The pathogenetic mechanisms of arrhythmias, including high-grade ventricular arrhythmias (including non-sustained ventricular tachycardia), in patients with coronary heart disease may be different. Therefore, the characteristics of ventricular arrhythmias must be considered based on the totality of data, taking into account all the available features. The importance of a personalized approach to the management of a patient with coronary heart disease who had extensive myocardial infarction 18.5 years ago, followed by mammary coronary artery bypass grafting, aneurysmectomy and the de-velopment of heart failure with a low ejection fraction, in whom ventricular arrhythmias occurred against the background of a stable course of coronary disease , but after emotional stress, is reflected in this work. An extended examination, as well as a detailed study of the nature of ventricular arrhythmias, made it possible to determine the main provoking factor and select an individualized pathogenetic treatment with a good antiarrhythmic result that persists for several years of observation. Conducting mental tests and psychological questioning can be recommended for patients with coronary heart disease and chronic heart failure as an additional examination to assess the contribution of the psycho-emotional factor to arrhythmogenesis after excluding the ischemic and sympathetic nature of ventricular ectopia. It is incorrect to consider that all ventricular arrhythmias in patients with coronary heart disease are ischemic in nature, and in some clinical situations this statement is even erroneous.
An increase in left ventricular (LV) extracellular volume (ECV) is an important parameter of LV morphology and is considered synonymous with myocardial fibrosis, as well as a reliable marker of myocardial injury and impaired cardiac function. Accurate methods for detecting and assessing myocardial fibrosis are very important for clinical practice. The current standard for myocardial fibrosis imaging is delayed gadolinium enhanced cardiac magnetic resonance imaging (MRI) or T1 mapping, but these techniques have limitations. They can be avoided by using dual-energy computed tomography (DECT), which makes it possible to identify myocardial fibrosis, including small-focal fibrosis, in two different ways (subtraction technique and iodine density measurement technique). The literature analysis carried out by the authors showed good comparability of MRI and DECT results in determining ECV in patients with various heart diseases of both ischemic and non-ischemic nature, including cardiomyopathies, aortic stenosis, pulmonary hypertension, sarcoidosis, and amyloidosis. In addition, the use of DECT to identify myocardial fibrosis is also possible if cardiac inflammation is suspected. In addition to evaluating the effectiveness of DECT compared with MRI, different scanning protocols were analyzed, since there is currently no consensus on the optimal contrast administration regimen. The issue of radiation exposure in modern DECT scanners is also separately considered. The authors showed that DECT is an important tool for determining ECV, which is of interest for clinical practice.
The assessment of platelet dysfunction is usually used by hematologists to diagnose inherited (such as Bernard-Soulier syndrome, platelet-type-von Willebrand disease, Glanzmann thrombasthenia, etc.), and acquired (symptomatic) platelet disorders (in hemoblastoses, uremia, liver cirrhosis, etc.), as well as to predict the risk of intraoperative bleeding in these groups of patients. Later, laboratory platelet function tests began to be used by cardiologists, first in experimental and clinical studies. In further years, attempts were made to introduce them into clinical practice. Current data show association between platelet hyperreactivity and pathogenesis of cardiovascular events. At the same time, despite the various consensus papers on assessing thrombotic and bleeding risk, monitoring antiplatelet therapy, including those published by Russian experts, in practice there are many subtleties and questions about the practical aspects of using laboratory tests. In addition, the definition of platelet phenotype does not have a clear concept. The review purpose was to describe laboratory methods for assessing the platelet function, to give more information to cardiologists about its practical value and to understand what basic scientists and physicians mean by the term “platelet phenotype”.
Dyslipidemia is one of the most significant modifiable cardiovascular risk factors. The change in the modern paradigm for dyslipidemia treatment from high-intensity statin therapy to high-intensity lipid-lowering therapy makes it possible to more often use new drug classes to achieve the target level of low-density lipoprotein cholesterol. The article presents two case reports on the use of inclisiran as part of combination lipid-lowering therapy for secondary prevention in patients at very high cardiovascular risk. Based on the presented cases, following clinical aspects of the management of cardiovascular patients are discussed: the safety of achieving low-density lipoprotein cholesterol levels below 1 mmol/l in a patient with asymptomatic cerebral infarction, the need for adequate dyslipidemia treatment after revascularization, the strategic importance of prescribing lipid-lowering therapy in patients with cerebrovascular disease to reduce the cardiovascular risk, adherence to therapy as a significant aspect of effective dyslipidemia control.
Aim. To study the changes of the levels of cardiac biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin I (hsTnI)) in patients with newly diagnosed multiple myeloma (MM) during programmatic treatment with bortezomib (VCd regimen).Material and methods. This prospective pilot study included patients with a newly diagnosed MM (n=30), who were scheduled for a cycle of chemotherapy including a proteasome inhibitor (bortezomib). All patients underwent standard laboratory (complete blood count, biochemical tests, serum protein electrophoresis), electrocardiography, echocardiography, as well as the level of specific laboratory markers of myocardial dysfunction (NT-proBNP) and injury (hsTnI) was determined immediately before treatment, after 3 and 6 cycles of chemotherapy.Results. The mean age was 63,8±10 years with a slight predominance of men (56,7%, n=17). The patients initially had an increased level of NT-proBNP (316 [75,9; 602,6] pg/mL) with its decrease to 144,0 [102,3; 294,0] pg/ml after 3 cycles and to 109,2 [59,9; 344,5] pg/ml after 6 cycles of chemotherapy. At the MM onset, the mean hsTnI values were 0,06 [0,03; 0,49] ng/mL, whereas after 3 and 6 chemotherapy cycles it accounted for 0,02 [0,01-0,68] and 0,65 [0,02; 1,51] ng/ml, respectively, with the normal range of less than 0,1 ng/ml. Despite this, no statistical significance has been obtained. There were no clinical and/or laboratory signs of heart failure, ischemia, or other non-cardiac causes of elevated NT-proBNP levels in this cohort. Multivariate regression analysis revealed the following significant factors influencing the initial hsTnI level: paraprotein, hemoglobin and erythrocyte sedimentation rate (ESR). The resulting regression model was characterized by a strong correlation (r=0,702, p<0,001).Conclusion. MM and its pathogenetic features such as paraproteinemia may be challenging for NT-proBNP and hsTnI levels assessment in group of interest before treatment. An unreliable assessment of these markers before chemotherapy may lead to incorrect baseline cardiovascular risk stratification and make it difficult for a cardiologist/cardio-oncologist to choose proper management strategy.
The increase in the prevalence of dietary risk factors and non-communicable diseases over the past decades has led to the search for new predictors, one of which is skipping breakfast. The article examines the potential of using the "daily breakfast"/"skipping breakfast" criterion as a prognostic marker. The results of studies on the correlation of daily breakfast with dietary risk factors (obesity and hypertension), type 2 diabetes, cardiovascular diseases and the risk of cardiovascular death are presented and analyzed. The effect of breakfast on the depression risk, which is an independent marker of cardiovascular diseases, is being studied. Also, possible pathogenetic mechanisms linking skipping breakfast with increased blood pressure are discussed. Research data is provided confirming the importance of morning meals for health. The article presents data on the prevalence of daily breakfast in the Russian population and in the populations of other countries with developed economies. Information is provided on the history of studying the effect of daily breakfast on health. Also, controversial scientific data is provided on the effect of skipping breakfast on body weight and its effective control. The role of morning meals in weight reduction programs is fully discussed. The issues of connection between the morning meal and daily calorie intake, the nutritional value of consumption of total protein, vitamins and minerals, as well as the uniform meal distribution across the day are considered. Data from a scientific discussion on the criteria for an "ideal" breakfast are presented, and general recommendations on the energy and nutritional value of a morning meal and the optimal composition of food are outlined.
Pericarditis is an inflammation of the heart serous membrane of an infectious or non-infectious nature. Secondary pericardial effusion can be one of the few signs of cancer of the lung, pleura or breast in young people, while early treatment of the underlying pericarditis cause is the only factor influencing patient survival. We present a case report on a 28-year-old female patient who was hospitalized at the Sechenov University Cardiology Clinic for continuous recurrent pericarditis. During the examinations, end-stage lung adenocarcinoma was revealed, which for a long time was disguised as various diseases. Unfortunately, immunochemotherapy was not successful and the patient’s condition was complicated by recurrent pulmonary embolism with progressive cardiopulmonary failure. A peculiarity of this case is the development of recurrent pericarditis in a young female patient with lung adenocarcinoma, which is difficult to diagnose using non-invasive examination methods. Long-term ineffective treatment of recurrent pericarditis is a reason for cancer suspicion in young patients.
Despite the declining cardiovascular mortality, the incidence of myocardial infarction (MI) is still high, and therefore the issues of its timely diagnosis remain extremely relevant. In addition to the main diagnostic criteria and typical electrocardiographic (ECG) signs, there are many secondary patterns that suggest MI. Wellens’ syndrome (WS) is one of these ECG patterns, which indicates that the patient is at high risk of left ventricular anterior wall MI, caused by occlusion of the anterior interventricular artery (AIA) or its critical stenosis. Despite the relatively low incidence of WS, it is necessary to increase physicians’ awareness in order to prevent MI and reduce its possible negative consequences.This article presents clinical cases of WS, which show the importance of its diagnosis in the management of patients with anginal pain. The first patient is 43-year-old with a diagnosis of class III exertional angina, a history of anginal pain, and the presence of inverted T waves in V2-V3 leads. AIA stenting was performed on the 7th day of hospitalization. The second patient is 67-year-old with a similar diagnosis and history, biphasic T waves in I, aVL, V1-V3 and V5-V6 leads, deeply inverted T waves in V4. Stenting of the AIA and right coronary artery (RCA) was performed on days 5-6 after the most severe episode of anginal pain and after the anginal pain became recurrent. In both cases, WS was not diagnosed. The third patient, 57-year-old, with T wave inversion in II, III, aVF, leads ST segment elevation of less than 1 mm in lead III, minimal ST segment depression in aVL and V2-V3 leads, followed in less than 2 hours by ST segment elevation in II, III, aVF leads. In this patient, WS was diagnosed in a timely manner, urgent coronary angiography was performed, 99% RCA stenosis was detected, and RCA stenting was performed. The outcome is left ventricular inferior wall non-Q wave MI. The last cited case of WS indicates that this syndrome develops not only with AIA damage, but also with damage to other coronary arteries.
Aim. To study the gender and age characteristics of dyslipidemia in the population of the Nizhny Novgorod region.Material and methods. A total of 2501 people aged 35-74 among the population of the Nizhny Novgorod region were examined, selected by stratified multi-stage random sampling. The study was performed as part of the third epidemiological study ESSE-RF3. All respondents underwent an anthropometric survey, a questionnaire to identify chronic non-communicable diseases and related risk factors. The following laboratory tests were performed: total cholesterol (TC), low-density lipoproteins (LDL-C), high-density lipoproteins (HDL-C), triglycerides (TG). Among the entire cohort of patients at the time of blood sampling, 276 people (11,0%) were receiving lipid-lowering drugs. They were excluded from further analysis. Hypercholesterolemia (HCL) was recorded with a total cholesterol ≥5,0 mmol/l, an increased level of LDL-C — with a level ≥3,0 mmol/l, hypertriglyceridemia (HTG) — with a TG ≥1,7 mmol/l, a reduced level of HDL-C — with a level in males ≤1,0 mmol/l, in women ≤1,2 mmol/l.Results. The prevalence of HCL was 65,1%. In the young cohort (40-44 years), men were significantly more likely to have hypercholesterolemia, but in the middle (50-54 years) and older (60 years or more) age groups, this lipid metabolism disorder was observed with greater frequency among females. In addition, 68,9% of the respondents had elevated LDL-C levels. When studying the prevalence of this type of dyslipidemia in different age groups among men and women, a similar trend can be noted with similar TC values, but significant gender differences in the prevalence of elevated LDL-C levels l were revealed only in the 60-64 and 65-69 years groups. The prevalence of HTG among the adult population of the Nizhny Novgorod region was 42,6%. Among the 35-49 years and 55-59 years age groups, the prevalence of elevated TG levels was significantly more common among men. The incidence of decreased HDL-C levels was 13,3%. This type of dyslipidemia was significantly more often detected among men only in the youngest subgroup (35-39 years).Conclusion. Among the population of the Nizhny Novgorod region, hypercholesterolemia occurred in 65,1% of respondents, an increased level of LDL-C — in 68,9%, a HTG — in 42,6%, a reduced level of HDL-C — in 13,3%. The data obtained determine a high cardiovascular risk and require the development of prevention and treatment measures for lipid metabolism disorders.
Pulmonary hypertension is a serious cardiovascular pathology, often complicating the course of heart failure (HF). Excessive pulmonary artery pressure increases right ventricular afterload and progressively leads to dysfunction, which is associated with adverse outcomes regardless of left ventricular ejection fraction. In this regard, more attention should be paid to determining the right ventricular condition. Currently, in order to assess the right heart function in patients with pulmonary hypertension and HF, the right ventricular (RV)-pulmonary arterial (PA) coupling, is increasingly being used. The conventional formula to calculate this parameter is the ratio of tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). This index has proven to be a powerful predictor of adverse outcomes. But this calculation method has a number of limitations and can lead to errors. It is extremely important to exclude or minimize any possible inaccuracies during prognostic assessment, which is why new researches of alternative RV-PA calculation options have been recently published. Such things as problems that can occur during TAPSE and PASP evaluation, ways of modifying the assessment of right heart’s functioning in patients with pulmonary hypertension and heart failure have been addressed. The value of new RV-PA alternative «surrogate» indexes has been discussed.
Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.
Currently, more and more cases of distant myocardial infarction are being registered. This pathological condition occurs due to an acute decrease in myocardial blood supply, which was provided by a donor artery, which blood supply system is anatomically not directly connected to the affected area. Cases of distant myocardial infarction are sporadic. Therefore, there are difficulties in choosing the right management strategy. During percutaneous coronary intervention, it is possible to perform recanalization of an artery with chronic occlusion, which anatomically supplies blood to the affected wall, and/or donor artery stenting, which supplies the infarction zone due to collaterals. The article presents a case of non-Q wave myocardial infarction of left ventricular anterior wall, which developed in a patient with 90% stenosis in the proximal left anterior descending (LAD) artery, chronic occlusion of the middle LAD segment, and 80% stenosis in the proximal right coronary artery. Direct stenting of the right coronary artery led to a significant increase in the contrast intensity in intersystem collaterals from the posterior interventricular artery to LAD artery. This was accompanied by an improvement in the clinical symptoms and a complete absence of angina throughout the patient’s hospital stay.
Aim. To identify predictors of paroxysmal atrial fibrillation (pAF) in patients with stable angina after coronary artery bypass grafting (CABG), as well as to evaluate the effect of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.Material and methods. We examined 92 patients with stable angina who received CABG, aged 64±7 years (men, 78,3%). Among this cohort, 81,5% of patients had multivessel coronary artery disease, carbohydrate metabolism disorders — 35,6%, hypertension — 96,7%, chronic kidney disease (CKD) — 23,9%, preprocedural pAF — 10,9%, previous myocardial infarction (MI) — 54,3%. Off-pump CABG was performed in 31,5%, including bilateral inthernal thoracic artery grafting — in 50%. Cardiopulmonary bypass time was 68 (55-83) minutes. The number of grafts was 2,7±0,7. In addition, 18,5% of individuals received SGLT-2 inhibitors. Serum creatinine content was determined by the Jaffe method, and CKD was diagnosed with glomerular filtration rate <60 ml/min. Acute kidney injury (AKI) was assessed according to the KDIGO criteria (2012).Results. The number of patients who had pAF after CABG was 29,3%, AKI — 16,3%. There were following parameters associated with pAF after CABG: creatinine (100;82-142 in patients with pAF and 83;69-105 μmol/l — without pAF, p=0,032) and urea (7,8;5,8-9,7 in patients with pAF and 5,9;4,7-9,1 mmol/l — without pAF, p=0,025) one day after the intervention; postoperative AKI was revealed in 33,3% and 9,2% (p=0,004), while the number of patients taking SGLT-2 inhibitors was 3,7% and 24,6% (p=0,019) in those with and without pAF, respectively. The probability of pAF after CABG increased by an average of 5,5 times with AKI. Patients with pAF after CABG compared to patients without pAF have a higher rate of AKI, intraoperative MI, and cardiac death.Conclusion. The number of patients with pAF after CABG was 29,3%, AKI — 16,3%. Post-CABG pAF predictor was postoperative AKI. The use of SGLT-2 inhibitors was associated with a lower incidence of pAF after intervention. Patients with pAF after CABG have a poor inhospital prognosis.
Aim. To study the effectiveness of atorvastatin 80 mg, prescribed immediately prior emergency endovascular intervention, in reducing the incidence of acute kidney injury (AKI) defined by сontrast-induced nephropathy (CIN) and by Kidney Disease: Improving Global Outcomes (KDIGO) criteria in patients with ST-segment elevation myocardial infarction (STEMI).Material and methods. The study included 386 patients with STEMI. Main group patients immediately prior to sheath insertion took atorvastatin at a high dose (80 mg). The control group was not prescribed statins before the intervention. In both groups, further statin therapy in the postoperative period was not regulated by the study protocol and was prescribed taking into account current guidelines. In order to equalize the groups according to the main clinical indicators, propensity score matching was carried out, as a result of which new comparison groups of 86 patients each were formed. In order to assess the nephroprotective properties, the following end points were selected: the incidence of AKI according to the CIN and KDIGO criteria, the frequency of serum creatinine level recovery to initial values on the 7th day.Results. In the study sample, the median glomerular filtration rate (GFR) on admission was 86,5 [70,0-97,0] ml/min/1,73 m2. There were 22 (12,7%) and 15 (8,7%) patients with GFR<60 ml/1,73 m2 at admission and kidney pathology, respectively. The median volume of contrast injected during coronary angiography (CAG) and percutaneous coronary intervention (PCI) was 100 [90-200] ml, while there were 8 (4,7%) patients in whom the volume of contrast injected exceeded 3,7xGFR. In the group of patients receiving atorvastatin before the intervention, the incidence of AKI was significantly lower according to CIN criteria as follows: 9 (10,5%) vs 21 (24,4%) (p=0,016, odds ratio (OR) (95% confidence interval (CI) — 0,36 (0,16-0,85)), while in case of diagnosis according to KDIGO criteria there was no significant difference: 6 (7,0%) vs 13 (15,1%) (p=0,143, OR (95% CI) — 0,42 (0,15-1,17)).The frequency of serum creatinine level recovery to initial values on the 7th day was higher in the main group: 57 (66,3%) vs 43 (50,6%) (p=0,037, OR (95% CI) — 1,92 (1,04-3,56)). Inhospital mortality was higher in the control group: 6 (7,0%) vs 1 in the main group (1,2%) (p=0,120, OR (95% CI) — 0,17 (0,02-1,47)).Conclusion. The use of atorvastatin at a dose of 80 mg immediately before emergency coronary angiography in patients with STEMI, in comparison with the traditional statin prescription in the postoperative period, reduces the risk of AKI according to the CIN criteria, and also improves renal function.
Aim. To study the possible relationship between polymorphic variants of ABCB1 (rs2032582, rs1045642, rs1128503), CYP3A5 (rs776746), CYP3A4 (rs35599367) and CYP2J2 (rs890293) genes with residual equilibrium concentrations (Cmin,ss) of rivaroxaban in patients with non-valvular atrial fibrillation (AF) and stage 3 and 4 chronic kidney disease (CKD).Material and methods. A total of 123 patients 52 to 97 years old (median age, 82 years) with AF in combination with stage 3 and 4 CKD were included in the study. Each patient underwent a pharmacogenetic and pharmacokinetic study.Results. Cmin,ss and dose-adjusted concentration (Cmin,ss/D) of rivaroxaban were significantly higher in patients with the TT genotype than with the CT genotype of the polymorphic variant rs1045642 of the ABCB1 gene (Сmin,ss 60,5 [36,7;173] ng/ml and 54,8 [23,1;97,3] ng/ml, respectively, р=0,016; Сmin,ss/D 4,06[2,3;8,1] ng/ml/mg and 2,2 [1,1;4,9] ng/ml/mg, р=0,006). In patients with the T allele (CT and TT genotypes), compared with CC genotype carriers, Cmin,ss and Cmin,ss/D were significantly higher (Cmin,ss 60,5 [36,7;173] ng/ml and 45,8 [20,9;82,3] ng/ml, respectively, p=0,029; Cmin,ss/D 4,06 [2,3;8,1] ng/ml/ mg and 2,6 [1,2;4,8] ng/ml/mg, respectively, p=0,014). Also, Cmin,ss and Cmin,ss/D was significantly higher in patients with the TT genotype according to the polymorphic variant rs2032582 of the ABCB1 gene than in patients with the GG genotype (p=0,02 and р=0,016 respectively). Cmin,ss and Cmin,ss/D in T allele (GT and TT genotypes) carriers were significantly higher than in T allele homozygotes (Cmin,ss 57,1 [27,7;106,0] ng/ml versus 37,6 [18,6;61,7] ng/ml respectively, p=0,024; Cmin,ss/D 3,6 [1,7;7,4] ng/ml/mg versus 2,3 [1,1;4,09] ng/ml/mg respectively, p=0,032). Differences in Сmin,ss and Сmin,ss/D of rivaroxaban were detected when comparing TC, CC and TT genotypes of polymorphism rs1128503 of the ABCB1 gene. When comparing Сmin,ss and Сmin,ss/D of rivaroxaban among carriers of AG and GG genotypes of the rs776746 polymorphism of the CYP3A56986A>G gene, no significance was detected (p>0,05). Also, no difference in Cmin,ss and Cmin,ss/D was found when comparing carriers of the CC and CT genotypes of the rs35599367 polymorphism of the CYP3A4 gene, and carriers of the CC and AC genotypes of the rs890293 polymorphism of the CYP2J2 gene (p>0,05).Conclusion. The carriage of T allele by polymorphic variants rs1045642 and rs2032582 of the ABCB1 gene affects Cmin,ss and Cmin,ss/D of rivaroxaban.
Aim . To outline echocardiographic features and assess their prognostic significance for major cardiovascular adverse events (MACEs) within 12 months in patients with type 2 myocardial infarction (MI), compared to type 1 MI (T1MI). Material and methods . The prospective observational study included 161 MI patients who underwent coronary angiography within 24 hours of admission. Type 2 MI (T2MI) diagnosis aligned with the Fourth Universal Definition. Echocardiography and speckle-tracking echocardiography were performed within 72 hours of hospitalization. MACEs encompassed cardiovascular death, non-fatal MI, non-fatal stroke, and HF-related readmissions. Logistic regression analysis was conducted to evaluate their associations with the outcomes. Results . T2MI were diagnosed in 74 patients (median age, 65 years; males, 55,4%). During follow up, 18 patients for each MI type experienced at least one MACE event. Left ventricular (LV) systolic dysfunction (LV ejection fraction [LVEF] <50%) was observed in 41 (55.4%) T2MI patients, compared with 66 (75.9%) T1MI patients (p=0.014). Median LVEF and global longitudinal strain [GLS] were 47.5% and 13.4%, respectively, for T2MI, compared to 45% and 13.9%, respectively, for T1MI (p=0.032 and p=0.332, respectively). LV diastolic dysfunction [DD] was observed in 56 (75.7%) T2MI and 77 (88.5%) T1MI patients. Grade III was more frequent in T2MI in comparison with T1MI (14.9% vs 1.1%, p=0.001, respectively), whereas grade I was more common in T1MI patients (75.9% vs 43.2%, p=0.004, respectively). Right ventricular (RV) dysfunction was observed more frequent in T2MI patients, compared to those with T2MI (52.7% vs. 35.6%, p=0.025, respectively). In univariate analysis, grade III DD was significantly associated with MACEs in T2MI (odds ratio [OR] 5.1, 95% confidence interval [CI], 1.3–18.5, p=0.017). In multivariate analysis, GLS ≤ 9.6% (OR = 17.3, 95% CI 3.0-99.5, p=0.001), and prior MI (OR = 16.6, 95% CI 1.7–157.6, p=0.015) were significantly associated with a heightened risk of MACEs in T2MI patients. Conclusion . Patients with T2MI had high prevalence of LV and RV dysfunction. Echocardiographic assessments, particularly speckle-tracking echocardiography, hold promise in predicting adverse outcomes for these individuals.
Aim. To study the effect of azilsartan medoxomil (AZL-M) on the 24-hour blood pressure (BP) profile in patients with hypertension (HTN), type 2 diabetes (T2D) and stable coronary artery disease (CAD).Material and methods. A total of 183 patients with CAD in combination with HTN and T2D took part in the study (100 men (54,64%), 83 women (45,36%)). All patients were previously prescribed a statin, antiplatelet therapy, a beta-blocker, and an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB). At baseline, the proportion of people taking ARBs and ACEIs was 30% and 70%, respectively. All study participants were discontinued from a previously prescribed ARBs or ACE inhibitors and were prescribed 6-month AZL-M (Edarbi®) therapy. During this period, according to the study plan, patients visited the medical center to assess the effectiveness and safety of therapy and blood pressure changes.Results. The mean age of the patients was 65,0 years (60-69 years), while the mean body mass index (BMI) — 31,24 kg/m2. The mean age of female participants was higher than the mean age of males: 66,35±6,59 vs 62,72±8,82 years (p=0,002). The mean BMI in women was higher and was 33.08 kg/m2, while in men it was 30,74 kg/m2 (p=0,001). Six-month AZL-M therapy decreased 24-hour BP values. Thus, the time index of systolic blood pressure (SBP) hypertension in the daytime decreased from 63% to 12%, while at night from 70% to 10%, and the time index of diastolic blood pressure (DBP) hypertension in the daytime from 18% to 10%, and at night from 44% to 8%. The main result is confirmation of AZL-M effectiveness in relation to BP control, as well as good drug tolerability. At the visit after 1-month AZL-M therapy, target BP values were recorded in 45,4% of participants, and after six months — the proportion of people with normal 24-hour BP values was 69,9%.Conclusion. Edarbi® therapy in patients with HTN in combination with T2D and stable CAD leads to 24-hour BP normalization. At the same time, the drug has a good safety profile, since the reported adverse events were not related to the drug.
Aim. To present clinical characteristics and assess serious adverse outcomes (death, acute cardiovascular events) in outpatients with atrial fibrillation (AF) in one of the Yaroslavl clinics for 10 years.Material and methods. A total of 212 patients with AF aged from 23 to 94 years were included in the REQUAZA AF registrу — Yaroslavl at the first visit to the clinic in 2013. Their health status was monitored over 10,5 years through in-person visits, phone contacts with patients, their relatives, and treating physicians. Recorded data included the AF type, comorbid conditions, extent and quality of examinations and treatments, development of serious adverse events, and mortality. Statistical processing was carried out using the Microsoft Office 365 application software package.Results. Most patients (66,5%) were diagnosed with persistent AF. Paroxysmal, persistent, and newly detected forms were observed in 26,4%, 3,8%, and 3,3% of patients, respectively. Most AF patients had concomitant cardiovascular diseases, most frequently hypertension (96,7%), heart failure (91,6%), and coronary artery disease (91,2%). A total of 54 patients (25,5%) had prior stroke or transient ischemic attack. Complete information was obtained for 203 patients (95,8%), of which 164 (78,5%) passed away during the follow-up period. The leading death cause was cardiovascular disease, particularly cerebrovascular events (n=111; 67,7%). The highest mortality was recorded within the first two years of follow-up, during which more than a quarter (25,1%) of the registered patients had died. The COVID-19 pandemic did not significantly affect the mortality rates. The most common AF complications were stroke and transient ischemic attack, with a total of 74 episodes in the history and follow-up period, including 7 recurrences.Conclusion. Ambulatory AF patients represent a group with a high frequency of cardiovascular events and fatal outcomes. In the observed group of ambulatory AF patients, annual mortality exceeded 10%, and over 3/4 of patients died within 10 years. The leading death cause was cardiovascular disease, primarily cerebrovascular events.
The article is devoted to various aspects of white coat effect (WCE) in patients with hypertension (HTN). WCE is due to the patient’s anxious response to office blood pressure (BP) measurement and is characterized by a BP increase. In patients with HTN, WCE is detected with a high frequency. Pronounced WCE in hypertensive patients is associated with worsening the HTN course and the prognosis of all-cause and cardiovascular mortality. In addition, BP increase in these patients during a doctor’s visit may lead to additional prescription of antihypertensive drugs, increasing costs and side effects. To identify WCE, a large number of methods are used, which can be divided into following groups: I – data from clinical and daytime ambulatory blood pressure measurement, II – clinical and home BP assessment, III – only ambulatory BP measurement, IV – clinical and laboratory BP data, and V – only clinical BP measurement. There are following WCE in patients with HTN: female sex, age, never smoking, as well as anxiety, introversion, etc. WCE is due to the patient’s anxiety state during office BP measurement and a conditioned reflex BP increase associated both with the physician presence and medical background. Severe WCE in some groups of patients with HTN may be associated with a worse prognosis compared with other hypertensive patients as follows: in individuals with a significant difference between clinical and ambulatory blood pressure levels or between the first and third BP office data, with a combination of resistant HTN and WCE, with WCE increasing from visit to visit, etc.
