Vol 11, No 6 (2025)

Despite the fact that various tools for screening and diagnostics of nutritional deficiency have been proposed previously, “gold” standard in this sphere has not been determined. Therefore, correct and convenient assessment of nutritional status in fragile patients with chronic heart failure (CHF) is of particular importance.

The aim: to estimate nutritional status using CONUT scale and the impact of malnutrition on the prognosis in patients over 75 years old having CHF.

Material and methods.158 patients with CHF over 75 years old – 96 (60.8%) female and 62 (39.8%) male patients (Me [IQR], age – 83.0 [77.8–87.0] years) were prospectively included in the study. All participants had their nutritional status determined using the CONUT scale and body composition using bioimpedance analysis. Composite endpoint included death from all causes and rehospitalizations for CHF within 1 year after discharge from the hospital, secondary endpoint included in-hospital mortality.

Results. Normal nutritional status index (0–1 point on CONUT scale) was fixed only in 17.1% (n = 27) of the study participants. Nutritional deficiency was noted in 82.9% (n=131) of patients, from them light degree of malnutrition (2–4 points) was detected in 55.0% (n=72), moderate (5–8 points) – in 38.2% (n=50), severe (≥ 9 points) – in 6.8% (n=9) of those examined individuals. Patients with severe nutritional deficiency were characterized by marked symptoms of CHF, high degree of physical inactivity, and tendency to active cellular and skeletal muscle mass deficiency. With a score of ≥2 on the CONUT scale, the odds of in-hospital mortality increased five-fold (odds ratio 5.3; 95% confidence interval: 1.6–40.7; p <0.05), and death or rehospitalization for CHF within 1 year after discharge from the hospital – four-fold (odds ratio 3.8; 95% confidence interval: 1.2–11.6; p <0.05).

Conclusion. Assessment of nutritional deficiency regardless of its severity (≥ 2 points on CONUT scale) in patients ≥75 years old with CHF allows us to identify a high-risk group for adverse outcomes.

The purpose of phenotyping patients with chronic heart failure (CHF) is risk stratification, as well as optimization of treatment of this syndrome, associated with an extremely negative prognosis. Currently, it is relevant the classification of CHF by the ejection fraction (EF) parameter, according to which CHF is distinguished to be with reduced (CHFrEF, ≤ 40%), moderately reduced (CHFmrEF, 41–49%) and preserved EF (CHFpEF, ≥ 50%).

The aim: to identify pathogenetic determinants of CHF phenotypes of ischemic etiology in the conditions of a one-stage cross-sectional study.

Material and methods. The study included 235 patients with CHF of ischemic etiology, functional class II–IV. From them, a combined group (n = 171) with reduced EF regardless of the degree of this reduction (CHFrEF, CHFmrEF) and with CHFpEF (n = 64) was identified. Clinical profile of patients and the levels of laboratory markers in circulating blood were studied, including using the method of enhanced Raman spectroscopy.

Results. Patients with CHFpEF were significantly older: 74.00 ± 8.08 and 69.40 ± 8.94 years, respectively (p = 0.001), with a predominance of females among them (53%). Although the prevalence of arterial hypertension was the same in both groups, the average blood pressure figures were higher in the CHFpEF group. Myocardial infarction was significantly more common in the CHFrEF group – 77.7 versus 43.7% in the CHFpEF group (p = 0.001). With a comparable structure of the severity of CHF syndrome, a lower level of NT-proBNP was observed in the CHFpEF group. Parameters characterizing myocardial damage (troponin I), endothelial dysfunction (P-selectin), and concentration of soluble receptors to advanced glycation end products (S-RAGE) were comparable in the study groups. Serum enhanced Raman spectroscopy (SERS) did not demonstrate its discriminatory ability in identifying patients with different left ventricular EF.

Conclusion. The most significant factor determining CHF phenotype in patients with coronary heart disease is a history of myocardial infarction, which is typical for patients with CHFrEF. Also, in this group, it is worth to note greater inflammatory activity in accordance with the level of leukocytes and alanine aminotransferase. Predominance of females, old age, and elevated blood pressure figures were more typical for patients with CHFpEF.

It is generally accepted that the number of patients with gout and chronic hyperuricemic tubulointerstitial nephritis (CHTIN) is steadily increasing; these conditions are often developing sequentially with underlying persistent hyperuricemia. Nonsteroidal anti-inflammatory drugs (NSAIDs) are an indispensable class of drugs for gout, but they have a negative effect at renal function, which, in particular, does not exclude the risk of developing renal magnesium transportation disorders and magnesium-deficient conditions.

The aim: to determine the effect of selective NSAIDs (nimesulide, celecoxib, etoricorxib) at renal magnesium transportation in patients with CHTIN.

Materials and methods. The study included 132 patients having HCTIN with serum uric acid level > 360 mmol/l, glomerular filtration rate (GFR) ≥ 60 ml/min./1.73 m2 and chronic gouty arthritis of tophaceous form, who were under dispensary observation by nephrologists and rheumatologists and required NSAIDs due to joint pain syndrome. Using adaptive randomization method, the participants were divided into 3 groups comparable by age, gender, body mass index, nature of joint damage and renal function. Group 1 (n = 48) received nimesulide (course dose 6000 mg/month), group 2 (n = 44) – celecoxib (6000 mg/month), group 3 (n = 40) – etoricoxib (2700 mg/month). Renal magnesium transportation was assessed basing on the estimation of magnesium concentration in blood serum and daily urine with calculation of its clearance and compared with estimated GFR (according to СКD-EPI formula) before the prescription of NSAIDs and on the 30th day of their administration. Routine clinical, laboratory, and ultrasound examination of kidneys allowed us to exclude other somatic pathology.

Results. A 30-day course of treatment with selective cyclooxygenase 2 inhibitors (nimesulide, celecoxib, and etoricoxib) for the treatment of gouty arthritis in HCTIN patients with GFR above 60 ml/min/1.73 m2 significantly reduced estimated GFR, increased urinary magnesium excretion, its renal clearance, and moderately reduced serum magnesium levels. No significant differences were found between studied NSAIDs in their effects on changes in serum magnesium concentration, renal transportation, and eGFR (p >0.05).

Conclusion. The development of magnesium deficiency in the blood, even with short-term administration of NSAIDs, requires compensation for hypomagnesemia and appropriate monitoring.

Long-term post-COVID syndrome (LPS) has a wide prevalence (from 30 to 80%) and is represented by more than 200 symptoms. At the same time, the structure of risk factors and pathogenetic mechanisms of LPS have not been sufficiently studied. The study of these aspects is a promising direction in therapy, which can help in preventing the occurrence of long-term LPS and ensuring its effective treatment.

The aim: to determine the phenotypes (clusters) of LPS and some pathophysiological mechanisms of their development basing on cluster analysis.

Material and methods. Clinical cross-sectional screening study included 802 patients with LPS symptoms who consecutively visited outpatient clinic from April 2020 to April 2024. LPS was established in the presence of typical signs and symptoms (including in combination with symptoms of comorbid conditions) that developed during or after COVID-19 and lasted more than 12 weeks.

Results. The average duration of the period after COVID-19 in the study participants was 8.5 [3.4; 14.1] months. 802 patients were clustered into 6 LPS phenotypes: 1) polysymptomatic with chronic comorbid pathology; 2) chronic respiratory; 3) cardiovascular; 4) thromboembolic; 5) acute respiratory; 6) acute ischemic.

Conclusion. Performing cluster analysis allowed us to identify the following differences in the frequency of development of LPS phenotypes in 802 outpatients who visited the clinic during 4 years of observation: polysymptomatic with chronic comorbid pathology – 66.6%, chronic respiratory – 14.5%, cardiovascular – 5.2%, thromboembolic – 2%, acute respiratory – 8.0%, acute ischemic – 3.7%. For each LPS phenotype, specific predictors of its formation were determined. It has been proven that the pathogenetic mechanisms of LPS development differ depending on the cluster.

Acute cardiorenal syndrome is a common complication of acute decompensation of chronic heart failure (ADCHF), which is associated with a high risk of acute renal injury (ARI), which worsens the prognosis and complicates therapy. The possibility of early detection of ARI and optimization of treatment using a comprehensive assessment of venous and renal congestion according to VExUS protocol and natriuresis is still remaining to be poorly understood.

The aim: to evaluate the clinical and prognostic role of total venous and renal congestion using the VExUS protocol in the development of AKI in patients with ADCHF, as well as their impact on diuretic-associated natriuresis.

Material and methods. The study included 155 patients with ADCHF (mean age 72 ± 12 years) hospitalized in the intensive care unit. The participants underwent Doppler ultrasonography estimation of venous congestion using VExUS protocol, and analysis of natriuresis in 2 hours after the first dose of furosemide.

Results. Venous congestion was found in all patients, from them severe grade 3 congestion – in 54.8%. ARI was diagnosed in 57% of participants, more often it was found in case of severe venous congestion (77.8 vs. 33.3 and 36.4% with mild and moderate congestion, respectively; p < 0.001). Monophasic renal blood flow was associated with the risk of ARI development (relative risk 3.61; 95% confidence interval: 1.82–7.14; p < 0.001). Urine sodium concentration < 70 mmol/L 2 h after furosemide administration was more often observed with severe venous congestion and monophasic renal blood flow. Patients with severe general and renal congestion had lower diuresis and the need for higher doses of furosemide.

Conclusion. In patients with ADCHF, severe venous congestion and significant renal blood flow impairment according to VExUS data are associated with an increased risk of ARI and reduced natriuretic response to the first dose of furosemide. A comprehensive assessment of these parameters can be used for early risk stratification and optimization of diuretic therapy.

Chronic heart failure with supranormal ejection fraction (CHFsnEF) occurs in 2.5–25% of patients, mainly in females, with non-ischemic genesis of this syndrome, with concomitant diseases such as arterial hypertension, diabetes mellitus, atrial fibrillation, and low levels of N-terminal pro-brain natriuretic peptide. Patients with CHFsnEF are characterized by high mortality and poor prognosis. High mortality in this cohort of patients has become the reason for a detailed study of the clinical profile of CHFsnEF individuals.

The aim of the review is to discuss the existing terminology and the cutoff value of the left ventricular ejection fraction, above which a patient could be considered as having CHFsnEF, peculiarities of pathophysiology, occurrence of this phenotype in the population of individuals with heart failure and preserved left ventricular ejection fraction, the connection of genetic predisposition and development of CHFsnEF. Current article presents information on the clinical picture, features of the clinical course against the background of multimorbidity and current principles of CHF snEF verification. Possible influence of pharmacotherapy at the prognosis of patients with CHFsnEF is discussed.

Thrombotic complications are remaining to be the leading cause of cardiovascular mortality in Russia and throughout the world. Acetylsalicylic acid (ASA) is a key component of antithrombotic therapy, but its use is limited by the risk of gastrointestinal complications. The combination of ASA with magnesium hydroxide makes it possible to minimize side effects while maintaining high efficiency.

The aim of the presented literature review is to analyze current data on the use of ASA in combination with magnesium hydroxide for thrombotic complications prevention in patients having cardiovascular diseases. Article discusses the classification of antithrombotic drugs, role and place of ASA in the prevention of recurrent myocardial infarction, ischemic stroke, unstable angina pectoris and thrombotic complications after vascular interventions in accordance with current clinical guidelines, as well as peculiarities of the action and advantages of ASA combination with magnesium hydroxide.

Hypokalemia has a wide range of possible causes and is associated with the risk of serious complications. The article presents a rare clinical case of observation of a patient with persistent hypokalemia and uncontrolled arterial hypertension, which developed due to pseudohyperaldosteronism syndrome associated of taking therapeutic doses of glycyrrhizic acid. The presented clinical case illustrates the importance of careful collection of anamnesis, including drug history, in all patients, as well as increased vigilance regarding secondary causes of the development of arterial hypertension and adverse events associated with taking a wide range of different drugs (including those containing glycyrrhizic acid), especially in the elderly and / or patients with liver disease.

Millions of patients with cardiovascular diseases receive acetylsalicylic acid (ASA), but some of them have acute events despite the drug therapy. One of the backgrounds for the development of cardiovascular events in groups of increased cardiovascular risk may be the lack of response to standard low doses of ASA. In recent years, possible causes and risk factors for this phenomenon have been actively discussed, including its connection with the presence of an enteric coating in ASA drugs, as well as possible ways to overcome it by identifying the most vulnerable groups of patients for whom it is preferable to prescribe certain forms of ASA or individual dose selection. The article discusses new clinical studies devoted to this problem and the corresponding changes in the recommendation documents.

The article presents a review of modern approaches to the diagnosis of metabolic-associated fatty liver disease with an emphasis on the difficulties of diagnosis verification in patients with normal body mass index. New diagnostic criteria proposed in 2024 clinical guidelines, as well as the possibilities of using transient elastography with a controlled attenuation parameter as a promising method of non-invasive diagnostics are considered. Particular attention is paid to the phenotype of non-obese metabolic-associated fatty liver disease, its prevalence and pathophysiological peculiarities. The practical significance of the review lies in generalization of modern data that contribute to the timely detection of the disease in outpatient practice.

Arterial hypertension is a leading modifiable risk factor of cardiovascular diseases. To increase life expectancy in patients with arterial hypertension, adequate blood pressure (BP) control is necessary to reduce the risk of cardiovascular complications. As an initial therapy, most patients are recommended to use a combination of antihypertensive drugs, preferably it should be a fixed combination, to improve adherence to therapy. The most frequently prescribed combination antihypertensive therapy is a combination of long-acting dihydropyridine calcium antagonists and angiotensin II receptor blockers. New combination of azilsartan medoxomil and amlodipine is characterized by a synergistic mechanism of antihypertensive action, complementary pharmacokinetics, it can provide 24-hour blood pressure control and reduce its daily variability, and also helps achieve target blood pressure with the highest probability in comparison with combinations of other sartans with amlodipine.