Kardiologiya最新文献

Aim    Acute kidney injury (AKI) remains a common complication of coronary artery revascularization surgery and is associated with adverse outcomes in critically ill surgical patients. Body mass index (BMI) is associated with various diseases. This study aimed to evaluate the association between BMI and the risk of AKI in patients undergoing coronary artery revascularization surgery.Material and methods    In this retrospective cohort study, data were extracted from the Medical Information Mart for Intensive Care (MIMIC) - IV database from 2008 to 2019 for patients undergoing coronary artery revascularization surgery. The outcome was the occurrence of AKI after ICU admission. Covariates were selected using LASSO regression. Univariable and multivariable logistic regression models were utilized to assess the association between BMI and the odds of developing AKI in patients undergoing coronary artery revascularization surgery, with results presented as odds ratios (OR) and 95 % confidence intervals (CI). Subgroup analyses were performed based on age, surgery, anticoagulant use, and the Sequential Organ Failure Assessment (SOFA) score was computed to further explore the association between BMI and AKI.Results    This study included 3017 patients who underwent coronary artery revascularization surgery, of whom 2172 (72.8 %) developed AKI. Increasing BMI was significantly associated with elevated odds of AKI in patients undergoing coronary revascularization (OR = 1.10, 95 % CI: 1.08-1.12), indicating a 10 % increase in AKI risk for each unit increase in BMI, adjusted for demographic variables (age and gender) in Model 1. After further adjustment in Model 2 for significant baseline characteristics including comorbidities (type 2 diabetes, heart failure, malignant tumors, and chronic kidney disease) and ICU scoring systems (SOFA, APS III, SAPS II, OASIS, and CCI), the association remained significant with an 11 % increased risk of AKI per BMI unit increase (OR = 1.11, 95 % CI: 1.08-1.13).Conclusion    BMI may be a promising parameter for assessing the risk of AKI in paty revascularization surgery, providing valuable information for risk stratification and management of ICU patients undergoing such procedures.

Aim      To assess the need for palliative medical care (PMC) in patients with chronic heart failure (CHF) depending on their body composition.Material and methods  The study included 298 subjects (115 men and 183 women aged 61 [53; 69] years), who were divided into 5 groups based on their body composition, the presence of obesity and sarcopenia. Kaplan-Meier analysis was used to assess survival, and Cox regression was used to assess the impact of factors.Results Analysis of the need for PMC in patients with CHF depending on body composition showed that patients with sarcopenic obesity had a shorter time to onset of indications for PMC (14.2±2.2 months; 95% confidence interval (CI) 9.8-18.5 months) compared to patients in other groups. The probability of indications for PMC significantly increased with an increase in the ratio of muscle mass index to body mass index (MMI/BMI) by 22.9 times (p<0.001); with an increase in functional class by one by 1.99 times (p<0.001); with an increase in the galectin-3 concentration by 1 ng/ml by 1.02 times (p=0.002); with a decrease in the Barthel index by 0.96 times (p<0.001); and with the presence of sarcopenia by 73% (p<0.001).Conclusion      Patients' need for PMC is influenced by body composition, and patients with sarcopenic obesity have a shorter time to indications for PMC compared to patients with or without isolated body composition disorders.

Aim    To identify predictors and develop a model for prognosis of left ventricular (LV) ejection fraction (EF) 12 months after ST-segment elevation myocardial infarction (STEMI) on electrocardiogram (ECG).Material and methods    This was a prospective registry study of patients admitted within 24 h of STEMI. Concentrations of soluble suppression of tumorigenicity 2, proprotein convertase subtilisin/kexin type 9, N-terminal pro-B-type natriuretic peptide (NTproBNP), high-sensitivity troponin I (TnI), and C-reactive protein were measured. LVEF was determined using the Simpson method at one, 10-12 days, and 12 months after STEMI. The study included 138 patients; after 12 months, LVEF was determined in 112 patients. The patients were divided into groups based on their LVEF: with preserved EF (pLVEF), LVEF ≥50% (n=51); moderately reduced EF (mrLVFE), LVEF 41-49% (n=40); and reduced EF (rLVEF), LVEF ≤40% (n=11).Results     A model for predicting LVEF 12 months after STEMI was constructed using the ordinal regression. The model sensitivity was 88.2% for predicting pLVEF, 71.8% for predicting mrLVEF, and 72.5% for predicting rLVEF. The model specificity was 59.1%. The factors determining LVEF in STEMI patients after 12 months included the formation of postinfarction LV aneurysm, LVEF on days 10-12 after STEMI, the magnitude in mm of ST segment elevation on the ECG upon admission, and the TnI concentration on the first day of STEMI.Conclusions    The obtained model for predicting LVEF 12 months after STEMI allows prognosing LVEF in all its ranges with a sensitivity of more than 70%.

Aim      To study the long-term clinical profile of safety and efficacy of anticoagulant therapy (ACT) in patients with atrial tachyarrhythmias (AT) after interventional treatment.Material and methods  A total of 5,611 medical records of patients managed in the Department of Surgical Treatment of Complex Heart Rhythm Disorders and Electrical Pacing of the Cardiology Research Institute of Tomsk National Research Medical Center (TNRMC) from 01.01.2017 through 31.12.2019 was analyzed. The study included 1,342 of the patients with various forms of AT who underwent the catheter treatment for heart rhythm disorders.Results The administration of ACT to patients with AT after the interventional treatment is safe, since the combined use of an invasive strategy and ACT does not increase the risk of major and minor bleeding. The effective intervention allows significantly reducing the risk of ischemic stroke in patients with paroxysmal and persistent atrial fibrillation and virtually completely excluding the likelihood of other thromboembolic complications.Conclusion      Successful radiofrequency ablation/cryoballoon ablation of atrial fibrillation foci significantly reduces the risk of ischemic stroke, while the invasive strategy does not increase the risk of major and minor bleeding.

Aim      To study the distribution of lipoprotein(a) [Lp(a)] concentrations in a large sample of the adult population of the Russian Federation depending on gender and age, and the Lp(a) association with the incidence of ischemic heart disease (IHD).Material and methods  Cross-analysis of electronic medical records of patients older than 18 years managed in the MEDSI Group of Companies as a part of primary and secondary prevention.Results Among 73,763 patients, the mean age was 45 [37; 56] years, 57.3% were women. The median Lp(a) concentration was 11 [6.0; 32.0] mg/dl. The median Lp(a) concentration in women was higher than in men, 12.0 and 10.5 mg/dl, respectively (p<0.0001). Hyperlipoproteinemia(a) (Lp(a) >30 mg/dl) was diagnosed in 26% (n=19,188) of patients (95% confidence interval (CI): 25.7-26.3), statistically significant association with IHD was observed over the entire range of elevated Lp(a) concentrations (p<0.001). Extremely high Lp(a) concentrations exceeding 180 mg/dl were detected in 852 (1.2%) of patients, and 210 of them were diagnosed with IHD. Logistic regression analysis confirmed a significant association between Lp(a) concentrations and IHD (odds ratio (OR) 1.006; 95% CI 1.003-1.008; p<0.001). With an increase in Lp(a) by 1 mg/dl, the likelihood of having IHD increased by 1.006 times. With Lp(a) >50 mg/dL, the likelihood of IHD increased by 1.32 times (OR 1.320; 95% CI 1.254-1.390; p<0.001), with Lp(a) >180 mg/dL, by 2.06 times (OR 2.058; 95% CI 1.758-2.408), and with Lp(a) 30-50 mg/dL, by 1.1 times (OR 1.100; 95% CI 1.017-1.188; p=0.016).Conclusion      Every fourth person has an elevated Lp(a) concentration, which determines a high risk of developing cardiovascular diseases. Taking into account the accumulated data, early assessment of the Lp(a) concentration is necessary for all adults.

Aim    To evaluate the effect of extended-release metformin (metformin long) on plasma concentrations of short-chain fatty acids (SCFA), physical performance and muscle strength in patients with chronic heart failure (CHF), sarcopenia and prediabetes.Material and methods    The study included 27 patients (mean age 68±9.8 years) with CHF, sarcopenia and prediabetes randomized into the groups of intervention (n=14) (metformin long + healthy lifestyle, HLS) and control (n=13) (HLS). Measurement of SCFA (C3, iC4, C4, αC5, βC5, C5, iC6, C6) concentrations, bioimpedancemetry, Short Physical Performance Battery (SPPB) test, and dynamometry were performed at the beginning of the study and after 6 months. R language and RStudio software were used for statistical analysis.Results    The study groups were comparable in clinical characteristics. The SCFA concentrations were significantly increased, except for iC6. After 6 months of treatment, the SCFA concentrations were decreased, except for C5, iC6, C3. Metformin long improved the physical performance and strength index. The median SPPB score in the control group was 4 [3.0; 9.5] and in the metformin group, 9 [7.25; 9.75], p = 0.0014. In the control group, the change in Δ strength index was -4.65 [-11.09; 17.66], in the metformin group, 18.75 [8.17; 33.03], p = 0.031.Conclusion    Metformin exerts a beneficial effect on plasma SCFA and physical performance in patients with prediabetes, CHF, and sarcopenia.

The article presents a clinical case of a 19-year-old patient with catecholaminergic polymorphic ventricular tachycardia caused by the pathogenic homozygous variant p.Ile193Asnfs*17 (rs397516643) in the CASQ2 gene, the early manifestations of which were recurrent syncope during emotional stress, supraventricular and polymorphic ventricular arrhythmias in the absence of structural changes in the heart. The article showed the evolution of heart rhythm disorders during the observation period. The authors discussed the issues of risk stratification for sudden cardiac death and the strategy for its prevention in this pathology.

Aim    Analysis of survival and the impact of etiology, adverse prognosis factors, and therapy on the survival of patients with pulmonary arterial hypertension associated with immune-mediated inflammatory rheumatic diseases (PAH-IIRD).Material and methods    The study included 95 patients: 76 with systemic scleroderma (SSc), 9 with mixed connective tissue disease (MCTD), 8 with systemic lupus erythematosus (SLE), one with rheumatoid arthritis, and one with Sjogren's disease with diagnosed PAH. All patients were prescribed PAH-specific therapy and followed up for at least 5 years during this treatment. The endpoint of the study was all-cause death.Results    During the 5-year follow-up period, 37 patients with PAH-SSc and 4 with PAH-MCTD (43%) died. There were no fatal outcomes in PAH-SLE. One-, two-, three-, and five-year survival rates in the overall group of patients were 91%, 80%, 73%, and 57%, respectively. In patients with PAH-SSc, one-, two-, three-, and five-year survival rates were worse than in PAH-MCTD (88%, 76%, 68%, 51% and 100%, 89%, 89%, 56%, respectively). The factors associated with a fatal outcome included age, gender, functional class, 6-minute walk test distance, right atrial pressure, cardiac output, pulmonary vascular resistance, and biomarker (uric acid and N-terminal pro-brain natriuretic peptide) concentrations. The use of macitentan and/or riociguat, as monotherapy or in combination with another PAH-specific drug, significantly reduced the 5-year risk of fatal outcome (OR 0.38 [0.16; 0.89], p=0.027).Conclusion    The survival of patients with PAH-IIRD remains low. Further studies aimed at finding new pathogenetic targets are needed; the use of modern PAH-specific drugs (macitentan and/or riociguat) modifies the course of the disease, increasing the survival.

Aim      To evaluate the possibilities of screening for Fabry disease (FD) in a particular region of the Russian Federation.Material and methods  This was an open prospective non-comparative study. The screening included patients with left ventricular (LV) hypertrophy >13 mm without severe hypertension; patients who had suffered stroke without an apparent cause; patients with peripheral pain syndrome associated with distal polyneuropathy with predominant damage to small fibers; patients with signs of FD during physical examination; coarse facial features; angiokeratomas (inner thighs, hands, abdomen, oral mucosa); thermoregulation disorders; chronic kidney disease. Screening for FD in the region was accompanied by educational activities on the diagnosis of the most common rare (orphan) diseases in adults; also, the routing of patients with FD was mapped out. General practitioners and cardiologists also had an opportunity to send dried blood spots directly to reference centers for the diagnosis of FD and other diseases associated with LV hypertrophy.Results Of the 125 patients who underwent the screening, only 4 had a reduced alpha-galactosidase A activity (to 1.71; 0.78; 0.44; 0.60 μmol/l/h), and in one of them, the diagnosis of FD was genetically confirmed. Five patients with "atypical" FD were identified during the work on FD diagnostics in the region, due to the improved knowledge about the signs of orphan diseases, as well as the mapped-out patient routing with the possibility to evaluate the panel of enzyme activity and metabolites of the diseases associated with LV hypertrophy.Conclusion      During the screening examination of 125 patients with suspected FD, it was possible to confirm the diagnosis in one (0.8%) patient. To increase the effectiveness of screening, it is necessary not only to provide the opportunity for diagnosing enzymes and metabolites, but also to conduct educational programs with the formation of routing for patients with suspected orphan diseases associated with LV hypertrophy.

Aim    To evaluate the effects of inflammatory parameters on mortality and prognosis in patients who were hospitalized with acute heart failure (AHF) and phenotypically classified.Material and methods    Between December 2020 and August 2021, 240 patients, who were newly diagnosed with acute heart failure (AHF) or those with heart failure and who developed decompensation, were prospectively included in the study. The patients composed four equal groups of 60 patients each according to the phenotypical class of AHF: warm-wet, warm-dry, cold-wet, and cold-dry. Acute phase reactants, namely C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and plasma albumin, were examined at hospitalization, discharge, and 30±7 days after discharge. The reactants were compared between the groups in terms of mortality and prognosis.Results    Univariate analyses showed that, at the time of initial hospitalization, a one-unit increase in albumin decreased the mortality risk 0.794‑fold, while a one-unit increase in CRP increased the mortality risk 1.013‑fold and a one-unit increase in ESR increased the mortality risk 1.026‑fold (p<0.001, p=0.003, and p=0.002, respectively). At discharge, a one-unit increase in albumin decreased the mortality risk 0.85‑fold (p=0.043). However, multivariate analyses showed that, at the time of initial hospitalization, a one-unit increase in albumin decreased the mortality risk 0.803‑fold, while a one-unit increase in the ESR value increased the mortality risk 1.021‑fold (p<0.001 and p=0.049, respectively). Although a statistically significant difference was observed between the warm-dry group and the other groups in terms of in-hospital mortality distributions (p=0.032), there was no statistically significant difference between the groups in terms of out-of-hospital mortality (p>0.050).Conclusion    In AHF patients, low albumin values at initial hospitalization and discharge, high CRP and ESR values at initial hospitalization predict increased mortality.