Vol 94, No 4 (2022)

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.