Cardiovascular Therapy and Prevention
ISSN / EISSN : 1728-8800 / 2619-0125
Published by: Silicea - Poligraf, LLC (10.15829)
Total articles ≅ 1,044
Latest articles in this journal
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2677
There is currently no approved list of vascular cognitive impairment biomarkers. The main problem for the practitioner in identifying cognitive impairment in patients is the differential diagnosis of Alzheimer's disease, vascular cognitive impairment, and other diseases, which are much less common. Vascular cognitive impairment includes post-stroke dementia, cognitive dysfunction in cardio-and cerebrovascular diseases. Without etiology identification, it is impossible to prescribe adequate treatment. Another challenge is identifying cognitive impairment before dementia develops. This literature review is devoted to the search and critical analysis of candidates for biomarkers of vascular cognitive impairment and the establishment of markers of moderate cognitive dysfunction. The papers were searched for in the Web of Science and PubMed databases. A list of cerebrospinal fluid, plasma, serum and genetic biomarkers was made, allowing for differential diagnosis between vascular impairment and Alzheimer's disease. The markers of moderate cognitive dysfunction, which make it possible to identify cognitive impairment at the pre-dementia stage, were also identified.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2714
Aim. To study the efficacy and safety of direct oral anticoagulant (DOAC) therapy after implantation of cardiac resynchronization therapy (CRT) devices in atrial fibrillation (AF) patients with coronary artery disease (CAD) and dilated cardiomyopathy (DCM). Material and methods. The study included 93 patients followed up from 2014 to 2016 (71 men and 22 women) aged 33-85 years (59,7±10,6) with stable CAD (group 1, n=44) and DCM (group 2, n=49). All patients were diagnosed with AF. The left ventricular ejection fraction (LVEF) was 30,6±3,8%; the left ventricular end-diastolic dimension was 230,9±60,8 mm. All patients received anticoagulants for the prevention of thromboembolic events: a vitamin K antagonist (warfarin) or DOAC. The analysis of medical records, as well as ECG records, echocardiographic, 24-hour ECG monitoring data and information from implanted device was carried out. The follow-up period lasted 24 months. Results. After 24-month follow-up, positive dynamics was noted in all patients — LVEF increased from 30,6±3,7% to 39,5±5,8%). In patients with DCM, a more pronounced increase in myocardial contractile function was noted. Stroke within time interval from 12 to 24 months developed in two patients taking warfarin, from different groups. Transient ischemic attacks were observed in 6 patients: in one patient from group 1 during the period from inclusion and 12-month visit, and in 5 patients from 12 to 24 months. Out of 5 patients, two belonged to group 1 and three — to group 2, while one patient took aspirin and the other 4 — warfarin. One patient from group 1 with persistent AF and vitamin K antagonist therapy had left atrial appendage thrombosis. Hemorrhagic strokes and major bleeding have not been reported. Conclusion. Among patients taking DOAC, regardless of the underlying disease (CAD or DCM) and response to CRT, bleeding events were less often recorded, and there were no thromboembolic events.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2539
Comorbidity is one of the most significant problems of modern healthcare. Numerous studies have analyzed the possible pathogenetic mechanisms and relationships between a wide variety of diseases. Cardiovascular (CVD) and pulmonary diseases, in particular chronic obstructive pulmonary disease (COPD), have a number of the same risk factors and pathogenetic links, which aggravate each other's course. Moreover, CVD and COPD are among the most common diseases in the world. This review provides up-to-date information on the prevalence, risk factors and pathophysiological mechanisms underlying this unfavorable combination of diseases. Some problems of diagnosis and treatment of patients with COPD and CVD are also discussed.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2791
The coronavirus disease 2019 (COVID-19) pandemic requires not only the creation of vaccines to prevent the spread of the disease, but also the development of novel drugs aimed at reducing viral load, suppressing an excessive immune response and preventing the severe complications such as lung fibrosis and acute respiratory distress syndrome. One of the promising targets for studying the development of pneumonia, systemic inflammation and disseminated intravascular coagulation in COVID-19 is the plasminogen activator system. In patients with a severe disease course, impaired activity or expression of plasminogen activators significantly increases the blood level of D-dimer and fibrinogen, as well as correlates with intravascular coagulation and thrombus formation. The second promising target for studying the pathogenesis of COVID-19 is the adiponectin/T-cadherin system: adiponectin is able to reduce the content of pro-inflammatory cytokines, the increase of which is characteristic of COVID-19, and stimulate the production of an anti-inflammatory cytokine interleukin-10. The review describes the role of plasminogen and T-cadherin activators in their possible participation in the development of pulmonary fibrosis in COVID-19 and hemostasis regulation, as well as cardio- and vasculoprotective function of adiponectin and its receptor, T-cadherin.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2847
В данном документе обсуждаются особенности АТТ у лиц пожилого и старческого возраста в различных клинических ситуациях.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2838
The first review on the effectiveness of remote monitoring in cardiovascular patients was published in 2007, which is still relevant, reaching the peak during the Coronavirus disease 2019 (COVID-19) pandemic. Reduced availability of elective outpatient care, and sometimes reluctance of patients to visit the office due to the pandemic, required changes in ambulatory follow-up. In order to increase the availability of healthcare and reduce the mortality of Perm Krai population from cardiovascular diseases during the COVID-19 pandemic, a project for remote monitoring of high-cardiovascular-risk patients was developed and implemented. The developed remote monitoring project represents regular phone contacts with a patient included in the remote monitoring program, according to which the need for further face-to-face consultation, additional diagnostic tests and treatment strategy is determined. The working group of the project identified indications for including patients in remote monitoring, algorithms for phone contacts and management options depending on the responses received from patients. The project was launched in July 2020. Initially, it included five medical institutions, which selected 3901 patients. The results will be published as the project moves forward.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2725
The prevalence of endovascular interventions for coronary chronic total occlusion (CTO) remains small worldwide. This is due to the complexity of procedure and the risk of intraoperative complications. In this regard, the search for predictors of unsuccessful endovascular intervention in CTO plays a special role. This will allow for a careful selection of patients with the most favorable expectation effect of the operation. Aim. To identify predictors of unsuccessful endovascular recanalization of CTO. Material and methods. This retrospective study included 180 patients with chronic coronary artery disease (CAD) in the period from November 2017 to June 2019, who had multivessel lesion in combination with CTO. In all patients, an attempt was made to achieve complete myocardial revascularization. Depending on the success of procedure, the patients were divided into two groups: complete and incomplete myocardial revascularization. The follow-up period was 12 months. Results. All baseline characteristics of patients in the compared groups were similar. The successful recanalization rate of occlusion was 79,5%. Multivariate regression analysis showed that calcified CTO (p32 (p=0,006), CTO length >30 mm (p=0,046) and CTO of circumflex artery (p<0,01) are significant predictors of unsuccessful endovascular recanalization of CTO. To assess the predictive value of the model, a ROC analysis was carried out, and the area under the curve (AUC) was calculated. The AUC was 0,87, which indicates a high predictive quality of the model. The sensitivity and specificity of the model were 78 and 81%, respectively. Conclusion. The study showed that the presence of calcified CTO, SYNTAX score >32 points, CTO length >30 mm, and CTO of circumflex artery are significant predictors of unsuccessful CTO recanalization.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2586
In the pattern of abdominal complications after cardiac surgery, acute mesenteric ischemia is rare but high-mortality pathology. In the initial stages, the disease has no specific signs, which makes it difficult to perform early multislice computed tomography to diagnose it. Risk stratification and an individual approach to the choice of diagnostic and therapeutic measures aimed at early restoration of mesenteric blood flow will reduce the mortality in this complication.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2699
Aim. To study the advantages of ultrasound versus anthropometric assessment of muscle mass for early diagnosis of sarcopenia in patients >45 years of age. Material and methods. The study included 79 patients aged 4589 years with coronary artery disease (CAD), hypertension, type 2 diabetes, heart failure, class 1-3 obesity. Diagnosis of hypertension was carried out according to the European (2018) and Russian (2019) guidelines; CAD — according to Russian Society of Cardiology (2020) guidelines. Sarcopenia was diagnosed according to 2010 European Working Group on Sarcopenia in Older People (EWGSOP) criteria and 2018 EWGSOP2 guidelines. Muscle mass (MM) was determined by two methods: 1 — by measuring the rectus abdominis muscle (RAM) thickness using the ultrasound; 2 — by measuring the arm and lower leg circumference. Muscle strength was determined by wrist dynamometer. Muscle function was assessed using the 4-m gait speed test. Results. The study showed that in patients aged >45 years admitted to the emergency cardiology department, the body mass index exceeded 25 kg/m2 in 88,6% of cases. The incidence of sarcopenia of varying severity was 55,7% (n=44). The differences in RAM thickness, arm and lower leg circumference between the groups of patients with/without sarcopenia were significant (p<0,001), but were less than the threshold only for RAM thickness. RAM thickness levels progressively decreased with increasing severity of sarcopenia and significantly differed at all stages compared to patients without sarcopenia (p<0,001), regardless of body mass index. A decrease in lower leg circumference below the threshold values determining a MM decrease was observed only in severe sarcopenia, and arm circumference — in both men and women only in severe sarcopenia. There were no significant differences for arm and lower leg circumference depending on sarcopenia stages in overweight and obese patients. Conclusion. MM assessment by measuring RAM thickness with ultrasound in comparison with the anthropometric method makes it possible to diagnose sarcopenia in patients >45 years of age with cardiovascular diseases and obesity at earlier stages and to promptly recommend preventive measures.
Cardiovascular Therapy and Prevention, Volume 20; doi:10.15829/1728-8800-2021-2637
Aim. To evaluate the effectiveness of myocarditis therapy depending on the diagnosis approach (with or without myocardial biopsy). Material and methods. The study included 83 patients ≥18 years old with severe and moderate myocarditis (25 women and 58 men; mean age, 45,7±11,7 years), established by myocardial biopsy (group 1, n=36) or by a non-invasive diagnostic algorithm (group 2, n=47), for which immunosuppressive therapy (IST) was carried out. Inclusion criteria were left ventricular (LV) end-diastolic dimension >5,5 cm and ejection fraction (EF) <50%. An endomyocardial (n=31) or intraoperative (n=5) biopsy with a study of the viral genome and level of anticardiac antibodies were performed. Coronary angiography (29%), cardiac multislice computed tomography (75%), cardiac magnetic resonance imaging (41%), and 99mTc-MIBI scintigraphy (35%) were also carried out. The mean follow-up period was 3 years (36 [12; 65] months). The study was approved by the Intercollegiate Ethics Committee. Results. The groups were completely comparable in age, baseline parameters (class III [2,25; 3] and III [2; 3] heart failure (HF); end-diastolic LV dimension, 6,7±0,7 and 6,4±0,7 cm; EF, 29,9±8,7 and 31,4±9,3%), the extent of cardiac therapy (excluding the administration rate of в-blockers — 94,4 and 78,7%, p<0,05) and 1ST (methylprednisolone in 91,7 and 89,4% of patients at a mean dose of 24 [16; 32] and 20 [15; 32] mg/day, azathioprine in 50,0 and 46,8% of patients at a mean dose of 150 mg/day or mycophenolate mofetil 2,0 g/day in 30,6% in group 1, hydroxychloroquine 0,2 g/day in 27,8 and 23,4%). Biopsy in group 1 revealed active/borderline (61/39%) myocarditis, in 8 patients — viral genome in the myocardium, including parvovirus B19 in 7 of them. Both groups showed a comparable significant increase in EF after 6 months up to 37,6±8,1 and 42,6±11,5% (p<0,001) and after 27 [12; 54] months up to 43,4±9,6 and 45,5±12,3% (p<0,001), as well as a significant decrease in HF class to 2 [1; 2] in both groups. An increase in EF by ≥10% was recorded in 70 and 72% of patients, respectively. The mortality rate was 13,9 and 12,8%. Taking into account the only transplantation in group 2, the death+transplantation endpoints reached 13,9 and 14,9% of patients (without significant differences between the groups). Conclusion. In patients with severe and moderate myocarditis diagnosed with and without myocardial biopsy, the effectiveness of combined therapy, including IST, was comparable. If it is impossible to perform a biopsy, complex non-invasive strategy makes it possible to diagnose myocarditis with different probability rate and conduct an effective IST, the refusal of which mostly is not justified.