Kardiologiya最新文献

Aim    Search for subclinical manifestations of cardiotoxicity in cancer patients at high and very high risk of cardiotoxicity and evaluation of the effectiveness of drug primary prevention during the antitumor treatment. Material and methods    The study included 150 cancer patients with a high and very high Mayo Clinic (USA) Cardiotoxicity Risk Score. The main group consisted of 84 patients at high and very high risk of cardiotoxicity who were prescribed cardioprotective therapy, including a fixed combination of the angiotensin-converting enzyme inhibitor (ACEI) perindopril and the beta-blocker bisoprolol with trimetazidine. The comparison group consisted of 66 patients who refused cardioprotective drugs or had intolerance to them. All patients underwent 24-hour ambulatory blood pressure monitoring (ABPM) and multibiomarker analysis, including measurements of troponin I (TnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), myeloperoxidase (MPO), soluble tumor suppressor type 2 (sST2), and two-dimensional echocardiography (EchoCG) with assessment of left ventricular global longitudinal systolic strain (LV GLS) before chemotherapy and 1, 3, 6, 9, and 12 months after the start of cardiotoxic antitumor therapy. Results    In patients of the comparison group already at 6 months, the left atrial volume index (LAVI) was significantly increased, and the left ventricular end-diastolic volume index (LVEDVi) showed a tendency towards an increase reaching a significant difference by 9 months of observation. In the main group, these parameters did not significantly change during the study. At the last stage of observation, there were statistically significant differences in LAVI and LVEDVi between the compared groups. The dynamics of LV GLS in the compared groups showed multidirectional changes. In the main group, this parameter remained virtually unchanged while in the comparison group, it decreased by ≥15% in 13 patients and reached a statistically significant difference. Clinically pronounced cardiotoxicity and a decrease in the left ventricular ejection fraction (LVEF) developed in 7 of these patients. During the antitumor treatment, the concentrations of the biomarkers remained within the reference values, with the exception of TnI. The greatest differences between the groups were noted in the analysis of mortality. Thus, by the final visit, 13.1% of patients had died in the main group while in the comparison group, mortality was almost two times higher and reached 22.7%. Conclusion    The study demonstrated clinical effectiveness of the cardioprotective therapy in cancer patients at high and very high risk of cardiotoxicity. The patients who did not receive the primary drug prevention of cardiovascular toxicity had a statistically significant impairment of the LV systolic function, an increased number of developed complications, and a higher mortality.

Aim    To compare the long-term effectiveness of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in patients with atrial fibrillation (AF).Material and methods    This retrospective single-site study included 597 patients with AF who had undergone CBA (n=241) or RFA (n=356) between 2016 and 2024. The study participants included 355 men (59.5%) and 242 women (40.5%) aged 58.4±10.8 years. The follow-up period was 13.0 [10.0; 27.5] months. The primary endpoint was late recurrence of AF (≥90 days after catheter ablation (CA)) confirmed by electrocardiography (ECG) or ECG Holter monitoring. To minimize confounding, the groups were compared by the propensity score matching (PSM, 234 pairs). The absence of AF recurrence was analyzed using Kaplan-Meier survival curves and group comparison with the log-rank test. Predictors for an increased risk of AF recurrence were identified by the univariate and multivariate Cox regression analysis. Results    With the use of PSM, late AF recurrence was found in 41 (17.5%) patients after CBA and in 85 (36.3%) after RFA (p<0.001). Thus, at 48 months after CA, AF recurrence was absent in 70% of patients in the CBA group and 53% patients in the RFA group; the difference between the groups was statistically significant (log-rank p=0.005). In the multivariate Cox analysis, independent predictors of AF recurrence were body mass index (BMI) (odds ratio (OR) 1.11; 95% confidence interval (CI) 1.05-1.18; p<0.001) and early AF recurrence within 90 days (OR 4.43; 95% CI 2.72-7.21; p<0.001). Conclusion    According to the study univariate analysis, CBA showed an advantage over RFA in terms of the efficacy in the long-term period. Body mass index and early AF recurrence were independent predictors of late AF recurrence after CA.

Background Hyperuricemia (HUA) frequently coexists with coronary artery disease (CAD) and is linked to adverse cardiovascular outcomes. The long-term impact of urate-lowering therapy (ULT) on clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), in CAD patients after percutaneous coronary intervention (PCI) has not been determined. That was the aim of this study.Material and methods In this retrospective cohort study, we included 649 patients with HUA who underwent PCI between July 2014 and May 2020. Patients who received standardized ULT for at least one month post-PCI were assigned to the treatment group, while those untreated or nonadherent were assigned to the non-treatment group. Outcomes were assessed using Kaplan-Meier survival curves, multivariate Cox regression models, and propensity score matching. Preoperative and postoperative cardiac function, including left ventricular ejection fraction and right ventricular systolic pressure (RVSP), was evaluated.Results Over a median follow-up of 6.32 years, the incidence of all-cause mortality was 30.41 per 1,000 personyears, and MACEs occurred at a rate of 45.90 per 1,000 person-years. ULT was associated with a significant reduction in all-cause mortality (hazard ratio [HR]: 0.915; 95 % confidence interval [CI]: 0.645-0.998) and MACEs (HR: 0.887; 95 % CI: 0.661-0.990). Subgroup and sensitivity analyses confirmed these benefits, regardless of baseline uric acid (UA) concentrations or early UA normalization.Notably, ULT was most effective in reducing cardiovascular mortality and myocardial infarction, with no significant effect on stroke or heart failure. Cardiac function in the treatment group improved post- PCI, with significant improvements in diastolic function and RVSP. In a sensitivity analysis using propensity score matching, the protective effect of ULT on both all-cause mortality and MACEs remained robust, reinforcing the conclusions of the primary analyses.Conclusion Early initiation of ULT in patients with HUA after PCI is associated with improved long-term survival, reduced MACEs, and better cardiac function. These findings underscore the clinical value of ULT.

Pulmonary embolism (PE) is a complex emergency condition, the diagnosis and treatment of which still have many unresolved issues and "gray areas". Current clinical guidelines for the management of patients with PE are partly outdated and do not take into account a number of modern data. In this review, the authors identified unresolved issues and provided the latest data on the assessment of pre-test probability, risk stratification, diagnosis and treatment of acute PE, particularly in patients with intermediate-high and high risk of death. The issues of reperfusion catheter techniques and intensive care are addressed individually. The requirement for specialized PE centers of expert level and their prospects are discussed.

Aim     To study the activation sequence of compensatory mechanisms during the development of diastolic dysfunction.Material and methods            The study was performed on rats with stress cardiomyopathy induced by high doses of isoproterenol (120 mg/kg twice a day). Heart function was studied 3-5 and 8-10 days after the injection by echocardiography and left ventricular (LV) catheterization. The content, isoform composition of the sarcomeric protein connectin (titin) and its mRNA content were also measured.Results            The early period was characterized by the presence of systolic dysfunction evident as a decrease in the minute volume due to impaired myocardial  LV contractility, and slower LV filling and relaxation. Compensatory changes at this stage were manifested as increases in the left atrial volume and diastolic pause duration due to reduced contraction rate and arterial elasticity. The content of the more compliant N2BA connectin isoform and its mRNA was increased. These changes facilitated increases in LV filling and ejection. In the second period, diastolic dysfunction developed, when the minute volume, contraction rate and LV contractility became normal, although the left atrial pressure remained elevated, and the aortic diameter and LV wall thickness increased. The increased content of the N2BA isoform remained, and this was associated with stable slowing of LV relaxation.Conclusion      The study showed that in the initial period, compensation is achieved by urgent mobilization of the circulatory system, while the improvement in myocardial contractility is secondary.

Aim     To assess the effect of annual seasonal flu vaccination for 3 years on the risk of acute respiratory infection (ARI) and cardiovascular events (CVE) in cardiological patients followed up using two analytical methods.Material and methods            This prospective comparative study included 817 patients in October 2012. CVE, other chronic non-communicable diseases, and ARI recorded from October 2012 through November 2015 were analyzed. Vaccinated and unvaccinated patients were compared using survival curves and a self-controlled case series method for paired 6-month periods. Differences were considered statistically significant at p<0.05.Results            The analysis included 813 patients (mean age, 63.3±11.6 years; 40.5% men; in the 2012/13-2013/14-2014/15 season, 45-44-41% of patients, respectively, were vaccinated; 1, 2, and 3 vaccinations were received by 60, 57, and 285 patients, respectively; 413 were unvaccinated). Compared to unvaccinated patients, the patients vaccinated three times developed the first ARI later (p<0.0001); the relative risk of developing cardiovascular complications (CVC) was 0.88 (95% confidence interval: 0.65-1.10). Among vaccinated patients, there were fewer patients with ARI (p<0.001) and cardiovascular diseases (p=0.02) not only in summer compared to winter, but also in summer, ARI developed in 41.2% fewer patients than in unvaccinated (p=0.002).Conclusion      The use of two analytical methods allowed us to identify additionally both non-specific and persistent specific effects of three-year flu immunization in cardiological patients in summer, which needs to be confirmed in randomized placebo-controlled studies.

Aim    To analyze the biomechanics of the thoracic aorta (TA) in degenerative calcific aortic stenosis (AS) using segmental ultrasound assessment of the aortic wall deformation.Material and methods        A total of 109 patients with severe AS and 11 healthy volunteers were evaluated. 2D speckle-tracking transesophageal echocardiography was performed in all patients. We calculated the global peak systolic circumferential strain (GCS, %), GCS normalized to pulse arterial pressure (GCS/PAP), and β2 stiffness index (SI) of the aortic wall at 4 levels of the TA: sinuses of Valsalva (SV), sinotubular junction (STJ), mid-ascending aorta (AA), and descending aorta (DA).Results In patients with aortic stenosis, GCS and GCS/PAP in all TA segments were statistically significantly lower than in healthy volunteers (SV: 3.1 [1.3; 4.4] and 3.8 [1.5; 5.9]; 12.2 [9.9; 13.4] and 20.2 [17; 28.6], p<0.001; at STJ level: 4.5 [2.4; 6.5] and 5.7 [3.3; 8.7]; 8.4 [5.6; 10] and 14.7 [10.9; 18.6], p<0.001; at AA level: 3.1 [0.8; 4.7] and 3.9 [1.4; 6.4]; 8.6 [7.6; 11.7] and 18.0 [12.1; 20.2], p<0.001; DA: 3.9 [3.1; 6] and 5.6 [3.6; 8.4]; 10.4 [7; 11.2] and 17.2 [14.1; 21.5], p<0.001, respectively). Furthermore, the SI in AS patients was statistically significantly increased to 19.1 [12.9; 26.5] and 4.8 [3.6; 5.3], p<0.001 in SV; 13.4 [10.1; 19.9] and 6.7 [5.6; 8.3], p<0.001 at STJ level; 17.8 [13.4; 26.9] and 5.6 [4.6; 8.1], p<0.001 at AA; 17.2 [11.1; 25.3] and 5.6 [4.6; 7.4], p<0.001 at DA, respectively. 69 (63.3%) AS patients had multidirectional GCS of the aortic wall in the aortic root and the TA ascending and descending sections. Patients with AS showed a uniform decrease in GCS and GCS/PAD and an increase in the SI and diameters in all TA segments from the aortic annulus to the descending section. In all AA segments, GCS, GCS/PAD and SI did not differ between AS patients with bicuspid aortic valve (AV) (n=47) and tricuspid AV (n=62) (p>0.05). An inverse correlation was found between the mean transaortic pressure gradient and GCS and GCS/PAD in the SV (r=-0.33; p<0.01, and r=-0.26; p<0.01, respectively) and in the AA (r=-0.23; p<0.05 and r=-0.21; p<0.05, respectively).Conclusion    Severe AS is associated with non-adaptive remodeling of the TA, reduced and multidirectional deformation along the circumference of the aortic wall in the aortic root, and the TA ascending and descending segments, which is closely related to disorders of transaortic hemodynamics.

Aim Atrial fibrillation (AF) and heart failure (HF) are prevalent cardiovascular conditions. The estimated glomerular filtration rate (eGFR) is a crucial marker for assessing kidney function and has demonstrated prognostic significance in various cardiovascular diseases. However, its specific impact on patients with both AF and HF remains unclear.Material and methods This retrospective cohort study utilized data from the MIMIC-IV database, focusing on a subset of ICU patients diagnosed with both atrial fibrillation (AF) and heart failure (HF). Patients were categorized based on eGFR levels, and the association between eGFR and all-cause ICU mortality, as well as 28‑day post-discharge mortality, was analyzed using the Cox proportional hazards model.Results Analysis revealed significant differences (p<0.001) in age, ICU length of stay, and prevalence of chronic diseases across different eGFR groups. As eGFR increased, the risk of death (HR) significantly decreased. The group with the lowest eGFR (first quartile, Q1) had the highest mortality risk, whereas the highest eGFR group (Q4) showed a protective effect (HR=1.14, P=0.019). There was a significant non-linear relationship between eGFR and all-cause mortality (p<0.001). Lower eGFR levels substantially increased mortality risk, highlighting eGFR as a key prognostic indicator for AF patients with HF. Survival probability and mortality risk varied significantly among different eGFR levels (HR=0.54, 95 % CI: 0.48- 0.60, p<0.001). These findings underscore the importance of monitoring and intervening in renal function.Conclusion Lower eGFR levels are independently linked to higher all-cause mortality in patients with AF and HF.

Objective To explore the clinical application value of right ventricular (RV) myocardial global longitudinal strain(RVGLS) in assessing changes in RV function in patients with pulmonary embolism.Material and methods Patients with pulmonary embolism who were treated successfully in our hospital from January 2022 toDecember 2023 were enrolled in this study. Included were 34 pulmonary embolism patients without pulmonary hypertension (Group B), 31 with pulmonary hypertension (Group C), and 35 healthy volunteers, matched by gender and age (Group A). Clinical data and RV function-related variables of these groups were compared.Results Compared with pre-treatment values of Group A, the following variables of Groups B and C had higher pre-treatment values (p<0.05): RV end-diastolic diameter (RVEDD), RV to left ventricular diameter ratio (RV / LV), RV work index (RIMP), main pulmonary artery diameter (MPA), pulmonary artery systolic pressure (PASP), RVGLS, RV free wall longitudinal strain (RVFWLS),The following variables had lower values (p<0.05): RV area change fraction (RVFAC), RV ejection fraction (RVEF), RV short-axis shortening rate (RVFS), tricuspid annular peak systolic velocity (S'), tricuspid annular systolic excursion (TAPSE). After therapy, significant differences were observed in the aforementioned indicators between Group C (with pulmonary hypertension) and Group A (healthy controls), with Group C showing persistently elevated RVEDD, RV / LV ratio, RIMP, MPA, PASP, RVGLS, and RVFWLS, alongside reduced RVFAC, RVEF, RVFS, S', and TAPSE compared to Group A (all p<0.05). Compared to pre-treatment values in Group B (without pulmonary hypertension), pre-treatment Group C demonstrated significantly higher RVEDD, RV / LV ratio, RIMP, MPA, PASP, RVGLS, and RVFWLS, and significantly lower RVFAC, RVEF, RVFS, S', and TAPSE (all p<0.05). Post-treatment comparisons between Groups B and C revealed that these differences remained significant (all p<0.05). ROC curve analysis revealed that RVGLS> 20.59 % is the best cutoff value for predicting the occurrence of pulmonary embolism, and RVGLS> -17.42 % is the best cutoff value for predicting the occurrence of pulmonary hypertension in patients withpulmonary embolism. The results of multivariable logistic regression model analysis showed that RVGLS>-20.59 % is independently related to the occurrence of pulmonary embolism, and RVGLS>-17.42 % is independently related to pulmonary embolism complicated by pulmonary hypertension (p<0.05). In Groups A and B, RVGLS was negatively correlated with RVFAC, RVEF, and TAPSE (p<0.05 for all) and positively correlated with RIMP and PASP (p<0.05 for all). In Groups B and C, RVGLS was negatively correlated with RVFAC and RVEF in patients with pulmonary embolism before and after treatment (for all <0.05) and positively correlated with RIMP and PASP (p<0.05 for all).Conclusion RVGLS can be applied to evaluate the RV function of patien