Vol 94, No 9 (2022)

Cover Page

Full Issue


Acute decompensation of heart failure: state of the problem

Zhirov I.V., Nasonova S.N., Tereshchenko S.N.


Are presented the key aspects of the management of patients with acute decompensation of heart failure leading to improved clinical outcomes. Are described the existing problems and possible solutions.

Terapevticheskii arkhiv. 2022;94(9):1047-1051
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"Guiding lights" for the diagnosis of chronic thromboembolic pulmonary hypertension in the flow of patients with pulmonary embolism

Chazova I.E., Martynyuk T.V., Gorbachevskii S.V., Gramovich V.V., Danilov N.M., Panchenko E.P., Chernyavskiy A.M., Shmalts A.A., Yavelov I.S.


On December 13, 2021, an expert council was held to determine the position of experts of different specialties regarding the reasons for the low level of diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) in real clinical practice in a pandemic of a new coronavirus infection and possible ways to improve detection in patients with pulmonary embolism (PE) ) in history. The reasons for the low level of diagnosis of CTEPH are the insufficient level of knowledge of specialists, especially primary care physicians; lack of clear regulatory documents and expert centers for the management of this category of patients. Primary diagnosis of CTEPH in a pandemic can be strengthened through the widespread use of telemedicine for consultations of primary care physicians with specialists from expert centers; to maximize the role of echocardiography and computed tomography (CT) as differential diagnostic tools for dyspnea, in particular in patients with COVID-19. To increase the detection rate of CTEPH, diagnostic vigilance is required in patients with risk factors and episodes of venous thromboembolism. To improve the screening of CTEPH, it is necessary to create an algorithm for monitoring patients who have had PE; provide educational activities, including through the media; create materials for patients with accessible information. The regulatory documents should designate the circle of responsible specialists who will be engaged in long-term monitoring of patients with PE. Educational programs are needed for primary care physicians, cardiologists, and other physicians who come into the field of view of patients with CTEPH; introduction of a program to create expert centers for monitoring and managing patients with the possibility of performing ventilation-perfusion lung scintigraphy, cardiopulmonary stress test, CT, right heart catheterization. It seems important to build cooperation with the Ministry of Health of Russia in order to create special protocols, procedures for managing patients with PE and CTEPH.

Terapevticheskii arkhiv. 2022;94(9):1052-1056
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Original articles

The atorvastatin effects on the prevention of contrast-induced acute kidney injury during computed tomography with contrast media

Vasin A.A., Mironova O.I., Fomin V.V.


Aim. To assess the role of atorvastatin to the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media.

Materials and methods. One hundred patients with CVD undergoing CT with with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). Patients were divided into 3 groups – 16 (15.8%) patients receiving atorvastatin at a dose of 80 mg 24 hours and 40 mg before the CT and 40 mg after; 33 (32.7%) patients – 40 mg before the CT and 40 mg after; 52 (51.5%) people not receiving statin therapy. The primary endpoint was CI-AKI according to KDIGO criteria: the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media. There were 51% of men. The average age was 59.77±14.4. The most frequent cardiovascular disease was hypertension – 86%.

Results. CI-AKI was diagnosed in 4 (3.96%) patients. At the same time, it was not possible to establish statistically significant relationships (p<0.05) between risk factors and the development of CI-AKI. Statins can be a successful way to prevent this complication.

Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after computed tomography with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

Terapevticheskii arkhiv. 2022;94(9):1057-1061
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Remote electrocardiogram telemonitoring after endovascular interventions on the coronary arteries

Danilushkin Y.V., Basinkevich A.B., Shamrina N.S., Bubnov D.S., Silvestrova G.A., Ageev F.T., Matchin Y.G.


Aim. To evaluate the effectiveness of a new system for telemetric electrocardiogram (ECG) monitoring in patients after endovascular interventions (EI) on the coronary arteries (CA).

Materials and methods. 168 patients with chronic ischemic heart disease who underwent EI on the CA on an outpatient basis, and during routine hospitalization, followed by telemetric ECG-monitoring after interventions were included. The monitoring was carried out using a three-channel telemetric recorder Astrocard HE3 (Russia), which provides continuous monitoring of 3-lead ECG for a long time.

Results. The telemetry was successfully performed in all 168 (100%) patients. In 165 (98%) patients, the quality of the recording was regarded as good, in 3 (2%) – as satisfactory. There were no cases of disconnection of the device, no interruptions in recording. During the observation period, no life-threatening arrhythmia revealed. When comparing the telemetry results in different groups of patients, there were no significant differences in the incidence of arrhythmia. Patients with a history of percutaneous coronary interventions were questioned; according to which 92% of respondents reported that they felt more comfortable after the intervention followed by telemetric ECG-monitoring.

Conclusion. Carrying out telemetric ECG-monitoring after EI on the CA improves the quality of observation after the procedure, promotes early discharge of patients, makes the intervention more comfortable and safe. The introduction of this technique into clinical practice will make it possible to more widely use the outpatient approach when carrying out EI, and to increase the turnover of specialized beds and the efficiency of the work of medical institutions.

Terapevticheskii arkhiv. 2022;94(9):1062-1066
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Features of vectorcardiograms in patients with hypertension complicated by chronic heart failure with reduced left ventricle ejection fraction

Sakhnova T.A., Blinova E.V., Yurasova E.S., Uskach T.M., Blinova N.V., Aidu E.A., Trunov V.G., Saidova M.A.


Aim. To explore the features of vectorcardiograms (VCG) of patients with essential hypertension complicated by chronic heart failure with reduced left ventricular ejection fraction (CHFrLVEF).

Materials and methods. We analyzed VCGs of 70 hypertensive patients with CHFrLVEF and 275 hypertensive patients without clinical signs of CHF and with LVEF>50%. We assessed the presence of rhythm and conduction disturbances, and the parameters of the synthesized VCG, i.e., module of the maximum QRS vector, planarity index of the spatial QRS loop (P/S), and spatial angle between the integral QRS and T vectors (sQRS-Ta).

Results. In hypertensive patients with CHF, certain conditions were detected more often as compared with hypertensive patients without CHF, i.e., atrial fibrillation (AF) in 52.9% vs 5.1%; p<0.0001, and left bundle branch block (LBBB) in 38.6% vs 0.4%; p<0.0001. The module of the maximum QRS vector and sQRS-Ta were significantly greater and P/S was significantly less in VCGs of patients with CHF. ROC-analysis showed that the presence of AF and LBBB just as VCG parameters assessed in this study provide clear discrimination between hypertensive patients with or without CHF both in the group as a whole and in the subgroups (1) without LBBB, (2) with sinus rhythm, and (3) with AF. sQRS-Ta was the most informative parameter (threshold >137°, sensitivity 91%, specificity 92%). The P/S indicator at the optimal threshold value 0.92 was characterized by lower specificity (68%) with rather high sensitivity (79%).

Conclusion. AF, LBBB, increased module of the maximum QRS vector and sQRS-Ta, and decreased P/S index are present in hypertensive patients with CHFrLVEF as compared with patients without CHF.

Terapevticheskii arkhiv. 2022;94(9):1067-1071
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Ectopic obesity in patients without manifested cardiovascular disease: regulations, frequency and clinical characteristics

Podzolkov V.I., Bragina A.E., Osadchiy K.K., Rodionova Y.N., Djafarova Z.B., Khalenyan M.H., Dishkaya S.O.


Aim. To determine the frequency, distribution and characteristics of ectopic obesity in patients without manifested cardiovascular disease.

Materials and methods. We examined 320 patients without manifested cardiovascular disease (average age 63.8±13.9 years), 38 of them – without cardiovascular risk factors (healthy referent group). Anthropometric indicators were measured, body mass index (BMI) was calculated. Degree, type of obesity, lipid profile were evaluated. All patients underwent multi-detector chest computed tomography in spiral mode on Toshiba Aquilion Prime scanner using standardized protocol. Perivascular adipose tissue (PVAT) and pericardial adipose tissue (PAT) were detected using specialized semi-automatic software Tissue Composition Module QCTPro (Mindways Software, Inc., USA) after scanner calibration with special phantom. PAT and PVAT exceeding the 90th percentile in the healthy referent group were considered as ectopic obesity. Statistical analysis was performed using Statistica 10.0 software (StatSoft Inc., USA).

Results. PAT volume ≥3.2 cm3 and PVAT volume ≥0.4 cm3 were criteria for high pericardial and high perivascular fat; 81 (25.2%) patients had ectopic obesity, 85 (26.5%) patients – abdominal obesity; 146 (42.9%) people had high pericardial fat, 134 (39.4%) – high perivascular fat. The frequency of ectopic obesity in patients with arterial hypertension (AH) was statistically significantly higher compared to persons without AH. Significantly more often ectopic forms of obesity were detected in patients with overweight and obesity. The high pericardial fat and high perivascular fat were found in patients with overweight and normal body weight. When comparing the clinical characteristics of patients with abdominal and ectopic obesity, metabolic parameters, as well as the incidence of hypertension and dyslipidemia, did not differ significantly.

Conclusion. Ectopic obesity can develop outside of global obesity. In addition, this type of obesity is accompanied by metabolic disorders and AH, regardless of the abdominal distribution of adipose tissue.

Terapevticheskii arkhiv. 2022;94(9):1072-1077
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The effectiveness of cardiac contractility modulation in patients with chronic heart failure and atrial fibrillation: results of the 12-month follow-up

Safiullina A.A., Uskach T.M., Sapelnikov O.V., Grishin I.R., Cherkashin D.I., Amanatova V.A., Akchurin R.S., Tereshchenko S.N.


Aim. To evaluate the efficacy, safety and effect on the prognosis of cardiac contractility modulation (CCM) in patients with chronic heart failure (CHF) with reduced left ventricular ejection fraction and atrial fibrillation compared with the group of only optimal drug therapy (ODT) of the 12-month follow-up.

Materials and methods. Patients (n=200) were sequentially included in two groups: group 1 patients with CHF who are on ODT in combination with implanted CCM devices (n=100), group 2 comparison – patients with CHF who receive only ODT (n=100). Initially and after 12 months, 12-channel electrocardiography (ECG), transthoracic echocardiography, daily ECG-monitoring, determination of the level of NT-proBNP, a six-minute walk test and an assessment of the quality of life according to the Minnesota Questionnaire were performed.

Results. In the CCM therapy group, a significant clinical improvement was revealed, which was expressed in the form of a decrease in functional class CHF by NYHA (New York Heart Association), an increase in the distance of a six-minute walk test and an improvement in the quality of life according to Minnesota Questionnaire, as well as an improvement in left ventricle contractile function compared to the ODT group. The absence of a proarrhythmogenic effect of the CCM was shown. There was a significant decrease in the frequency of the readmission due to CHF and the probability of achieving the combined endpoint in the CCM therapy group compared with only ODT.

Conclusion. The use of CCM in patients with CHF and atrial fibrillation is an effective and safe method of therapy that leads to the development of reverse remodeling of the myocardium, improves the clinical status of patients and reduces the frequency of readmission due to decompensation of CHF.

Terapevticheskii arkhiv. 2022;94(9):1078-1084
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Impact of anxiety disorders on adherence to anticoagulant therapy in patients with atrial fibrillation

Fomicheva A.V., Troshina D.V., Simonov A.N., Kopylov P.I., Andreev D.A., Volel B.A.


Aim. To evaluate the impact of anxiety disorders on adherence to anticoagulant therapy (ACT) in patients with atrial fibrillation (AF).

Materials and methods. 179 outpatients (131 women, 48 men, mean age 69.9±6.2 years) with AF were examined. The research methods included a physical examination according to the standards of medical care in an outpatient facility, clinical and psychopathological examination using psychometric scales.

Results. Based on the assessment of adherence to ACT using the Morisky–Green test, 2 groups of patients were identified: Group 1 – patients with high adherence to ACT, Group 2 – patients with partial/low adherence to ACT. In group 1, anxiety disorders were verified in 51.7% of cases, in group 2 – 54.3%. There were no statistically significant differences in the prevalence and severity of anxiety in the study groups. In accordance with the binary logistic regression model, the probability of high adherence to therapy is determined by higher (compared with the group of patients with partial/low adherence to therapy) scores in terms of “mental health” (p<0.001), “vital activity” (p=0.02) and the total score of the SF-36 scale (p=0.08), as well as the extraversion parameter (p=0.02) of the NEO-FFI scale.

Conclusion. In the present study, no significant association was found between anxiety symptoms and a decrease in adherence to ACT in patients with AF. However, the results obtained suggest a contribution to the adherence to therapy of personality characteristics.

Terapevticheskii arkhiv. 2022;94(9):1085-1093
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Mechanical circulatory support in refractory cardiogenic shock: retrospective register study

Savvinova P.P., Manchurov V.N., Haes B.L., Skrypnik D.V., Vasilieva E.J., Shpektor A.V.


Cardiogenic shock (CS) is one of the main causes of death in patients with acute myocardial infarction (AMI). Mortality from CS remains high, despite the introduction of myocardial revascularization and the use of modern medication. The use of mechanical circulatory support (MCS) is promising, it could reduce mortality in patients with AMI and CS.

Aim. To define effectiveness and safety of MCS in patients with AMI and CS.

Materials and methods. Our study includes 47 patients with AMI and refractory CS, who were treated at the University Clinic of Cardiology of the Yevdokimov Moscow State University of Medicine and Dentistry from 2019 to 2022. Mortality and various complications were analyzed in patients with refractory CS, patients who received and did not receive mechanical circulatory support (intra-aortic balloon pump – IABP, extracorporeal membrane oxygenation – ECMO).

Results. Mortality among patients with refractory CS was significantly lower in the subgroup of patients who received mechanical circulatory support devices (59% vs 93%; p=0.02). Moreover, reliability is achieved mainly due to patients in whom were VA-ECMO implanted (p=0.02), not IABP (p=0.16).

Conclusion. VA-ECMO associated with reduced mortality and should be considered in patients with AMI and refractory CS. Further research is needed to select the optimal method of mechanical circulatory support in patients with CS.

Terapevticheskii arkhiv. 2022;94(9):1094-1098
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Prevalence of combination of functional dyspepsia and irritable bowel syndrome: a meta-analysis of studies using the Rome III–IV Criteria

Andreev D.N., Bordin D.S., Vyuchnova E.S., Lebedeva E.G., Dicheva D.T., Umyarova R.M., Maev I.V.


Aim. To systematize data on the prevalence of the combination of functional dyspepsia (FD) and irritable bowel syndrome (IBS) using the Rome III–IV Criteria.

Materials and methods. A search in electronic databases MEDLINE/PubMed, EMBASE, and Cochrane was conducted. The depth of search was 17 years (from January 2006 to May 2022). Original publications from peer-reviewed periodicals that applied the Rome III–IV Criteria for diagnosis of FD and IBS in an adult patient population with detailed descriptive statistics to allow the resulting data to be included in the meta-analysis were selected for final analysis.

Results. The final analysis included 38 studies involving 17,993 patients with FD and 15,883 patients with IBS. In the overall pool of studies using the Rome III–IV Criteria, the pooled prevalence of FD in patients with IBS was 34.625% (95% confidence interval [CI] 28.159–41.390), and the pooled prevalence of IBS in patients with FD was 37.549% (95% [CI] 31.511–43.787). A random-effects model was used in the analyses since significant heterogeneity between results was found (p<0.0001; I2>98%). Using the Rome III Criteria, the pooled prevalence of FD in patients with IBS was 31.993% (95% CI 26.135–38.150; I2=98.17%), while the prevalence of IBS in patients with FD was 34.694% (95% [CI] 29.319–40.273; I2=97,89%). An analysis of papers using the Rome IV Criteria demonstrated that the pooled prevalence of FD in patients with IBS was 42.614% (95% CI 18.588–68.675; I2=98.97%), and the prevalence of IBS in patients with FD was 50.444% (95% CI 37.956–62.904; I2=94,39%).

Conclusion. This meta-analysis demonstrated that the prevalence of the combination of FD and IBS identified using the Rome III–IV Criteria is high and is reported in approximately 1 in 3 patients with the functional gastrointestinal disorders concerned. The prevalence of a combination of FD and IBS identified using the Rome IV Criteria is at least 10% higher than that using the Rome III Criteria.

Terapevticheskii arkhiv. 2022;94(9):1099-1108
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Clinical notes

Patent foramen ovale as the cause of recurrent embolic strokes. Case report

Komarov A.L., Krivosheeva E.N., Makeev M.I., Merkulov E.V., Tripoten M.I., Panchenko E.P.


А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.

Terapevticheskii arkhiv. 2022;94(9):1109-1114
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Heart failure and obesity

Safiullina A.A., Uskach T.M., Saipudinova K.M., Tereshchenko S.N., Chazova I.E.


Obesity is an independent predictor of cardiovascular diseases (CVD), including heart failure (HF). Nevertheless, numerous studies have shown that patients with CVD who are overweight and slightly obese have a better short-term and moderate prognosis than thinner patients with CVD. This phenomenon has been called the “obesity paradox”. Understanding the “obesity paradox” is important in patients with HF, given the high prevalence of obesity in patients with HF. The article presents an overview of clinical studies devoted to the study of obesity as a risk factor for HF, the pathogenesis of HF in obesity, and highlights the issues of the “obesity paradox” and the treatment of obesity in this category of patients.

Terapevticheskii arkhiv. 2022;94(9):1115-1121
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History of medicine

On the history of vectorcardiography: past, present, future

Yurasova E.S., Blinova E.V., Sakhnova T.A.


The vector concept in the analysis of the electrical signals of the heart began to be used at the dawn of the development of electrocardiology. For several decades, vectorcardiography has developed in parallel with electrocardiography; reached its peak in the 60s, and after a period of cooling experienced a resurgence since the early 90s, when it became possible to mathematically synthesize vectorcardiograms (VCG) from digital electrocardiograms in 12 leads. VCG reflects the same phenomena as electrocardiography, but allows you to calculate and visualize a number of three-dimensional characteristics of the electrical signals of the heart. The article describes the main milestones in the development of the VCG, the history of international cooperation in this area, the contribution of domestic scientists to this field of science. Modern promising areas of research related to the vector concept of the analysis of the electrical signals of the heart are briefly reflected.

Terapevticheskii arkhiv. 2022;94(9):1122-1125
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