Highlights

The study evaluates the safety and efficacy of an outpatient cardiac rehabilitation (CR) program using remote technologies compared to a traditional physician-supervised in-person CR program in patients after coronary artery bypass grafting (CABG). It was shown that the remote format is non-inferior to in-person rehabilitation in terms of safety and efficacy and demonstrates advantages in several parameters, such as adherence to physical training (PT) and the maintenance of achieved exercise tolerance (ET) levels.

Aim. To evaluate the safety and efficacy of an outpatient CR program using remote monitoring technologies compared to a traditional CR program in a rehabilitation center for patients after CABG.

Methods. The study included 108 patients who had undergone elective CABG. After completing the inpatient phases of CR, patients were randomized into two groups. Group 1 (n = 51) received standard center-based CR with bicycle ergometer training under direct physician supervision. Group 2 (n = 57) underwent a home-based CR program with independent PT, using remote monitoring tools (a pedometer and the domestic “Nomokard” 4-lead Holter ECG monitor). The duration of the PT phase was three months for both groups. Key endpoints were ET, adherence to PT and pharmacotherapy, achievement of target risk factor levels (BP, HR, LDL-C, smoking cessation), and the frequency of adverse events during 12 months of follow-up.

Results. After 3 months of PT, both groups showed a significant and comparable increase in ET. However, after 12 months of follow-up, the home-based training group with remote ECG monitoring maintained a statistically significant improvement in ET (from 104 W to 107.5 W; p = 0.003), while the clinic-based training group showed a decrease from the peak value (from 112 W to 105 W; p = 0.024). The proportion of highly adherent patients was higher in the home-based training group (52.6% vs. 37.3%). No significant differences in the frequency of serious adverse events (death, myocardial infarction (MI), acute cerebrovascular accident (stroke), hospitalization due to CAD progression) were found between the groups. After one year, both groups recorded significant and comparable improvements in medication adherence, achievement of target BP and HR levels, and smoking cessation. Remote ECG monitoring in the home-based training group allowed for the timely detection and management of significant arrhythmias (e.g., transient AV block, atrial fibrillation) without interrupting the rehabilitation process.

Conclusion. A home-based CR program with remote ECG monitoring and telephone support is non-inferior to traditional clinic-based CR in terms of safety and efficacy for patients after CABG. Furthermore, it demonstrates advantages regarding the long-term maintenance of functional achievements and adherence to PT. The use of remote technologies enhances patient engagement and allows for the prompt diagnosis and management of potential complications in an outpatient setting.

Highlights

Since 2022 NICaS system developed by Israel company NiMedical was registered in Russia. It allows quick and reproducible assessment of hemodynamic indicators using bioimpedance cardiography. The evaluation of promising non-subjective (in comparison with Echo) method in patients with persistent atrial fibrillation is reported.

Aim. Compassion of hemodynamic indicators depending on rhythm or rate control strategy in patients with persistent atrial fibrillation.

Methods. The evaluation of hemodynamic changes in two comparable groups of patients with atrial fibrillation using bioimpedance cardiography and subsequent validation if the active restoration of sinus rhythm or rate control is reasonable as first line tactics.

Results. When bioimpedance cardiogram was registered immediately after cardioversion, no significant changes in hemodynamic indicators were observed. A month later there were clear positive changes manifested by an improvement in cardiac output from 5.45 ± 2.25 L/min to 6.39 ± 2.81 L/min, p = 0.05, cardiac index from 2.64 ± 0.99 to 3.09 ± 1.28, p = 0.029, cardiac power index from 0.57 ± 0.22 to 0.66 ± 0.26, p = 0.027, as well as total peripheral resistance index reduction from 3562.22 ± 1709.86 to 2900.86 ± 1139.16, p = 0.05. In the rate control group positive tendency was also noticed, but there was no statistical reliability.

Conclusion. A preliminary analysis of the hemodynamic parameters in patients with persistent atrial fibrillation using the impedance cardiography method allows us to conclude about the convenience of these measurements and serves as additional argument for rhythm control approach.

Highlights

The effect of the occluded superficial femoral artery on the patency of the aorto-femoral baypass remains controversial, since, on the one hand, in the absence of patency of the femoral-popliteal segment arteries, vascular resistance in the proximal segment increases, on the other hand, a passable deep femoral artery is a good runoff.

Background. Aorto-femoral bypass surgery is the “gold standard” in the treatment of extended lesions of the iliac arteries, as well as femoral-popliteal bypass surgery for extended lesions of the SFA, however, open multilevel reconstruction is not always possible (severe comorbid background of the patient, lack of adequate outflow arteries), in this regard, it seems interesting to search for a less invasive method of restoring blood flow by SFA or restoration of blood flow along the DFA of the thigh as along the main collateral of the lower limb.

Aim. To compare the effectiveness of aorto-femoral bypass surgery with restoration of blood flow by DFA and aorto-femoral bypass surgery with extended endarterectomy from SFA

Methods. The study included 82 patients with atherosclerotic lesions of the iliac arteries and arteries of the femoral-popliteal segment. The patients are divided into 2 groups. Group 1 included patients who underwent aorto-femoral bypass surgery with restoration of blood flow through the HBA. The second group consisted of patients who underwent aorto-femoral bypass surgery with loop endarterectomy from PBA. The primary patency of the aorto-femoral shunt, freedom from amputation, freedom from reintervation, as well as long-term survival were evaluated.

Results. Technical success in both groups was 100%. In group 1, there were no cases of early thrombosis of the aorto-femoral shunt and death in the early postoperative period. There are also no cases of amputation. In the second group, 2 cases of thrombosis were registered in the early postoperative period. The 5-year patency of the aorto-femoral shunt was 97.1% in group 1 and 95.7 % in the second group (p = .389) Long–term freedom from amputation did not differ – in group 1 it was 97.1% by year 5 and 93.7% in the second group (p= .098) Long-term survival was higher in the second group, but the difference was not statistically significant (p = .237)

Conclusions. Restoration of blood flow through the deep artery of the thigh with aorto-femoral bypass surgery allows to stop the symptoms of ischemia. Endarterectomy from SFA is an effective and safe alternative to femoral-popliteal bypass surgery. In our research, SFA reocclusion did not lead to acute or critical ischemia, and in half of the cases, the violation of the patency of PBA was asymptomatic. Occluded SFA is not a risk factor for impaired patency of the aorto-femoral shunt in the long term. 

Highlights

Right ventricular (RV) dysfunction can be observed in patients with left heart valve pathology and severe functional tricuspid valve insufficiency. The study of RV function parameters allows for the prediction of the early postoperative period. TAPSE proved to be the most sensitive indicator, including in patients with high pulmonary hypertension.

Background. Severe functional tricuspid insufficiency is often found when surgical treatment of valve pathology of the left heart chambers is necessary. Timely correction of the pathology before the development of right ventricular failure can reduce the surgical interventions risk, improve immediate results and the quality of life of patients in the remote period.

Aim. The study was to identify the correlation between clinical parameters, parameters of right ventricular function and the immediate results of surgical treatment of patients with severe functional tricuspid valve insufficiency.

Methods. The study included 40 patients. The average age is 64.5 ± 8.5 (34–86) years. In 20 – MV insufficiency, in 11 – aortic stenosis and relative MC insufficiency, and in 9 M-A malformation. Grade 3 TR insufficiency – 35 (78%) patients, grade 4 TR – 5 (22%) patients. All of them had class III–IV symptoms to NYHA. In the preoperative period, a general clinical and echocardiography examination was performed. Measures of RV function included: fractional change in right ventricular area (FAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler sonography (RV FWS), pulmonary artery systolic pressure (PASP), and of the tricuspid annular plane systolic excursion ratio in pulmonary artery systolic pressure (TAPSE/PASP). To assess the closeness of the bond (r), the Chaddock scale was used. For all statistical results, a significance level of < 0.05 was adopted.

Results. The average LV EF was 60.5 ± 6.8 (46–75) %, PASP: 64.7 ± 14.4 (31–110) mm Hg. 25 (63%) patients had high PASP (PASP > 60 mm Hg). Mean TAPSE/PASP: 0.28 ± 0.09 (0.11–0.52), FAC: 33.04 ± 6.2 (20–64) %, TAPSE: 16.47 ± 3.1 (11–20.6) mm, RV FWS: –17.04 + 3.9 (–5.4 – –26.2) %. In-hospital mortality of 3 (7,5%) patients. Statistical analysis showed a moderate correlation between mortality, TAPSE: –-0.3483 (p = 0.030) and LVEF: –0.3387 (p = 0.035), a very weak correlation between mortality and RV FWS: –0.1307 (p = 0.434), the absence between mortality, FAC: 0.0445 (p = 0.791) and pulmonary hypertension: –0.0521 (p = 0.753).

Conclusions. TAPSE can be considered as the most sensitive indicator of pancreatic function in patients with severe tricuspid valve insufficiency, pulmonary hypertension did not affect the immediate outcome of surgical treatment.

Highlights

Combined interactions of polymorphic loci in lipid and carbohydrate metabolism genes in patients with myocardial infarction) and obesity were studied in the presented research. It was hypothesized that these interactions can explain the individual differences in the risk of cardiometabolic disorders due to modulation of their manifestation.

Aim. To investigate the patterns of gene-gene interactions of polymorphic loci in lipid and carbohydrate metabolism genes in patients with myocardial infarction depending on the presence of comorbid obesity.

Methods. 146 patients with acute myocardial infarction, divided into groups with and without obesity were examined. The control cohort consisted of 300 apparently healthy residents of the region. DNA was isolated from peripheral blood using phenol-chloroform extraction. Genotyping of 12 polymorphic variants in 8 genes involved in the regulation of lipid and carbohydrate metabolism was performed using the TaqMan assay on a ViiA™ 7 analyzer. Gene-gene interaction analysis was performed using MDR v.3.0.2.

Results. In this study, significant associations between the IGF1R gene rs2229765 polymorphism and APOE gene rs7412 polymorphism associated with an increased obesity risk in myocardial infarction patients were identified. Using the MDR assay, key gene-gene interaction models were identified: a four-locus model associated with myocardial infarction risk (rs1137101 LEPR – rs1137100 LEPR – rs1042031 APOB – rs6725189 APOB) and a twelve-locus model associated with obesity risk including all analyzed polymorphic loci. The greatest entropic contributions to myocardial infarction risk were found to be made by APOB gene rs6725189 polymorphism, LEPR gene rs1137100 polymorphism, and LIPC gene rs1800588 polymorphism, while a pronounced synergistic effect was detected for the rs6725189-rs1042031 (APOB) pair. In the obesity risk model, the greatest individual contributions were observed for APOE gene rs7412 polymorphism and IGF1R gene rs2229765 polymorphism, while strong synergistic interactions were observed for pairs including LEPR gene rs1137100 polymorphism.

Conclusion. Assessment of gene-gene interactions revealed that the combined pathogenetic effects of polymorphic loci of lipid and carbohydrate metabolism genes exceed their independent contributions. This finding can be used to assess the genetic risk of myocardial infarction and develop personalized approaches to the prevention and management of patients with cardiometabolic comorbidity.

Highlights

The article presents the results of analysis of hospital morbidity and mortality in patients with cardiovascular diseases receiving specialized medical care at the Department of Infectious Diseases of the Kuzbass Clinical Cardiology Dispensary named after Academician L.S. Barbarash.

Aim. To analyze hospital morbidity and mortality in patients with new coronavirus infection (NCI) who received specialized medical care at the Department of Infectious Diseases of the Kuzbass Clinical Cardiology Dispensary named after Academician Barbarash.

Methods. The object of the study were the reports of the head of the Department of Infectious Diseases regarding patients with circulatory system diseases (CSD) and NCI receiving care at the Kuzbass Cardiology Center for the period from 10.21.2020 to 30.06.2022. The subject of the retrospective study were the types of CSD and mortality (ICD-10 code) in treated patients. The unit of analysis – treated patients with CSD (18 years and older) and NCI (U07.1 and U07.2).

Results. Data of 1 248 patients with CSD and NCI were analyzed. The highest number of such cases occurred in 2021, accounting for more than half of all patients treated at the Department. More than half of the patients were hospitalized with acute coronary artery disease (CAD), less than a quarter of the patients were hospitalized with chronic CAD and heart failure. Acute coronary syndrome (ACS) was verified in 38.9% of patients, stroke in 22.4% of patients, and pulmonary embolism in 1.8% of patients (n = 22). Patients were more often admitted with acute (primary) myocardial infarction (MI) and unstable CAD (17.6% and 15%, respectively), and half as often with recurrent MI (6.3%). Less than 40% of patients were hospitalized due to chronic CSD, among which prevailed chronic CAD and decompensated chronic heart failure (CHF) (19.7%). Mortality was 16%, mortality within 24 hours was 2.5%. The mean age of the deceased patients was 72.69 ± 12.22 years. The proportion of patients of working age who died was 10.8 times lower than that of patients older than working age. On average, women were 1.1 times more likely to die during the analyzed period. Acute CSD (32.3%), chronic CSD (33.5%) and stroke (34.2%) caused death at an equal rate.

Conclusion. Patients with ACS and stroke were the majority of treated patients. Patients were more often admitted with primary MI and unstable CAD, and half as often with recurrent MI. The most predominant chronic CSD were chronic CAD and decompensated CHF. One sixth of all treated patients died. Acute and chronic CSD and stroke caused death at an equal rate.

Highlights

Uncontrolled hypertension is not a rare manifestation of post-COVID syndrome. Given the fact that RAAS is interested in the penetration of the virus into the body, it can be assumed that uncontrolled hypertension after COVID-19 is associated with polymorphism of genes encoding angiotensin II. The presented review is the result of a thorough search of relevant articles in the databases of scientific electronic libraries eLIBRARY.RU, PubMed, Cyberleninka as of November 5, 2024.

Absract

The term “long COVID” (PASC) has gained international recognition and is widely used to describe a wide range of symptoms after COVID-19. According to international studies, at least 65 million people worldwide suffer from PASC, and the number of cases is increasing. A new paradigm of PASC is proposed, which includes biological, psychological and social factors integrated into a single model. Genetic polymorphisms are a key element of the biological component of the paradigm. Taking into account the pathogenesis of COVID-19, the role of genetic polymorphisms of the components of the renin-angiotensin-aldosterone system (RAAS) in the development of PASC is discussed. However, the results of international studies are not unambiguous. The documented high risk of developing PASC in patients with arterial hypertension, the occurrence of uncontrolled arterial hypertension after infection, makes it possible to isolate the corresponding subphenotype in the cardiovascular phenotypic profile of PASC. The genetic architecture of blood pressure includes genetic polymorphisms of the RAAS components. Given the involvement of RAAS, it seems promising to study candidate gene polymorphisms in uncontrolled arterial hypertension within the framework of PASC. Studying this part of the molecular mechanisms of PASC pathogenesis opens up opportunities for personalized treatment strategies.

Highlights

The problem of arterial hypertension in young people has become more urgent in recent decades. The emergence and spread of new methods of smoking, the influence of psychoemotional stress, and mutations in a number of genes are among the leading risk factors for the development of arterial hypertension. New prevention strategies should include recommendations for lifestyle modification to provide a comprehensive approach to managing the health of young people.

Absract

Arterial hypertension in young people is a medical problem that requires close attention from both doctors and researchers. In recent years, there has been a trend towards an increase in cases of hypertension among young people, which is associated with a number of modifiable and unmodifiable risk factors. The main modifiable factors include smoking, alcohol consumption, sedentary lifestyle, poor nutrition and psychoemotional stress, which can significantly affect blood pressure levels. In addition, one should not forget about the role of genetic predisposition and gender, since men are more prone to developing hypertension. These factors are interrelated and can lead to the development of cardiovascular diseases in the future. Early detection and correction of risk factors such as overweight and dyslipidemia can significantly reduce the risk of hypertension and its associated complications. Proposed prevention strategies should include recommendations on physical activity and lifestyle changes to ensure an integrated approach to youth health management. For a deeper understanding of the pathogenesis of hypertension in young people, additional research is needed to develop effective methods of intervention and prevention. Given the growing prevalence of this problem, the relevance of developing and implementing preventive programs is increasing, which can contribute to improving the health and quality of life of the younger generation.

Highlights

The data of domestic and foreign sources on the relationship between obstructive sleep apnea syndrome and chronic kidney disease are analyzed and presented. The features of clinical manifestations of obstructive sleep apnea syndrome in patients with chronic kidney disease are shown. The protective effect of CPAP therapy on kidney function is highlighted.

Abstract

Obstructive sleep apnea syndrome (OSA) and chronic kidney disease (CKD) are clinically significant diseases with high comorbidity, potentiating the risk of developing cardiovascular complications. The prevalence of these pathological conditions is progressively increasing. At the same time, the problem of association between OSA and CKD is underestimated and quite relevant. The review article presents the features of the clinical course of OSA in patients with CKD, as well as the main pathophysiological mechanisms influencing the relationship between OSA and CKD. The role of CPAP (Continuous Positive Airway Pressure, CPAP) therapy in reducing the risk of CKD progression and complications is shown.

Highlights

The research presented in this paper evaluates the alternatives for the 1^st stage of hemodynamic correction of HLHS, outlines possible complications that may emerge in the postoperative phase, and provides approaches for their overcome in the intraoperative period.

Abstract

Hypoplastic left heart syndrome (HLHS) is a congenital heart disease that describes in the underdevelopment of the left-sided structures of the heart. HLHS is a rare defect in infants born and occurs in 2–3% of all congenital heart diseases. Primary heart transplantation demonstrates a radical correction of HLHS. However, a shortage of organs and a prohibition on this procedure to juvenile make it unavailable. Therefore, this review presents options for surgical correction of newborns with hypoplastic left heart syndrome, their advantages and disadvantages, as well as possible complications.

Highlights

The presented article highlights the issues of increasing life expectancy, pathophysiological changes in the cardiovascular system associated with age, and aspects of cardiac care for elderly patients.

Abstract

Aging is an inevitable part of life, and age-associated changes in the cardiovascular system begin to manifest themselves in youth, gradually affecting almost all organs and systems. A deep understanding of the mechanisms of aging is extremely important for the development of effective prevention and treatment measures, especially among populations at high risk of developing cardiovascular diseases. It is cardiovascular diseases that remain the main cause of death among elderly patients. However, the elderly face additional health problems, such as poly- and multimorbidity, frailty, cognitive impairment, and polypharmacy, which go beyond the traditional protocols of medical care. All of these factors are closely related to each other, creating a complex picture that requires a completely different approach to the organization of cardiac care for elderly patients.

It should be noted that geriatric cardiology has not been officially designated as a field of medical science, although it is aimed specifically at developing the right management strategy for elderly patients suffering from cardiovascular diseases or at high risk of developing them. This branch of medicine is based on the principles of both classical cardiology and geriatrics, striving to provide a patient-based approach to each patient and improve the overall prognosis of the course of diseases.

This article is devoted to various aspects of aging, in particular, the significant increase in the average life expectancy of modern patients, the main pathophysiological changes occurring in the cardiovascular system over time, as well as the prospects for further development of geriatric cardiology as an independent discipline.

Highlights

• The article presents a retrospective analysis of 281 cases of sudden cardiac arrest that occurred outside intensive care units in the Krasnoyarsk Regional Clinical Hospital for 2022-2024. The main epidemiological characteristics of patients, profiles of departments with the largest number of episodes of sudden cardiac arrest, features of temporary distribution and outcomes of resuscitation measures have been established.

Background. Sudden cardiac arrest (SCA) currently remains one of the most serious problems of the healthcare system. Cardiac arrest in the hospital is a potentially preventable condition. In some patients, cardiac arrest develops outside the intensive care unit: in the specialized department, in the hall, corridor, dialysis room, etc. This category of patients deserves special attention.

Aim: to study the characteristics, frequency and outcomes of SCA in patients undergoing inpatient treatment outside the intensive care units, in a multidisciplinary hospital and to evaluate the effectiveness of resuscitation measures for the development of measures to improve medical care for SCA.

Methods. An analysis was conducted of 281 cases of sudden circulatory arrest outside the intensive care unit that occurred in 2022–2024 in the Krasnoyarsk Regional Clinical Hospital

Results. In 2022, 2023 and 2024, 412 cases of cardiac arrest that occurred outside the intensive care units were recorded in the Regional Clinical Hospital. This work includes an analysis of 281 cases of cardiac arrest that occurred in specialized departments (264; 16.75%), in the hemodialysis room (8; 1.94%), in the multispiral computed tomography room (4; 0.97%) and in the hospital corridor or lobby (5; 1.21%). Cases of sudden cardiac arrest associated with a critical condition upon admission (the first hours of hospitalization) and cardiac arrest during surgical interventions were excluded. A significant proportion of patients were over 66 years of age (this group accounted for 68.68% – 193 patients), (χ² = 78.47, ρ < 0.001). There were no statistically significant differences between the number of women (151; 53.74%) and men (130; 46.26%) among patients (χ² = 3.139 ρ = 0.077). Most patients – 257 (91.46%) were admitted for emergency indications. Most often, sudden cardiac arrests occurred in the pulmonology (70; 24.91%), cardiology (42; 14.95%), neurology (40; 14.23%) and nephrology (38; 13.52%) departments. Among the reasons for hospitalization of patients, the most common were cardiovascular diseases (94; 33.45%), new coronavirus infection (43; 15.30%) and chronic renal failure (35; 12.46%). Sudden cardiac arrests occurred during the daytime in 152 cases (54.1%), at night – in 129 cases (45.9%), (χ² = 3.765 ρ = 0.053). It was possible to restore spontaneous cardiac rhythm in 88 patients (31.32%). Ten of them (3.56%) were discharged from the hospital. In the remaining cases – 193 patients (68.68%) biological death was stated as a result of ineffective resuscitation measures. Cardiovascular diseases as the initial cause of death were registered in 102 patients (37.64%), as the immediate cause of death in 105 (38.74%). In one patient (0.37%) sudden cardiac death was established as the immediate cause of death (I46.1 according to ICD 10).

Conclusion. It was established that sudden cardiac arrest outside the intensive care units in the Krasnoyarsk Regional Clinical Hospital amounted to 2.99 cases per 1000 hospitalizations, with such cases most often recorded in the pulmonology, cardiology and neurology departments. The average age of patients was 66.4 years, without significant gender differences. The main heart rhythm recorded on the ECG was asystole – 257 cases (91.46%). Restoration of cardiac activity was achieved in 88 cases (31.32%), 10 patients (3.56%) were discharged from the hospital. In 78 patients (27.76%), death occurred as a result of repeated cardiac arrest.

Highlights

• In patients with rheumatoid arthritis, lipid profile indicators do not allow one to fully assess the severity of atherosclerosis. The systemic inflammatory response index, the systemic immune inflammation index, and the neutrophil-lymphocyte ratio are prognostically significant in assessing the likelihood of atherosclerotic plaque development in the carotid arteries in patients with rheumatoid arthritis.

Aim. To study the role of lipid metabolism disorders and systemic inflammation in the pathogenesis of carotid artery (CA) atherosclerosis in patients with rheumatoid arthritis (RA).

Methods. Thirty patients with RA underwent ultrasound duplex scanning of the CA (USDS CA). The criterion for the presence of an atherosclerotic plaque (AP) was local thickening of the CA by more than 50% compared to the surrounding areas. A complete blood count was assessed, including the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) values, and lipidogram parameters. Based on the general blood test data, indices reflecting the activity of systemic inflammation were calculated.

Results. According to the results of USDS CA the patients were divided into 2 groups: group 1 - with the presence of AP in the CA (n = 19) and group 2 without AP in the CA (n = 11). Patients with the presence of AP in the CA had lower triglyceride values ​​than those without AP (1,27 ± 0,48 vs. 1,73 ± 0,5 mmol/L, p = 0,02). The levels ​​of total serum cholesterol, low-density lipoproteins and high-density lipoproteins were not statistically distinguishable between the two groups. The Castelli risk indices 1 and 2, the atherogenic index of plasma as well as the atherogenicity coefficient and the combined lipoprotein index showed no significant differences between the study groups. The systemic inflammatory response index (SIRI), neutrophil-lymphocyte ratio (NLR), systemic immune inflammation index (SII), ESR and CRP values ​​were higher in patients with AP in CA. Smoking, a family history of cardiovascular diseases, concomitant hypertension, and systemic glucocorticosteroid treatment were not linked to the development of CA.

Conclusion. Lipid metabolism paremeters, as well as indices based on lipidogram data, were not associated with the risk of developing CA atherosclerosis in patients with RA. NLR, SII, SIRI, as well as ESR and CRP are prognostically significant in determining the risk of developing atherosclerotic CA lesions.

Highlights

• The study analyzed social factors, comorbidities, hospitalization characteristics, and laboratory and instrumental parameters in patients who died from sudden cardiac death (SCD) in a hospital setting. A multivariate Cox regression model was developed to predict the risk of death based on the identified SCD predictors.

Aim. To identify factors influencing the risk of SCD in hospitalized patients.

Methods. A retrospective analysis of 150 medical records was conducted at the Krasnoyarsk Regional Clinical Hospital from 2018 to 2023. Among them, 75 cases (50,0%) of in-hospital sudden cardiac death (SCD) were identified, including 42 men and 33 women aged 35 to 82 years. The remaining 75 patients (50,0%) with an equivalent age and sex distribution who underwent inpatient treatment at the same institution and were subsequently discharged formed the control group. Over 100 parameters were analyzed, including patient social characteristics, hospitalization characteristics, severity of condition, comorbidities, and changes in laboratory and instrumental parameters.

Results. According to the results of the univariate Cox regression analysis, the greatest contribution to the risk of sudden cardiac death (SCD) was associated with an increased time from disease onset to hospitalization, the presence of coronary heart disease (CHD), chronic heart failure, arterial hypertension, ECG-detected tachycardia, and disability status. In the multivariate Cox regression model, three independent predictors were significantly associated with an increased risk of SCD: longer time to hospitalization (HR = 1.48; 95% CI 1.23–1.78), presence of disability (HR = 1.83; 95% CI 1.09–3.07), and CHD (HR = 2.02; 95% CI 1.13–3.64). The constructed model demonstrated strong prognostic performance (C-index = 0.74; ROC-AUC = 0.91; Se = 0.84; Sp = 0.82), indicating its clinical utility for risk stratification of SCD in hospitalized patients.

Conclusion. Timely medical attention for patients with risk factors for SCD can reduce their mortality. Many SCD predictors can be identified through medical history collection and laboratory and instrumental diagnostics. A program has been developed for inpatient care that can calculate the risk of death based on the presence of SCD risk factors.

Highlights

• For the first time in Kuzbass, a study was conducted to identify asymptomatic cardiac arrhythmias in the working-age population at the enterprise «AZOT». The study allowed for early diagnosis of arrhythmias requiring interventional treatment, reduced risks of complications, and ensured the return to work and a full life for patients with asymptomatic heart rhythm disorders.

Aim. To conduct a comprehensive examination to identify the prevalence of asymptomatic heart rhythm disorders requiring interventional treatment for tachyarrhythmia among the working-age population of AZOT LLC.

Methods. As part of the regional project «Kuzbass without arrhythmia» а total of 1,324 AZOT employees were examined, including 745 men (56.3%) and 578 women (43.7%), with an average age of 54 years. The first stage of the study included lectures on cardiovascular diseases for employees, while the second stage involved an assessment of their medical history and laboratory and instrumental examinations.

Results. The lecture course contributed to a 2.5–fold increase in employee motivation to complete the second stage of the examination. Atrial fibrillation and ventricular extrasystole (VES) were detected in 0.6% of ECG recordings and 0.4%, respectively. During 24-hour ECG monitoring, atrial fibrillation was detected in 1.8% of patients, ventricular extrasystoles in 4.8%, and supraventricular extrasystoles in 3.7%. Heart rhythm disturbances occurred in one in ten patients, with no symptoms or clinical manifestations, representing a 9.1% incidence. All patients with atrial fibrillation had indications for surgical treatment. Follow-up observation is recommended for supraventricular and ventricular extrasystoles.

Conclusion. Increased staff awareness facilitated the detection of arrhythmias and timely treatment.

Highlights

• At the best of our knowledge, it is the first study confirmed the prognostic significance of the global assessment of thrombotic burden (MAPH) scale in patients with myocardial infarction with ST-segment elevation has been confirmed in domestic real clinical practice. The modification of the scale, MAPHm, is presented, which allows more accurate one assessment of the hospital mortality risk in patients with myocardial infarction with ST-segment elevation.

Aim. To evaluate the prognostic value of the new score for determining thrombus burden (MAPH) in patients with ST-segment elevation myocardial infarction (STEMI).

Methods. The study included STEMI patients (n = 171) admitted to PCI centre. All patients were assessed for the MAPH score, an estimation of the thrombotic burden based on age, hematocrit, mean platelet volume (MPV), and total protein concentration. In the modified score (MAPHm), we replaced total protein with fibrinogen concentration. In-hospital mortality was used as the end point.

Results. Surviving patients included in the study were younger: 63 (54; 70) years vs. 70 (66; 85) years, p = 0.001, and were characterized by higher MPV (p = 0.003). Screening hematological parameters, lipid profile characteristics, prevalence of cardiac risk factors, arterial hypertension, and diabetes mellitus were comparable. Most often, the MAPH index was equal to 1 point in surviving patients (51 (33.8) %) and 2 points in deceased patients (10 (50%)). At the same time, MAPH equal to 0 did not occur among patients who reached the endpoint. 2 or more points on the MAPH scale were associated with an increased risk of death: OR 2.7 (CI 1.1; 7.2), p = 0.031. For the modified MAPHm, the OR was 6.9 (CI 2.5; 19.2), p = 0.000.

Conclusion. The new MAPH score and its modified version MAPHm can be used for risk stratification of patients with STEMI.

Highlights

• Oral administration of proteinogenic branched-chain amino acids (leucine, isoleucine, and valine) and magnesium citrate to hyperlipidemic mice did not affect the concentration of calciprotein particles in the serum.
• The addition of magnesium citrate to calcium- and phosphate-supersaturated serum obtained from patients with ST-segment elevation myocardial infarction resulted in a statistically significant decrease in calciprotein particle concentration.
• These findings suggest the potential utility of magnesium citrate for reducing the circulation of calciprotein particles in the blood as soon as they aggregate excessive calcium and phosphate.

Aim. To evaluate the effects of proteinogenic branched-chain amino acids (leucine, isoleucine, and valine; BCAA) and magnesium citrate on the concentration of calciprotein particles (CPPs) in the blood of hyperlipidemic (ApoE-knockout) mice, as well as in the serum of patients with ST-segment elevation myocardial infarction (STEMI) following ex vivo addition of magnesium citrate.

Methods. The study included 270 ApoE-knockout mice (135 male and 135 female mice) that received BCAA (55 mg/day, equivalent to a human equivalent dose of 13.5 g/day) or magnesium citrate (1.85 mg/day, equivalent to a human equivalent dose of 450 mg/day), starting from the age of 1, 3, or 6 months (90 mice per group; 45 male and 45 female mice in each). At 12 months of age, all animals were euthanized, and serum CPP concentrations were quantified using flow cytometry with a fluorescently labeled bisphosphonate probe. Additionally, serum samples from 27 patients with STEMI were analyzed ex vivo by inducing mineral stress through the addition of CaCl₂ and Na₂HPO₄·12H₂O, followed by magnesium citrate supplementation to assess its capacity to attenuate CPP formation.

Results. Oral administration of BCAA or magnesium citrate in ApoE-knockout mice did not affect serum CPP concentrations. In contrast, the addition of magnesium citrate to calcium- and phosphate-supersaturated serum from STEMI patients led to a reduction in CPP concentration in 74% of cases (20/27), with an over 81% (22/27) rate of reduction compared to the respective non-supersaturated serum.

Conclusion. The obtained data suggest a potential therapeutic effect of magnesium citrate, which may exert chelating properties and promote the dissolution of circulating CPPs in the blood.

Highlights

• The article contains current literature data on risk factors, diagnosis and treatment of myocardial perforation by endocardial lead during implantation of pacemakers and cardioverter-defibrillators.

Absract

The increasing number of implantations of antiarrhythmic electronic implantable devices to an increase in the absolute number of complications. Cardiac perforation is a rare complication of pacemaker and cardioverter-defibrillator implantation, which can lead to death. Currently, there is no unequivocal opinion on the management tactics for patients with endocardial lead perforation. In this review, we summarize the current information on the main methods of diagnosis and treatment of myocardial perforation. Also, special attention is paid to the main factors contributing to the occurrence of this complication.