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Role of Imaging Modalities in the Quantitative Assessment of Atherosclerotic Plaques in the Thoracic Aorta. 成像模式在胸主动脉动脉粥样硬化斑块定量评估中的作用。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2457
A V Vrublevsky, V V Saushkin

Aim: Comparative analysis of the height of atherosclerotic plaques (AP) in the descending thoracic aorta (TA) according to two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE), and contrast-enhanced multislice computed tomography (MSCT).

Material and methods: The TA was examined using 2D, 3D TEE and contrast-enhanced MSCT in 34 patients (20 men and 14 women aged 68 [62; 71] years). AP heights were compared using the Bland-Altman method and the Spearman correlation analysis. This was a blinded comparative study which assessed the AP morphometry using each of the radiation modalities without knowing the results of the method being compared.

Results: 100 APs were examined in the descending TA. The mean height of all analyzed APs in the descending TA was 2.2 mm [2; 2.7] for 2D TEE, 3.1 mm [2.7; 3.55] for 3D TEE, and 3.05 mm [2.55; 3.55] for MSCT. The AP heights measured with 2D TEE was statistically significantly smaller than the heights of similar APs measured either with 3D TEE or MSCT. The mean difference (bias) was 0.88±0.34 mm between 2D and 3D TEE, and 0.83±0.41 mm between 2D TEE and MSCT. The correlation coefficients for the AP heights were r=0.87 (p<0.001) between 2D and 3D TEE and r=0.86 (p<0.001) between 2D TEE and MSCT. There were no differences in the height of similar APs between 3D TEE and MSCT.

Conclusion: The three-dimensional reconstruction of AP in the TA by TEE is more accurate for quantitative assessment of AP than a two-dimensional study.

目的:根据二维(2D)和三维(3D)经食道超声心动图(TEE)以及对比增强多层计算机断层扫描(MSCT)对降主动脉(TA)中动脉粥样硬化斑块(AP)的高度进行比较分析:使用二维、三维 TEE 和对比增强 MSCT 对 34 名患者(男性 20 人,女性 14 人,年龄 68 [62; 71] 岁)的 TA 进行了检查。使用 Bland-Altman 方法和 Spearman 相关性分析比较了 AP 高度。这是一项盲法比较研究,在不了解比较方法结果的情况下,使用每种放射模式对 AP 形态学进行评估:在降序TA中检查了100个AP。二维 TEE、三维 TEE 和 MSCT 所分析的 TA 降支动脉 AP 的平均高度分别为 2.2 毫米 [2; 2.7]、3.1 毫米 [2.7; 3.55]和 3.05 毫米 [2.55; 3.55]。二维 TEE 测量的 AP 高度在统计学上明显小于三维 TEE 或 MSCT 测量的类似 AP 高度。二维和三维 TEE 之间的平均差(偏差)为 0.88±0.34 毫米,二维 TEE 和 MSCT 之间的平均差(偏差)为 0.83±0.41 毫米。二维和三维 TEE 之间 AP 高度的相关系数为 r=0.87 (p<0.001),二维 TEE 和 MSCT 之间的相关系数为 r=0.86 (p<0.001)。结论:结论:TEE 对 TA AP 的三维重建比二维研究更能准确定量评估 AP。
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引用次数: 0
[Morphofunctional Analysis of the Role of Epicardial Adipose Tissue in the Formation of the Obesity Paradox in Chronic Heart Failure]. [心外膜脂肪组织在慢性心力衰竭肥胖悖论形成中的作用的形态功能分析]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2469
V E Milyukov, V A Bryukhanov, C C Nguyen

Based on the available modern medical literature, the article summarizes data on the morpho-functional significance of epicardial adipose tissue (EAT) in health and heart failure, analyzes the likelihood and reliability of the formation of the obesity paradox, and also discusses its possible morpho-functional mechanisms. The authors reviewed and analyzed the consequences of the obesity paradox in the aspect of the normal EAT phenotype protectivity. The review proposed ways of further research in this direction aimed at a deep anatomical and physiological analysis and at determining the morpho-functional role of EAT in the adaptive mechanisms of myocardial trophic provision, which may be an important part of the pathogenetic connection between obesity and CHF and, therefore, can improve outcomes in such patients.

文章根据现有的现代医学文献,总结了心外膜脂肪组织(EAT)在健康和心力衰竭中的形态功能意义,分析了肥胖悖论形成的可能性和可靠性,并讨论了其可能的形态功能机制。作者回顾并分析了肥胖悖论在正常 EAT 表型保护性方面的后果。这可能是肥胖与慢性心力衰竭之间病理联系的重要组成部分,因此可以改善此类患者的预后。
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引用次数: 0
Interleukin 6 Signalling in Heart Failure With Preserved and Reduced Ejection Fraction. 白细胞介素 6 信号在射血分数保留和降低的心力衰竭中的作用
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-03-31 DOI: 10.18087/cardio.2024.3.n2534
E V Samoilova, A А Korotaeva, I V Zhirov, Yu O Aksenova, S N Nasonova, S N Tereschenko

Aim: Identification of interleukin-6 (IL-6) signaling pathways in patients with chronic heart failure (CHF).

Material and methods: The diversity of IL-6 effects is due to the presence of classical signaling and trans-signaling pathways. The study included 164 patients with CHF hospitalized for acute decompensated heart failure (ADHF), of which 129 had reduced left ventricular ejection fraction (HFrEF), and 35 had preserved ejection fraction (HFpEF). Blood concentrations of IL-6, soluble IL-6 receptor (sIL-6R), soluble transducer protein gp130 (sgp130), and high-sensitivity C-reactive protein (hsCRP) were measured.

Results: Patients with HFpEF had lower concentrations of IL-6 (6.15 [2.78, 10.65] pg/ml) and hsCRP (11.27 [5.84, 24.40] mg/ml) than patients with HFrEF (9.20 [4.70; 15.62] pg/ml and 17.23 [8.70; 34.51 mg/ml], respectively). In contrast, concentrations of rIL-6R were higher in HFpEF (59.06 [40.00; 75.85] ng/ml) than in HFrEF (49.15 [38.20; 64.89] ng/ml). Concentrations of sgp130 were not significantly different. In patients with HFrEF, positive correlations were found between the concentrations of IL-6 and hsCRP, IL-6 and rIL-6R, and IL-6 and sgp130, while in patients with HFpEF, there was a correlation only between IL-6 and hsCRP, which appeared stronger than in patients with HFrEF (r=0.698; p<0.001 and r=0.297; p<0.05, respectively).

Conclusion: Classical IL-6 signaling and trans-signaling are expressed to different degrees in patients with HFrEF and HFpEF in ADHF. The results of the study supplement the existing knowledge about the pathogenesis of inflammation in CHF and may contribute to the development of new methods and approaches to the treatment of the disease.

目的:鉴定慢性心力衰竭(CHF)患者的白细胞介素-6(IL-6)信号通路:IL-6作用的多样性是由于经典信号传导途径和跨信号传导途径的存在。研究纳入了164名因急性失代偿性心力衰竭(ADHF)住院的CHF患者,其中129人左室射血分数降低(HFrEF),35人射血分数保留(HFpEF)。测量了血液中IL-6、可溶性IL-6受体(sIL-6R)、可溶性转导蛋白gp130(sgp130)和高敏C反应蛋白(hsCRP)的浓度:HFpEF患者的IL-6浓度(6.15 [2.78, 10.65] pg/ml)和hsCRP浓度(11.27 [5.84, 24.40] mg/ml)低于HFrEF患者(分别为9.20 [4.70; 15.62] pg/ml和17.23 [8.70; 34.51 mg/ml])。相比之下,HFpEF 患者的 rIL-6R 浓度(59.06 [40.00; 75.85] 纳克/毫升)高于 HFrEF 患者(49.15 [38.20; 64.89] 纳克/毫升)。sgp130 的浓度没有明显差异。在HFrEF患者中,IL-6与hsCRP、IL-6与rIL-6R、IL-6与sgp130的浓度呈正相关,而在HFpEF患者中,只有IL-6与hsCRP之间存在相关性,且相关性似乎比HFrEF患者更强(分别为r=0.698;p<0.001和r=0.297;p<0.05):结论:经典的IL-6信号传导和跨信号传导在ADHF的HFrEF和HFpEF患者中有不同程度的表达。该研究结果补充了现有的有关 CHF 炎症发病机制的知识,可能有助于开发治疗该疾病的新方法和途径。
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引用次数: 0
[Whether to implant a defibrillator or not? The Possibility of Using the MADIT-ICD Benefit Score Calculator in Real Practice]. [是否植入除颤器?在实际应用中使用 MADIT-ICD 效益评分计算器的可能性]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2447
N N Ilov, S A Boytsov, A A Nechepurenko

Aim: To study the predictive capabilities of the MADIT-ICD Benefit Score calculator in assessing the benefit of implantable cardioverter defibrillator (ICD) placement for the primary prevention of sudden cardiac death (SCD).

Material and methods: This study included 388 patients with NYHA II-IV functional class chronic heart failure (CHF) with a left ventricular ejection fraction (LVEF) ≤35 % who underwent ICD placement for the primary prevention of SCD. Patients were followed up for two years to record the endpoints of first-time paroxysmal sustained ventricular tachyarrhythmia (VT) or non-arrhythmic death.

Results: According to the results of calculation with the MADIT-ICD Benefit Score calculator, 276 (71 %) patients had a high risk of VT (score ≥7) and 150 (39 %) had a high risk of non-arrhythmic death (score ≥3). 336 (94%) patients would benefit from an ICD: 148 (38 %) with a high level of probability and 218 (56 %) with a medium level of probability. According to the incidence of endpoints, VT episodes predominated in the low-ICD benefit group (36%), while the high-ICD benefit group had a relatively high incidence of non-arrhythmic death (12%).

Conclusion: The results obtained for a cohort of Russian patients with CHF and reduced LVEF indicated that the use of the MADIT-ICD Benefit Score in routine clinical practice does not improve the stratification of SCD risk compared to the traditional approach to selecting patients with CHF for ICD based on the LVEF value.

目的:研究MADIT-ICD获益评分计算器在评估植入式心律转复除颤器(ICD)用于心脏性猝死(SCD)一级预防的获益方面的预测能力:该研究纳入了388名左室射血分数(LVEF)≤35%的NYHA II-IV功能分级慢性心力衰竭(CHF)患者,这些患者接受了ICD置入术,用于SCD的一级预防。对患者进行为期两年的随访,记录首次阵发性持续室性心动过速(VT)或非心律失常死亡的终点:根据 MADIT-ICD 效益评分计算器的计算结果,276 名(71%)患者有 VT 的高风险(评分≥7),150 名(39%)患者有非心律失常死亡的高风险(评分≥3)。336(94%)名患者将从 ICD 中获益:148(38%)名患者有高风险,218(56%)名患者有中风险。根据终点的发生率,VT 发作在低 ICD 受益组中占多数(36%),而高 ICD 受益组的非心律失常死亡发生率相对较高(12%):对一组 LVEF 降低的俄罗斯 CHF 患者的研究结果表明,在常规临床实践中使用 MADIT-ICD 收益评分与根据 LVEF 值为 CHF 患者选择 ICD 的传统方法相比,并不能改善 SCD 风险分层。
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引用次数: 0
Evaluation of the Relationship Between Vitamin D Deficiency and Subclinical Cardiac Dysfunction Using 2D/3D Strain Echocardiography in Healthy People. 使用二维/三维应变超声心动图评估健康人维生素 D 缺乏与亚临床心功能障碍之间的关系
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2331
Demet Menekse Gerede Uludag, Berna Imge Aydogan, Türkan Seda Tan, Aynur Acıbuca, Nazlı Turan, Rıfat Emral, Irem Dincer, Cetin Erol

Aim: Vitamin D deficiency has a high prevalence in the population and is highly associated with cardiovascular diseases. The aim of this study was to evaluate subclinical left ventricular (LV) function using strain analysis in healthy individuals with vitamin D deficiency.

Material and methods: 113 healthy volunteers were enrolled in the study (age, 44.1±7 yrs, 34 male). All volunteers underwent two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography after conventional echocardiographic evaluation. The subjects were divided into two groups according to their vitamin D concentrations. 61 subjects with vitamin D less than 20 ng / ml were included in the vitamin D deficiency group. The baseline clinical characteristics, laboratory measurements, echocardiographic data, including 2D and 3D global longitudinal strain (GLS) values, were compared between the groups.

Results: The 2D GLS values of the subjects with vitamin D deficiency were lower (mathematically less negative) than subjects with normal vitamin D (-16.1±3.4 vs -19.3±4.2, p<0.001). Similarly, the 3D GLS results were lower in subjects with vitamin D deficiency (-18.3±5.2 vs -24.1±6.9, p<0.001). A significant correlation was detected between the vitamin D concentrations and the 2D and 3D GLS measurements. (r=0.765 and r=0.628, respectively, p<0.001). Vitamin D was found to be an independent predictor of impaired 2D and 3D LV GLS (p=0.031, p=0.023, respectively).

Conclusion: Subclinical LV dysfunction in healthy individuals with vitamin D deficiency was demonstrated by 3D and 2D strain analysis. Due to potential negative effects of vitamin D deficiency on cardiac function, more attention should be paid to healthy individuals with vitamin D deficiency.

目的:维生素 D 缺乏症在人群中的发病率很高,并且与心血管疾病密切相关。本研究旨在利用应变分析评估维生素 D 缺乏症健康人的亚临床左心室(LV)功能。在常规超声心动图评估后,所有志愿者均接受了二维(2D)和三维(3D)斑点追踪超声心动图检查。受试者按维生素 D 浓度分为两组。维生素 D 低于 20 纳克/毫升的 61 名受试者被纳入维生素 D 缺乏组。对两组受试者的基线临床特征、实验室测量结果、超声心动图数据(包括二维和三维全局纵向应变(GLS)值)进行比较:结果:与维生素 D 正常的受试者相比,维生素 D 缺乏者的二维 GLS 值更低(数学负值更小)(-16.1±3.4 vs -19.3±4.2,p<0.001)。同样,维生素 D 缺乏者的 3D GLS 结果也较低(-18.3±5.2 vs -24.1±6.9,p<0.001)。维生素 D 浓度与二维和三维 GLS 测量结果之间存在明显的相关性。(分别为 r=0.765 和 r=0.628,p<0.001)。维生素 D 是二维和三维左心室 GLS 受损的独立预测因子(分别为 p=0.031 和 p=0.023):结论:三维和二维应变分析表明,维生素D缺乏的健康人存在亚临床左心室功能障碍。由于维生素 D 缺乏对心脏功能有潜在的负面影响,因此应更加关注维生素 D 缺乏的健康人。
{"title":"Evaluation of the Relationship Between Vitamin D Deficiency and Subclinical Cardiac Dysfunction Using 2D/3D Strain Echocardiography in Healthy People.","authors":"Demet Menekse Gerede Uludag, Berna Imge Aydogan, Türkan Seda Tan, Aynur Acıbuca, Nazlı Turan, Rıfat Emral, Irem Dincer, Cetin Erol","doi":"10.18087/cardio.2024.2.n2331","DOIUrl":"10.18087/cardio.2024.2.n2331","url":null,"abstract":"<p><strong>Aim: </strong>Vitamin D deficiency has a high prevalence in the population and is highly associated with cardiovascular diseases. The aim of this study was to evaluate subclinical left ventricular (LV) function using strain analysis in healthy individuals with vitamin D deficiency.</p><p><strong>Material and methods: </strong>113 healthy volunteers were enrolled in the study (age, 44.1±7 yrs, 34 male). All volunteers underwent two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography after conventional echocardiographic evaluation. The subjects were divided into two groups according to their vitamin D concentrations. 61 subjects with vitamin D less than 20 ng / ml were included in the vitamin D deficiency group. The baseline clinical characteristics, laboratory measurements, echocardiographic data, including 2D and 3D global longitudinal strain (GLS) values, were compared between the groups.</p><p><strong>Results: </strong>The 2D GLS values of the subjects with vitamin D deficiency were lower (mathematically less negative) than subjects with normal vitamin D (-16.1±3.4 vs -19.3±4.2, p&lt;0.001). Similarly, the 3D GLS results were lower in subjects with vitamin D deficiency (-18.3±5.2 vs -24.1±6.9, p&lt;0.001). A significant correlation was detected between the vitamin D concentrations and the 2D and 3D GLS measurements. (r=0.765 and r=0.628, respectively, p&lt;0.001). Vitamin D was found to be an independent predictor of impaired 2D and 3D LV GLS (p=0.031, p=0.023, respectively).</p><p><strong>Conclusion: </strong>Subclinical LV dysfunction in healthy individuals with vitamin D deficiency was demonstrated by 3D and 2D strain analysis. Due to potential negative effects of vitamin D deficiency on cardiac function, more attention should be paid to healthy individuals with vitamin D deficiency.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 2","pages":"73-79"},"PeriodicalIF":0.5,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095089","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
The MAPH Score Predicts Coronary Slow Flow. A Retrospective Case-Controlled Study. MAPH 评分可预测冠状动脉慢血流。一项回顾性病例对照研究。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2322
Mustafa Kaplangoray, Kenan Toprak, Cihan Aydın, Yusuf Cekici, Arafat Yıldırım, Ozge Ozcan Abacıoglu

Aim: The MAPH score is a new score that combines mean platelet volume (MPV), hematocrit, and total protein, which are markers of whole blood viscosity (WBV). We aimed to investigate the relationship between the MAPH score and the coronary slow flow phenomenon (CSF).

Material and methods: A total of 201 patients were included in the study. 105 had CSF and 96 had normal coronary flow (NCF). Coronary flow was measured by the Thrombolysis in Myocardial Infarction frame count (TFC) method. The patients' MPV, age, hematocrit, and total protein were recorded. High (HSR) and low shear rates (LSR) were calculated, based on total protein and hematocrit values. Cut-off values for CSF were determined using the Youden's index, and the score was determined as 0 or 1 according to the cut-off values. The sum of these scores was the MAPH score.

Results: The mean age of the patients included in the study was 51.1±7.9 (n=201, 54.2 % male). Hyperlipidemia, DM, and HT rates of both groups were similar, but the mean age of the CSF group was higher (p=0.773; p=0.549; p=0.848; p <0.001, respectively). Total protein, MPV, hematocrit, HSR and LSR were higher in the CSF group (p< 0.001, for all values). Comparative receiver operating characteristic (ROC) curve analysis showed that the performance of the MAPH score in predicting CSF is better than the performance of these parameters separately.

Conclusion: A new score, the MAPH score, may be used to identify the presence of CSF.

目的:MAPH评分是一种新的评分方法,它结合了平均血小板体积(MPV)、血细胞比容和总蛋白等全血粘度(WBV)指标。我们旨在研究 MAPH 评分与冠状动脉慢流现象(CSF)之间的关系:研究共纳入 201 名患者。105例患者有CSF,96例患者冠脉血流正常(NCF)。冠状动脉血流采用心肌梗死溶栓帧计数法(TFC)进行测量。记录了患者的 MPV、年龄、血细胞比容和总蛋白。根据总蛋白和血细胞比容值计算出高剪切率(HSR)和低剪切率(LSR)。使用尤登指数确定 CSF 的临界值,并根据临界值将分数确定为 0 或 1。这些分数的总和即为 MAPH 分数:研究对象的平均年龄为 51.1±7.9(n=201,54.2% 为男性)。两组患者的高脂血症、糖尿病和高血压发病率相似,但 CSF 组的平均年龄更高(分别为 p=0.773;p=0.549;p=0.848;p <0.001)。CSF 组的总蛋白、MPV、血细胞比容、HSR 和 LSR 均较高(所有值均为 p<0.001)。接收器操作特征曲线(ROC)比较分析表明,MAPH 评分预测 CSF 的性能优于单独预测这些参数的性能:结论:一种新的评分方法--MAPH 评分可用于识别 CSF 的存在。
{"title":"The MAPH Score Predicts Coronary Slow Flow. A Retrospective Case-Controlled Study.","authors":"Mustafa Kaplangoray, Kenan Toprak, Cihan Aydın, Yusuf Cekici, Arafat Yıldırım, Ozge Ozcan Abacıoglu","doi":"10.18087/cardio.2024.2.n2322","DOIUrl":"10.18087/cardio.2024.2.n2322","url":null,"abstract":"<p><strong>Aim: </strong>The MAPH score is a new score that combines mean platelet volume (MPV), hematocrit, and total protein, which are markers of whole blood viscosity (WBV). We aimed to investigate the relationship between the MAPH score and the coronary slow flow phenomenon (CSF).</p><p><strong>Material and methods: </strong>A total of 201 patients were included in the study. 105 had CSF and 96 had normal coronary flow (NCF). Coronary flow was measured by the Thrombolysis in Myocardial Infarction frame count (TFC) method. The patients' MPV, age, hematocrit, and total protein were recorded. High (HSR) and low shear rates (LSR) were calculated, based on total protein and hematocrit values. Cut-off values for CSF were determined using the Youden's index, and the score was determined as 0 or 1 according to the cut-off values. The sum of these scores was the MAPH score.</p><p><strong>Results: </strong>The mean age of the patients included in the study was 51.1±7.9 (n=201, 54.2 % male). Hyperlipidemia, DM, and HT rates of both groups were similar, but the mean age of the CSF group was higher (p=0.773; p=0.549; p=0.848; p &lt;0.001, respectively). Total protein, MPV, hematocrit, HSR and LSR were higher in the CSF group (p&lt; 0.001, for all values). Comparative receiver operating characteristic (ROC) curve analysis showed that the performance of the MAPH score in predicting CSF is better than the performance of these parameters separately.</p><p><strong>Conclusion: </strong>A new score, the MAPH score, may be used to identify the presence of CSF.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 2","pages":"67-72"},"PeriodicalIF":0.5,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095090","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
Ticagrelor Induced Cheyne-Stokes Respiration and Asystolic Ventricular Standstill: A Case Report. 替卡格雷诱发切恩-斯托克斯呼吸和收缩期心室停搏:病例报告。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2123
Bektaş Murat, Selda Murat, Eylem Kivanc

Ticagrelor is a potent, direct-acting, and reversible P2Y12‑adenosine diphosphate receptor blocker. It has a rapid onset of action and an intense and consistent platelet reactivity inhibition that has been demonstrated to be superior to clopidogrel in decreasing major adverse events in acute coronary syndrome (ACS). Although ticagrelor is well tolerated in ACS patients, it has side effects, such as dyspnea and bradyarrhythmia, as reported in the Platelet Inhibition and Patient Outcomes (PLATO) study. Furthermore, it was reported that ticagrelor's bradyarrhythmic potential was transient and not clinically significant beyond the acute initiation phase. Nor was there a difference in rates of syncope or need for pacemaker insertion during 30 days of follow-up. Here we report a case of ticagrelor associated with Cheyne-Stokes respiration and asystolic ventricular standstill in a patient with ACS who required resuscitation and insertion of a temporary pacemaker.

替卡格雷是一种强效、直接作用且可逆的 P2Y12 腺苷二磷酸受体阻断剂。它起效迅速,对血小板反应性的抑制强烈而稳定,在减少急性冠脉综合征(ACS)主要不良事件方面优于氯吡格雷。虽然ticagrelor在ACS患者中耐受性良好,但它也有副作用,如呼吸困难和缓慢性心律失常,这在血小板抑制和患者预后(PLATO)研究中已有报道。此外,据报道,替卡格雷的缓慢性心律失常潜能是短暂的,在急性起始阶段之后并无临床意义。在 30 天的随访中,晕厥发生率或起搏器植入需求也没有差异。在此,我们报告了一例替卡格雷与Cheyne-Stokes呼吸和收缩期心室停滞相关的ACS患者,该患者需要进行复苏并植入临时起搏器。
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引用次数: 0
[Characteristics of Inferior Myocardial Infarction With a Special Electrocardiographic Pattern (Aslanger) in Metabolic Syndrome]. [代谢综合征中具有特殊心电图模式(Aslanger)的下心肌梗死的特征]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2532
A Yu Tretyakov, O V Ermilov, S P Zakharchenko, V A Tretyakova, G V Biryukov, D P Kotova

Aim: To evaluate the features of ST-segment elevation myocardial infarction with the Aslanger pattern in comparison with traditional forms of inferior myocardial infarction in metabolic syndrome.

Material and methods: This study included 30 patients with inferior myocardial infarction in the presence of metabolic syndrome: 9 patients with the Aslanger electrocardiographic pattern (group 1, age 59.7 [58.4; 63.1] years) and the rest with one of the traditional forms (control group, 59.9 [57.2; 63.8] years, matched by all criteria of metabolic syndrome). All patients underwent primary percutaneous intervention with assessment of the angiographic picture. The magnitude of ST-segment elevation was measured in lead III at the J point and following 0.06 seconds, and the optimal threshold value of this indicator was determined for a new picture of myocardial infarction.

Results: The infarct-related artery in the Aslanger pattern was more often the circumflex artery (p=0.0099), and coronary thrombosis was characterized by a lower TIMI thrombus grade (p=0.014). SYNTAX values for the Aslanger pattern and for the traditional picture of inferior infarction with ST elevation in lead II≥III were higher than for a similar picture with ST elevation in lead III>II. The level of cTnI at admission (p=0.013) and after 24 hours (p=0.0017), the platelet count (p=0.0011) and mean volume (p=0.0047) in group 1 had smaller values than with traditional inferior infarction. The ST elevation at J point and at J+0.06 s point for lead III with the Aslanger pattern was significantly lower than values of such shift in lead III>II and lead II≥III with traditional inferior infarction (p<0.001). An elevation value ≤1.5 mm at J point +0.06 s was a predictor of infarction with the Aslanger pattern. Constructing the ROC curve made it possible to determine that with the Aslanger pattern, the best cutoff value for this index is 2 mm.

Conclusion: Myocardial infarction with the Aslanger pattern as compared with traditional lower infarction in metabolic syndrome is characterized by specific individual angiographic signs, lower ST segment elevation, cTnI level, and thrombotic disorders.

目的:评估阿斯朗格模式ST段抬高型心肌梗死与代谢综合征下壁心肌梗死传统形式的特征比较:本研究纳入了 30 名患有代谢综合征的下壁心肌梗死患者:9 名患者具有阿斯朗格心电图模式(第一组,年龄 59.7 [58.4; 63.1] 岁),其余患者具有其中一种传统心电图模式(对照组,年龄 59.9 [57.2; 63.8] 岁,符合代谢综合征的所有标准)。所有患者都接受了经皮介入治疗,并对血管造影进行了评估。在 J 点和 0.06 秒后测量导联 III 的 ST 段抬高幅度,并确定心肌梗死新图像的最佳阈值:结果:阿斯朗格模式的梗死相关动脉多为环状动脉(P=0.0099),冠状动脉血栓形成的特征是 TIMI 血栓分级较低(P=0.014)。阿斯朗格模式的 SYNTAX 值和导联 II≥III ST 基底节段抬高的传统下壁心肌梗死模式的 SYNTAX 值均高于导联 III>II ST 基底节段抬高的类似模式。第 1 组患者入院时(p=0.013)和 24 小时后(p=0.0017)的 cTnI 水平、血小板计数(p=0.0011)和平均体积(p=0.0047)的数值均小于传统下壁心肌梗死患者。阿斯朗格模式的导联Ⅲ在J点和J+0.06 s点的ST段抬高值明显低于传统下壁心梗的导联Ⅲ>Ⅱ和导联Ⅱ≥Ⅲ的ST段抬高值(p<0.001)。J点+0.06 s时的抬高值≤1.5 mm是预测阿斯朗格模式心梗的指标。通过构建 ROC 曲线可以确定,在阿斯朗格模式下,该指数的最佳临界值为 2 毫米:结论:阿斯朗格模式心肌梗死与传统的代谢综合征下心肌梗死相比,具有特殊的血管造影征象、较低的ST段抬高、cTnI水平和血栓形成障碍。
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引用次数: 0
[Physicians' Adherence to Clinical Guidelines on the Chronic Heart Failure Diagnosis and Treatment: Changes Over 2 Years of the Document's Existence]. [医生对《慢性心力衰竭诊断和治疗临床指南》的遵守情况:文件发布两年来的变化]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2436
N D Perepech, A V Tregubov, I E Mikhailova

Aim: To study how physicians' commitment to the basic provisions of clinical guidelines (CGs) for the diagnosis and treatment of chronic heart failure (CHF) has changed over the two years of the document existence.

Material and methods: An anonymous survey was performed for 263 physicians (204 cardiologists, 46 internists and 13 other specialists) who were trained in advanced training programs in 2022. The questionnaire included questions regarding self-assessment of the respondents' professional knowledge, their attitude to the role of CGs in everyday practice and ideas about methods for treatment of CHF.

Results: Respondents gave 60.6 % correct answers to questions related to the treatment of CHF. More than 70% correct answers were given by 42.7% of cardiologists and 17.4% of internists. Compared to 2020, the proportion of cardiologists who gave more than 70 % correct answers increased significantly (p<0.05). CGs were considered mandatory by 26.2% and important or sometimes useful by 71.5% of respondents. Cardiologists considered CGs mandatory more frequently than internists (29.9 and 15.2 %, respectively; p=0.04). The mean number of correct answers was greater in the subgroup of respondents who considered CGs mandatory (p<0.001). More than 70% correct answers were given by only 43.8% of cardiologists, who considered themselves fully informed and able to advise colleagues on complex issues of diagnosis and treatment of CHF, and 40.6% of physicians who considered their knowledge acceptable for managing patients with CHF.

Conclusion: The majority of physician consider CGs an important methodological document but only a little more than 25 % are aware that CGs are mandatory. Cardiologists are better informed than internists about the principal provisions of National Clinical Guidelines for the diagnosis and treatment of CHF, but the average level of physician knowledge remains low.

目的:研究慢性心力衰竭(CHF)诊断和治疗临床指南(CGs)出台两年来,医生对其基本规定的承诺发生了哪些变化:对 2022 年接受高级培训课程的 263 名医生(204 名心脏病专家、46 名内科医生和 13 名其他专家)进行了匿名调查。调查问卷包括受访者对专业知识的自我评估、对CG在日常实践中的作用的态度以及对CHF治疗方法的看法等问题:受访者对有关治疗慢性心力衰竭的问题给出了 60.6% 的正确答案。42.7%的心脏病专家和 17.4%的内科医生给出了超过 70% 的正确答案。与 2020 年相比,回答正确率超过 70% 的心脏病专家比例显著增加(p<0.05)。26.2%的受访者认为心电图必须使用,71.5%的受访者认为心电图重要或有时有用。与内科医生相比,心脏病专家更常认为 CGs 是强制性的(分别为 29.9% 和 15.2%;p=0.04)。在认为 CGs 是强制性的受访者亚群中,正确答案的平均数量更高(p<0.001)。只有 43.8%的心脏病专家和 40.6%的医生给出了超过 70% 的正确答案,前者认为自己完全了解并有能力就慢性阻塞性肺疾病诊断和治疗的复杂问题向同事提供建议,而后者则认为自己在管理慢性阻塞性肺疾病患者方面的知识是可以接受的:结论:大多数医生认为CGs是重要的方法文件,但只有25%多一点的医生知道CGs是强制性的。心脏病专家比内科医生更了解《国家临床指南》中关于诊断和治疗慢性心力衰竭的主要规定,但医生的平均知识水平仍然较低。
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引用次数: 0
[Possibilities of Predicting Peak Oxygen Consumption in Patients With Chronic Heart Failure According to the 6‑Minute Walk Test]. [根据 6 分钟步行测试预测慢性心力衰竭患者峰值耗氧量的可能性]。
IF 0.5 4区 医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-02-29 DOI: 10.18087/cardio.2024.2.n2551
Yu L Begrambekova, D A Fedotov, N A Karanadze, T A Lelyavina, M A Bortsova, Ya A Orlova
<p><strong>Aim: </strong>To determine the correlation between the results of the 6-minute walk test (6MWT) and peak oxygen consumption (VO2peak) for populations of patients with chronic heart failure with pronounced clinical and demographic differences; to study a possibility of indirect measurement of VO2peak based on the results of 6MWT using the formulas available from the literature.</p><p><strong>Material and methods: </strong>Two databases were analyzed: 50 patients included in the AEROFIT study (group A), and 31 patients from the Almazov National Medical Research Center (group B). The inclusion criteria were the availability of data from the cardiopulmonary stress test and the 6MWT. The possibility of predicting VO2peak was calculated based on the results of 6MWT using the formulas reported in the literature (L. P. Cahalin et al., 1996; R. M. Ross et al., 2010; R. A. Adedoyin et al., 2010). The predictive accuracy of the models was assessed using the coefficient of determination (R2). The relationship between functional and clinical-demographic indicators was assessed using the Pearson or Spearman correlation analysis.</p><p><strong>Results: </strong>The study groups differed significantly in all parameters, except for the proportion of men and the mean VO2peak. Group B patients were 20 years younger than group A patients, had a lower left ventricular ejection fraction (24.06±7.75 and 41.52±10.48 %, respectively; p<0.001), and covered a 130 m shorter distance in the 6MWT. Despite the absence of a significant difference in VO2peak between groups A and B (13.6 and 13.1 ml / kg / min, respectively; p=0.6581), 61 % of group B patients and 20% of group A belonged to Weber functional class IV. In group A, the 6MWT distance correlated closely with VO2peak (R=0.78; p<0.01) and weakly with age (R=0.4) and body mass index (R=0.3). In group B, the 6MWT distance correlated only with VO2peak (R=0.77; p<0.01). For group A, the R.M. Ross et al. model demonstrated high accuracy in determining the mean VO2peak value with a 0.06% prediction error normalized to measured VO2peak. For group B, none of the models showed satisfactory predictive accuracy. The Ross and Cahalin models showed the best coefficients of determination for groups A and B: Group A, Ross et al. (R2=0.58) and Cahalin et al. (R2=0.59); Group B, Ross et al. (R2=0.59) and Cahalin et al. (R2=0.6).</p><p><strong>Conclusion: </strong>In two groups of patients with a statistically insignificant difference in the mean values of VO2peak, the mean values of 6MWT distance were significantly different, although these indicators correlated closely. The VO2peak prediction models showed satisfactory accuracy for estimation of mean VO2, but poor accuracy for estimation of individual values. A better predictive accuracy is determined by similar clinical and demographic characteristics between the training and testing populations, and likely also by models based on larger, more diversified populatio
目的:确定临床和人口统计学差异明显的慢性心力衰竭患者群体的 6 分钟步行测试(6MWT)结果与峰值耗氧量(VO2peak)之间的相关性;研究根据 6MWT 结果使用文献中的公式间接测量 VO2peak 的可能性:分析了两个数据库:AEROFIT 研究(A 组)的 50 名患者和阿尔马佐夫国家医学研究中心(B 组)的 31 名患者。纳入标准是心肺压力测试和 6MWT 数据的可用性。根据 6MWT 的结果,使用文献(L. P. Cahalin 等人,1996 年;R. M. Ross 等人,2010 年;R. A. Adedoyin 等人,2010 年)中报道的公式计算预测 VO2peak 的可能性。使用决定系数 (R2) 评估了模型的预测准确性。使用皮尔逊或斯皮尔曼相关分析评估功能指标与临床人口学指标之间的关系:结果:除男性比例和平均 VO2 峰值外,研究组在所有参数上都存在明显差异。B 组患者比 A 组患者年轻 20 岁,左心室射血分数较低(分别为 24.06±7.75% 和 41.52±10.48%;p<0.001),6MWT 跑动距离短 130 米。尽管 A 组和 B 组的 VO2 峰值没有明显差异(分别为 13.6 和 13.1 毫升/千克/分钟;p=0.6581),但 61% 的 B 组患者和 20% 的 A 组患者属于韦伯功能分级 IV 级。在 A 组,6MWT 距离与 VO2 峰值密切相关(R=0.78;p<0.01),与年龄(R=0.4)和体重指数(R=0.3)关系不大。在 B 组中,6MWT 距离仅与 VO2 峰值相关(R=0.77;p<0.01)。对于 A 组,R.M. Ross 等人的模型在确定平均 VO2 峰值方面表现出很高的准确性,预测误差为 0.06%,与测量的 VO2 峰值归一化。对于 B 组,没有一个模型显示出令人满意的预测准确性。罗斯和卡哈林模型对 A 组和 B 组显示出最佳的决定系数:A 组,罗斯等人(R2=0.58)和卡哈林等人(R2=0.59);B 组,罗斯等人(R2=0.59)和卡哈林等人(R2=0.6):两组患者的 VO2peak 平均值差异在统计学上并不显著,但 6MWT 距离的平均值却有显著差异,尽管这些指标密切相关。VO2peak 预测模型对平均 VO2 值的估计准确性令人满意,但对单个值的估计准确性较差。更好的预测准确性取决于训练和测试人群之间相似的临床和人口特征,也可能取决于基于更大、更多样化人群的模型。
{"title":"[Possibilities of Predicting Peak Oxygen Consumption in Patients With Chronic Heart Failure According to the 6‑Minute Walk Test].","authors":"Yu L Begrambekova, D A Fedotov, N A Karanadze, T A Lelyavina, M A Bortsova, Ya A Orlova","doi":"10.18087/cardio.2024.2.n2551","DOIUrl":"10.18087/cardio.2024.2.n2551","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To determine the correlation between the results of the 6-minute walk test (6MWT) and peak oxygen consumption (VO2peak) for populations of patients with chronic heart failure with pronounced clinical and demographic differences; to study a possibility of indirect measurement of VO2peak based on the results of 6MWT using the formulas available from the literature.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Material and methods: &lt;/strong&gt;Two databases were analyzed: 50 patients included in the AEROFIT study (group A), and 31 patients from the Almazov National Medical Research Center (group B). The inclusion criteria were the availability of data from the cardiopulmonary stress test and the 6MWT. The possibility of predicting VO2peak was calculated based on the results of 6MWT using the formulas reported in the literature (L. P. Cahalin et al., 1996; R. M. Ross et al., 2010; R. A. Adedoyin et al., 2010). The predictive accuracy of the models was assessed using the coefficient of determination (R2). The relationship between functional and clinical-demographic indicators was assessed using the Pearson or Spearman correlation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study groups differed significantly in all parameters, except for the proportion of men and the mean VO2peak. Group B patients were 20 years younger than group A patients, had a lower left ventricular ejection fraction (24.06±7.75 and 41.52±10.48 %, respectively; p&lt;0.001), and covered a 130 m shorter distance in the 6MWT. Despite the absence of a significant difference in VO2peak between groups A and B (13.6 and 13.1 ml / kg / min, respectively; p=0.6581), 61 % of group B patients and 20% of group A belonged to Weber functional class IV. In group A, the 6MWT distance correlated closely with VO2peak (R=0.78; p&lt;0.01) and weakly with age (R=0.4) and body mass index (R=0.3). In group B, the 6MWT distance correlated only with VO2peak (R=0.77; p&lt;0.01). For group A, the R.M. Ross et al. model demonstrated high accuracy in determining the mean VO2peak value with a 0.06% prediction error normalized to measured VO2peak. For group B, none of the models showed satisfactory predictive accuracy. The Ross and Cahalin models showed the best coefficients of determination for groups A and B: Group A, Ross et al. (R2=0.58) and Cahalin et al. (R2=0.59); Group B, Ross et al. (R2=0.59) and Cahalin et al. (R2=0.6).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In two groups of patients with a statistically insignificant difference in the mean values of VO2peak, the mean values of 6MWT distance were significantly different, although these indicators correlated closely. The VO2peak prediction models showed satisfactory accuracy for estimation of mean VO2, but poor accuracy for estimation of individual values. A better predictive accuracy is determined by similar clinical and demographic characteristics between the training and testing populations, and likely also by models based on larger, more diversified populatio","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 2","pages":"34-42"},"PeriodicalIF":0.5,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095087","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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