性心脏病(IHD)并发慢性心力衰竭(CHF)患者的运动耐量、生活质量(QoL)以及心血管系统结构和功能状态指标的长期影响:这项开放式随机 EXCEL 研究纳入了 120 例经确诊的 IHD 患者,这些患者均并发 NYHA II-III 功能分级 CHF,且左心室射血分数降低或处于中等水平。患者被随机分为第1组(40人),最佳药物治疗(ODT)和EECP(35小时,每年2个疗程);第2组(40人),ODT和EECP(35小时,每年1个疗程);第3组(对照组;40人),ODT和安慰剂反搏(35小时,每年1个疗程)。所有患者均接受了 6 分钟步行测试(6MWT)、临床状态评估、MLHFQ 和 SF-36 问卷调查的 QoL、大血管和微血管的结构和功能状态、脑钠肽前体(NT-proBNP)测量以及基线和 12 个月后的超声心动图检查:结果:12 个月后,第 1 组和第 2 组的 6MWT 距离在统计学上显著增加(分别为 44.5% 和 24.9%),以下指标也有所改善:QoL(SF-36、MLHFQ)、大血管状况(相位移动、径向增强指数、主动脉中心收缩压(CASP))和微血管状况(闭塞指数、灌注毛细血管百分比、毛细血管恢复百分比)以及左心室收缩功能(分别从 40.6±7.5% 到 47.5±10.2% 和从 41.3±6.8% 到 43.9±10.3%)均有所改善。12个月时,6MWT增加20%的患者比例分别为97.5%、72.5%和7.7%。所有组别中,NT-proBNP 均有统计学意义上的明显下降。在第 3 组中,因慢性阻塞性肺病住院的发生率和综合终点的风险明显更高:在为期 12 个月的研究中,EECP 对并发心房颤动的 IHD 患者的效果包括改善运动耐量、生活质量、血管和心脏功能参数,以及降低不良后果的发生率。
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引用次数: 0
Predictors of the Development of Associated Clinical Conditions in Working-Age Patients With Cardiovascular Risk Factors in Conditions of High Adherence to Treatment. 具有心血管风险因素的工龄患者在治疗依从性高的情况下出现相关临床症状的预测因素。
IF 0.5 4区 医学 Q3 Medicine Pub Date : 2024-01-31 DOI: 10.18087/cardio.2024.1.n2594
N A Koziolova, A I Chernyavina, E A Polyanskaya

Aim: To determine predictors for the development of associated clinical conditions (ACC) in patients of working age with cardiovascular risk factors (CVRFs) in the conditions of high compliance with the treatment and healthy lifestyle (HLS).

Material and methods: The study included 364 patients with CVRFs without target organ damage and a history of ACC. Mean age was 42.24±8.08 years. Patients were examined in consistency with the Russian Society of Cardiology (RSC) 2020 guidelines for arterial hypertension and chronic heart failure. The follow-up period was 6.45±0.42 years. 350 patients completed the study, 9 patients died during the follow-up period, and 5 were lost to follow-up. Patients were divided into two groups based on the development of ACC. The first group consisted of 56 (16%) patients with verified ACC, the second group included 294 (84%) patients without ACC.

Results: Regression logistic and correlation analyses confirmed the prognostic significance for the development of ACC by 12 indicators. The risk of ACC in smokers was increased more than 7 times (odds ratio (OR) 7.44, 95% confidence interval (CI): 3.42-16.21), and when type 2 diabetes mellitus (DM) developed, more than 9 times (OR 9.47, 95% CI: 4.36-20.59); with chronic kidney disease (CKD), more than 6 times (OR 6.75, 95% CI: 3.41-13, 37); with a history of COVID-19 (COronaVIrus Disease 2019) pneumonia, 7 times (OR 7.11, 95% CI: 3.04-16.58); with left ventricular hypertrophy (LVH), 6 times (OR 6, 35, 95% CI: 3.14-12.83); with CAVI index>7.2, almost 3 times (OR 2.69, 95% CI: 1.48-4.86); with PVWcf (carotid-femoral pulse wave velocity) >13 m/s, more than 5 times (OR 5.61, 95% CI: 2.79-11.28); with R-AI index (augmentation index) >1, more than 2 times (OR 2.26, 95% CI: 1.3-3.9); and with an increase in the indexed left atrial volume (ILAV) >27 ml/m2, more than 8 times (OR 8.80, 95% CI: 4.61-16.79). In the presence of polymorphisms in the form of homozygosity for the minor allele of the AGT gene (Thr174Met, rs4762), the risk of developing ACC increased 14 times (OR 14.13, 95% CI: 4.69-42.57), the APOE gene (Cys130Arg, rs429358), 11 times (OR 11.18, 95% CI: 4.18-29.93), and in the intron of the PRARα gene (rs4253778), 8 times (OR 8.11, 95% CI: 3.75-17.53).

Conclusion: The development of ACC in patients with high compliance with treatment and a healthy lifestyle is associated with smoking, type 2 diabetes and CKD, a history of COVID-19 pneumonia, LVH, increased ILAV >27 g/m2, more pronounced arterial stiffness assessed by an increase in CAVI indices >7.2, R-AI >1, and PWVcf >13 m/s; and with the presence of polymorphism of the AGT, APOE and PPARα genes in the form of homozygosity for the minor allele.

目的:确定在高度遵从治疗和健康生活方式(HLS)的条件下,具有心血管风险因素(CVRFs)的工龄患者出现相关临床症状(ACC)的预测因素:研究对象包括 364 名无靶器官损害且有 ACC 病史的心血管危险因素患者。平均年龄为(42.24±8.08)岁。根据俄罗斯心脏病学会(RSC)2020 年动脉高血压和慢性心力衰竭指南对患者进行了检查。随访时间为 6.45±0.42 年。350名患者完成了研究,9名患者在随访期间死亡,5名患者失去了随访机会。根据 ACC 的发展情况,患者被分为两组。第一组包括56名(16%)已证实患有ACC的患者,第二组包括294名(84%)未患有ACC的患者:结果:回归逻辑分析和相关分析证实,12项指标对ACC的发生具有预后意义。吸烟者发生 ACC 的风险增加了 7 倍多(比值比 (OR) 7.44,95% 置信区间 (CI):3.42-16.21),发生 2 型糖尿病 (DM) 的风险增加了 9 倍多(OR 9.47,95% CI:4.36-20.59);有慢性肾脏病(CKD)时,超过6倍(OR 6.75,95% CI:3.41-13,37);有COVID-19(COronaVIrus Disease 2019)肺炎病史时,超过7倍(OR 7.11,95% CI:3.04-16.58);有左心室肥厚(LVH),6倍(OR 6,35,95% CI:3.14-12.83);有CAVI指数>7.2,近3倍(OR 2.69,95% CI:1.48-4.86);有PVWcf(颈动脉-股动脉脉搏波速度)>13 m/s,超过5倍(OR 5.61,95% CI:2.79-11.28);R-AI指数(增强指数)>1,超过2倍(OR 2.26,95% CI:1.3-3.9);指数化左心房容积(ILAV)>27 ml/m2增加,超过8倍(OR 8.80,95% CI:4.61-16.79)。如果存在 AGT 基因小等位基因(Thr174Met,rs4762)同源多态性,则患 ACC 的风险增加 14 倍(OR 14.13,95% CI:4.69-42.57),APOE基因(Cys130Arg,rs429358)增加11倍(OR 11.18,95% CI:4.18-29.93),PRARα基因内含子(rs4253778)增加8倍(OR 8.11,95% CI:3.75-17.53):结论:在治疗依从性高、生活方式健康的患者中,ACC的发生与吸烟、2型糖尿病和慢性肾脏病、COVID-19肺炎病史、LVH、ILAV增加(27 g/m2)、CAVI指数增加(7.2、R-AI >1和脉搏波速度(PWVcf >13 m/s)的增加、AGT、APOE和PPARα基因的多态性(小等位基因的同源性)。
{"title":"Predictors of the Development of Associated Clinical Conditions in Working-Age Patients With Cardiovascular Risk Factors in Conditions of High Adherence to Treatment.","authors":"N A Koziolova, A I Chernyavina, E A Polyanskaya","doi":"10.18087/cardio.2024.1.n2594","DOIUrl":"10.18087/cardio.2024.1.n2594","url":null,"abstract":"<p><strong>Aim: </strong>To determine predictors for the development of associated clinical conditions (ACC) in patients of working age with cardiovascular risk factors (CVRFs) in the conditions of high compliance with the treatment and healthy lifestyle (HLS).</p><p><strong>Material and methods: </strong>The study included 364 patients with CVRFs without target organ damage and a history of ACC. Mean age was 42.24±8.08 years. Patients were examined in consistency with the Russian Society of Cardiology (RSC) 2020 guidelines for arterial hypertension and chronic heart failure. The follow-up period was 6.45±0.42 years. 350 patients completed the study, 9 patients died during the follow-up period, and 5 were lost to follow-up. Patients were divided into two groups based on the development of ACC. The first group consisted of 56 (16%) patients with verified ACC, the second group included 294 (84%) patients without ACC.</p><p><strong>Results: </strong>Regression logistic and correlation analyses confirmed the prognostic significance for the development of ACC by 12 indicators. The risk of ACC in smokers was increased more than 7 times (odds ratio (OR) 7.44, 95% confidence interval (CI): 3.42-16.21), and when type 2 diabetes mellitus (DM) developed, more than 9 times (OR 9.47, 95% CI: 4.36-20.59); with chronic kidney disease (CKD), more than 6 times (OR 6.75, 95% CI: 3.41-13, 37); with a history of COVID-19 (COronaVIrus Disease 2019) pneumonia, 7 times (OR 7.11, 95% CI: 3.04-16.58); with left ventricular hypertrophy (LVH), 6 times (OR 6, 35, 95% CI: 3.14-12.83); with CAVI index&gt;7.2, almost 3 times (OR 2.69, 95% CI: 1.48-4.86); with PVWcf (carotid-femoral pulse wave velocity) &gt;13 m/s, more than 5 times (OR 5.61, 95% CI: 2.79-11.28); with R-AI index (augmentation index) &gt;1, more than 2 times (OR 2.26, 95% CI: 1.3-3.9); and with an increase in the indexed left atrial volume (ILAV) &gt;27 ml/m2, more than 8 times (OR 8.80, 95% CI: 4.61-16.79). In the presence of polymorphisms in the form of homozygosity for the minor allele of the AGT gene (Thr174Met, rs4762), the risk of developing ACC increased 14 times (OR 14.13, 95% CI: 4.69-42.57), the APOE gene (Cys130Arg, rs429358), 11 times (OR 11.18, 95% CI: 4.18-29.93), and in the intron of the PRARα gene (rs4253778), 8 times (OR 8.11, 95% CI: 3.75-17.53).</p><p><strong>Conclusion: </strong>The development of ACC in patients with high compliance with treatment and a healthy lifestyle is associated with smoking, type 2 diabetes and CKD, a history of COVID-19 pneumonia, LVH, increased ILAV &gt;27 g/m2, more pronounced arterial stiffness assessed by an increase in CAVI indices &gt;7.2, R-AI &gt;1, and PWVcf &gt;13 m/s; and with the presence of polymorphism of the AGT, APOE and PPARα genes in the form of homozygosity for the minor allele.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139698898","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}
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Kardiologiya
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