Idiopathic pulmonary hypertension (IPAH) nowadays frequently diagnosed in older patients. Consequently, comorbidity increased, complicating patient risk assessment and diagnosis, and influencing therapeutic decisions. This article focuses on comparing clinical, instrumental and demographic parameters, survival rates, and prognosis in patients with “classical” IPAH and those with comorbidities.Materials and Methods. The study included patients (n=56) with a verified diagnosis of IPAH between 2014 and 2023. All participants were divided into two groups: patients with IPAH without comorbidities (n=26) — Group 1; and patients with IPAH and comorbidities (n=30) — Group 2. The following examinations were performed: 6 minute walk test, echocardiography, right heart catheterization, NTproBNP level assessment, and clinical and biochemical blood tests. Mortality risk assessment was conducted at the time of diagnosis, after 1 year, and after 3 years of therapy using risk stratification scales.Results. Comorbid patients were older: 46,5 [35,2; 53,0] years vs. 33,0 [28,0; 38,0] years, p=0,001. At time of diagnosis, they had higher body weight and systolic blood pressure values, reflecting the presence of comorbidities. After 36 months, statistically significant differences between the groups were observed in: 6MWT distance (p=0,04); NT-proBNP levels (p=0,014); pulmonary artery systolic pressure ( p=0,014), mean pulmonary artery pressure (p=0,01), mixed venous oxygen saturation (p=0,009), right atrial pressure (p=0,033), pulmonary vascular resistance (p=0,012). Survival rates at 1, 3, and 5 years were 96,1%, 92,3%, and 92,3% respectively in Group 1, . In Group 2, survival rates were 96,7% at 1 year, 86,7% at 3 years, and 73,3% at 5 years (p=0,022).Conclusion. The increasing proportion of comorbidity patients with IPAH in the population affects the diagnosis and treatment of this patient group, their survival rates, and response to therapy. For a more accurate risk assessment, it is already necessary to include the comorbidity profile in the list of parameters evaluated during risk stratification.
A review of modern Russian and foreign literature on the problem of impaired coronary blood flow reserve as a manifestation of microvascular dysfunction has been conducted. When searching for information on this issue, materials from the following databases were used: RSCI, Best Evidence, Scopus, Elsevier, PubMed, Clinical Evidence, Cochrane Library. Microvascular angina (MVA) is a clinically significant form of ischemic heart disease characterized by myocardial ischemia in the absence of obstructive epicardial coronary artery lesions. This review summarizes key pathophysiological mechanisms contributing to cardiovascular complications in patients with MVA, highlights modern biomarkers and imaging methods used for risk stratification and prognosis, and discusses therapeutic individualization and future directions in clinical monitoring.
Objective: to evaluate the effect of correction of HF therapy based on indicators of multisensory ICD sensors on the clinical course of the disease and the frequency of shocks.Materials and methods. 111 patients with HF and indications for ICD implantation for the primary prevention of sudden cardiac death were included in the prospective study, then they were divided into two groups: in the studied (n=56) ICD with a multisensory set of sensors; in the comparison group (n=55), standard ICD without sensors. The patients were monitored for 12 months, and the dynamics of quality of life, clinical and laboratory parameters, device monitoring data, discharge episodes, and the number of hospitalizations due to HF decompensation were analyzed.Results. The patient groups were initially comparable in terms of gender, age, etiology of the disease and severity of the condition. All patients were on optimal medication therapy for HF for more than 3 months. Initially, there were no significant differences in the level of NTpro-BNP and the six-minute walking test distance, and there were no еchocardiography indices in both groups. After 6 months, during device interrogation, diuretic therapy was changed in the study group, taking into account the indicators of multisensory sensors, in the comparison group only based on clinical data. After 12 months, both groups showed positive dynamics in the quality of life index; a significant increase in ejection fraction and NT-proBNP levels in the study group, a significant decrease in the six-minute walking test distance in the comparison group, a comparable number of both adequate and inadequate ICD discharges, and a significantly lower number of hospitalizations for decompensation in the study group.Conclusion. The use of ICD multisensory monitoring was associated with a statistically significant improvement in the clinical course of HF and the frequency of shocks in patients compared with standard ICD.
Cardiorenal syndrome (CRS) covers a spectrum of disorders affecting both the heart and kidneys, in which acute or chronic dysfunction in one organ can cause acute or chronic dysfunction in another organ. The concept of CRS has streamlined the numerous relationships between acute and chronic heart and kidney diseases and united cardiologists and nephrologists in the struggle for the quality and life expectancy of patients. Identification of kidney involvement in the pathological process at the early stages of the cardiovascular continuum, starting with risk factors, will allow for preventive measures that will help improve both cardiovascular and renal outcomes. The above has led to the preparation of these recommendations. The recommendations include modern approaches to the diagnosis, treatment and prevention of all 5 types of CRS in various cardiovascular diseases. The recommendations briefly present the main pathophysiological mechanisms of cattle development and modern classifications. The extremely relevant and, in our opinion, insufficiently covered issues of diagnosis and treatment of contrast-induced nephropathy, renal replacement therapy and its place in the treatment of cattle are highlighted in detail, which, in our opinion, will make the recommendations interesting and useful for a wide range of specialist doctors. The recommendations are intended not only for cardiologists, nephrologists, cardiac and endovascular surgeons, anesthesiologists, intensive care physicians and perfusiologists, but also for general practitioners and internists who are on the first line of the fight against CRS. It is noteworthy that when preparing the recommendations, we used our own experience of the State Institution «Republican Scientific and Practical Center of Cardiology» and the State Institution «Minsk Scientific and Practical Center for Transplant Surgery and Hematology» (Minsk, Republic of Belarus).
Background. Cardiac remodeling is a complex bidirectional process in which structural and functional parameters of the heart deviate from the norm in response to impaired intracardiac hemodynamics following acute myocardial infarction. Reverse left ventricular (LV) remodeling is manifested by improved systolic and diastolic function due to a decrease in cardiac chamber volume.Objectives. To analyze the dynamics and degree of reverse remodeling of the left ventricle after surgical correction of post-infarction aneurysms of the left ventricle. Based on the results, develop a model for predicting ultrasound parameters in patients in the postoperative period.Methods. A retrospective analysis of treatment outcomes was conducted for 174 patients who underwent post-infarction aneurysm repair followed by coronary artery bypass grafting (CABG) at the Nizhny Novgorod Research Institute of Cardiology and the Nizhny Novgorod Clinical Hospital named after Academician B.A. Korolev between 2011 and 2022. Patients were divided into two groups. The first group underwent Cooley repair and CABG, while the second group underwent Dor repair and CABG. The patients had various risk factors that influenced the development of LV remodeling processes. Ultrasound imaging was used to obtain data on the LV and other cardiac structures. Artificial intelligence was used to predict the potential extent of cardiac reconstruction.Results. A significant reduction in ultrasound measurements of LV volume was observed in patients at various postoperative times. The most significant practical outcome of the study was the development of a clinically applicable machine learning model for predicting surgical outcomes. Its high accuracy (confirmed by a low median error) allows the model to be used for preoperative planning to individualize surgical tactics. The model helps determine the "sweet spot" in the extent of resection — one that is sufficient to initiate reverse remodeling but safe from the risk of low-output syndrome. The implementation of such AI-based decision support systems directly contributes to improved surgical safety and patient outcomes.Conclusion. In cardiac surgery, a key indicator of success is reverse LV remodeling against the background of heart failure remission after surgery. In recent years, assessment of this process has become a cornerstone of clinical practice, as it serves as the main predictor of a favorable long-term prognosis for patients.
Introduction . Despite significant advances in modern medicine, the prevalence of cardiovascular disease (CVD) remains high. Studying current trends in the prevalence of major CVD risk factors (RF) in different occupational groups is of particular interest Aim : to assess current trends in the prevalence of major CVD RFs based on a comparative analysis of baseline and follow-up studies in an organized population of white-collar workers. Material and research methods . A follow-up preventive study was conducted among employees of one of the research institutes in Baku 15 years after the baseline survey. The follow-up study included 136 participants (92 women and 44 men), and the baseline study included 196 participants (111 women and 85 men). A set of standard epidemiological methods used in cardiology was applied. Results . The follow-up study demonstrated a tendency toward a higher prevalence of arterial hypertension (35.9-26.1% and 47.7-36.9%; p>0,05) and diabetes mellitus (9.8-4.5% and 13.6-8.4%; p>0,05) in both women and men compared with the baseline survey; however, these differences were not statistically significant (p>0.05). At the same time, a tendency toward a lower prevalence of overweight, low physical activity, smoking, excessive salt intake and alcohol consumption was observed, more pronounced among men. Among men, the prevalence of low physical activity (11.4% vs. 38.1%; p<0.01), smoking (13.6% vs. 41.7%; p<0.01) and excessive salt intake (4.5% vs. 16.7%; p<0.05) was significantly lower in the follow-up study; no cases of excessive alcohol consumption were recorded. The proportion of men without CVD risk factors increased more than twofold compared with the baseline study (11.4% and 4.8%; p>0,05). Conclusion . The findings confirm the need for regular monitoring and multicomponent correction of CVD risk factors and support the development of gender-oriented prevention programs.
Research objective: to evaluate global longitudinal strain of the left ventricle in patients with hypertrophic cardiomyopathy (HCM) with different locations of myocardial thickening, with and without concomitant stenotic lesion of the coronary arteries. Materials and methods. Clinical data, echocardiography with speckle tracking echnology, and coronary angiography data from 69 patients with HCM aged 27 to 91 years were analysed. The optimal quantitative threshold for global longitudinal strain was determined by ROC analysis. Results. Echocardiography revealed septal HCM in 26 (37.7%) patients; symmetrical HCM in 18 (26.1%); combined variant in 14 (20.3%); apical variant in 9 (13%); and mid-ventricular variant in 2 (2.9%). Coronary angiography revealed stenotic lesions of the coronary arteries in 32 (46.4%) individuals with HCM. Global longitudinal strain in patients with HCM and concomitant stenotic lesion of the coronary arteries was > −11.2% (AUC 0.839). The degree of reduction in the indicator depended on the location of left ventricular thickening (AUC 0.867÷1). Obesity and reduced left ventricular ejection fraction in HCM reduced global longitudinal strain to > −8.5% (AUC 0.789) and > −7.4% (AUC 0.983), respectively. Conclusion. A decrease in global longitudinal strain of the left ventricle in patients with HCM suggests concomitant stenotic lesion of the coronary arteries: in the septal variant > −12.9%; symmetrical > −11.1%; apical > −10.2%. However, in each individual case, factors affecting global longitudinal strain of the left ventricle regardless of stenotic lesion of the coronary arteries should be taken into account: obesity and decreased left ventricular ejection fraction.
Chronic heart failure (CHF) is a severe clinical syndrome, which can develop in patients with various heart diseases. Tactics of management of patients with CHF depends on cause of development of this syndrome, therefore exact diagnosis is especially important. Echocardiography (EchoCG) is the main method in algorithm of examination with any cardiological examination, but neither EchoCG, nor other traditional cardiological methods of examination in all clinical situations can reveal cause of development of CHF, therefore search for new diagnostic strategies is important. Objective of the work : to show possibilities of magnetic resonance tomography of heart in examination of patients with chronic heart failure on example of own clinical observations. Materials and methods . Analyzed heart studies performed on patients with chronic heart failure from March 2024 to December 2025. An analysis of the literature devoted to the diagnosis of chronic heart failure was conducted, and the search was carried out using the Google Scholar, Scopus, PubMed, and Web of Science databases. All clinical cases presented in the article were performed by the authors of the article. Results . Along with traditional methods of cardio-visualization (EchoCG, scintigraphy of myocardium), MRI with contrast agent is included in diagnostic algorithm of examination of patients with chronic heart failure, especially in complex situations. The article presents standard protocols of MRI for analysis of structural and functional changes of myocardium, contraindications to performance of MRI. On clinical observations possibilities of MRI are demonstrated in clarification of etiology of chronic heart failure in patients with reduced ejection fraction and preserved ejection fraction of left ventricle. Presented clinical cases of use of MRI for differential diagnosis of various causes of hypertrophy of myocardium of LV in patients with CHF, differential diagnosis of ischemic and non-ischemic lesion of myocardium. Conclusion . In the work are demonstrated the possibilities magnetic resonance tomography is highly informative method of diagnosis in patients with chronic heart failure, both in patients with reduced ejection fraction and in absence of its reduction.
Introduction . In world practice, the common femoral artery is considered the traditional access for endovascular treatment of brachiocephalic arteries. Case report . The possibility of radial access for endovascular treatment of common carotid artery «in-stent restenosis» in a patient with occlusion of infrarenal abdominal aorta and the only functioning internal carotid artery on the ipsilateral side was demonstrated. Conclusion . This experience of correcting the common carotid artery lesion using radial access is only a single clinical observation and cannot be interpreted as a universal algorithm.
Objectives . The primary objective was to describe antihypertensive and lipid lowering effectiveness of a polypill of amlodipine, atorvastatin, and perindopril at week 12 in patients with arterial hypertension (HTN) and hypercholesterolemia in daily clinical practice. Design and method . The TARGET study (NCT05764317) was a 12-week ambispective observational study. Adult out-patients with HTN and hypercholesterolemia had initiated treatment with the polypill in dosage strengths of 5/10/5 mg; 5/20/5 mg or 5/20/10 mg within 1 month before enrollment. The primary outcome was mean change from baseline in office systolic and diastolic blood pressure (SBP, DBP) and low-density lipoprotein cholesterol (LDL-C) at week 12. Main secondary outcomes were changes of quality of life as assessed by SF-36 questionnaire and adherence to therapy measured by a Russian questionnaire at week 12 compared to baseline. Effectiveness and safety analyses were performed in modified intention-to-treat population. Uni and multivariate regression models were used to define significant predictors for the achievement of target parameters. Results . Four hundred nine outpatients who had already initiated the polypill of amlodipine/atorvastatin/perindopril were included in the study. Very high or extreme cardiovascular (CV) risk initially had 160 (39.1%) of patients, 166 (40.6%) had high CV risk, 71 (17.4%) had moderate and 12 (2.9%) had low CV risk. Mean baseline blood pressure (BP, SD) was 157.3 (15.6)/ 92.3 (9.1) mmHg and mean LDL-C at baseline was 3.7 (1.0) mmol/L. Mean SBP decreased by 32.4 (15.3) mmHg and DBP by 15.0 (10.0) mmHg by week 12 (both р<0.0001). Mean LDL-C value decreased by 1.6 (0.9) mmol/L (р<0.0001). Changes in physical and psychological components of SF-36 were 5.7 (8.2) and 7.7 (9.9) points by week 12 compared to baseline. Proportion of patients with low/moderate adherence decreased from 17.4% (71/409) to 1.5% (6/409) by week 12, whereas a proportion of patients with a high adherence at the end of the observation period increased up to 97.5%. Older age (OR (odds ratio) 0.97, 95% confidence interval (CI) 0.94 to 0.99) and peripheral artery disease (PAD) (OR 0.44, 95% CI 0.22 to 0.91) were significant negative predictors for achieving target BP. Presence of T2D (OR 0.50, 95% CI 0.28 to 0.89) and LDL-C level increase by week 12 compared to baseline (OR 0.28, 95% CI 0.21 to 0.39) were negative predictors for LDL-C target value achievement. One non-serious adverse event (dry cough) and one special situation (insufficient lipid-lowering effectiveness) were reported. Conclusion. Treatment with a polypill amlodipine/atorvastatin/perindopril demonstrated significant BP and lipid-lowering effectiveness and was well tolerated. These changes were accompanied by improvement of adherence to treatment and quality of life.
Progressive Duchenne muscular dystrophy is a common X-linked recessive myopathy caused by a mutations in the gene encoding dystrophin. Duchenne muscular dystrophy is characterized by damage to the heart muscle with conduction and rhythm disturbances, and the development of dilated cardiomyopathy, which may be asymptomatic. The development of heart failure determines the unfavorable prognosis of patients with Duchenne muscular dystrophy. Insufficient awareness of physicians about the characteristics of heart damage in Duchenne muscular dystrophy creates the prerequisites for describing interesting clinical observations. The article presents a clinical observation of the development of dilated cardiomyopathy and heart failure with a low left ventricular ejection fraction in a 19-year-old male patient with Duchenne muscular dystrophy. The dynamics of Duchenne muscular dystrophy progression from the moment of diagnosis to the development of decompensated heart failure are described. The article presents clinical course data, laboratory parameters, electrocardiography and echocardiography data in dynamics. The article presents diagnostic criteria for Duchenne muscular dystrophy, prospects for therapy aimed at correcting the genetic defect by replacing, modifying or reparating the dystrophin gene. The presented case demonstrates the need for a personalized multidisciplinary approach to a patient with Duchenne muscular dystrophy, with the participation of an orthopedic surgeon, pulmonologist, cardiologist, endocrinologist, and ophthalmologist.
Idiopathic pulmonary hypertension (IPAH) is a rare severe disease with a poor prognosis. Assessing quality of life (QoL) using questionnaires can significantly complement clinical, laboratory and instrumental data. Aim . To assess QoL using various questionnaires in patients with a newly and previously diagnosed IPAH. Materials and methods . 73 patients with IPAH were included in the study, all patients filled out Qol questionnaires: universal (SF-36, EQ-5D-3L) and special for patients with pulmonary hypertension (CAMPHOR, PAH-SYMPACT, EmPHasis-10). Two groups were formed, comparable by age and gender: group 1-42 patients with newly diagnosed IPAH; group 2-31 patients with a previously diagnosed IPAH. Results . Significant differences in SF-36 were found in the scale of Mental Health (52 [40; 64] % in the first group and 60 [52; 80] % in the second, p=0,02) and Mental component summary (40,8 [34,3; 49,3] % and 49,1 [41,0; 55,9] %, respectively, p=0,03). According to the EQ-5D-3L results, differences were found in the Visual Analogue Scale (VAS) and EQ-5D Index: higher values were found in the second group (the median VAS score was 50 [40; 60] % in the first group and 60 [50; 70] % in the second, p=0,006, EQ-5D Index – 0,60 [0,30; 0,71] and 0,66 [0,57; 0,76], respectively, p=0,05). No significant differences were found in the results of CAMPHOR, PAH-SYMPACT, and EmPHasis-10 in two groups. Conclusions . Pathogenetic therapy promotes improvement of functional status of patients with IPAH. Low emotional status indicators in patients with a prevalent disease indicates the need to develop a system of psychological assistance for IPAH patients.
Introduction . The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains a challenging task. Despite the revised 2010 criteria of the ITF Task Force, most patients still face difficulties in establishing this diagnosis. Objective . To assess the clinical and genetic characteristics of patients with a preliminary diagnosis of “ARVC,” with a focus on the final diagnosis established after re-evaluation at the Republican Scientific and Practical Center of Cardiology (RSPC “Cardiology”). Material and methods . Twenty-eight patients (53.6% male, median age 35 [24; 43] years) with a preliminary diagnosis of ARVC referred to the RSPC “Cardiology” were examined. The clinical and instrumental evaluation included 12-lead ECG, 24-hour Holter monitoring, transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE). The ARVC diagnosis was based on the 2010 ITF criteria and classified into definite, borderline, and possible categories. Genetic testing for mutations in genes associated with cardiomyopathies and inherited rhythm disorders was performed using next-generation sequencing (NGS). Results . Among the 28 patients with a preliminary diagnosis of ARVC, only 7 (25%) were diagnosed with definite ARVC according to the 2010 ITF criteria and confirmed by genotyping (mutations in the PKP2 and DSG genes in 5 patients, mutation in the non-desmosomal TMEM43 gene in 1 patient, and mutations in ILK and RBM20 genes in 1 patient). Eight (28.6%) patients were diagnosed with borderline ARVC, and 4 (14.3%) with possible ARVC. In 9 (32.1%) patients, the diagnosis of ARVC was ruled out due to misinterpretation of cardiac MRI. Genotyping revealed no ARVC-associated mutations in the borderline, possible, or excluded groups. A total of 7 (25%) patients received an ICD; of these, 6 were deemed appropriate, while 1 was considered inappropriate due to an unconfirmed ARVC diagnosis. Conclusions . A misdiagnosis of ARVC was found in 32.1% of patients suspected of having the condition. The most common reason for false suspicion was misinterpretation of cardiac MRI results, particularly regional dyskinesia/akinesia of the right ventricular wall due to factors such as pericardial constriction, right ventricular diverticulum, pectus excavatum, right ventricular enlargement in athletes, or frequent arrhythmias causing artifacts. Genotyping proved helpful in timely confirmation of the ARVC diagnosis in this patient cohort.
Objective . To evaluate the efficacy and safety of this method in patients with severe dysfunction of the mitral valve prosthesis. Materials and methods . From May 2015 to March 2024, 25 patients with mitral valve prosthesis failure due to degenerative changes were treated in the Department of Cardiovascular Surgery. The patients underwent transapical implantation of the prosthesis in the mitral position using the valve-in-valve technique using the Edwards Sapien XT (Edwards Lifesciences USA – California) and Myval (Meril Life Sciences, Vapi, India) valve systems via transfemoral access. Results .Implantation was successful in all cases, no conversion to open intervention was registered. Comparison of preoperative and postoperative echocardiographic parameters revealed a statistically significant decrease in the level of mean and maximum transprosthetic pressure gradients (12 [9.5; 16.2] versus 6 [4.7; 6] and 29.5 [22; 33.5] versus 12 [10; 14.75], respectively, p<0.0001), as well as the level of SPPA from 76 [62; 95] to 40 [35; 45] mmHg, p<0.0001 Conclusion . Transcatheter implantation in the mitral position using the "valvein-valve" technique for the treatment of patients with high surgical risk with degeneration of the mitral valve prosthesis is an effective and safe technique. An important stage in this intervention is careful preoperative planning with the selection of a prosthesis of the required size and assessment of an unfavorable clinical outcome depending on the anatomical features of the patient.
A clinical case of pulmonary artery branches embolism with bone cement deposits after lumbar vertebral hemangioma's percutaneous vertebroplasty is presented. Pulmonary artery embolism with bone cement is a frequent, but not always clinically significant complication of vertebroplasty. However, some patients have severe and even life-threatening complications like massive thromboembolism in the pulmonary artery and heart chambers, so postoperative screening after percutaneous vertebroplasty is very important. The most common methods for visualizing embolic occlusions of pulmonary artery branches with bone cement are X-ray and computed tomography. Computed tomography is rightfully considered the gold standard for diagnosing pulmonary embolism, but modern digital X-ray also successfully identifies bone cement deposits in the pulmonary arteries. X-ray is an inexpensive, accessible and objective method of examination and can be used as a postoperative screening. The purpose of this report is paying attention to the possibilities of classical X-ray in visualizing pulmonary artery's bone cement deposits after percutaneous vertebroplasty.
In this document we provide comprehensive review of contemporary approaches to diagnostic work-up and management of atrial fibrillation (AF) in adults. These guidelines are based on systematic methods to evaluate and classify evidence and provide a foundation for the delivery of quality cardiovascular care. Previous version of Eurasian clinical practice guidelines published in 2019 required revision due to a number of randomized clinical trials in major medical and surgical approaches to AF published in 2019-2024. Updated version of Eurasian Clinical practice guidelines based on methodology of European society of cardiology guidelines (2024) and American heart association/ American College of cardiology guidelines (2023). Revision included not only new scientific data but also took into consideration regional differences in healthcare systems, medical services and drugs availability and epidemiology of AF in Eurasian region.
Aim : to assess the dynamic of cardiac remodeling by magnetic resonance imaging (MRI) in pulmonary arterial hypertension (PAH) patients as a result of combination specific therapy including selexipag intake in long-term use (up to 12-month). Materials and methods. The study was performed on 50 PAH patients being observed at department of pulmonary hypertension and heart diseases of E.I. Chazov National Medical Research Center of Cardiology. A comparative analysis of clinical, functional and hemodynamic parameters, including cardiac MRI, was performed in all participants and resulted in selexipag administration. Results . Right ventricular end-systolic volume index (RVESVI) correlated with N-terminal pro-brain natriuretic peptide (NT-proBNP) ratio (p=0,0002), RVESVI also correlated with systolic pulmonary arterial pressure (SPAP) (p=0,0019), right ventricle stroke volume index (RVSVI) correlated with NT-proBNP ratio (p<0,0001), RVSVI also correlated with SPAP (p=0,0007). The use of selexipag as part of a combined PAH-specific therapy resulted in right atrial volume reduction, right ventricle ejection fraction and RVSVI increase, which were assessed by cardiac MRI. Conclusion . Cardiac MRI as noninvasive method for assessment of right ventricle size and function in PAH patients either at therapy administration or therapy effectiveness assess is a promising direction for approaches development of new prognostic parameters in PAH risk stratification.
Cardiovascular diseases (CVD) occupy the first place in the structure of morbidity, mortality and disability of the population, therefore, the problem of effective treatment of CVD is still one of the most important in modern cardiology. CV diseases require lifelong therapy, so overcoming poor adherence is relevant in the treatment of patients. Suboptimal adherence is a proven risk factor that decreases the effectiveness of treatment, increases the risk of developing CV complications, as well as worsens the disease outcomes and quality of life. In addition, there is a large number of factors affecting adherence to treatment, which significantly complicates the solution of this problem. Coronary heart disease (CHD) due to high prevalence worldwide is a poorly managed risk factor for CV risk and death. Despite the wide range of available medications, adherence to therapy in CHD patients is extremely low and it is associated with an unfavorable CV prognosis. Prescription of adequate drug treatment improves the clinical condition of CHD patients and decreases the level of CV complications and death. Currently, there is no single strategy for improving adherence to treatment. There is a negative correlation between the level of adherence to therapy and the number of prescribed medications. According to current recommendations, one of the most reasonable ways to solve the problem of poor adherence to pharmacotherapy is prescribing single-pill combinations. The concept of using single-pill combinations is defined as the combination of several drugs contained in a single dosage form. This strategy helps to improve the control of several risk factors at the same time and reduce the risk of CV events. The results of many studies confirm the effectiveness of introducing single-pill combinations in the real clinical practice, since it simplifies the treatment regimen and leads to better CV prognosis by reducing the risk of developing CV complications. This literature review presents a modern view on the problem of adherence to treatment in CHD patients.
Objective : to study psychological (questionnaires data), psychophysiological (electroencephalography and skin galvanic reaction) and biochemical parameters (hormones and cytokines) in patients with coronary artery disease (CAD) in comparison with healthy volunteers. Materials and methods . The study included 23 patients with confirmed CAD and 25 healthy individuals. All participants underwent: psychological testing (questionnaires PSM-25, Leonova, Jenkins, SACS), biochemical blood analysis (cortisol, ACTH, ACTH releasing factor, neuropeptide Y, etc.), psychophysiological examination (skin galvanic reaction and electroencephalography (EEG) at rest and in response to stress). Results . Patients with CAD experienced higher levels of acute (91% vs. 52% in the control group, p=0.0033) and chronic stress (p=0.0277) according to the Leonova questionnaire. Biochemical analysis revealed lower levels of ACTH-RF (p=0.0112) and neuropeptide Y (p=0.0011) in patients with CAD. Assessment of autonomic nervous system reactivity using a galvanic skin reaction confirmed a stronger sympathetic response to stress in patients with CAD (the potential difference between two skin areas under stress was 523±178 μV versus 415±169 μV in the control group, p=0.0363). No significant differences were found in other questionnaires (PSM-25, Jenkins, SACS), other hormones and neuropeptides (cortisol, ACTH, prolactin, etc.) and EEG parameters. Conclusion . This study confirms that patients with coronary artery disease are characterized by a higher level of acute and chronic stress, increased autonomic reactivity to stress (according to skin galvanic reaction), and also revealed changes in regulatory peptides (ACTH releasing factor, neuropeptide Y).
