Vol 10, No 4 (2024)

Several trials have been conducted in the last 2 decades that challenged the management of patients with acute heart failure (AHF) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) endorsed the evidence from these trials. The aim of this document was to adapt recommendations from existing CPGs to assist physicians in decision making concerning specific and complex scenarios related to AHF.

Methods. The flow for the adaptation procedure was first the identification of unsolved clinical issues in patients with AHF following the PICO (population, intervention, comparison and outcomes) process, then critically appraise the existing CPGs and choose the recommendations, which are most applicable to these specific and complex scenarios.

Results. Seven PICOs were identified and CPGs appraisal was performed. There is no single test able to assist physicians in discriminating patients presenting with acute dyspnea, congestion or hypoxemia. Measurement of natriuretic peptide (NP) and/or cardiac troponin levels on hospital admission is recommended to establish a prognosis in acutely decompensated heart failure, and some other tests may be considered for additive risk stratification. To quantify the degree of congestion in patients with AHF the use of echocardiography and NP is recommended, and chest X-ray and lung ultrasound may be considered. The strategies to manage arterial hypotension and low cardiac output that lead to a more effective resolution of symptoms and a reduction in mortality include short-term, continuous intravenous inotropic support, vasopressor (preferably norepinephrine), renal replacement therapy and temporary mechanical circulatory support. The most updated recommendations on how to treat specifically the patients with AHF and certain comorbidities (diabetes mellitus, COPD, anaemia, kidney dysfunction, and cardiac arrhythmias) are covered. Patients with AHF should generally be discharged from hospital only when their clinical condition is stable, the signs and symptoms of congestion are resolved and the management plan is optimised. The most effective strategies to reduce the readmissions and mortality after discharge are provided. Overall, 51 recommendations were endorsed and the rationale for the selection is reported in the main text.

Conclusion. By the use of proper methodology for the adaptation process, this document offers a simple and updated guide for practising clinicians dealing with AHF patients.

Abstract. While aging, the number of chronic pathologies in patients increases, and cardiovascular comorbidity also is growing. For patients in the older age group, improving life quality (QL) and prognosis from the perspective of a patient-centered approach is especially actual.

The aim: to assess the quality of life of comorbid patients of an older age group with obstructive sleep apnea syndrome (OSA) using a patient-centered approach.

Material and methods. The sample included 102 patients (58 male and 44 female) of elderly and senile age with cardiovascular pathology. The average age of individuals was 66.7 ± 6.1 years. SF-36, EQ-5D-5L questionnaires (Russian, 2009 EuroQol Group), vertical visual analogue scale (VAS), hospital anxiety and depression scale (HADS), mini-mental state examination scale (MMSE) were used in the study. All patients underwent a standard general clinical examination and comorbidity assessment using modified Charlson comorbidity index (CI), including one adjusted for age. For OSA assessment, Berlin questionnaire, Epworth sleepiness scale, and cardiorespiratory monitoring were used. Observation of patients lasted 12 months, prognosis and quality of life were estimated.

Results. Estimation of life quality in older age group of patients with high comorbidity showed a decrease in life quality index comparatively to the initial one – 0.43 (0.26; 0.65) versus 0.50 (0.47; 0.84), p = 0.04. A decrease in this parameter was also observed in patients with OSA – 0.41 (0.24; 0.68) versus the initial value of 0.54 (0.44; 0.80), p = 0.035. The study group of patients is characterized by a low frequency of seeking medical help (only 10.8% of persons with a newly diagnosed OSA were consulted by somnologist).

Conclusion. For patients of the older age group having OSA with high comorbidity, it is important to use a patient-centered approach in order to improve prognosis and quality of life.

Patients with chronic heart failure (CHF) have a large number of comorbid conditions that can aggravate the course of the disease. Gender peculiarities also play an important role, but the mechanisms of CHF development in male and female individualв in comparison have not been fully studied. Molecular genetic research is a modern direction in studying the risk of CHF development and progression, but a literature review shows their ambiguous results, which indicates the importance of further research in this area.

The aim: to evaluate clinical, functional and molecular genetic characteristics of patients with CHF.

Material and methods. The study included 157 patients (average age 68.9 ± 9.5 years) with diagnosed CHF, who underwent laboratory, instrumental and molecular genetic studies (polymorphisms rs632793 of NPPB gene and rs5065 of NPPA gene). The participants were divided into two groups: the 1st group included male pesons (n = 79), the 2nd group included female persons (n = 78). Next, among the study persons (n = 157), a subgroup of patients with the results of molecular genetic study was identified in the quantity of 68 persons (36 males and 32 females).

Results and conclusion. Among all studied patients (n = 157), stage IIa CHF (52.3%, n = 82), III functional class of the disease (63%, n = 99), CHF with preserved ejection fraction (52.8%, n = 83) were most common. When assessing comorbid pathologies, the leading position was occupied by hypertension (96.8%, n = 152). In the group of male patients, persons of working age were more common (p < 0.001). When analyzing comorbid conditions, a significantly higher frequency of permanent atrial fibrillation (AF) was revealed in the group of men (p = 0.04). According to the results of laboratory and instrumental examination methods, no significant differences were identified. A correlation was found between the rs632793 polymorphism of NPPB gene and AF in CHF in female patients (odds ratio 6.600; 95% confidence interval: 1.229–35.439; p = 0.02). Obtained data could be used for personalized assessment of the risk of AF developing in case of CHF.

Atrial fibrillation (AF) is one of the common complications after coronary artery bypass grafting (CABG) operation, with a prevalence of 20 to 30%. Rare studies have confirmed the correlation of the low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio with the incidence of postoperative AF.

The aim: to analyze the correlation between preoperative LDL/HDL ratio and new-onset AF after CABG.

Material and methods. Patients operated in the cardiac surgery department of Research Institute – Regional Clinical Hospital No. 1 named after professor S.V. Ochapovsky from July 1, 2022 to January 1, 2023 were included in the study. CABG was performed in 552 patients, 60 of whom were diagnosed with AF in the early postoperative period (group A). Sinus rhythm was recorded in 424 patients, 64 of whom were included in the comparison group (B) using a random number generator.

Results. In 60 patients (10.9%) AF developed in the early postoperative period. Univariate logistic regression analysis showed that preoperative LDL/HDL ratio was not directly associated with postoperative arrhythmia. When performing ROC analysis, the area under AUC curve for this index was 0.469 (95% confidence interval: 0.364–0.574; p = 0.054), which indicates that there is no significant correlation between examined parameter and the probability of developing atrial fibrillation after CABG.

Conclusion. Correlation between the preoperative LDL/HDL ratio and the incidence of postoperative AF was not established.

The worldwide prevalence of asymptomatic hyperuricemia (ASH) throughout the world is high and has a tendency to increase over the past few decades. Growth in serum uric acid (UA) levels can cause “silent” tissue damage and increase the risk of a number of diseases, such as arterial hypertension, obesity, metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, etc.

The aim: to study the correlation between asymptomatic increases in UA level and the level of biochemical markers of metabolic syndrome in the blood serum of apparently healthy young male individuals.

Material and methods. A cohort study of 575 deidentified young male patients (18–44 years old according to World health organization criteria) without comorbidities was performed. All participants were assessed for UA levels, serum creatinine, glomerular filtration rate (GFR), triglyceride concentrations, total cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL), glucose, glycated hemoglobin (HbA1c), insulin, and also for height, weight, body mass index (BMI).

Results. ASH was identified in 243 male individuals (41% of participants). A weak positive correlation was established between the levels of uric acid and creatinine in the blood serum, positive correlation of the level of uric acid with the amount of triglycerides, total cholesterol, LDL, insulin, and BMI. No correlation was found between the level of UA in the blood serum and the level of glucose, GFR, HDL, and HbA1c.

Conclusion. Due to the high prevalence of ASH among young population, regular screening of serum UA levels is necessary. The results of the study indicate the need to study the cause-and-effect relationships of ASH development with obesity, disorders of lipid and carbohydrate metabolism, kidney function disorders in order to prevent the development and progression of chronic diseases.

Diabetic foot syndrome (DFS) is one of the most dangerous complications of diabetes mellitus (DM). According to the State register, in Russia the frequency of limb amputations in patients with type 2 diabetes mellitus (DM 2) is 10.9 cases per 10 thousand adult patients. Averting of ulcers formation can prevent up to 85% of lower limb amputations.

The aim: to evaluate the efficacy of extracorporeal shock wave therapy (SWT) for DFS treatment in patients with DM 2.

Material and methods. Pilot study included 17 patients with DM2 and DFS without a peptic ulcer. The average age of the participants was 64.9 ± 9.0 years, duration of DM 2 existence was 12.6 [10.0; 15.0] years. All patients underwent clinical examination, laboratory and instrumental examination: electrocardiography, volumetric sphygmography with analysis of the ankle-brachial (ABI) and finger-brachial (FBI) indexes, and assessment of sensory peripheral sensitivity. Neuropathy screening diagnostic scales and SF-36 quality of life questionnaire were used. SWT treatment sessions were performed using CARDIOSPEC system (Medispec, Israel).

Results. Initially, the average ABI value was within the normative values (right – 1.01 ± 0.14, left – 1.05 ± 0.07). Patients with type 2 diabetes, DFS and a decrease in FBI of less than 0.65 received a 3-week course of shock wave therapy. A significant increase in FBI on the side exposed to SWT was fixed after 3 weeks, maintaining a statistically significant difference comparatively to baseline values after 6, 9 and 12 weeks. On the opposite foot, which was the control, the average PPI value at all stages of observation did not change significantly. All patients showed recovery of vibration and tactile sensitivity after a course of shock wave therapy. A significant improvement of life quality in all components of physical health of SF-36 questionnaire also took place.

Conclusion. Use of a 3-week course of shock wave therapy in patients with type DM 2 and diabetic foot syndrome without an ulcer defect contributed to the improvement of perfusion of the lower limb on the affected side, which was accompanied by a significant increase in FBI, improvement in sensory peripheral sensitivity and life quality of patients.

Takotsubo syndrome (TS) is characterized by transient local systolic dysfunction, predominantly involving the apex and/or middle segment of the left heart ventricle, in the absence of thrombotic occlusion of the coronary arteries according to coronary angiography data. Clinically, TS resembles acute coronary syndrome and has similar electrocardiographic signs. Current review outlines modern ideas about the epidemiology, predisposing factors, triggers, diagnostic criteria and prognosis for TS, and also highlights the main approaches to the treatment of this disease. Taking into account the range of remaining questions, further research is needed to examine prognosis and develop clinical recommendations for the treatment and prevention of TS.

Article presents a clinical case of successful orthotopic cardiac transplantation with further acute humoral graft rejection. Prevalence of chronic heart failure requiring radical treatment, number of operations related to organ transplantation in Russia, as well as the successful rehabilitation of patients after such kind of surgical interventions are discussed.

A clinical case of a rare pathology in a 21-year-old patient – recurrent cardiac myxoma in combination with pigmented nodular adrenal hyperplasia, blue nevi, testicular tumor from Sertoli cells, nodular goiter, which corresponds to the diagnosis of “Carney complex”, first described by Carney J.A. et al. in 1985 is described in the article. Carney complex is a multidisciplinary problem that requires awareness of therapists, who may meet signs of the disease in its early stages and must, in this case, promptly refer the patient to a specialized endocrinological center for molecular genetic research and treatment.

Article covers in details the peculiarities of clinical picture (sequence of development and severity of symptoms), possible concomitant complications of chronic prostatitis (CP), diagnostic methods used in modern clinical practice and key directions of medicamentous treatment for this disease. Special attention is paid to the use of antioxidants and microelements in the complex therapy of CP.

Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) have a number of risk factors which are common to those of central nervous system lesions, and also act as an independent cause of the development of cerebrovascular, neurodegenerative, cognitive and mental disorders. The development of drugs applicable not only for the treatment of NAFLD itself, but also for the correction of its psychoneurological complications is an urgent task of modern experimental biomedicine and pharmacology. A promising group of compounds that have shown high therapeutic potential in patients with NAFLD, as well as having a wide range of pleiotropic effects, are sodium-glucose cotransporter inhibitors (gliflozins). Current review represents data concerning the mechanisms of gliflozins’ neuroprotective efficacy, which are of greatest interest in light of the possibility of correcting the neurological complications of NAFLD.

Digestive system is currently considered to be a kind of communication center responsible for the health and well-being of the entire body. In this regard, prevention and timely treatment of functional disorders of gastrointestinal tract functioning play an important role in life quality and general health of a person. For these purposes, curative mineral waters are used as one of the available methods. Foreign and domestic studies reveal high efficacy and safety of their use in various diseases of the digestive system, including functional constipation. Among magnesium sulfate-enriched mineral waters, natural mineral water Donat has the most significant effect. Minimum number of contraindications, good tolerability and lack of addiction allow us to recommend it both for the relief of functional constipation and also for preventive purposes to maintain optimal functioning of the digestive system.