卷 97, 编号 9 (2025): Issues of cardiology

Currently, the proportion of patients with heart failure is progressively increasing. Despite the progress in drug therapy, additional manipulations are often necessary to correct cardiovascular pathology in these patients. Given the high comorbidity, the use of classical surgical techniques is impossible in some cases. Implantation of high-tech devices, catheter ablation of arrhythmogenic areas, transcatheter mitral valve plastic surgery are minimally invasive surgical methods. Proper interaction between a cardiologist and a cardiovascular surgeon allows for the maximum personalization of the approach to the treatment of each patient, achieving maximum results with significantly reduced risks.

Aim. To identify phenotypic clusters of patients with various types of obesity and to study their gender, clinical, laboratory and genetic characteristics.

Materials and methods. 100 patients (47 men and 53 women, median age 58.5 [50; 69] years) were included in the cross-sectional study. All patients underwent chest and retroperitoneal space computed tomography with the calculation of pericardial, perivascular adipose tissue volumes and the thickness of perirenal fat. Alleles and genotypes of the peroxisome proliferator activated receptor gamma (PPARG) rs1801282 polymorphism, angiotensin II receptor type 1 (AGTR1) rs5186 polymorphism, and vascular endothelial growth factor A (VEGF-A) rs699947 polymorphism were identified in all patients. Cluster analysis was performed with python version 3.11. using the k-means algorithm. Silhouette value 0.2.

Results. Cluster 1 (n=36) consisted of middle-aged patients (men – 38.9%) with hypertension (HTN) – 100%, combined obesity [general obesity (GO) – 61%, abdominal obesity (AO) – 100%, ectopic obesity – 80.5%] and dyslipidaemia (77.8%). Cluster 2 included 14 patients: elderly (77.8%) men (71.4%) with HTN (100%), combined obesity (GO – 92.8%, AO – 85.7%, ectopic obesity – 100%), high incidence of dyslipidaemia (92.8%) and target organ damage. Cluster 3 consisted of 21 patients, mostly elderly (87.5%) women (76.2%) with HTN (90.1%), AO (80.9%), without GO (0%) and perirenal obesity (0%). Cluster 4 consisted of 29 patients, mostly young men without HTN (0%) with isolated AO (72.4%). The highest prevalence of risky alleles of the studied polymorphisms was found in cluster 2 (25, 32.1, 64.3%). The frequency of risky alleles was low 10.3, 20.7 and 43.1% in the most metabolically favourable cluster 4 compared to cluster 2.

Conclusion. We identified 4 clusters of obese patients in our study. Among them, the most unfavorable from a metabolic and genetic point of view was cluster 2, and the most favourable was cluster 4.

The revealed interrelationships between obesity, type 2 diabetes mellitus, cardiovascular diseases and chronic kidney disease are an important problem of modern healthcare worldwide, which is gradually becoming an epidemic. The study of these diseases in such a combination becomes the subject of discussion among scientists and the topic of various consensus documents. Factors such as hyperglycemia, insulin resistance, increased activity of the renin-angiotensin-aldosterone system, formation of glycation end products, oxidative stress, calcium metabolism disorders, mitochondrial malfunctions, and persistent chronic inflammation are fundamental to understanding of this syndrome (or disorder) and developing approaches to prevention and treatment. This review article describes both the basic principles of diagnosis and treatment of cardio renal metabolic syndrome and approaches to primary and secondary prevention.

Myxoma refers to benign tumors and accounts for up to 50% of all primary neoplasms of the heart. Usually cases of myxoma as an independent disease are given. In the presented clinical case, left atrial myxoma was combined with lentiginosis: a lot of black papular rashes on the skin of the face, head, entire surface of the trunk and extremities, as well as black patches on the surface of the lips and a hamartoma polyp of the esophagus. These changes may be a manifestation of multiple hamartoma syndrome, which is a rarely diagnosed pathology. Another feature of the case is the onset of myxoma by the clinic of acute posterior myocardial infarction with ST segment elevation and pathological Q wave in a 29-year-old patient. According to coronary angiography, stenoses of the coronary arteries were not detected. A pronounced vasospasm of the left coronary artery was found. There was an increase in the level of lactate dehydrogenase 808.11 units/l and troponin I at admission up to 433.8 ng/ml, with an increase to 19 010 ng/ml. The given clinical example shows the importance of a comprehensive examination of patients with myxomas to exclude other hereditarily mediated syndromes, especially in the presence of skin pigmentation.

Ventricular arrhythmias are common and life-threatening complications of myocardial infarction. The article describes the evolution of the research and implementation of methods for treating ventricular arrhythmias in myocardial infarction into clinical practice, and discusses possible trends in the future development of this area.