On December 19^th, 2024, the Council of Experts held a meeting with the support of “Geropharm” LLC, dedicated to solving the issue of obesity and the need to develop personalized dietary care for the population of the Kemerovo region.

Highlights

Considering the systemic nature of psoriasis and the high prevalence of cardiovascular diseases among this cohort of patients, it is particularly important to focus on the therapy of these conditions in real clinical practice. Thus, the correct choice of pharmacological strategy and timely adjustment of the ongoing therapy play a crucial role in the course of these diseases.

Abstract

Background. Currently, psoriasis, as a chronic immune-mediated disease of a multifactorial nature, is one of the most common diseases worldwide. Given the systemic nature of this disease, the level of comorbid pathologies is high, especially those associated with cardiovascular diseases.

Aim. To assess the features of the ongoing therapy for psoriasis and CVD in real clinical practice.

Methods. The open prospective observational clinical study was conducted. 160 patients diagnosed with mild to severe generalized psoriasis vulgaris constituted the main group, 40 patients were included in the control group. All patients underwent basic clinical and laboratory tests, physical examination with an assessment of body mass index, severity of the disease according to the PASI and DLQI index, psycho-emotional state, and measurement of blood pressure using the Korotkov method. Depending on the age of the patient, the cardiovascular risk (CVR) was assessed using the SCORE2/2OP scale. The therapy used to treat patients with psoriasis and CVD was analyzed.

Results. According to the results of the study, patients with high cardiovascular risk (47%) prevail among the patients of the main group, compared with the control group (CG) (30%). There is a high incidence of arterial hypertension (AH) – 34.4% (CG – 22.5%), dyslipidemia – 40% (CG – 5%) (of which only 60% received lipid-lowering therapy), rhythm disturbances – 2% (CG – 1%), CHF – 1% (CG – 1%). Optimal antihypertensive therapy was received by 80% of patients, 20% required hospitalization in the Internal Medicine Department for additional examination and correction of CVD therapy. The use of systemic therapy was quite frequent: 21% received methotrexate, 23% – biological therapy.

Conclusion. Thus, in real clinical practice, constant assessment and prevention of CV risk, monitoring of risk factors such as weight, blood pressure, BMI, cholesterol, PASI and DLQI are necessary for a patient-specific, multidisciplinary approach to the treatment of patients with psoriasis and CVD.

Highlights

Telomere length and cardiovascular risk factors relationship in stable coronary artery disease patients with borderline coronary arteries stenosis with and without metabolic risk factors (diabetes mellitus and obesity) indicate complex and various mechanisms of coronary artery disease development in this category patients.

Abstract

Aim. To identify the relationship between telomere length and cardiovascular risk factors in patients with different clinical phenotypes of coronary artery disease (CAD) with borderline stenosis of the coronary arteries (CA).

Methods. The study included 201 patients with stable angina 1–3 class and borderline (50–70%) CA stenosis. Patients underwent physical examination, clinical and biochemical blood tests, assessment of systemic inflammation markers and atherosclerotic plaque stability, genetic markers (relative telomere length (RTL) was determined by real-time PCR), instrumental studies (ECG, ultrasound of the heart, neck vessels, coronary angiography, determination of stiffness markers, moreover, cognitive functions and the presence of early vascular aging (EVA) were assessed. Statistical calculations were performed using the RStudio program. Pairwise associations between two continuous variables were investigated by calculating Spearman`s correlation coefficients, between other types of variables it was investigated by using biserial correlation coefficients. Testing of statistical hypotheses was performed at a critical significance level of p = 0.05, i.e. the difference was considered statistically significant if p < 0.05.

Results. The 1^st group consisted of patients with stable CAD phenotype without diabetes mellitus (DM) and obesity (71 (35.3%) patients), the 2^nd group consisted of patients with stable CAD phenotype and type 2 DM (51 (25.4%) patients), the 3^rd group consisted of patients with stable CAD phenotype and metabolically unhealthy obesity phenotype (MUO) (79 (39.3%) patients). When assessing the correlation relationships in the group of patients with the stable CAD phenotype without DM and MUO, the telomere length (TL) indicator correlated positively with the augmentation index (p = 0.036) and negatively with the number of points on the MMSE scale (p = 0.045), with the level of IL-1 (p = 0.022), with the level of MMP-9 (p = 0.040). In the group of patients with the stable CAD phenotype and diabetes mellitus, negative correlations were found between the TL and the levels of TC (p < 0.001), LDL (p = 0.001), the presence of right coronary artery (RCA) lesion (p = 0.025), the level of MMP-9 (p = 0.035), tEAT (p = 0.044) and the level of micro-RNA-208a (p < 0.001) and positive correlations with the age of myocardial infarction (p = 0.023), the level of blood urea (p = 0.005) and the level of micro-RNA-21 (p = 0.019). In the group of patients with the stable CAD phenotype and MNF, the TL indicators positively correlated with the presence of lesion of the anterior descending artery (p = 0.018) and RCA (p = 0.018).

Conclusion. The revealed correlation relationships of TL with various cardiovascular risk factors indicate complex mechanisms of development of coronary artery disease with borderline stenosis of the coronary arteries.

Highlights

The results obtained in the study will make it possible to introduce the use of markers of myocardial fibrosis in real practice in order to diagnose the degree of fibrosis during a newly reported episode of atrial fibrillation, and subsequently predict the possibility of restoring rhythm and developing recurrent arrhythmia, and stratify the risks of complications.

Abstract

Aim. To determine the significance of risk factors and concomitant pathology in patients with newly diagnosed atrial fibrillation and their impact on significant clinical outcomes.

Methods. The study included 143 patients, including 50 patients without severe chronic noncommunicable diseases who meet the inclusion criteria (absence of severe cardiovascular diseases, absence of diseases accompanied by severe fibrosis, absence of a pacemaker, absence of hemodynamically significant heart defects that can lead to surgical treatment within a year, absence of chronic heart failure and survival > 2 years). Patients' complaints were studied, medical history, as well as laboratory tests of markers of myocardial fibrosis (transforming growth factor β, galectin 3), as well as instrumental research methods (electrocardiography, echocardiography). The assessment of adverse clinical outcomes was carried out within 1 year after inclusion in the study.

Results. Thyroid diseases (RR 1.516 95% CI [1.235; 1.862]), obesity (RR 2.571 95% CI [1.241; 5.327]), hypertension (RR 3.214 95% CI [1.374; 7.521]), hemodynamically significant heart defects (RR 1.469 95% CI [1.208; 1.786]) are clinically significant risk factors for the development of adverse clinical outcomes (myocardial infarction, stroke, repeated hospitalization, coronary angiography, radiofrequency ablation) with newly diagnosed atrial fibrillation. A high level of transformative growth factor β increases the chances of adverse outcomes by 7.66 times (95% CI: 2.32–25.35) and the chances of repeated hospitalization by 31.4 times (95% CI: 2.48–397.39). Galectin 3 had no significant impact on the risk of repeated hospitalization and the development of adverse clinical outcomes. Risk of adverse clinical outcomes was high in case of transformative growth factor β level equal to or greater than 5.61 ng/mL.

Conclusion. Transforming growth factor β is a promising marker for predicting the risk of repeated hospitalization, as well as a marker for the development of adverse clinical outcomes such as myocardial infarction, stroke, repeated hospitalization, radiofrequency ablation and coronary angiography. Thyroid diseases, obesity, arterial hypertension, and heart defects are clinically significant risk factors for the development of adverse clinical outcomes in newly diagnosed atrial fibrillation.

Highlights

Postoperative atrial fibrillation is a common complication after heart surgery. In the presented study, the analysis of data of patients with postoperative atrial fibrillation (158 patients) compared with patients without arrhythmia revealed a statistically significant (p < 0.05) difference in the size of the left atrium, end-diastolic size of the left ventricle, the left ventricular ejection fraction, the wall thickness of the left ventricle, the value of systolic pressure in the pulmonary artery and significant regurgitation on the mitral the valve. A preoperative echocardiogram can help predict the development of arrhythmia in the postoperative period.

Abstract

Background. Postoperative atrial fibrillation is a common complication after heart surgery. The arrhythmia occurs more often during the first five days after surgery, with a peak between 24 and 72 hours, and rarely after the first week. A change in the deformation of the left atrium cavity is associated with atrial fibrosis and may predict the risk of developing a new AF.

Aim. To identify echocardiographic predictors of newly diagnosed postoperative atrial fibrillation in patients who underwent open-heart surgery for any indication.

Methods. The study included patients operated in the Cardiac Surgery Department No. 2 of the State Medical Research Institute-KKB No. 1 of Krasnodar in the period from January 1, 2020 to January 1, 2021. During the analyzed period of time, open heart surgery was performed in 1 503 patients, 158 of whom had newly diagnosed postoperative atrial fibrillation (10.5%).

Results. In the presented study, the analysis of data of patients with postoperative atrial fibrillation compared with patients without arrhythmia revealed a statistically significant (p < 0.05) difference in the size of the left atrium, end-diastolic size of the left ventricle, the left ventricular ejection fraction, the wall thickness of the left ventricle, the value of systolic pressure in the pulmonary artery and significant regurgitation on the mitral the valve

Conclusion. Echocardiography is currently the main non-invasive tool for the analysis of cardiac function in the preoperative setting of cardiovascular surgery. The use of known parameters such as left atrial size, end-diastolic pressure, left ventricular ejection fraction using tissue Doppler sonography is a sensitive marker of arrhythmia in the early postoperative period.

Comment by the scientific editor of the journal on the article “Echocardiographic predictors of postoperative atrial fibrillation”, Z.G. Tatarintseva, E.D. Kosmacheva

Highlights

The effect of carotid endarterectomy on the cognitive status of patients remains controversial, as patients with carotid atherosclerosis suffer from chronic cerebrovascular insufficiency, show risk factors for the progression of the atherosclerosis, and suffer from transient ischemic attacks and ischemic stroke.

Abstract

Background. Carotid endarterectomy has been performed for more than 65 years to prevent primary and secondary ischemic stroke in patients with stenosis and lesion of brachiocephalic arteries. Numerous studies show that revascularization of the carotid artery not only protects against stroke, but can also lead to changes in cognitive functions. However, the effect of carotid endarterectomy on the cognitive status of patients remains controversial, since patients with carotid atherosclerosis suffer from chronic cerebrovascular insufficiency, transient ischemic attacks and ischemic stroke, therefore, the available data are ambiguous and quite contradictory.

Aim. To determine the risk factors for cognitive impairment in patients after carotid endarterectomy within 6-month follow-up.

Methods. The study included 110 patients with carotid atherosclerosis who underwent carotid endarterectomy. Upon hospitalization, cognitive status was assessed, echocardiography, lipid profile, matrix metalloproteinase-9 (MMP-9), monocyte chemoattractant protein-1 (MCP-1) were studied, systemic immune-inflammation index (SII), neutrophils to leukocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) were calculated. After 6 months, a group of patients with decreased cognitive function was identified.

Results. The results revealed the following factors of cognitive decline: type 2 diabetes mellitus (p < 0.025), a history of cerebrovascular disease (p < 0.006), elevated LDL (p < 0.05). There was an increase in indicators of systemic inflammation and fibrosis in the group with impaired cognitive function: NLR increased by 8.1% (p < 0.05), PLR by 4.5% (p > 0.05), (SII) by 15.8% (p < 0.01), MMP-9 by 51.7% (p < 0.001), and MCP-1 by 21.2% (p < 0.001). After 6 months patients of this group presented with the lower ejection fraction (10.3% decrease (p < 0.01). The average LDL level was 16.7% higher (p < 0.05).

Conclusion. Risk factors for cognitive impairment six months after carotid endarterectomy were diabetes mellitus, smoking, uncontrolled arterial hypertension, multifocal atherosclerosis, a history of stroke, dyslipidemia, increased levels of fibrosis markers and indicators of systemic inflammation.

Highlights

Autogenous arterial grafts are the most optimal choice of treatment in direct revascularization of the femoropopliteal segment of the lower extremity arteries. However, autogenous grafts can be unavailable due to a number of different clinical, anatomical and technical limitations. Biological prostheses are an alternative choice. They are extremely convenient for the surgeon, show high strength, flexibility, low thrombogenicity, sufficient biocompatibility, reduced susceptibility to infection, sufficient elasticity, and inertness to surrounding tissues. Another method of treating atherosclerosis is stenting. This technique is widespread, but it has its drawbacks. According to literary data, this technique does not always show satisfactory results of primary and secondary patency. The study and comparison of these techniques remains relevant. In this article, we compared the results of femoropopliteal bypass and stenting for occlusive lesion of the femoropopliteal segment of the lower extremity arteries.

Abstract

Aim. To conduct a comparative retrospective analysis of the immediate and mid-term results of femoropopliteal bypass grafting with the “KemAngioprotez” epoxy-treated vascular xenograft and stenting for atherosclerosis of the lower extremity arteries.

Methods. Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases” and the State Autonomous Healthcare Institution “Korolev Clinical Hospital named after S.V. Belyaev” provided the data for the analysis. The study included 115 patients who underwent femoropopliteal bypass with the “KemAngioprotez” epoxy-treated vascular xenograft from 2012 to 2022 and 73 patients who underwent stenting from 2014 to 2023 for chronic occlusive lesion of the lower extremity arteries. Data analysis was performed using the StatTech v. 4.6.3 software (Stattech LLC, Russia).

Results. The analysis of the patients from the subgroup with a 1-6-month follow-up revealed statistically significant differences regarding primary patency - 84.4% in the bypass group, 62.5% in the stenting group (p = 0.002), repeat unplanned intervention on the target limb - 10.1% in the bypass group, 34.7% in the stenting group (p < 0.001), the number of aneurysms - 0.0% in the bypass group, 8.3% in the stenting group (p = 0.008), and the number of amputations - 0.9% in the bypass group, 14.3% in the stenting group (p = 0.001).

During 7-12-month follow-up there were no statistically significant differences between the groups in terms of end points. When analyzing the two-year results, the bypass group demonstrated advantages over the stenting group in terms of primary patency (79.6% vs. 45.5%, respectively, (p = 0.002)), repeat unplanned intervention (4.2% vs. 45.5%, respectively, (p < 0.001)). The groups did not show significant differences in the number of amputations and aneurysm formation.

Conclusion. According to the results obtained, when choosing a treatment strategy between a stenting procedure with unmodified stents and a femoropopliteal bypass, in the absence of a pronounced comorbidities, specialists should choose the open revascularization. Considering the data obtained in a continuous sample of patients, the clinical effectiveness of endovascular interventions is still debatable, but it still has its place in clinical practice.

Highlights

• The KemAngioprosthesis xenobioprosthesis, in comparison with the synthetic ePTFE prosthesis, demonstrates satisfactory results in the formation of permanent vascular access for chronic hemodialysis, comparable with literature data.
• The KemAngioprosthesis xenobioprosthesis may be an alternative to the synthetic ePTFE prosthesis in clinical practice while providing vascular access for long-term renal replacement therapy.

Abstract

Aim. Comparative analysis of hospital complications of the use of xenobioprosthesis “KemAngioprosthesis” for the formation of permanent vascular access in comparison with prostheses made of synthetic material ePTFE (Venaflo II).

Methods. This study will present data from two centers and analyze hospital complications. Eighty-two patients were included in the retrospective two-center study, which were divided into two groups depending on the type of prosthesis used. Fifty operations using a biological prosthesis “KemAngioprosthesis”. And thirty-two cases of surgical interventions using a synthetic prosthesis made of ePTFE (Venaflo II).

Results. In the KemAngioprosthesis and Venaflo II groups, the following were registered: Still syndrome 2( 4%) and 2 (6%), (p = 0.641), prosthetic thrombosis 2 (4%) and 2 (6%), (p = 0.641), bleeding 1 (2%) and 1 (3%), (p = 1.000), hematomas 3 (8%) and 3 (10%), (p = 0.674). The combined endpoint is 7 (14%) and 7 (21%), respectively (p = 0.381).

Conclusion. Based on the comparative analysis conducted with a comparison of the hospital results of the use of the Xenobioprosthesis “KemAngioprosthesis” and a synthetic prosthesis made of ePTFE (Venaflo II), it is possible to conclude about the comparable frequency and structure of the main adverse events. Both types of prosthesis in the formation of permanent vascular access for chronic hemodialysis demonstrate satisfactory results comparable with the literature data. This allows us to conclude that in clinical practice, when providing vascular access for long-term renal replacement therapy, the xenobioprosthesis “KemAngioprosthesis” can be an alternative to a synthetic prosthesis made of ePTFE

Highlights

For the first time, the long-term outcome of using the KemAngioprotez vascular xenograft as a permanent vascular access in patients undergoing chronic hemodialysis will be described and comparative assessed with synthetic Venaflo II ePTFE vascular graft.

Abstract

Aim. To study whether the KemAngioprotez vascular xenograft is an effective alternative to Venaflo II ePTFE vascular graft in patients undergoing chronic hemodialysis.

Methods. The study included 44 patients with KemAngioprotez vascular xenograft and 26 patients with Venaflo II ePTFE vascular graft. The follow-up period was ≥ 12 months from the moment of the creation of permanent hemodialysis vascular access. The endpoints of the study included the patency of the prosthesis, which was assessed over a period of 3.6 and 12 months, respectively, as well as adverse events: death from any cause, infectious complications, bleeding from the prosthesis, aneurysm and thrombosis of the prosthesis.

Results. Based on a comparative analysis and a comparison of long-term results, there were no statistically significant differences in adverse events during the 12-month follow-up period. The indicators of the primary and secondary endpoint after 12 months in the KemAngioprotez group were 1.375 and 1.789 times higher, respectively, compared with the Venaflo II group. Venaflo II ePTFE grafts are 2,593 times more susceptible to infectious complications. Synthetic grafts, in this study, are devoid of such a complication as aneurysmal dilation, in comparison with the KemAngioprotez vascular xenograft.

Conclusions. In clinical practice, when providing vascular access for long-term renal replacement therapy, the KemAngioprotez vascular xenograft is an effective alternative to the Venaflo II ePTFE vascular graft. The disadvantages of vascular xenografts are aneurysmal dilatations, the advantages are a low risk of infectious complications.

Highlights

The presented work expands knowledge regarding the features of mortality from cardiovascular diseases in municipalities of a large industrial region of Siberia in the period from 2015 to 2023, based on the adopted agglomeration approach to regional development.

Abstract

Mortality due to cardiovascular diseases (CVD) is a multifactorial problem reflecting the health of the population and the level of socio-economic development of the country and regions, and therefore requires special attention from health authorities.

Aim. To conduct a comparative analysis of the mortality rate of the population from CVD in the municipalities of Kuzbass for the period from 2015 to 2023.

Methods. Kuzbass Regional Medical Information and Analytical Center provided federal statistical monitoring forms that included data on mortality rate of the adult population from CVD in the municipalities of Kuzbass. The study period was from 2015 to 2023.

Results. In the North Kuzbass and South Kuzbass agglomerations there are territories that are the least populated but have the highest mortality rate from CVD: in the North Kuzbass - Chebulinsky, Izhmorsky, and Tisulsky municipal areas (0.52%, 0.39% and 0.71% of the population, respectively, and 1^st, 2^nd and 3^rd place in the ranking by the mortality rate from CVD); in the South Kuzbass - Kaltansky, Kiselevsky, Osinnikovsky urban districts (1.14%, 3.36% and 1.71% of the population, respectively, and 9^th, 7^th and 6^th place in the ranking by the mortality rate from CVD). There was a stable system for providing medical care to patients with CVD in 12 municipalities of Kuzbass (5 of which belonged to the South Kuzbass agglomeration), thus the mortality rate there was below the regional one. There were 12 municipalities with a mortality rate from CVD 15% lower compared with regional mortality rate, out of which 3 belonged to the South Kuzbass agglomeration. There were 9 municipalities with a mortality rate higher than the regional one by more than 15%, out of which 2 territories were included in the South Kuzbass agglomeration.

Conclusion. The study analyzed the differences in mortality rates from CVD among the population of municipalities within a constituent entity of the Russian Federation – a large industrial region of Siberia, based on the agglomeration principle of management. The results revealed municipalities with high and low levels of mortality from CVD in 2015-2023, and the authors provided a rating of these territories.

Highlights

• Aortic endothelial cells and perivascular endothelial cells have distinct distribution of phosphorylated forms of endothelial nitric oxide synthase (eNOS)
• In hypertensive rats, aortic endothelial cells have increased levels of activated eNOS (Ser632 and Ser1177) whilst perivascular endothelial cells have elevated levels of inhibited eNOS (Ser117 and Thr495).
• Perivascular endothelial cells have increased levels of total and phosphorylated eNOS in comparison with aortic endothelial cells.

Abstract

Aim. To study the expression of endothelial nitric oxide synthase (eNOS) and its modified forms in the aortic endothelial cells and perivascular endothelial cells in hypertensive and normotensive rats.

Methods. The study included 12 male hypertensive ISIAH rats and 12 male normotensive Wistar rats at the 4 months of age. Following the cryosectioning, we performed an immunohistochemical staining of descending aorta using different antibodies to total eNOS and to phosphorylated eNOS (Ser117, Thr495, Ser632, Ser1177). Next, we scanned the whole slide images and conducted a semi-quantitative analysis of immunohistochemical signal in the aortic endothelial cells and perivascular endothelial cells using ImageJ software. Statistical analysis was carried out by Mann–Whitney U-test (when comparing eNOS expression in the endothelium of hypertensive and normotensive rats) and Wilcoxon matched-pairs signed-rank test (when comparing eNOS expression in the aortic endothelial cells and perivascular endothelial cells).

Results. Aortic endothelial cells and perivascular endothelial cells of hypertensive rats tended to the increase in total eNOS regardless of the antibody, although the staining pattern differed across the antibodies. Aortic endothelial cells of hypertensive rats had higher expression of eNOS phosphorylated at Ser632 and Ser1177 sites (activating phosphorylation) whereas perivascular endothelial cells displayed elevated levels of eNOS phosphorylated at Ser117 and Thr495 (inhibiting phosphorylation) and Ser632 (activating phosphorylation). Expression of total and phosphorylated eNOS in perivascular endothelial cells was significantly higher than in the aortic endothelial cells.

Conclusion. In comparison with normotensive Wistar rats, hypertensive ISIAH rats are characterised by an increased expression of activated eNOS in the aortic endothelial cells (Ser632 and Ser1177 phosphorylation) and by an elevated expression of inhibited eNOS (Ser117 and Thr395 phosphorylation) in the perivascular endothelial cells. Perivascular endothelial cells have a higher expression of total and phosphorylated eNOS than aortic endothelial cells.

Highlights

Acquired long QT syndrome is a rare disease, but the frequency of QTc prolongation increases with polypragmasia.

Abstract

Acquired long QT syndrome is a rare condition. However, the prevalence of prolonged QTc interval increases among patients with polypharmacy. The risk of both QTc interval prolongation and torsades de pointes (TdP) tachycardia escalates exponentially with the concomitant use of multiple QTc-prolonging drugs. This article explores the underlying mechanisms of the condition and methods to mitigate the risk of potentially fatal arrhythmias.

Highlights

The article summarizes modern ideas about the classification, pathogenesis, main clinical symptoms, diagnosis and approaches to the treatment of systemic amyloidosis. An important postulate of today's diagnosis of amyloidosis is the morphological identification of amyloid in biopsies of affected tissues, including by typing. The goal of therapy for any type of amyloidosis remains the removal of precursor proteins, which justifies the use of certain aggressive drug regimens or other drastic measures. Recent achievements in studying the problem of amyloidosis have made it possible to formulate classification criteria for amyloidosis and treatment approaches, as well as significantly improve the prognosis of patients with various types of amyloidosis.

Abstract

Amyloidosis is a rare disease that can be diagnosed during life. More often, amyloidosis is asymptomatic or has non-specific symptoms. For this reason, diagnosis and treatment is carried out untimely, the results of therapy are ineffective. The purpose of this analytical review is to identify the most effective methods for early diagnosis of amyloidosis. To characterize a promising method of amyloidosis therapy for today. Thus, timely diagnosis of systemic amyloidosis and modern approaches to the treatment of this disease will increase the overall survival of patients.

Highlights

• Intermittent claudication in the lower limbs is a bothersome symptom in patients with peripheral arterial disease (PAD).
• Pulsed electromagnetic therapeutic modality is a newly recommended intervention for managing PAD-induced lower-limb intermittent claudication when added to exercise rehabilitation.

Abstract

Aim. Despite the improvement with rest, lower-limb intermittent claudication is a bothersome issue/symptom in patients with peripheral arterial disease (PAD). Utilizing its benefits in increasing vasodilation/angiogenesis in patients with circulatory disorders/issues, adding pulsed electromagnetic therapeutic modality (PEMTM) to exercise rehabilitation of PAD is a newly recommended intervention in managing PAD-induced lower-limb intermittent claudication. This interventional study aimed to check the effects of adding PEMTM to elliptical exercise on vascular hemodynamics, functional outcomes, and quality of life in PAD sufferers.

Methods. PAD older men were assigned randomly into the group of elliptical exercise (n = 20, received only elliptical exercise and by-physician prescribed for-PAD pharmacotherapies) or study group (n = 20, received PEMTM, elliptical exercise, and by-physician prescribed for-PAD pharmacotherapies). The eight-week PEMTM or elliptical exercise was applied 3 times weekly. The following outcomes were evaluated: PAD patients’ ankle brachial index test, diameter of posterior tibial artery, lower-limb claudication pain time, lower-limb claudication pain distance, modified walking-impairment questionnaire, short-form-36 health survey, disease-specific quality-of-life evaluation by the intermittent claudication questionnaire, summation score of short physical performance battery, pain-free six-minute walked distance, and the total six-minute walked distance.

Results. The present paper showed a significant effect of elliptical exercise alone or combined with PEMTM on all measured parameters with a significant superiority to the combined application of elliptical exercise and PEMTM.

Conclusion. Gained hemodynamic and functional benefits of elliptical exercise in PAD elderly could be magnified by adding PEMTM to elliptical exercise.

Highlights

The study presents an analysis of the prevalence of dynapenia, parameters characterizing the rigid-elastic properties of arterial vessels, endothelial dysfunction and inflammation in females with arterial hypertension, which made it possible to suggest pathogenetic links in their relationships.

Abstract

Aim. To assess the prevalence of dynapenia in patients with arterial hypertension (AH) and to identify possible relationships between them.

Methods. The study included 148 women of various ages. Participants were divided into four groups based on age and the presence of hypertension. The control group consisted of 30 middle-aged women without hypertension. All participants underwent a range of tests, including assessment of muscle strength, arterial wall stiffness, augmentation and reflection indices, endothelial dysfunction, fractolkine and caspase-3 levels, and walking speed.

Results. Dynapenia was detected in 25.4% of women with hypertension, and age correlated with a decrease in muscle strength. In elderly women with hypertension, the stiffness index was 10% higher than in middle-aged and senile women (p < 0.001). The augmentation index in elderly women with hypertension was 40% higher than in senile women (p < 0.01) and 63% higher than in middle-aged women (p < 0.00001). The reflectivity index in elderly women with hypertension exceeded that in middle-aged women by 17% (p < 0.05). High blood pressure contributed to changes in the elasticity of vascular walls and functional disorders. Concentrations of fractalkine (0.204 ± 0.012 pg/mL, p < 0.0005) and caspase-3 (1.109 ± 0.05 ng/mL, p < 0.000001) served as markers of chronic inflammation.

Conclusion. Dinapenia is diagnosed in a quarter of women with hypertension. Age-related changes lead to increased vascular wall rigidity, increased augmentation and reflection, development of endothelial dysfunction and inflammation, which probably initiates the process of arterial remodeling, worsening tissue metabolism and becoming an important link in the development of the cardiovascular gerontological continuum.

Commentary to the article “The relationship between dynapenia and arterial hypertension in female patients”, Yu.F. Shevchenko, S.G. Gorelik, A.N. Ilnitsky, E.D. Bazdyrev, O.N. Kurganskaya, K.N. Lelikova, K.G. Maslov, E.P. Nichik, E.A. Voronina

Highlights

The analysis of laboratory parameters capable of assessing the lethal outcome in patients with COVID-19 was carried out. After that, these parameters were ranked depending on the magnitude of the odds ratio.

Abstract

Aim. To assess the predictive value of laboratory parameters as factors of lethal outcome in patients with novel coronavirus infection (COVID-19).

Methods. The prospective study included 164 patients hospitalized in a monoinfection hospital in the period from November 3, 2020 to January 15, 2021. The diagnosis of COVID-19 was verified by PCR testing for the presence of SARS-CoV-2 RNA in nasopharyngeal and oropharyngeal specimens. Diagnosis, classification of pneumonia based on CT findings, disease severity according to the National Early Warning Score (NEWS), and treatment were conducted according to the “Temporary Guidelines. Prevention, diagnosis and treatment of a new coronavirus infection (COVID-19)”, version 9 (10/26/2020). The end of the study was the outcome of hospitalization: discharge or death. The main group consisted of 25 patients with a fatal outcome (Group 1), the 2^nd group (n = 139) consisted of surviving patients.

Results. The mortality rate was 15.2%. 56% of the deceased were males, and 44% were females. The average age of the deceased was 72 years [68; 83], compared to 65 years [59,0; 70,5], р < 0,001 in the surviving group. 97.6% of patients were in clear consciousness, while 2.4% were in a state of stupor and soporific. Odds ratio (OR) analysis showed that predictors of fatal outcome in COVID-19 were elevated troponin concentration in blood (OR = 18,38 (95% confidence interval (CI) 6,503–51,97; p < 0,001), D-dimer level > 700 ng/mL (OR = 17,79; 95% CI 6,362–49,77; p < 0,001), procalcitonin (PCT) > 0.28 ng/mL (OR = 7,357; 95% CI 2,840–19,06; p < 0,001), and platelets < 180 × 10⁹/L (OR = 4,76; 95% CI 2,00–11,1; p = 0,001). Monocytes ≥ 6.0% (OR = 0,205; 95% CI 0,067–0,627) were identified as a protective factor.

Conclusion. The most significant parameters for predicting prognosis in COVID-19 are troponin, D-dimer, PCT, and platelets. Monitoring these parameters will allow clinicians to identify patients at high risk of death early, requiring more active treatment measures.

Highlights

This article presents our own experience and summarizes the global experience of performing coronary artery bypass surgery using robotic technologies. There are very few articles on this topic, there are no domestic articles at all (as well as no domestic experience), however, this area is the peak of minimally invasive surgery and is quite an advanced and developing area. Studying international experience and highlighting domestic experience will allow us to come to the right decision in each individual case and to develop robotic surgery everywhere in the leading centers of our country.

Background. Coronary artery bypass (CAB) is the most commonly performed surgical procedure in cardiovascular surgery with a constantly evolving minimally invasive approach. Minimally invasive cardiac surgery, including robot-assisted coronary artery bypass surgery, can reduce the intensity of postoperative pain, significantly reduce the incidence of postoperative wound infections and hospital stay. However, the widespread use of robot-assisted interventions in clinical practice is difficult due to a number of drawbacks and requires further study.

Aim. To study the possibilities of robotic technologies in coronary surgery in the conditions of the profile hospital.

Methods. In our clinic (University Clinical Hospital № 1 of Sechenov University) 3 MICSCAB operations were performed in the period from May to July 2024, but the left internal thoracic artery was harvested by robotic instruments using Da Vinci Si system. On analysis, we found that all grafts had satisfactory blood flow and were of sufficient length, patients had fewer complaints of chest pain on follow-up interview, and the operation time lengthened marginally.

Results. In all cases, conversion to median sternotomy and repeat thoracotomy or sternotomy due to bleeding was not required. In the early postoperative period, no arrhythmias, pleural effusion, wound infections, or other cardiovascular complications were observed. Postoperative recovery was uneventful. The mean LIMA harvesting time was 111 ± 11.1 minutes, and the total operation duration was 282 ± 7 minutes. The average blood loss was 167 ± 76 mL. Patients remained in the intensive care unit (ICU) for 1 day, with a total hospital stay averaging 8 days.

Conclusion. This intervention is an intermediate step in performing a full robotic bypass, but further studies are needed to analyze the promise and necessity of this technique.

Highlights

• Combination lipid-lowering therapy reduces total cholesterol, low-density lipoprotein cholesterol, and triglycerides and increases high-density lipoprotein cholesterol in patients with acute coronary syndrome.
• Combination lipid-lowering therapy does not affect serum level of calciprotein particles or serum calcification propensity.
• Serum level of calciprotein particles shows a positive correlation with triglycerides and a negative correlation with high-density lipoprotein cholesterol.

Abstract

Aim. To evaluate the impact of combination lipid-lowering therapy (CLT) on parameters of lipid and mineral profile in patients with dyslipidemia and acute coronary syndrome (ACS) or chronic coronary syndrome (CCS).

Methods. We consecutively enrolled patients with ACS (n = 10) and CCS (n = 5) with low-density lipoprotein cholesterol (LDL-C) > 3,5 mmol/L. The follow-up was 4 months with monthly lipid profile checkpoints. CLT included HMG-CoA reductase inhibitors (atorvastatin 40–80 mg/day or rosuvastatin 20–40 mg/day), cholesterol absorption inhibitor ezetimibe (10 mg/day), and PCSK9 inhibitor alirocumab (300 mg/mL subcutaneously, once per month). Before and after the CLT, we have also evaluated the serum level of calciprotein particles (CPPs) and serum calcification propensity.

Results. Patients with ACS and CCS had similar total cholesterol (TC), LDL-C, and triglycerides (TG) before and after the CLT. The level of high-density lipoprotein cholesterol (HDL-C) in patients with ACS was lower than in CCS (р = 0.018 and p = 0.037 before and after the CLT, respectively). CLT reduced TH, LDL-C, and TG (p = 0.002, p = 0.002, and p = 0.019, respectively) and increased HDL-C (р = 0.018) in patients with ACS. Serum level of calciprotein particles (CPPs) in patients with ACS was higher in comparison with CCS before the treatment (р = 0.04). Serum calcification propensity did not differ between the patients with ACS or CCS.

Conclusion. CLT demonstrated safety and efficacy in patients with ACS and CCS, reducing the levels of TH, LDL-C, and TG, while not affecting serum CPP level and serum calcification propensity. Achievement of target TH and LDL-C values requires the extension of CLT, broader use of ezetimibe, and increased compliance to CLT which demands the intake of multiple drugs.

Highlights

The review describes the current state of the problem of assessing the risk of development, early diagnosis and primary prevention of atrial pre-fibrillation.

Abstract

The presented review describes the principles of primary prevention of atrial fibrillation from the standpoint of assessing the mechanisms of its formation and the risk of developing this arrhythmia. The first stage of atrial pre-fibrillation is characterized by the presence of potentially modifiable risk factors for its occurrence, and the second – by electrical and structural remodeling of the heart. The article presents the results of correction of potentially modifiable risk factors of atrial pre-fibrillation, and evaluates the effectiveness of using pharmacological and non-drug therapy. The article presents literature data on the effectiveness of correction of potentially modifiable risk factors, the use of pharmacological and non-drug therapy at the stages of atrial pre-fibrillation.

Highlights

Pulmonary embolism is a life–threatening complication caused by surgery on the heart and blood vessels. This case report describes a case of a 60-year-old patient diagnosed with pulmonary artery thrombosis after minimally invasive multiple coronary artery bypass grafting according to MSCT angiography. Thrombectomy of the right pulmonary artery was performed with cardiopulmonary bypass and Calafiore cardioplegia along with thrombectomy of the common femoral, common iliac and large subcutaneous veins on the left, and crossectomy. Constant monitoring, stabilization and improvement of the patient's condition demonstrated the effectiveness of the selected diagnostic method and treatment strategy.

Abstract

Massive pulmonary embolism (PE) is a serious life-threatening complication in the postoperative period of cardiovascular surgery. This case describes the treatment strategy in a 60-year-old patient after minimally invasive multiple coronary artery bypass grafting. The massive PE that occurred in the postoperative period required simultaneous open surgery – thrombectomy of the right pulmonary artery with cardiopulmonary bypass and thrombectomy of the vena femoralis communis (VFC), vena saphena magna (VSM), and crossectomy. One-stage approach is justified in order to reduce the risk of recurrent PE, pulmonary hypertension and right ventricular failure in the long-term period. This clinical case demonstrates successful one-stage surgical treatment of massive PE using two different vessels after minimally invasive cardiac surgery - multiple coronary artery bypass grafting (MICSCABG).