Terapevticheskii arkhiv

 

About

Therapeutic archive journal (ISSN key title is "Terapevticheskiy arkhiv") was founded by the prominent Russian therapists M.P. Konchalovsky and G.F. Lang in 1923. Then its editors-in-chief were Professors V.N. Vinogradov and A.G. Gukasyan. Since 1972, E.I. Chazov, Academician of the Russian Academy of Sciences, has been heading the editorial board of the journal.

Over 90 years, there have been more than 1000 issues where the authors and editorial staff have done their best for readers to keep abreast of current advances in medical science and practice and for physicians to master the advanced principles of recognition and treatment of a wide spectrum of visceral diseases.

The papers published in the journal (editorials, original articles, lectures, reviews, etc.) cover both current scientific achievements and practical experience in diagnosing, treating, and preventing visceral diseases. The authors of publications are not only Russian, but also foreign scientists and physicians. All papers are peer-reviewed by highly qualified Russian specialists.

The journal is published monthly. Traditionally, each issue has predominantly certain thematic areas covering individual therapy specializations. Every year, one of the issues is devoted to related problems in practical medicine (allergology and immunology, neurology and psychiatry, obstetrics, oncology, etc.). This all draws the attention of the reading public to the journal.

 

Editor-in-Chief

Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: http://orcid.org/0000-0002-1576-4877

 

Publications

Monthly issues publish in print and online in Open Access under the Creative Commons NC-ND 4.0 International Licensee.

 

Indexation

  • Web of Science:
    • Russian Science Citation Index (RSCI)
    • Core Collection (Science Citation Index Expanded)
  • PubMed/Medline
  • Index Medicus
  • Current Contents Connect
  • BIOSIS Previews
  • Scopus/EMBASE
  • Ulrich’s Periodicals Directory
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Current Issue

Vol 94, No 4 (2022)

Cover Page

Full Issue

Editorial

Molecular cardiology: from decoding the genetic nature and mechanisms of the diseases development to the introduction into the clinic
Zateyshchikov D.A., Favorova O.O., Chumakova O.S.
Abstract

In recent decades, advances in molecular biology have led to a change in understanding the inheritance mechanisms and development of cardiological diseases of predominantly genetic origin, such as hypertrophic and dilated cardiomyopathies, familial hypercholesterolemia, etc. This knowledge made it possible to develop fundamentally new drug interventions. Programs for detecting cardiac diseases of predominantly genetic origin have been created, including genetic counseling and testing. Competence in this area is becoming a necessary part of a cardiologist's job.

Terapevticheskii arkhiv. 2022;94(4):463-466
pages 463-466 views

Original articles

Prognostic significance of equivalent density of calcium deposits of coronary arteries in men with osteopenic syndrome and prior coronary artery bypass grafting: prospective study
Kokov A.N., Masenko V.L., Barbarash O.L.
Abstract

Aim. Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up.

Materials and methods. A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.9±1.8 months.

Results. Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p<0.001), a decrease in the T-criterion of the thigh (r=-0.21; p<0.001) and lumbar vertebrae (r=-0.19; p<0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.54–5.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis ≥30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD.

Conclusion. According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.

Terapevticheskii arkhiv. 2022;94(4):467-472
pages 467-472 views
Transthyretin amyloid cardiomyopathy. Features of histological diagnosis: study design
Guselnikova V.V., Fedorova E.A., Gudkova A.J., Shavlovsky M.M., Korzhevskii D.E.
Abstract

Aim. To compare efficiency and specific features of transthyretin amyloid staining by different histological dyes and thus to assess their suitability for diagnostic purposes.

Materials and methods. Samples of left and right heart ventricles were taken from patients over 70 years-old of both genders (n=10) with immunohistochemically verified transthyretin amyloidosis (ATTR). All samples were stained with Congo red, Alcian blue, toluidine blue and methylene violet.

Results. Specificity and sensitivity of Congo red staining was comparable to those of immunohistochemical staining. For verification of amyloid presence after Congo red staining one could use fluorescent microscopy instead of polarization microscopy. It allows a more accurate diagnosis of amyloidosis. Confocal microscopy with spectral unmixing improves detection sensitivity of amyloid by elimination of background fluorescence of muscle tissue and autofluorescence of lipofuscin. Alcian blue staining gives the same result as Congo red. In addition, it’s less labor-intensive and free of false-positive and false-negative results caused by final processing of slide preparation. Toluidine blue and methylene violet develop metachromatic staining upon binding to transthyretin fibrils, likely due to specific biochemical features of these fibrils.

Conclusion. The most reliable method for histochemical diagnosis of ATTR is the Congo red staining with subsequent analysis using fluorescence or confocal microscopy. For diagnostic screening, the use of Sodium sulphate-Alcian blue staining method is highly promising. Metachromatic stains are less effective for ATTR diagnosis.

Terapevticheskii arkhiv. 2022;94(4):473-478
pages 473-478 views
The relationship between the level of Lр(а) and the prevalence of atherosclerosis among young patients
Klesareva E.A., Afanasieva O.I., Sherstyuk E.E., Tmoyan N.A., Razova O.A., Tyurina A.V., Afanasieva M.I., Ezhov M.V., Pokrovsky S.N.
Abstract

Background. Hyperlipoproteinemia (a) is an independent and cause risk factor for atherosclerotic cardiovascular diseases (ASCVD). The correlation between lipoprotein (a) – Lp(a) and inflammation in the vessel wall was actively studied during the past few years. C-reactive protein (CRP) plays an important role in ASCVD.

Aim. To analyze the relationship between hyperlipoproteinemia (a), inflammatory markers, and the early development of stenosing atherosclerosis (AS) in several vascular pools.

Materials and methods. 76 patients, 55 men aged 18 to 55 years and 21women – 18 to 60 years, with the results of instrumental examination of coronary, carotid and lower extremities vascular pools were enrolled. Three groups: with stenosing (≥50%) AS of only one (group 1, n=29); two or three (group 2, n=21) vascular pools. 26 patients without coronary heart disease and AS were included in the control group. All patients in groups 1 and 2 and 65% of those in the control group took statins. The concentrations of Lp(a), CRP, lipids and blood count were determined.

Results. The patients of the three groups did not differ in age. In the groups with AS (79% in group 1 and 85% in group 2), there were more men (relative to 54% in the control group). Diabetes mellitus was more common only in patients with multifocal AS. The absolute number of blood monocytes and leukocytes, the neutrophil-lymphocyte ratio, as well as Lp(a) level were higher in patients of groups 1 and 2 relative to the control. The maximum Lp(a) level (median [25%; 75%]) was observed in patients with lesions of two or more vascular pools vs the control group (49 [4; 96] mg/dL, vs 10 [4; 21] mg/dL, p=0.02). The CRP level was significant elevated in patients from group 2 – 7.2 [4.0; 9.7] mg/L, relative to group 1 – 2.5 [1.0; 4.7] mg/L, and the control group 2.9 [1.2; 4.9] mg/L, p<0.05. The Lp(a) and CRP concentration, or the presence of diabetes mellitus in patients, regardless of other risk factors, were associated with severe stenosing AS in young and middle age.

Conclusion. An elevated concentration of Lp(a) (≥30 mg/dL) determines the presence of both isolated and multifocal stenosing AS in the examined patients. A simultaneous increase in the concentration of both Lp(a) and CRP, as well as the presence of diabetes mellitus, are associated with the premature development of stenosing atherosclerotic lesions in several vascular regions at once. Measurement of these predictors in young and middle-aged patients makes it possible to use them as biochemical markers to assess the likelihood of multifocal lesions of the vascular pool.

Terapevticheskii arkhiv. 2022;94(4):479-484
pages 479-484 views
A new approach in the diagnosis of lung lesions in patients with COVID-19: lung ultrasound protocol versus CT scan
Saidova M.A., Avalyan A.A., Galaeva M.A., Belkind M.B.
Abstract

Aim. To develop a protocol for ultrasound diagnostics of COVID-19 pneumonia and to assess the diagnostic capabilities of the method in comparison with computer tomography (CT).

Materials and methods. The study included 59 patients with a new coronavirus infection. In order to identify changes in the lung tissue characteristic of a new coronavirus infection, we used a special protocol for ultrasound of the lungs, which was developed by us in such a way that the data obtained were compared by segment with the results of CT of the lungs.

Results. When comparing the results of lung ultrasound with the data of CT diagnostics, according to the new protocol, the percentage of lung tissue damage during ultrasound of the lungs averaged 70.8% in the group [62.5; 87.5], and according to the results of CT – 70.0% [60.0; 72.5] (p=0.427). Thus, the ultrasound of the lung lesions was almost completely consistent with the changes revealed by CT. In order to assess the diagnostic value of lung ultrasound in identifying severe lung tissue lesions corresponding to CT 3–4, ROC analysis was performed, which showed the high diagnostic value of lung ultrasound in identifying severe lung tissue lesions.

Conclusion. A new protocol was developed for assessing the severity of lung tissue damage according to ultrasound data, which showed a high diagnostic value in detecting COVID-19 pneumonia in comparison with CT. The results obtained give reason to recommend this protocol of ultrasound of the lungs as a highly sensitive method in diagnosing the severity of COVID-19 pneumonia. Its application is very important for dynamic examination of patients, especially in conditions of low availability of CT.

Terapevticheskii arkhiv. 2022;94(4):485-490
pages 485-490 views
Proinflammatory laboratory predictors of pneumonia in ischemic stroke patients: prospective study
Kochetov A.G., Lyang O.V., Zhirova I.A., Ivoylov O.O., Politidis R.R., Novozhenova Y.V.
Abstract

Background. Bacterial pneumonia is a frequent complication of ischemic stroke at the hospital stage. The search for prognostic laboratory markers of pneumonia remains an urgent task, as it will allow to individualize the approach to the treatment and rehabilitation of such patients.

Aim. To investigate the prognostic significance of proteins of the acute phase of inflammation, as well as to evaluate them as early predictors of the development of pneumonia in patients with ischemic stroke.

Materials and methods. The study included 302 patients in the acute period of ischemic stroke. C-reactive protein (CRP), tumor necrosis factor α, interleukin-6 (IL-6), neutrophil elastase, neopterin, serum amyloid A (SAA), secreted phospholipase type 2 (sPLA2) were determined in all patients on the first day by enzyme immunoassay. Statistical data processing was carried out using SPSS and Microsoft Excel software (USA).

Results. At the hospital stage, pneumonia developed in 82/302 patients (27.2%; 95% confidence interval 22.3–32.3%). The levels of CRP, IL-6, sPLA2, SAA and neopterin significantly differed in the presence and absence of pneumonia. Step-by-step logistic regression analysis revealed the significance of IL-6 and CRP concentrations in the prognosis of pneumonia. The threshold value of IL-6 concentration was 3.45 pg/ml (sensitivity – 82.4%, specificity – 66.7%). The prognostic value of a positive result (PPR) in the prognosis of pneumonia was 40%, a negative result (PNR) – 92%. The threshold value of CRP was 1640 mg/l with a sensitivity of 65.8% and a specificity of 74.8%. The PPR of the threshold value of the concentration of CRP was 45%, PNR – 80%.

Conclusion. The measurement of the concentration of IL-6 and CRP on the first day of ischemic stroke makes it possible to identify patients with the greatest risk of pneumonia at the hospital stage. The results of the work indicate the necessity to include CRP and IL-6 in the list of mandatory laboratory tests that should be carried out for each patient with ischemic stroke on the first day from the onset of the disease.

Terapevticheskii arkhiv. 2022;94(4):491-496
pages 491-496 views
Organizing pneumonia as a pulmonary manifestation of post-COVID syndrome: features of diagnosis and treatment
Akulkina L.A., Shchepalina A.A., Kitbalian A.A., Potapov P.P., Moiseev A.S., Brovko M.Y., Sholomova V.I., Moiseev S.V.
Abstract

Treatment of patients with long-term persistent symptoms after COVID-19 is an urgent problem for clinicians around the world. One of the most significant manifestations of post-COVID-19 syndrome is organizing pneumonia that is usually treat with corticosteroids. The paper presents a clinical case of typical course of post-COVID-19 organizing pneumonia in a patient without previous lung disease. Risk factors, diagnostic methods and treatment options in this group of patients are also discuss.

Terapevticheskii arkhiv. 2022;94(4):497-502
pages 497-502 views
Predictive value of QRS complex duration in patients with chronic heart failure and atrial fibrillation: retrospective study
Uskach T.M., Sharapova Y.S., Safiullina A.A., Zinovyeva E.V., Tereshchenko S.N.
Abstract

Aim. To study of the features of the clinical course and prognosis in patients with chronic heart failure with low ejection fraction (HFrEF) and atrial fibrillation (AF) depending on the width of the QRS complex.

Materials and methods. We studied the case histories of 514 patients (aged 60.2±13.84 years, 78% men) with HFrEF, hospitalized at the Chazov National Medical Research Center of Cardiology (Moscow) for the period from Jan 1, 2017 to Dec 31, 2018. Patients were divided into 2 groups depending on the duration of the QRS complex.

Results. Clinical and statistical retrospective analysis of the medical histories of patients with HFrEF, depending on the QRS duration, showed the predominance of patients with a QRS complex size of less than 130 ms (60.7%). In HFrEF, the expansion of the QRS complex is accompanied by an increase in the rate of readmission in patients with sinus rhythm (p=0.004). In patients with AF, the rehospitalization rate is significantly higher than in sinus rhythm and does not depend on the QRS duration (p=0.001). The incidence of unfavorable outcomes increases in connection with the addition of AF, which is most likely a more significant risk factor than QRS width.

Conclusion. These results highlight that patients with AF and a narrow QRS complex have the same poor prognosis as those with a wide QRS complex and require the close attention of cardiologists.

Terapevticheskii arkhiv. 2022;94(4):503-510
pages 503-510 views
Zonulin and I-FABP are markers of enterocyte damage in celiac disease
Bykova S.V., Sabelnikova E.A., Novikov A.A., Baulo E.V., Khomeriki S.G., Parfenov A.I.
Abstract

Aim. To evaluate the level of serum I-FABP (Fatty-Acid-Binding Protein – a protein that binds fatty acids) and fecal zonulin as markers of the permeability of the mucous membrane of the small intestine in celiac patients.

Materials and methods. A total of 151 celiac patients (25 men and 126 women) were examined. The median age was 42 years. Group I included 58 patients with newly diagnosed celiac disease; in group 2 – 38 patients, knowingly or unknowingly violating the gluten-free diet; group 3 consisted of 55 patients strictly observing gluten-free diet. The control group consisted of 20 healthy volunteers: 4 men and 16 women. All patients underwent esophagogastroduodenoscopy by biopsy of the mucous membrane of the small intestine and assessment of duodenobioptates according to Marsh. In the blood serum, the level of antibodies to tissue transglutaminase IgA and IgG was determined by the enzyme-linked immunosorbent assay using kits manufactured by Orgentec Diagnostics GmbH (Germany), the concentration of I-FABP in blood serum was determined using Hycult Biotech kits (Netherlands). The content of zonulin in feces was investigated by enzyme-linked immunosorbent assay using kits from Immundiagnostik AG (Germany). Statistical analysis was performed using the Statistica 13.3 software (StatSoft Inc., USA).

Results. There was a significant increase in the level of antibodies to tissue transglutaminase IgA [120.0 (41.1–200)] IU/ml and IgG [31.4 (5.5–78.9)] IU/ml in patients of group 1 compared with group 2 [IgA 9.1 (2.9–87.6)] and IgG [3.8 (2.2–19.7)] IU/ml and group 3 [IgA 1.6 (1.0–3.2)] and IgG [2.2 (1.15–2.53)] (p<0.01). The level of I-FABP in blood serum in patients of group 1 averaged 2045 pg/ml, in patients in group 2 – 1406 pg/ml, in patients in group 3 – 1000 pg/ml. All patients showed a significant increase in the mean I-FABP values compared to controls (1, 2 and control – p<0.01, 3 and control – p=0.016). In patients with Marsh grade III A–C atrophy, the I-FABP level depended on the degree of damage to the mucosa and significantly differed from the control: March IIIA (median: 1310 pg/ml, interquartile range: 1212–1461 pg/ml), March IIIB (median: 2090 pg/ml, interquartile range: 1812–2322 pg/ml) as well as Marsh IIIC (median: 2058 pg/ml, interquartile range 1858–2678 pg/ml). The concentration of zonulin in feces in patients of group 1 averaged 111.6 pg/mg, in patients of group 2 – 90.5 pg/mg. In patients of group 3 – 50 IU/ml. The concentration of zonulin in feces increased as the degree of mucosa atrophy increased (r=0.585, p<0.01). However, despite the fact that both of these markers may indicate impaired permeability, each of them indicates damage to a certain level of the intestinal barrier, which is not always associated with the degree of mucosa atrophy.

Conclusion. Determination of serum I-FABP and fecal zonulin levels in celiac patients allows for the assessment of intestinal permeability and can serve as non-invasive markers for monitoring ongoing structural changes in the mucosa without the need for endoscopy.

Terapevticheskii arkhiv. 2022;94(4):511-516
pages 511-516 views
The possibilities of improving the treatment of chronic heart failure according to the results of a multicenter observational study BYHEART
Tereshchenko S.N., Cheremisina I.A., Safiullina A.A.
Abstract

Aim. To study the efficacy and safety of exogenous phosphocreatine (EF) in patients with chronic heart failure (CHF).

Materials and methods. The all-Russian prospective observational study BYHEART included 842 patients who were treated with EF. Before and after the course of EF therapy, the following studies were conducted: a questionnaire on the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and a clinical condition assessment scale (SHOCK), transthoracic echocardiography with an assessment of the left ventricular ejection fraction, a 6-minute walk test, determination of the level of pro-natriuretic N-terminal peptide (NT-proBNP), glomerular filtration rate. All patients before the course of EF received long-term optimal drug therapy of CHF.

Results. Statistical analysis was carried out in the general group of patients (n=842), as well as in groups of patients A (n=418, the course of treatment of EF is less than 20 g /course) and group B (n=424, the course of treatment of EF is greater than or equal to 20 g/course). The results obtained demonstrate a positive effect of the use of the course of therapy of EF in patients with CHF on the quality of life (QOL), reverse left ventricular remodeling, functional class of CHF, as well as the concentration of NT-pro-BNP, especially in the group of patients who received more than 20 grams of the medication.

Conclusion. The use of EF is a promising pharmacological method of treatment in addition to optimal drug therapy in patients with CHF.

Terapevticheskii arkhiv. 2022;94(4):517-523
pages 517-523 views
Problems and opportunities to improve diagnosis of asthma and chronic obstructive pulmonary disease in Russia: resolution of advisory board
Avdeev S.N., Emelyanov A.V., Aisanov Z.R., Sinopalnikov A.I., Fomina D.S., Nenasheva N.M., Leshchenko I.V., Zaikova-Khelimskaia I.V., Vizel A.A., Demko I.V., Shaporova N.L., Shulzhenko L.V., Shabanov E.A.
Abstract

Asthma and chronic obstructive pulmonary disease remain major problems of medicine, and still there is need to improve the level and quality of diagnosis of these diseases. Primary care physicians (general practitioners, therapists) should be involved widely and actively in this process. To simplify the diagnosis, special questionnaires have been developed, they can be used in a real clinical practice. Only this approach will bring statistical data closer to the true prevalence of these diseases and improve quality of their treatment.

Terapevticheskii arkhiv. 2022;94(4):524-529
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Myocardial scintigraphy with 99mTc-pyrophosphate in the diagnosis of cardiac amyloidosis: place in the diagnostic algorithm, features of the implementation and interpretation of the study
Ansheles A.A., Nasonova S.N., Zhirov I.V., Saidova M.A., Stukalova O.V., Tereshchenko S.N., Sergienko V.B.
Abstract

The article summarizes the current experience of the nuclear medicine department of the Chazov National Medical Research Center of Cardiology in the implementation of myocardium scintigraphy with 99mTc-pyrophosphate with the differential diagnosis of the types of cardiac amyloidosis. Causes of false-positive, equivocal and non-diagnostic results, are analyzed. Possible ways to eliminate mistakes, including by modifying protocols of planar and tomographic research and optimizing the whole diagnostic algorithm for amyloidosis of the heart, are discussed.

Terapevticheskii arkhiv. 2022;94(4):530-537
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Clinical notes

A rare clinical case of the patient with pulmonary hypertension associated with hereditary hemorrhagic telangiectasia. Case report
Kasparova A.M., Valieva Z.S., Martynyuk T.V.
Abstract

The article describes a rare clinical case of the patient with pulmonary hypertension associated with hereditary hemorrhagic telangiectasia and discusses the issues of the treatment choice of these patients. The presented clinical case is of interest because pulmonary hypertension was initially revealed, then its hereditary nature was confirmed and Osler–Weber–Rendu disease was diagnosed.

Terapevticheskii arkhiv. 2022;94(4):538-543
pages 538-543 views
Chronic inflammatory demyelinating polyneuropathy with an acute onset. Clinical case
Suponeva N.A., Grishina D.А., Ryabinkina Y.V., Arestova A.S., Melnik E.A., Tumilovich T.A.
Abstract

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a heterogeneous treatable dysimmune neuropathy. The variety of clinical forms and course of the disease can be challenging for proper diagnosis and early treatment. In a quarter of cases CIDP starts acutely, mimicking Guillain–Barré syndrome. The early diagnosis is especially important regarding differences in treatment and prognosis of these conditions. In this article, we present a clinical case of acute onset CIDP with a detailed analysis of the differential diagnosis between acute and chronic immune-mediated neuropathies.

Terapevticheskii arkhiv. 2022;94(4):544-551
pages 544-551 views

Reviews

The role of cardiac magnetic resonance imaging in defining the prognosis of patients with acute ST-segment elevation myocardial infarction. Part 2. Assessment of the disease prognosis
Terenicheva M.A., Stukalova O.V., Shakhnovich R.M., Ternovoy S.K.
Abstract

Currently the incidence of congestive heart failure after ST-segment elevation myocardial infarction (STEMI) tends to increase. Reperfusion therapy is still the only effective method to reduce an infarct size. Therefore, there is a high unmet need of novel cardioprotective treatments that would improve outcomes in such patients. Recent advances in cardiovascular magnetic resonance (CMR) methods enabled the identification of certain new infarct characteristics associated with the development of heart failure and sudden cardiac death. These characteristics can help identify new groups of high risk patients and used as a targets for novel cardioprotective treatments. This part of the review summarizes novel CMR-based characteristics of myocardial infarction and their role in the prognostic stratification of STEMI patients.

Terapevticheskii arkhiv. 2022;94(4):552-557
pages 552-557 views
Non-compact right ventricular myocardium – diagnostic and clinical features: A review
Oleynikov V.E., Donetskaya N.A., Vdovkin A.V., Babina A.V., Avdeeva I.V.
Abstract

Non-compact right ventricular myocardium is a rare type of cardiomyopathy, it usually results from arrested myocardial development during embryogenesis. This disease can be characterized by excessive prominent trabeculations and deep inter-trabecular recesses in the ventricular wall. It might be a component of biventricular non-compact cardiomyopathy or an isolated form. The article presents a review of the literature on the clinic and radiation diagnostics of non-compact right ventricular myocardium with the presentation of the issues of differential diagnosis.

Terapevticheskii arkhiv. 2022;94(4):558-564
pages 558-564 views
SGLT2 inhibitors in acute decompensated heart failure, what do we know?
Lapteva A.E., Nasonova S.N., Zhirov I.V., Tereshchenko S.N.
Abstract

The current worldwide prevalence of heart failure is growing, while its combination with cardiovascular and other conditions determines a poor prognosis in these patients. Furthermore, acute decompensated heart failure is associated with a low survival rate mostly caused by target organ damage. The effects of early administration of SGLT2 inhibitors on renal function in patients with acute decompensated heart failure are being studied to determine the possibility of improving response to treatment, as well as partial or complete recovery of renal function. The goal of the review was to synthesize currently available evidence for the use of SGLT2 inhibitors in patients with acute decompensated heart failure. A systematic search for studies published from 2018 to 2021 and their analysis was carried out in the following databases: Web of Science, Scopus, PubMed/MEDLINE.

Terapevticheskii arkhiv. 2022;94(4):565-571
pages 565-571 views
Management of iron deficiency in chronic heart failure
Uskach T.M.
Abstract

Iron deficiency is frequent in patients with chronic heart failure (CHF) with a prevalence of 50%, and its frequency varies depending on the study groups. The presence of iron deficiency limits erythropoiesis, leading to the development of anemia over time in patients with CHF, regardless of gender, race, and left ventricular ejection fraction (LVEF). Observational studies demonstrate a higher prevalence of iron deficiency in women and in patients with higher NYHA (New York Heart Association) functional class, decreased LVEF, increased brain natriuretic peptide (NT-proBNP), or increased high-sensitivity C-reactive protein. Iron deficiency and anemia in patients with CHF are independently associated with a decreased exercise capacity, hospitalizations for CHF, an increase in overall mortality and mortality from cardiovascular diseases. The clinical significance of iron deficiency requires the need to diagnose iron metabolism in all patients with CHF. Current guidelines for the diagnosis and treatment of CHF indicate the need to determine the level of ferritin and saturation of transferrin in all patients with a suspected diagnosis of heart failure. The use of oral iron therapy in patients with CHF demonstrates its low efficacy in correcting this condition according to the clinical trials. At the same time the use of intravenous iron therapy is safe and improves symptoms, exercise capacity and quality of life in patients with heart failure with reduced ejection fraction and iron deficiency, which has been shown both in international placebo-controlled trials and meta-analyses. The use of iron carboxymaltose should improve CHF symptoms, exercise capacity and quality of life in patients with CHF and LVEF<45%. Intravenous iron therapy has also been shown to reduce readmissions for CHF in patients with an LVEF<50% who have recently been hospitalized for worsening CHF.

Terapevticheskii arkhiv. 2022;94(4):572-578
pages 572-578 views
The risk of developing cardiovascular disease in bipolar disorder. Biological factors and therapy
Mosolov S.N., Fedorova E.Y.
Abstract

Background. Bipolar disorder (BD) is one of the most common mental disorders characterized by alternating episodes of mania/hypomania and depression, as well as the possibility of developing mixed conditions. Correct and timely diagnosis of BD is important due to the presence of a high suicidal risk and a high predisposition to the development of cardiovascular disease (CVD). The risk of CVD is higher in ВD than in other mental disorders.

Materials and methods. A sample assessment was made of current studies focusing on the vascular-bipolar link. The search was carried out in the PubMed and eLIBRARY databases for the following keywords: bipolar disorder, psychopharmacology, cardiovascular disease, biological mediators.

Results. There are several biological factors which explain the close association and common pathogenetic mechanisms of BD and CVD. The most interesting of them are inflammation, oxidative stress, and brain-derived neurotrophic factor. Neuroimaging methods have shown similar structural brain changes in people with BD and with CVD. There is some evidence of the efficacy of statins and angiotensin-converting enzyme inhibitors in reducing cardio-vascular risk factors in BD patients.

Conclusion. The predisposition of patients of BD to CVD is beyond doubt. It is necessary to consider the peculiarities of the course of BD and conduct active monitoring and preventive measures to reduce the risk of developing life-threatening CVDs. Further research focused on the pathogenetic relationship between BD and CVD could provide more insight into this area.

Terapevticheskii arkhiv. 2022;94(4):579-583
pages 579-583 views
Practical guidelines for the diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM or transthyretin cardiac amyloidosis)
Tereshchenko S.N., Zhirov I.V., Moiseeva O.M., Adasheva T.V., Ansheles A.A., Barbarash O.L., Galyavich A.S., Gudkova A.I., Zateyshchikov D.A., Kostareva A.A., Nasonova S.N., Nedogoda S.V., Pecherina T.B., Ryzhkova D.V., Sergienko V.B.
Abstract

This paper summarizes the data from updated international protocols and guidelines for diagnosis of transthyretin amyloid cardiomyopathy (ATTR-CM). The invasive and non-invasive diagnosis techniques and their combinations are briefly reviewed; the evidentiary foundations for each diagnostic option and tool are analyzed. The paper describes a customized algorithm for sequential diagnosis and differential diagnosis of patients with suspected ATTR-CM with allowance for the combination of clinical signs and diagnostic findings. Along with the awareness of primary care providers about the red flags of the disease and visualization criteria, as well as providing information to the patients about the possibility of performing therapy of ATTR amyloidosis and the risks of delayed diagnosis, the proposed algorithm enables timely patient routing and prescribing specific treatment.

Terapevticheskii arkhiv. 2022;94(4):584-595
pages 584-595 views

History of medicine

Pages from the history of therapeutic schools of the Central Institute for Improvement of Doctors – Russian Medical Academy of Continuous Professional Education
Sychev D.A., Osadchuk A.M., Loranskaya I.D., Ebzeeva E.Y.
Abstract

In the 1930s, therapeutic scientific and pedagogical schools were formed at the Central Institute for Advanced Training of Physicians: Cardiology School of prof. Dmitry D. Pletnev, School of Clinical Hematology and Emergency Care of prof. Alexander N. Kryukov, School of Dietetics and Gastroenterology of prof. Manuel I. Pevzner and School of Hematology of prof. Joseph A. Kassirsky. 2022 marks the 125th anniversary of the birth of an outstanding therapist, academician of the USSR Academy of Medical Sciences, Major General of the Medical Service, prof. Miron S. Vovsi. Along with the fact that M.S. Vovsi belongs to the scientific and pedagogical school of cardiology of prof. D.D. Pletnev, he managed to create his own. M.S. Vovsi is one of the creators of modern military field therapy, expanded the understanding of the pathogenesis of nephritis, pneumonia, coronary heart disease, hypertension, heart failure, he introduced new methods for diagnosing and treating these therapeutic pathologies that have not lost their relevance today.

Terapevticheskii arkhiv. 2022;94(4):596-599
pages 596-599 views


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