Kardiologiya最新文献

{"title":"[Laboratory Aspects of Using the Results of NT-Probnp Concentration Immunochemical Determination in the Management of Patients With Heart Failure: Support For Clinical Decision-Making].","authors":"N G Vinogradova, V S Berestovskaya, Z N Blankova, T V Vavilova, N V Gomyranova, V P Masenko, V Yu Mareev, A A Skvortsov, N A Sorokina, S N Tereshchenko","doi":"10.18087/cardio.2024.8.n2720","DOIUrl":"10.18087/cardio.2024.8.n2720","url":null,"abstract":"<p><p>The burden of heart failure (HF) has been increasing worldwide in recent decades. Early diagnosis of HF based on the outpatient measurement of natriuretic peptide (NP) concentration will allow timely initiation of the treatment and reducing the incidence of adverse outcomes in HF. Unfortunately, the frequency of NP testing remains low worldwide. At the online expert meeting held on March 15, 2024, the features of the N-terminal pro-brain natriuretic peptide (NT-proBNP) test (Elecsys proBNP by Roche) were discussed along with the interpretation of test results and presentation of results in laboratory reports. The experts addressed the features of the Elecsys proBNP test in patients with suspected HF in various clinical scenarios (chronic and acute HF). The limits of clinical decision for the NT-proBNP test were established depending on the clinical scenario. Changes in the Elecsys proBNP test results depending on the comorbidities were addressed. The experts suggested ways to optimize the format of the Elecsys proBNP test result reports in the Russian Federation, which will accelerate the implementation of the test in clinical practice and optimize the management of HF patients.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"68-78"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomolecules of Adipose Tissue in Atherosclerotic Plaques of Men With Coronary Atherosclerosis.","authors":"E V Garbuzova, Ya V Polonskaya, E V Kashtanova, E M Stakhneva, V S Shramko, I S Murashov, A V Kurguzov, A M Chernyavsky, Yu I Ragino","doi":"10.18087/cardio.2024.8.n2634","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2634","url":null,"abstract":"<p><strong>Aim: </strong>To study metabolic molecules (adiponectin, adipsin, resistin, glucagon-like peptide-1 (GLP-1), glucagon, secretin) of adipose tissue in atherosclerotic plaques (AP) and their associations with AP instability in men with coronary atherosclerosis.</p><p><strong>Material and methods: </strong>Metabolic molecules (adipocytokines and metabolic hormones) of adipose tissue can act as enzymes, hormones or growth factors in modulating insulin resistance and lipid and glucose metabolism and indirectly influence the course of the atherosclerotic process. This study included 48 men from whom 139 coronary artery (CA) samples were collected during coronary artery bypass grafting, after obtaining the informed consent. According to the histological conclusion, 84 (60.4%) CA plaques were stable, 44 (31.7%) were unstable, and 11 histological samples had a conditionally unchanged CA intima (7.9%). The concentrations of adiponectin, adipsin, resistin, GLP-1, glucagon, and secretin were measured in AP homogenates by multiplex analysis using the Human Metabolic Hormone V3 panel (MILLIPLEX, Germany). During the study, demographic and anthropometric characteristics, medical history, and presence of chronic diseases were recorded.</p><p><strong>Results: </strong>The glucagon concentration in the conditionally unchanged intima was 16.7% lower and in the fragments of unstable atherosclerotic plaques 41.2% lower than in fragments of stable APs. However, the glucagon concentration in stable APs was 28% higher than in unstable APs. The secretin concentration in the conditionally unchanged intima was also lower than in stable APs by 41.2%, while in stable APs, the secretin concentration was 20% higher than in unstable APs. The adiponectin concentrations were directly correlated with serum high-density lipoprotein cholesterol (HDL-C) concentrations (r=0.286; p=0.002), while the secretin concentrations were inversely correlated with serum HDL-C concentrations (r= -0.199; p=0.038). The probability of having an unstable AP (in relation to conditionally unchanged intima) increases by 35.8% with an increase in the AP glucagon concentration by 1 pg/mg protein. The probability of having a stable AP (in relation to unchanged intima) increases by 29.4% with an increase in the AP glucagon concentration by 1 pg/mg protein and by 10.1% with an increase in the AP secretin concentration by 1 pg/mg protein.</p><p><strong>Conclusion: </strong>The AP adiponectin concentration directly correlates and the AP secretin concentration inversely correlates with the serum concentration of HDL-C. The presence of both stable and unstable APs is directly associated with the AP glucagon concentration in men with coronary atherosclerosis. The AP secretin concentration is directly associated with plaque stability in men with coronary atherosclerosis. Further thorough study of the identified markers in atherosclerotic lesions will allow using them as potential targets for therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"39-47"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial on the article «Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation».","authors":"G E Gendlin, A M Baimukanov, E I Emelina, D A Paegle, I G Nikitin","doi":"10.18087/cardio.2024.8.n2728","DOIUrl":"10.18087/cardio.2024.8.n2728","url":null,"abstract":"<p><p>In relation with the published article \"Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation\", we have issued a comment. The authors of the article addressed a widely discussed topic of \"Short episodes of fast arrhythmias initially detected in records on implantable devices\". Further, these episodes are studied already by Holter monitoring of different durations with assessment of their clinical significance. This is the subject of the cited article and our comment.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"64-67"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of the Effectiveness of Riskometer Scales in Predicting the Risk of in-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention.","authors":"B I Geltser, K I Shahgeldyan, I G Domzhalov, N S Kuksin, V N Kotelnikov, E A Kokarev","doi":"10.18087/cardio.2024.8.n2602","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2602","url":null,"abstract":"<p><strong>Aim: </strong>Comparative evaluation of the effectiveness of riskometer scales in predicting in-hospital death (IHD) in patients with ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI) and the development of new models based on machine learning methods.</p><p><strong>Material and methods: </strong>A single-center cohort retrospective study was conducted using data from 4,675 electronic medical records of patients with STEMI (3,202 men and 1,473 women) with a median age of 63 years who underwent emergency PCI. Two groups of patients were isolated: group 1 included 318 (6.8%) patients who died in hospital; group 2 consisted of 4,359 (93.2%) patients with a favorable outcome. The GRACE, CADILLAC, TIMI-STe, PAMI, and RECORD scales were used to assess the risk of IHD. Prognostic models of IHD predicted by the sums of these scale scores were developed using single- and multivariate logistic regression, stochastic gradient boosting, and artificial neural networks (ANN). Risk of adverse events was stratified based on the ANN model data by calculating the median values of predicted probabilities of IHD in the compared groups.</p><p><strong>Results: </strong>Comparative analysis of the prognostic value of individual scales for the STEMI patients showed differences in the quality of the risk stratification for IHD after PCI. The GRACE scale had the highest prognostic accuracy, while the PAMI scale had the lowest accuracy. The CADILLAC and TIMI-STe scales had acceptable and comparable prognostic abilities, while the RECORD scale showed a significant proportion of false-positive results. The integrative ANN model, the predictors of which were the scores of 5 scales, was superior in the prediction accuracy to the algorithms of single- and multivariate logistic regression and stochastic gradient boosting. Based on the ANN model data, the probability of IHD was stratified into low (&lt;0.3%), medium (0.3-9%), high (9-17%), and very high (&gt;17%) risk groups.</p><p><strong>Conclusion: </strong>The GRACE, CADILLAC and TIMI-STe scales have advantages in the stratification accuracy of IHD risk in patients with STEMI after PCI compared to the PAMI and RECORD scales. The integrated ANN model that combines the prognostic resource of the five analyzed scales, had better quality criteria, and the stratification algorithm based on the data of this model was characterized by accurate identification of STEMI patients with high and very high risk of IHD after PCI.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"48-55"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Instrumental Methods of Diagnostics and Risk Assessment of Developing Antitumor Therapy Cardiovasculotoxicity.","authors":"Yu N Belenkov, I S Ilgisonis, N V Khabarova, Yu Yu Kirichenko Yu Yu","doi":"10.18087/cardio.2024.8.n2753","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2753","url":null,"abstract":"<p><p>The most important component of cardio-oncology is the assessment of the risk of development and diagnosis of cardiovascular toxicity of the antitumor therapy, the detection of which is largely based on visualization of the cardiovascular system. The article addresses up-to-date methods of non-invasive visualization of the heart and blood vessels, according to the 2022 European Society of Cardiology Clinical Guidelines on cardio-oncology. Also, the article discusses promising cardiovascular imaging techniques that are not yet included in the guidelines: assessment of coronary calcium using multislice computed tomography and positron emission computed tomography with 18F-labeled 2-deoxy-2-fluoro-d-glucose.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"3-12"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).","authors":"G P Arutyunov, E I Tarlovskaya, A G Arutyunov, T I Batluk, N A Koziolova, A I Chesnikova, A Yu Vaskin, D S Tokmin, I G Bakulin, O L Barbarash, N Yu Grigoryeva, I V Gubareva, N V Izmozherova, U K Kamilova, S G Kechedzhieva, Z F Kim, N A Koriagina, S V Mironova, N P Mitkovskaya, S V Nemirova, L M Nurieva, M M Petrova, E A Polyanskaya, A P Rebrov, A V Svarovskaya, E A Smirnova, A B Sugraliev, Ya B Khovaeva, G V Shavkuta, I I Shaposhnik, M Yu K Alieva, A B Almukhanova, A V Aparkina, R A Bashkinov, L N Belousova, E I Blokhina, V O Bochkareva, V M Buianova, F Yu Valikulova, A D Vende, A S Galyavich, V V Genkel, E V Gorbunova, E D Gordeychuk, E A Grigorenko, E V Grigoryeva, I L Davydkin, D S Evdokimov, A N Ermilova, Sh B Zhangelova, N V Zhdankina, E I Zheleznyak, N S Ilyanok, D A Kapsultanova, N A Karoli, E A Kartashova, A S Kuznetsova, A T Kumaritova, N A Magdeeva, S A Makarov, E S Melnikov, M V Novikova, I A Obukhova, E V Ponomarenko, A O Rubanenko, O A Rubanenko, F E Rustamova, V A Safronenko, E I Suchkova, A I Sycheva, D R Tagaeva, M A Trubnikova, T P Trunina, A G Frolov, V V Khatlamadzhiyan, Yu I Khokhlova, A I Chernyavina, O Yu Chizhova, M A O Shambatov, T V Shnyukova, Yu V Shchukin","doi":"10.18087/cardio.2024.8.n2683","DOIUrl":"https://doi.org/10.18087/cardio.2024.8.n2683","url":null,"abstract":"<p><strong>Aim: </strong>To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry.</p><p><strong>Material and methods: </strong>The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis &lt;50%, n = 165; 8.7%).</p><p><strong>Results: </strong>A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group.</p><p><strong>Conclusion: </strong>IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the \"aggressiveness\" of therapy.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"13-23"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natriuretic Peptide Concentrations and Echocardiography Findings in Patients with Micro-atrial Fibrillation.","authors":"Hüseyin Aykaç, Cihan Aydın, Aykut Demirkıran, Nurullah Uslu, Şeref Alpsoy","doi":"10.18087/cardio.2024.8.n2633","DOIUrl":"10.18087/cardio.2024.8.n2633","url":null,"abstract":"<p><strong>Aim: </strong>Atrial fibrillation (AF) is a rhythm disorder characterized by very rapid and disorganized atrial-derived electrical activations with uncoordinated atrial contractions. Very short periods of AF-like activity (micro-AF) may be precursors of undetected, silent episodes of atrial fibrillation. Here, we examined the relationship between natriuretic peptide concentrations and echocardiography findings in patients with micro-AF.</p><p><strong>Material and methods: </strong>The electrocardiograms (ECGs) of patients complaining of palpitations were recorded with a 24‑hour Holter monitor, and the patients were consecutively included in the study. Micro-AF was defined as sudden, irregular atrial tachycardia lasting less than 30 sec with episodes of ≥5 consecutive supraventricular depolarizations with the absolute absence of p-waves. After a G-power test, patients were consecutively included in the study: 45 patients in the micro-AF group and 45 patients in the control group. Laboratory parameters, ECG and echocardiographic findings of the two groups were compared.</p><p><strong>Results: </strong>N-terminal pro B-type natriuretic peptide (Pro-BNP) and serum troponin T concentrations were higher in the micro-AF group, (375.5±63.6 pg / ml vs. 63.1±56.8 pg / ml, p&lt;0.001; 13±11.4 ng / dl vs. 4.4±2.4 ng / dl, p&lt;0.001 respectively.) Each 1 pg / ml increase in serum Pro-BNP increased the risk of micro-AF by 1.8 %. In the ROC analysis, the cut-off value of Pro-BNP for the diagnosis of micro-AF was 63.4 pg / ml, with a sensitivity of 91.1 % and a specificity of 73.3 %. Atrial electro-mechanical delay durations were significantly higher in the micro-AF group. To predict micro-AF, the inter-annulus plane electromechanical delay time (inter-annulus plane AEMD) had a cut-off value of 18.5 sec, with a sensitivity of 93.3 % and a specificity of 91.1 %. Left intra-annulus plane electro-mechanical delay time (intra-annulus AEMD LEFT) had a cut-off value of 11.5 sec with a 95.6 % sensitivity and 75.6 % specificity. In the ECG evaluation, maximum P wave duration (Pmax) (113±10.2 ms vs. 98±10.4 ms; p&lt;0.001), minimum P wave duration (Pmin) (73.8±5.5 ms vs.70±6.3 ms; p&lt;0.001) and P wave dispersion (PWD) (39.1±7.9 ms vs.28±7.6 ms; p&lt;0.001) were longer in the micro-AF group.</p><p><strong>Conclusions: </strong>Micro-AF in patients may be predicted by evaluating ECG, echocardiographic, and serum natriuretic peptide data.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 8","pages":"56-63"},"PeriodicalIF":0.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possibilities of Azilsartan Medoxomil for Preparation for Planned Percutaneous Coronary Intervention in Patients With Type 2 Diabetes Mellitus.","authors":"A M Kochergina, O L Barbarash","doi":"10.18087/cardio.2024.7.n2671","DOIUrl":"10.18087/cardio.2024.7.n2671","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy and safety of azilsartan medoxomil for preoperative preparation and improving the long-term prognosis of elective percutaneous coronary intervention (PCI) in patients with ischemic heart disease (IHD), arterial hypertension (AH), and type 2 diabetes mellitus (DM).</p><p><strong>Material and methods: </strong>The study sample included patients with type 2 DM referred for elective PCI who had poor blood pressure (BP) control according to 24-hour BP monitoring (24-BPM) (mean daily systolic BP ≥130 mmHg, mean daily diastolic BP ≥80 mmHg). The data were collected from 2018 through 2020. A total of 75 patients was included and distributed by simple randomization into two groups: group 1 (main, n=37) received azilsartan medoxomil as an antihypertensive drug at a dose of 40 mg/day (previously prescribed angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers (ARB) were discontinued); group 2 (control, n=38) continued on their previous antihypertensive therapy. The follow-up period was 6 months. During each of 5 consecutive follow-up visits, the patient was examined, 24-BPM was recorded, and urinary markers of renal dysfunction (glomerular filtration rate, GFR; neutrophil gelatinase-associated lipocalin, NGAL; urine albumin-creatinine ratio, UACR; kidney injury molecule, KIM-1; and interleukin-18, IL-18) were measured.</p><p><strong>Results: </strong>During the azilsartan treatment, GFR decreased by 7.4%, while in the control group, it decreased by 18.9% (p&lt;0.001). For 6 months of follow-up, no changes in the NGAL concentration were found in the main group, while the NGAL concentration in the control group increased by 12.9%. With azilsartan, there was a decrease in the urinary concentration of IL-18 (16.9%), while in patients of the control group, IL-18 increased (7.14%). Proteinuria progressed in both groups, which was expectable given the presence of DM; however, in patients receiving azilsartan, the UACR value increased by 37.5%, while in patients of the control group, it increased by 96.15%. These differences were statistically significant. No statistically significant differences were found in the concentrations of cystatin C and KIM-1.</p><p><strong>Conclusion: </strong>This study demonstrated two important facts: the possibility for diagnosing contrast-induced acute kidney injury (CI-AKI) using new, more sensitive markers of kidney damage, which is important for assessing the effectiveness of prevention, and the possibility of using ARBs, in particular azilsartan, for the prevention of CI-AKI in patients with IHD in combination with AH and DM.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 7","pages":"48-55"},"PeriodicalIF":0.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries.","authors":"T H Hoang, V V Maiskov, I A Merai, Zh D Kobalava","doi":"10.18087/cardio.2024.7.n2526","DOIUrl":"10.18087/cardio.2024.7.n2526","url":null,"abstract":"<p><strong>Aim: </strong>To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA).</p><p><strong>Material and methods: </strong>This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis &lt;50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years.</p><p><strong>Results: </strong>MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p&lt;0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042).</p><p><strong>Conclusion: </strong>The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 7","pages":"56-63"},"PeriodicalIF":0.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors that Determined a Positive Response to Resynchronization Therapy in Patients With Chronic Heart Failure and Cardiac Dyssynchrony. One Center Experience.","authors":"A S Postol, N M Neminushchiy, G N Antipov, A V Ivanchenko, V V Lyashenko, D A Kalinin, S N Kotov, A B Vygovsky, Yu A Shneider","doi":"10.18087/cardio.2024.7.n2627","DOIUrl":"https://doi.org/10.18087/cardio.2024.7.n2627","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the efficacy of cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) associated with cardiac dyssynchrony and to identify the factors that influence the CRT efficacy.</p><p><strong>Material and methods: </strong>This retrospective study included 155 patients after implantation of CRT devices. The CRT devices with a built-in cardioverter-defibrillator (CRT-D) and without it (CRT-P) were implanted in 139 (89.7%) and 16 (10.3%) patients, respectively. The follow-up period was 52.37±35.94 months. Based on the study results, two groups of patients were formed depending on the presence of a clinical response to CRT, responders and non-responders. The factors that influenced the clinical response to CRT were studied. The effect of the baseline state of patients on the effect of therapy was assessed. The need for CRT optimization and a possibility of using electrocardiographic criteria for that purpose were studied. Modern devices and leads for CRT, their functional capabilities and their influence on the CRT efficacy were characterized. Statistical analysis was performed with an IBM SPSS Statistics 21.0 (Chicago, USA) package.</p><p><strong>Results: </strong>CRT implantation with the left ventricular lead placement according to the traditional technique, through the coronary sinus, was successful in 130 (87.9%) patients. Difficulties with the left ventricular lead placement were noted in 13 (8.3%) patients when other techniques were used. After 6 months, a hemodynamic and clinical response was observed in 112 (72.2%) patients, and no positive response in 43 (27.8%). The increase in left ventricular ejection fraction in the responder group was more than 21.8±3.7%, which was associated with an improvement of the 6-minute walk test results. Th clinical response was significantly influenced by the possibility of stimulation from the basal parts of the heart; the use of more modern devices for CRT and quadripolar left ventricular leads; timely CRT optimization; and persistent dyssynchrony in non-responders. During the follow-up period, 34 (21.9%) patients died. The death rate in the non-responder group was significantly higher than in the responder group, 18 (41.3%) vs. 16 (14.3%), p=0.001. The main cause of death in the group of non-responders was CHF. Heart transplantation was performed in 3 (1.9%) patients.</p><p><strong>Conclusion: </strong>CRT increases the life span and improves the quality of life in patients with CHF and cardiac dyssynchrony. There was a group of patients with no benefit from CRT in this study. Modern devices allow increasing the number of patients who benefit from CRT. Periodic optimization of CRT is necessary. When optimizing CRT, it is possible to use electrocardiographic criteria of effectiveness: duration of the QRS complex and changes in the position of the electrical axis of the heart.</p>","PeriodicalId":54750,"journal":{"name":"Kardiologiya","volume":"64 7","pages":"31-39"},"PeriodicalIF":0.5,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}