Terapevticheskii arkhiv

Aim. Development of a “Risk Score Scale” (RSS) to assess the risk of Major Adverse Cardiovascular Events (MACE) based on computed tomographic angiography (CTА) of the coronary arteries in patients with acute coronary syndrome.

Materials and methods. The study included 249 pаtients with acute coronary syndrome (77.5% of men, age 58.2±10.7 years). Myocardial infarction occurred in 73.5% of patients, unstable angina – in 26.5%. After percutaneous coronary intervention CTA was performed by 320 – row CT scanner. 30 CTА characteristics were determined.

Results. During 39.1 [18.0; 57.4] months of follow-up, 28.5% patients had combined primary endpoint events (PEE) including nonfatal myocardial infarction, unstable angina, cardiac death, unplanned percutaneous coronary intervention, ischemic stroke. RSS was developed by ROC analysis of the significant CT predictors of PEE, which were determined using a univariate Cox model. The uncensored period was 305 days – 26 PEE. Using the Yuden method, cut-off values, AUC values, and other indicators were calculated for predictors. RSS included the following 8 most optimal predictors with their cut-off values and score values: “number of coronary arteries with plaques” >1.5 – 1.0 point; “maximum plaque length” >14.5 mm – 1.16 points; “total length of plaques” >22.5 mm – 1.17; “maximal coronary stenosis” >77.5% – 1.23; “number of plaques with ≥50% stenosis” >3,5 – 1.1; “minimum plaque density” <29.1 HU – 1.33; “number of plaques with spotty calcifications” >1.5 – 1.23; “number of low attenuation plaque <30 HU” >0.5 – 1.00. For the resulting RSS calculated threshold value was 3 points. A score of >3 points indicates a high risk of MACE: odds ratio 7.2, 95% CI 2.6–19.7 (p<0.0001).

Conclusion. The use of RSS is a new and practically significant technique that makes it possible to improve the risk stratification of adverse outcomes.

Aim. To identify functional features in patients with interstitial lung diseases (ILD), depending on disease phenotypes, using the forced oscillation technique.

Materials and methods. A single-center cross-sectional observational study was conducted on 68 patients with ILD (mean age 64 years, 70.6% women). The diagnoses were distributed as follows: idiopathic pulmonary fibrosis 17.7%, chronic hypersensitivity pneumonitis 44.1%, non-specific interstitial pneumonia 14.7%, unclassified ILD 23.5%. According to Tomographia Computata data, fibrotic changes were detected in 74.1% of patients. All patients underwent comprehensive pulmonary function testing, including spirometry, body plethysmography, measurement of diffusing capacity of the lungs, and oscillometry (forced oscillation technique).

Results. The ΔX5 parameter was statistically significantly higher in patients with a fibrotic phenotype than in those without fibrosis [0.92 (0.06– 1.63) hPa×s/L vs 0.19 (-0.05–0.43) hPa×s/L; p=0.016]. Patients with fibrosis also had significantly lower for diffusing capacity of the lungs (45.5% vs 52% predicted; p=0.027) and CO diffusion capacity – Kco (73% vs 81.5% predicted; p=0.037) values. Independent predictors of the fibrotic phenotype were ΔX5 (odds ratio 6.386, 95% confidence interval 1.479–27.564; p=0.013) and Kco (odds ratio 0.929, 95% confidence interval 0.867–0.997; p=0.040). ROC analysis showed that the combination of ΔX5 and Kco parameters has high diagnostic value for detecting fibrosis (AUC 0.817; p<0.001).

Conclusion. The oscillometry parameter ΔX5 and the Kco index from diffusing capacity measurement are independent predictors of a fibrotic phenotype in patients with ILD. The combination of these functional parameters improves diagnostic capabilities for detecting fibrotic changes. The FOT method provides clinically important information in patients with ILD and restrictive impairment.

Aim. To assess the circulating levels of IL-1 and its activity regulators, IL-1Ra and IL-1R2, in patients with acute decompensated heart failure (ADHF) depending on body mass index (BMI).

Materials and methods. The study included 159 patients hospitalized for ADHF. Depending on the BMI, the patients were assigned to 5 groups. The first group included 30 patients with healthy weight (BMI<25 kg/m²), the second – 50 overweight patients (25≤BMI<30 kg/m²), the third – 38 patients with class I obesity (30≤BMI<35 kg/m²), the fourth – 28 patients with class II obesity (35≤BMI<40 kg/m²), the fifth group – 13 patients with class III obesity (BMI≥40 kg/m²).

Results. With increasing BMI, IL-1 levels increased, while IL-1R2 levels, on the contrary, decreased, but no statistically significant differences were found. IL-1Ra concentrations changed ambiguously and had U-shaped dependence. IL-1Ra levels were lower in overweight patients than in normal weight and obese groups. At the same time, the increase in obesity was accompanied by higher IL-1Ra levels. The highest IL-1Ra value was observed at a BMI≥40 kg/m².

Conclusion. In ADHF an increase in obesity is accompanied by an increase in the inhibition of IL-1 activity, which may be one of the mechanisms by which adipose tissue exerts a protective effect.

This review examines the pathophysiological processes affecting the Extracellular Volume (ECV) in both the acute and chronic phases of myocardial infarction. It discusses how the constellation of acute myocardial injuries leads to ECV expansion, establishing it as a robust and independent predictor of adverse left ventricular remodeling, major adverse cardiovascular events, and arrhythmic risk. The review outlines current methodologies for ECV assessment. It is shown that despite limitations related to its non-specific nature and the need for protocol standardization, ECV mapping surpasses traditional approaches in infarct size quantification and risk stratification, paving the way for personalized monitoring of treatment efficacy. The review encompasses foundational validation studies as well as recent research focused on the pathophysiological rationale of the method, technical aspects of its implementation, and clinical applications of ECV analysis, including its role in evaluating anti-remodeling therapies.

Neurofibromatosis (NF) is a hereditary disease characterized by the formation and growth of benign tumors of neuroectodermal origin. There are three main nosological forms: NF1, NF2, NF3. It is believed that the disease debuts in childhood and significantly reduces the life expectancy of patients. The main cause of death in middle age are cardiovascular diseases and malignant neoplasms. There are isolated publications on NF in patients over 60 years old. The relationship between NF and cardiorenal syndrome has not been sufficiently studied. The development of vasculitis with vasculopathy is described, which leads to narrowing and occlusion of the coronary, renal, cerebral and other arteries. The article presents a description of an 85-year-old patient with NF and the development of cardiorenal syndrome.

The work is dedicated to the 60th anniversary of the founding of the Department of Hospital Surgery No. 2 and aims to preserve the historical memory of the establishment and development of the Department, which was created on the basis of the N.V. Sklifosovsky Research Institute of Emergency Care in 1964. The paper tells about the prerequisites of the founding of the Department of Hospital Surgery of the Evening Medical Faculty of the 1st Moscow Order of Lenin I.M. Sechenov Medical Institute, contribution to the development of medical sciences, in particular surgery and transplantology, about all the heads of the Department (B.A. Petrov, A.P. Sytnik, V.I. Petrov, G.M. Solovev, A.F. Chernousov, A.I. Chernookov), their scientific and practical activities. The article presents for the first time historical photographs of the staff of the department at different times, archival documents.