Terapevticheskii arkhiv
Monthly peer-review medical journal
Editor-in-Chief
Irina Chazova
MD, PhD, Professor, Academician of the Russian academy of Sciences
ORCID: 0000-0002-1576-4877
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.
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
- Google Scholar
Current Issue
Vol 97, No 4 (2025): Вопросы диагностики
- Year: 2025
- Published: 08.05.2025
- Articles: 13
- URL: https://ter-arkhiv.ru/0040-3660/issue/view/9258
Full Issue
Editorial
Current approaches to risk stratification in choosing the optimal strategy for examination and early treatment of patients with pulmonary embolism
Abstract
Epidemiological data indicate a high prevalence of pulmonary embolism (PE) and a poor prognosis for this disease. The high rate of adverse outcomes of PE is due to the presence of multiple comorbidities in persons with this pathology and to errors in diagnosis and antithrombotic therapy. The review provides the most modern ideas about pre-test diagnosing patients with suspected PE. Clinical, laboratory, and instrumental risk stratification and early treatment approaches for PE are discussed in detail.



Original articles
Myocardial function in cardiac resynchronization therapy and factors significant for its improvement
Abstract
Aim. To analyze myocardial work in cardiac resynchronization therapy (CRT) and to determine the factors influence its positive dynamics.
Materials and methods. Global longitudinal strain (GLS) and myocardial work parameters including global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE) were analyzed in addition to standard transthoracic echocardiography (TTE) in 60 patients (mean age 61±10 years, 36 male) with left bundle branch block (LBBB), chronic heart failure (HF 2 [2; 3] FC (NYHA), decreased left ventricular ejection fraction (LF EF=28 [23; 31] %) before and 6 months after CRT implantation.. In all patients the segments with maximum and minimum WI value were determined and the difference in segments with maximal and minimal WI (Max-Min WI), as the indicator of myocardial work asymmetry was calculated.
Results. CRT led to reverse cardiac remodeling in 44 (73.3%) patients; clinical stabilization without positive TTE dynamics – in 11 (18.3%) patients, worsening or death – in 5 (8.3%) patients. In both groups of reverse remodeling and clinical stabilization CRT resulted in GWW reduction and thus GWE and GWI enhancement. However, the decrease in GWW in these patients is not accompanied by an increase in GCW and GLS, in contrast to patients with reverse remodeling, who developed statistically significant change in GCW and GLS during CRT. Patients with worsening or death were characterized by a minimal decrease in GWW in CRT (62,0 [9,7; 133,7] vs 149,5 [92.8; 206,2] mmHg% in patients with reverse remodeling and clinical stabilization; p=0,035). Max-Min WI turned out to be directly related to the LV EF change in CRT (rxy=0,336; p=0,017) that makes this value to be one of possible predictors of reverse remodeling during CRT.
Conclusion. Wasted myocardial work can serve a contractile reserve, which represent a target for CRT. Its mobilization and decrease can lead to stable clinical status in patients even in the absence of reverse myocardial remodeling.



Echocardiographic features of amyloid cardiomyopathy phenotypes in patients with different types of amyloidosis
Abstract
Aim. To determine the echocardiographic variants of phenotype presentation of amyloid cardiomyopathy (ACM) in patients with different types of amyloidosis.
Materials and methods. The study included 54 patients with ACM: 27 with light chain amyloidosis (15 [56%] males; the median age was 63.0 [56.5; 67.0]) and 27 patients with transthyretin amyloidosis (20 [74%] males; the median age was 73.0 [65.5; 78.5]). Standard echocardiographic parameters and the left ventricular (LV) global longitudinal strain in both groups were evaluated.
Results. Among patients with ACM, the following phenotypes were reported: hypertrophic phenotype (HP), a combination of hypertrophic and restrictive phenotypes (HP+RP), a combination of hypertrophic, restrictive phenotypes and ejection fraction (EF) less than 50% (HP+RP+EF<50%), and patients with minimal structural changes. In patients with HP+RP+EF<50%, significantly greater thickness of the LV posterior wall (p=0.025) and the relative wall thickness (p=0.010) were found; the LV global longitudinal strain was lower (p=0.001). There were significant differences in the size of the right atrium (p=0.036), the systolic pressure in the pulmonary artery (p<0.001), and the presence of a thickening of the free wall of the right ventricle (p<0.007) in the HP+RP group. Involvement of the heart valves was more common in patients with ATTR ACM.
Conclusion. After reviewing the echocardiographic data of patients, various phenotypic presentations of ACM and several correlations between echocardiographic characteristics depending on the type of amyloidosis were determined. Further study of echocardiographic parameters in patients with various types of amyloidosis may be promising for early diagnosis and proper treatment of ACM.



Predictors of right ventricular failure in patients after left ventricular assist device implantation
Abstract
Background. To determine predictors of early and late right ventricular failure (RVF) according to transthoracic echocardiography (TTEchoCG) and right heart catheterisation (RHC) in patients with left ventricular assist device (LVAD).
Materials and methods. Twenty-three patients with LVAD were included in the study. Before implantation, all patients underwent TTEchoCG with comprehensive evaluation of the right ventricle (RV) using speckle-tracking echocardiography (STE) and 3D-echocardiography (3D-RVEF), as well as RHC with measurement of standard indices and calculation of pulmonary artery pulsatility index (PAPi).
Results. The highest area under the ROC curve was the RV ejection fraction determined by 3D-RVEF (0.841 with 95% CI 0.677–1.006, sensitivity 0.889, specificity 0.786; p<0.001) with a cut-off value ≤42% (OR 29.3 with 95% CI 2.6–336.4; p=0.007) and PAPi (area on ROC curve 0.869 with 95% CI 0.503–0.975, sensitivity 0.778, specificity 0.857; p<0.001,) with a threshold value ≤2.2 (OR 20 with 95% CI 1.2–333.3; p=0.035). The combination of these parameters was the most accurate prognostic model (sensitivity 0.778, specificity 1). The combination of echocardiographic parameters – 3D-RVEF and systolic velocity of the tricuspid valve fibrous ring according to tissue myocardial Doppler (TMD: S’ml) has similar sensitivity (0.778) and slightly lower specificity (0.929).
Conclusion. The optimal independent echocardiographic predictor of early RVF is 3D-RVEF. The combination of 3D-RVEF and PAPi proved to be the most accurate model, but the combination of 3D-RVEF and S’ml-TMD echocardiographic parameters alone is only slightly inferior in specificity, which allows preliminary assessment of the risk of RVF.



Steroid-sparing effect of levilimab in rheumatoid arthritis in real practice
Abstract
Aim. Evaluation in real clinical practice steroid-sparing effect of levilimab therapy in patients with highly and moderately active rheumatoid arthritis (RA).
Materials and methods. Retrospective observational study (1 year) held at the Republican Clinical Diagnostic Center for the period from November 2022 to July 2023. All patients received corticosteroids (CS) at the time of levilimab (LVL) administration. The assessment of the decrease in the dosage of CS was carried out at 12, 24 and 52 weeks from the start of LVL-therapy.
Results. The analysis included 73 patients with RA (60 women and 13 men, average age – 56.3±10.5 years), the average dose of CS at the time of LVL initiation was 5.7±2 mg/day with an average duration of CS intake of 87.5 months [7; 137]. Twenty patients included in the follow-up received CS at a dosage of ≥5 mg. Of the 73 patients, by the end of the study, it was possible to achieve a reduction in the dosage of CS in 22 (30.1%) patients, and complete elimination of CS in 36 patients (49.3%). Only 3 patients received CS at a dosage of ≥5 mg after 52 weeks. Against the background of taking LVL, patients showed a decrease in clinical and laboratory activity of RA according to the Disease Activity Score in 28 joints with C-reactive protein indices by 47.1% and Disease Activity Score in 28 joints with Erythrocyte Sedimentation Rate by 48.2%. The positive dynamics of laboratory parameters was noted – a decrease in the level of C-reactive protein by 90.5% and ESR by 72%. During the observation a favorable safety profile of LVL was noted. The most frequently reported adverse event was an increase in alanine aminotransferase and aspartate aminotransferase, recorded in 41 patients (56.1%). One adverse event met the criteria of severity 3 according to Common Terminology Criteria for Adverse Events version 5.0 – lung carcinoma with unspecified cell type, stage 1.
Conclusion. Levilimab is a highly effective therapy option for patients with RA with a favorable tolerability and safety profile, against which an effective dose reduction and complete elimination of steroids is possible.



Anemia and comorbidity in people over 65: data from the Russian study EUCALYPTUS
Abstract
Background. Anemia is an essential component of comorbidity, being both a complication of chronic diseases and a factor in their progression. Comorbidity patients with low hemoglobin have a greater number of diseases, worse geriatric status parameters and the lowest survival. Especially negative consequences of a decrease in hemoglobin were noted in people of the older age group.
Aim. To investigate the relationship between anemia and comorbidity in patients aged 65 years and older.
Materials and methods. The results of a sub-analysis of the multicenter cross-sectional study EUCALYPTUS, which involved 4308 people (30% of men) aged 65 to 107 years (average age – 78 years), are presented. The comorbidity was assessed and the Charlson comorbidity index was calculated, and the complete blood count was studied.
Results. The frequency of comorbidity was 89%, anemia – 24%. The value of the Charlson comorbidity index in patients with anemia was greater than in those without anemia – 5 (4; 7) vs. 4 (3; 6) points (p<0.001). For every 1-point increase in Charlson index values, the odds of having anemia increase by 21% (odds ratio 1.21; 95% confidence interval 1.17–1.25; p<0.001). Multivariate regression analysis identified 9 independent predictors of anemia (age ≥82 years, male, history of myocardial infarction and stroke, peptic ulcer disease, atrial fibrillation, stage 4 and 5 chronic kidney disease, active cancer, no hypertension) with an odds ratio of 1.25 to 3.14. In the presence of 2–4 predictors, the risk of anemia increases 1.3–2.6 times, 5 predictors – almost 5 times, 6 or more – almost 13 times.
Conclusion. Comorbidity patients are at risk for the development of anemia, which requires timely treatment, including iron supplements if absolute or functional iron deficiency is confirmed.



Persistence of biologic therapy in patients with inflammatory bowel diseases in the Chelyabinsk region
Abstract
Aim. To assess the survival and reasons for discontinuation of genetically engineered biological therapy (GEBT) in patients with inflammatory bowel disease (IBD) in the Chelyabinsk region.
Materials and methods. In the period from 2014 to 2024, 249 patients with IBD in the Chelyabinsk region received GEBT or targeted immunosuppressants. Crohn's disease was diagnosed in 102 (41%) patients, ulcerative colitis (UC) – in 147 (59%). The primary endpoints of the study were survival and the effectiveness of GEBT, and the secondary endpoints were analysis of the reasons for discontinuation or change of therapy.
Results. Most often, drugs from the group of tumor necrosis factor á inhibitors were prescribed as the first line of therapy – 216 (86.7%). A total of 86 (34.5%) patients were transferred to the second-line therapy, and 19 (7.6%) patients with IBD required switching to the third line. The persistence of various GEBT drugs in the first line in patients with IBD during the analyzed period did not differ, but in patients with UC, the efficacy of infliximab was higher than adalimumab (p=0.019). In most cases ustekinumab and adalimumab were prescribed as the second-line therapy. No differences in persistence were found between the second-line GEBT drugs, but in pairwise comparison, the persistence of ustekinumab in patients with UC was statistically significantly higher compared to adalimumab (p=0.023). Allergic reactions and infections were recorded among the reasons for GEBT discontinuation in both the first and second lines in patients receiving tumor necrosis factor á inhibitors.
Conclusion. The persistence of the first line of GEBT in patients with IBD did not differ, in the second line ustekinumab demonstrated a longer survival compared to adalimumab in UC. The efficacy of infliximab in bionaive patients with UC was higher than adalimumab with comparable persistence of therapy.



Reviews
MicroRNA-499a in heart diseases: prospects for use in diagnostics. A review
Abstract
Cardiac-specific (or myomiR) miRNA-499a (miR-499a) is a small (21–22 bp) non-coding RNA that is involved in the regulation of cardiac function both under normal and in various pathological conditions. Every year new studies expand the range of known biological processes that are regulated by miR-499a in the heart. In acute and chronic cardiovascular diseases accompanied by cardiomyocyte damage, miR-499a enters the bloodstream and can circulate there for a long time. At the same time, it is detected in plasma significantly earlier than traditional protein biomarkers, which makes it a new promising biomarker for early diagnosis and prognosis of heart diseases. This review describes the functions of human miR-499a and its involvement in the development of heart diseases. The data indicating the high diagnostic value of this miRNA in blood are presented.



Spatial vector cardiography: From origins to the present day. A review
Abstract
Vectorcardiography (VCG) originated back in 1887 due to the discovery of the dipole theory of the heart electric vector by Augustus D. Waller. Despite the fact that the idea of constructing an electric vector of the heart quickly gained appreciation among scientists of that time, the technical imperfections of electrocardiographs and the complexity of manual calculations for a certain period of time reduced the interest of researchers in this method. The advent of digital electrocardiographs and the development of algorithms for the automatic construction of heart vectors gave VCG a second life and allowed us to look at vector theory from a different angle. It became possible to visualize the electrical processes of the myocardium in a three-dimensional image, to calculate the parameters of the depolarization and repolarization vectors. This review summarizes the currently available ideas and research results on the study of VCG. The concepts of global electrical heterogeneity and ventricular gradient based on the vector theory of the heart are discussed. The data of numerous studies testifying to the significant prognostic and diagnostic value of the obtained parameters of VCG are presented.



Strategies for choice of antiretroviral therapy in patients with HIV infection and concomitant cardiovascular disease: A review
Abstract
HIV infection is associated with an increased risk of cardiovascular and kidney disease. Comorbidity is gradually becoming one of the main drivers for premature mortality in HIV patients: in Russia, from 2007 to 2022, mortality rates in HIV patients not related to opportunistic infections increased more than twofold. People living with HIV have all the common cardiovascular risk factors, moreover, special attention should be paid to kidney function, since its impact on cardiovascular disease (CVD) risk is frequently underestimated. In the current document, approaches to selection of antiretroviral therapy (ART) are reviewed in the context of HIV patients with concomitant CVD/high cardiovascular risk. Main factors of ART choice were analyzed for regimens based on 2nd generation integrase strand transfer inhibitors dolutegravir/bictegravir and non-nucleoside reverse transcriptase inhibitor doravirine, which are included in the national and main international clinical guidelines and are available in the Russian Federation. A detailed review of the ART selection criteria includes effectiveness of contemporary antiretrovirals in high viral load, poor cell immunity, expected patients’ adherence, drug resistance profile, along with comorbidities such as CVD, excess body weight, and kidney disease. In addition, topics related to interdisciplinary interaction between infectious disease, cardiology/internal medicine specialist in context of people living with HIV with concomitant CVD are also covered in the paper.



Terminal ileitis: Questions of differential diagnosis and prospects for treatment. A review
Abstract
Idiopathic terminal ileitis (ITI) occurs in 0.5–7% of people. It is believed that in some of them the cause of ITI can be established over time, in some of them Crohn's disease develops, in a greater number of patients ITI is asymptomatic and capable of self-resolution. Diagnosis of the causes of terminal ileitis is difficult, and the choice of therapeutic tactics is complex. This is largely due to the lack of clinical guidelines for the treatment of ITI. The article is devoted to the development of an algorithm for the diagnosis and treatment of ITI, which determines its relevance. It is shown that in the case of asymptomatic ITI, drug therapy is not required, in the presence of symptomatic ITI involving only the mucous membrane, therapy should be started with the prescription of mesalazine, and if transmural damage to the wall of the terminal ileum is detected – with budesonide.



A novel strategy for the management of non-productive cough: mechanisms, efficacy, safety. A review
Abstract
Cough, as a protective reflex, can become hypersensitive under pathological conditions (e.g. acute respiratory viral infections, acute bronchitis, asthma), significantly impairing patients’ quality of life. Modern therapeutic approaches often focus solely on symptomatic cough suppression, while targeting its pathogenetic mechanisms, including MCP-dependent inflammation, remains understudied. The article examines the innovative antitussive drug Eladis®, designed to target chemokine-dependent mechanisms involved in the development of cough sensitization.
Aim. To conduct a systematic analysis of published data on the mechanisms of action, clinical efficacy, and safety of Eladis®, a novel antitussive drug that inhibits MCP-dependent inflammation, based on experimental and clinical trial results (phases I–III).
Materials and methods. The review synthesizes experimental data from in vitro and in vivo studies (guinea pigs), demonstrating selective suppression of TRPA1-dependent cough via inhibition of Golgi-resident glutamyl cyclase. Clinical trials included: phase I: pharmacokinetics and safety assessment in healthy volunteers (n=32); phase II: evaluation of lung function in patients with partially controlled asthma (n=250); phase III: randomized placebo-controlled study in acute respiratory viral infections and acute bronchitis (n=250).
Conclusion. Eladis® is a promising antitussive drug with a unique mechanism targeting MCP-dependent inflammation. It is effective for acute non-productive cough and offers new therapeutic potential for chronic respiratory diseases. Further research may expand its clinical applications.



History of medicine
Colonoscopy: History, development and prospects
Abstract
The article highlights the stages of formation and development of colonoscopy from simple rectal examinations to modern video endoscopy. The development of imaging technologies has improved the early diagnosis and verification of colorectal cancer and inflammatory bowel disease, screening of colon tumors. Moreover, it was made possible to carry out minimally invasive interventions – taking a biopsy and performing a polypectomy. The prospects of the method and its place in clinical practice are discussed.


