Aim. To study the prognostic value of interleukin-6 (IL-6) in assessing the risk of arrhythmia recurrence in patients with arterial hypertension (AH) and paroxysmal atrial fibrillation (AF). Materials and methods. 95 patients with AH and paroxysmal AF were included in the study. The prospective follow-up of the patients was 6 months, and the end point of the study was a reported recurrence of AF. Depending on the end point of the study, the patients were divided into 2 groups: group 1 included 32 patients who had a recurrence of AF within 6 months; group 2 consisted of 63 patients without recurrence of arrhythmia. Results. The average concentration of IL-6 in blood plasma at the inclusion visit was significantly higher in patients of group 1 than in patients of group 2 (p0.05). There was a significant increase in the Cardio-Ankle Vascular Index (CAVI index) in patients with AF relapses than in patients without AF relapses – 8.9 [8.6; 9.1] and 7.7 [7.5; 8.3] (p0.05). We found a moderate direct correlation between the value of the CAVI index and the plasma concentration of IL-6 (r=0.6; p=0.024). In patients with AH and paroxysmal AF, a statistically significant association with the likelihood of arrhythmia recurrence was shown by such indicators as the level of IL-6 in blood plasma (Odds Ratio 1.42, 95% Confidence Interval – CI 1.18–1.70; p=0.001) and the CAVI index (Odds Ratio 1.31, 95% CI 1.08–1.58; p=0.005). Conclusion. An increase in the level of IL-6 in blood plasma of more than 4.0 pg/ml with a sensitivity of 70% and specificity of 72% indicates a high risk of AF recurrence in patients with AH and paroxysmal AF (Area Under the Curve – AUC 0.76), increases the risk of recurrence of arrhythmia by 1.42 times (95% CI 1.18–1.70; p=0.001).
Pulmonary arterial hypertension (PAH) is a rare precapillary vascular lesion characterized by progressive vasoproliferative remodeling of the microcirculatory bed, increased vascular resistance, and decompensation of the right ventricle. Despite the development of modern approaches to diagnosis and treatment, global and national epidemiological registries indicate a steady increase in the prevalence of the disease, which has an unfavorable prognosis. The fundamental problem in the pathogenesis of PAH is its prolonged latent course: obliteration of the pulmonary arterioles develops gradually, and the appearance of clinical manifestations of the disease correlates with already irreversible structural changes. A natural consequence of the subclinical onset is a diagnostic delay (on average 2–3 years from the onset of the first complaints), which is recognized as an independent predictor of an poor outcome. This review is dedicated to the analysis of the evolution of approaches to the treatment of PAH over the past two decades. The historical era of stepwise monotherapy, which provided purely symptomatic control, has been replaced by the concept of actively influencing three classic pathogenetic signaling pathways: the endothelin pathway (endothelin receptor antagonists), the nitric oxide pathway (type 5 phosphodiesterase inhibitors and soluble guanylate cyclase stimulators), and the prostacyclin cascade. The review systematizes data from modern meta-analyses and randomized clinical trials that convincingly demonstrate the superiority of initial dual and early sequential three-component therapy. Special attention is paid to the analysis of the evidence base for the non-selective oral agonist of IP receptors, selexipag. Based on the results of the landmark phase III GRIPHON study and long-term cohort observations by V. McLaughlin et al. lasting up to 10 years, the high clinical efficacy of including selexipag in combination therapy regimens has been confirmed. It has been proven that timely pharmacological modulation of the prostacyclin pathway ensures long-term control over disease progression, significantly reduces the frequency of hospitalizations, and improves survival. Thus, the prescription of multicomponent therapy in patients with PAH becomes a fundamental standard that modifies the natural course of the disease and significantly improves the prognosis.
Aim. To evaluate the efficacy and safety of a course of intermittent Hypoxia-Hyperoxia Training (re-oxygenation therapy) during the second inpatient rehabilitation phase in patients with moderately reduced and preserved left ventricular ejection fraction (LVEF) after coronary artery bypass grafting (CABG). Materials and methods. The study included 32 patients on days 7–10 after CABG. All patients underwent physical training and were randomized into two groups. The intervention group received 10–14 daily sessions of re-oxygenation therapy lasting 40 minutes each in addition to physical training. The control group did not receive re-oxygenation therapy. The following assessments were performed: six-minute walk test, bicycle ergometry with evaluation of exercise tolerance, and LVEF measured by Simpson’s method. Results. At baseline (7–10 days post-CABG), there were no significant differences between the intervention and control groups in the analyzed parameters. After completing the rehabilitation course, the intervention group showed a 21.4% increase in six-minute walk test distance (p=0.02), while the control group showed no significant change (p=0.08); exercise tolerance increased by 50% in the intervention group (p=0.04) and did not change in the control group; LVEF increased by 6.7% in the intervention group (p=0.03) and by 2.2% in the control group (p=0.06). According to the Kansas City Cardiomyopathy Questionnaire (KCCQ), most patients in the intervention group who initially rated their health status as “moderate” shifted to the “high” health status category (p=0.0002), whereas no patients in the control group rated their health as “high.” No adverse events or therapy discontinuations related to re-oxygenation therapy were observed, and vital signs showed no negative changes. Conclusion. Re-oxygenation therapy combined with physical training during the inpatient rehabilitation phase after CABG is safe and significantly improves postoperative outcomes by enhancing exercise tolerance and quality of life.
The editorial discusses a wide range of relationships between arterial hypertension, lipid metabolism disorders, and atherosclerosis. The history of the issue and basic data on the epidemiology of these diseases are highlighted in detail. The features of the pathogenesis of atherosclerosis in combination with arterial hypertension are presented. Modern approaches to the choice of biochemical and instrumental methods of examination of patients with a combination of pathology, as well as clinical features, are discussed. The most important part of the article is the discussion about modern approaches to non-drug and drug treatment, taking into account current recommendations.
The article describes the origins of the Siberian Therapeutic School. It highlights the contributions to its formation by professors of the medical faculty of Tomsk Imperial University (from 1930 – Tomsk Medical Institute) – A.P. Korkunov, M.G. Kurlov, P.A. Lomovitskiy, and D.D. Yablokov. Students of M.G. Kurlov and D.D. Yablokov successfully headed therapeutic departments in newly established medical Universities, which allows them to be considered the founders of the therapeutic school, having made the most significant contribution to the establishment of internal medicine clinics in Siberia.
