Cardiology

Зюзин, В. С. Современная стратегия применения аллогенной крови в кардиохирургии / В. С. Зюзин, Ю. А. Шнейдер // Грудная и сердечно-сосудистая хирургия. – 2024. – Т. 66, № 3. – С. 282–290. (Modern strategy for the use of allogeneic blood in cardiac surgery.)

Today, in case of massive bleeding of during cardiac surgery, there is no alternative to donor blood. At the same time, the use of blood components is associated with a cascade of adverse consequences, including an increase in the incidence of deaths. The relationship between the increase in the number of complications and transfusion therapy has not only a qualitative, but also a quantitative relationship According to a WHO expert report published in 2021, the goal of universal access to safe blood and blood products has not been achieved in many countries. Modern transfusiology advocates scientifically based methods for the clinical use of allogeneic blood. In the English-language literature, the term “patient blood management” is used to define this approach. In domestic transfusiology, the established translation is patient blood management. The relevance of the problem is confirmed by the fact that for the last five years, PubMed produces 86,396 results for the query “patient blood management”. The purpose of this review, based on modern literature data, is to describe the results of clinical implementation of blood management in adult patients in cardiac surgery. Methods. The search was published in February 2024 using the PubMed, TRANSFUSION, eLIBRARY.RU evidence library databases for the period from 2019 to 2023, patient blood management, cardiac surgery, bleeding, blood transfusion, restrictive and liberal transfusion strategy. Exclusion of duplicate articles was done manually. An additional search was conducted among the reference lists of selected publications. The number of citations of the sources included in the review was determined using Google Scholar in February 2024. Results. In the first stage of selection, clinical studies, meta-analyses, randomized controlled trials, reviews and regular reviews without language restrictions were considered based on the content of the abstract. At the second stage, for studies that have passed the previous stage, the decision was adopted based on an assessment of full-text versions, which presented the consequences of preoperative anemia, postoperative bleeding, and transfusion therapy in adult cardiac surgery patients. The final version included 59 publications. Conclusion. The accumulated amount of data allows us to consider MCP today the “gold standard” of transfusion therapy during cardiac surgery. Clinical use of MCP allows improving patient treatment outcomes, avoiding the unreasonable use of donor blood components, and reducing financial costs of treatment. Despite the proven benefits, implementing MCP programs remains challenging.

Результаты применения методики «открытая грудина» у взрослых пациентов после кардиохирургических операций с искусственным кровообращением / Г. Г. Хубулава [и др.] // Грудная и сердечно-сосудистая хирургия. – 2024. – Т. 66, № 3. – С. 369–382. (Results of practice the “open chest” in adult patients during cardiac surgery with artificial circulation)

Purpose: to evaluate the results of the “open chest” practice in adult patients during cardiac surgery with artificial circulation. Material and methods. 95 patients were divided into two groups depending on the use of delayed suturing of the sternum at the final stage of the operation. The first group included 71 patients; at the final stage, metal osteosynthesis of the sternum was performed. The second group (“open chest”) – 24 patients, after installing drains, sutures were placed on the skin and underlying tissue according to Donati, then two layers of tape were glued, the sternum was not reduced. Results. In the first group, blood loss was twice as large, which was a statistically significant result, as well as a 22.7% higher rate of resternotomies, a greater number of complications (life-threatening rhythm disturbances by 6.7%, abdominal complications by 39.6%), and a greater number of complications. The need for transfusion of blood transfusion media, the symptoms of AHF resolved more slowly, and a more rapid stabilization of hemodynamic parameters and systemic perfusion was observed. Conclusion. The “open chest” technique is an effective method for the treatment of postoperative bleeding due to coagulopathy after cardiopulmonary bypass during cardiac surgery with cardiopulmonary bypass in adult patients. The “open chest” technique is an effective method of protecting the myocardium during cardiac surgery with on-pump after cardiac surgery with on-pump in adult patients. The “open chest” technique provides rapid resolution of systemic vascular hypoperfusion, intrinsic development of passive venous hypertension of the internal organs and provides rapid resolution of hemodynamic expansions, gradually reducing organ restrictions.

Неалкогольная жировая болезнь печени как триггер полиморбидности: есть ли выход из тупика? / О. Д. Остроумова [и др.] // Фарматека. – 2024. – Т. 31, № 4. – С. 62–69. (Non-alcoholic fatty liver disease as a trigger of polymorbidity. Is there a way out of the impasse?)

Non-alcoholic fatty liver disease (NAFLD) is a multisystem disease that not only affects the liver with the development of complications up to cirrhosis, but also associated by an increased risk of developing such diseases/conditions such as diabetes mellitus, cardiovascular pathology, metabolic syndrome, as well as oncological diseases. In this regard, NAFLD represents a medical and social burden associated with high mortality and a decrease in the quality of life of patients. To increase the awareness of physician about this pathology and a systematic approach to pharmacotherapy, in 2022 For the first time in Russia, a National Consensus on the management of adult patients with NAFLD has been released. According to the consensus, the criteria for rational drug therapy are not only the effect on slowing the progression of liver damage up to the regression of steatosis, steatohepatitis and fibrosis, but also a decrease in cardiometabolic risk factors. Currently, only ursodeoxycholic acid (UDCA) meets these requirements. In addition, this drug has a synergistic lipid-lowering effect when combined with statins, which makes it the drug of choice for the treatment of NAFLD at any stage. Considering the high efficiency and large evidence base, UDCA is included in the recommendations on NAFLD and combined pathology by various medical associations: gastroenterological, cardiological, therapeutic.

Искендеров, Б. Г. Роль генетического риска в оценке кардиоваскулярного прогноза у пациентов с синдромом удлиненного интервала QT / Б. Г. Искендеров, Т. В. Лохина, Н. В. Беренштейн // Фарматека. – 2024. – Т. 31, № 4. – С. 70–76. (The role of genetic risk in assessing cardiovascular prognosis in patients with long QT syndrome)

Congenital long QT syndrome (LQTS) is the most common primary electrical heart disease, characterized by an increased risk of polymorphic ventricular tachycardia and sudden cardiac death. The review article describes in detail the modern architecture of LQTS, approaches to stratification of cardiovascular prognosis and analysis of risk markers, including the role of genetic factors. In this regard, it is of interest to introduce new highly informative electrocardiographic risk markers for clinical outcomes in patients with congenital LQTS.

Тарасова, И. В. Роль эпикардиальной жировой ткани в развитии фибрилляции предсердий: обзор литературы / И. В. Тарасова, А. Л. Верткин // Лечащий врач. – 2024. – Т. 27, № 7. – С. 17–22. (The role of epicardial adipose tissue in the development of atrial fibrillation: a literature review.)

Atrial fibrillation, the most common persistent cardiac arrhythmia, is a common cause of strokes, heart failure, dementia, worsens the quality of life, increases mortality and has a significant impact on the health economy. The obesity pandemic leads to a serious increase in cardiovascular risks. Obesity is closely associated with the development of atrial fibrillation, as it is associated with diseases and conditions leading to structural and functional remodeling of the heart, as well as hypertrophy and dysfunction of epicardial adipose tissue. Epicardial fat is unique in its anatomy, extremely high secretory and metabolic activity, unobstructed proximity to the myocardium and the ability to interact with it due to the general blood flow. Under physiological conditions, epicardial adipose tissue performs a cardioprotective function. Obesity causes hypertrophy and hypoxia of adipocytes. Under these conditions, adipocytes lose their protective properties, epicardial fat mainly produces proinflammatory and profibrotic adipokines, infiltrates the myocardium, which contributes to the development of atrial fibrillation. Studies show that the thickness and volume of epicardial adipose tissue are directly correlated with the risk of atrial fibrillation, the severity of its course, and the recurrence of paroxysms after catheter ablation. Many potential mechanisms of arrhythmia induction in obesity have been discovered. Research is needed to further clarify these mechanisms and identify ways to prevent them. Taking into account the peculiarities of the structure and functions of epicardial adipose tissue, it is of interest as a promising therapeutic target. / Conclusion. This article represents an overview of the most significant scientific works devoted to the problem of epicardial obesity and its relationship with atrial fibrillation, systematizes modern ideas about the potential proarrhythmogenic effect of epicardial adipose tissue, therapeutic possibilities and future prospects.

Барышникова, И. Ю. Недоношенный ребенок с врожденным пороком сердца: перинатальные факторы риска развития кардиохирургических осложнений / И. Ю. Барышникова, Р. М. Гасанова // Детские болезни сердца и сосудов. – 2023. – Т. 20, № 4. – С. 235–241. (The preterm infant with congenital heart disease: perinatal risk factors for cardiac surgical complications.)

The growing population of premature infants acutely raises the issue of treatment prospects for low birth weight and premature infants with congenital heart disease (CHD). These patients are prone to many complications because, in addition to critically low body weight and physiological ‘unpreparedness’ of all systems and organs for extra-uterine functioning, they have pathological blood circulation due to CHD. It is noteworthy that the risk stratification scales for the development of complications after cardiac surgery do not include the peculiarities of the course of pregnancy and fetal development. This literature review is focused on the analysis of perinatal risk factors for the development of adverse outcome in premature infants with CHD under surgical treatment.

Нагиева, С. Э. Кардиомиопатии, вызванные патогенными вариантами в гене DMD / С. Э. Нагиева, А. В. Лавров, С. А. Смирнихина // Кардиология. (Cardiomyopathies caused by pathogenic variants in the DMD gene)

DMD is a gene located on X chromosome that is responsible for the formation of the dystrophin protein. Pathogenic variants in the DMD gene cause diseases such as Duchenne muscular dystrophy (DMD) and Becker muscular dystrophy (BMD). DMD is characterized by progressive muscle weakness, leading to loss of motor and respiratory functions, as well as cardiomyopathy and progressive heart failure due to the complete absence of dystrophin in the body. Patients with BMD synthesize a reduced amount of dystrophin, which distinguishes it from DMD by a milder clinical picture and an older age of onset. Cardiomyopathies are a common and, in some cases, the main manifestation of these pathologies. This review focuses on studies of diseases associated with dystrophinopathies, in which the main symptom is heart injury, cardiomyopathy, and also provides information about modern approaches to gene and targeted therapy for these diseases.

Влияние ингибиторов натрий-глюкозного котранспортера 2-го типа на диастолическую функцию левого желудочка: текущее состояние вопроса и перспективы / Е. В. Борисова [и др.] // Кардиология. 2024. Т. 64, № 7. С. 64-71. (The effect of sodium-glucose cotransporter type 2 inhibitors on left ventricular diastolic function: current status and prospects)

Sodium-glucose cotransporter-2 inhibitors (SGLT2 inhibitors) or gliflozins, are a new class of cardiovascular drugs with a proven clinical efficacy and a beneficial effect on prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Impaired left ventricular (LV) diastolic function (DF) is an important element in the pathogenesis of HFpEF. Experimental studies have found intracellular mechanisms for the so-called diastolic effects in gliflozins. Studies using laboratory models of experimental HFpEF have demonstrated a positive effect of dapagliflozin and empagliflozin on the elastic properties of cardiomyocyte myofilaments, the dynamics of myocardial fibrosis, and intracellular sodium and calcium homeostasis. The significance of anti-inflammatory, antioxidant properties of gliflozins in improving the cardiomyocyte DF has been experimentally established. The effect of SGLT2 inhibitors on LV DF in patients at high risk for cardiovascular diseases and their complications, that has been demonstrated in relatively small clinical studies, is due to primary cardiac and secondary effects. Results of individual studies confirmed the protective (in relation to myocardial relaxation) properties of gliflozins in the conditions of a diastolic stress test. The regression of LV diastolic dysfunction associated with the SGLT2 inhibitor treatment found in small observational studies is important in the context of the significant beneficial effect of empagliflozin and dapagliflozin on the prognosis of cardiovascular diseases that has been demonstrated in large randomized clinical trials in patients with HFpEF.

Григорьева, И. Н. Липиды крови при желчнокаменной болезни: ассоциации с факторами риска / И. Н. Григорьева, Д. Л. Непомнящих // Атеросклероз. 2024. Т. 20, № 2. С. 162-172. (Blood lipids in gallstone disease: associations with risk factors)

Aim of the review – to present an analysis of the literature data on the association of serum lipids with the presence of gallstone disease (GSD), as well as with the main risk factors for GSD – age, female sex, obesity, type 2 diabetes mellitus (DM2), arterial hypertension (AH) over a 50-year period. In numerous studies, hypertriglyceridemia (HTH), hypocholesterolemia of high-density lipoproteins (hypo-HDL) have been recognized as risk factors for GSD. In 1994–1995 in Novosibirsk (WHO MONICA project), in a population sample of women aged 25-64 (n = 870) and men aged 35–54 (n = 399) with sonographic diagnoses of GSD, GSD is much more common among men and women with lipid metabolism disorders: the highest frequency of GSD was noted in the 4th quartile of the distribution of total cholesterol (TC) levels (4.5 % for men and 12.4 % for women). For LDL cholesterol, the highest incidence of GSD was noted in the 5th quintile of the distribution (3.8 % in men and 10.9 % in women). When calculating by the largest χ2 method in women, the levels of TC (178 mg/dl), TG (177 mg/dl) in the blood were determined, exceeding which significantly increases the chance of GSD, for HDL cholesterol (68.5 mg/dl) the model is insignificant. There was a correlation between blood lipids and age, BMI, and DM2 in women with GSD, but not in men with GSD. The lipid profile in patients with GSD is not associated with AH. Most authors recognize GSD as a lipid-associated disease. However, the literature data are contradictory: there are opinions about a direct, inverse or absent association of blood lipids with GSD, perhaps due to differences in the design, size, and ethnicity of the subjects, as well as since the level of serum lipids is closely correlated with other risk factors for GSD, which significantly complicates the differentiated assessment of their contribution to the process of gallstone formation. Further studies of the contribution of lipid factors to the development of GSD are needed.

Загорулько, А. И. Биорезорбируемые скаффолды: прошлое и настоящее. Клинический пример 10-летнего наблюдения за пациентом с имплантированным стентом Absorb / А. И. Загорулько, М. В. Черняев, А. Г. Колединский // Атеросклероз. – 2024. Т. 20, № 2. С. 173-182. (Bioresorbable scaffolds: past and present. Clinical example of a 10-year follow-up of a patient with an implanted Absorb stent)

Today we can say with confidence that percutaneous coronary intervention is an effective, minimally invasive and safe method of treating coronary heart disease. As always complex problems require necessary solutions. One such challenge is the use of metallic covered stents because the stent frame remains permanently in the artery. The idea to create a bioresorbable scaffold appeared more than 20 years ago, and one of the pioneers was the Absorb scaffold, which was implanted in quantities of more than 150 000. During the existence of this stent, a large number of studies were carried out, strengths and weaknesses were identified and eventually came to the conclusion that it was discontinued, but creating Absorb gave a powerful drive to the invention of new types of scaffolds.

Каширина, А. П. Холестерин, не связанный с липопротеинами высокой плотности, и кардиометаболические заболевания / А. П. Каширина, Г. И. Симонова // Атеросклероз. 2024. Т. 20, № 2. С. 183-194. (Non-high-density lipoprotein cholesterol and cardiometabolic disease)

At the present stage, non-high-density lipoprotein cholesterol (non-HDL-C) is intensively studied as a predictor of cardiovascular mortality. Its elevation is associated with insulin resistance, which is a pathogenetic factor in the development of atherogenic (mixed) dyslipidaemia, which is characteristic of individuals with metabolic syndrome (MS) and type 2 diabetes mellitus (T2DM). This review analyses trends in non-HDL-C levels since 1985 in foreign countries and in the Russian Federation. Based on the results of international epidemiological studies, conclusions are drawn about the possibility of predicting the risk of MS and T2DM using non-HDL-C concentration as a marker. The necessity of conducting prospective cohort studies in the Russian population aimed at assessing the role of non-HDL-C in early diagnosis of MS and TDM2 has been shown. Literature sources were searched in electronic information databases eLIBRARY.RU and PubMed. The analyses included studies published from 1990 to 2023.

Суджаева, О. А. Точка зрения на ведение пациентов с хронической коронарной болезнью: часть 1 / О. А. Суджаева // Кардиология в Беларуси. Т. 16, № 3. C. 351-368. (Management of patients with chronic coronary disease: a point of view. Part 1)

This article provides an overview of the American Heart Association and American College of Cardiology Guidelines for the Management of Patients with Chronic Coronary Artery Disease 2023. The main sections are summarised: introduction, epidemiology, assessment, diagnosis and risk stratification, treatment, cost and cost-effectiveness considerations. Differences between European and American approaches to guideline development are emphasised.

Эффективность новых оральных антикоагулянтов в сравнении с варфарином в разных возрастных группах пациентов с фибрилляцией предсердий: обзор литературы / А. М. Кармильцына [и др.] // Кардиология в Беларуси. – 2024. – Т. 16, № 3. – C. 369–377. (Efficacy of new oral anticoagulants compared to warfarin in different age groups of patients with atrial fibrillation: a literature review)

Atrial fibrillation significantly increases the risk of thromboembolic complications, especially stroke, making anticoagulant therapy critically important for preventing these complications. This paper provides a detailed examination of atrial fibrillation (AF), the most common persistent form of arrhythmia, representing a signifi cant global public health issue. Focusing on data regarding the incidence of new AF cases from 2009 to 2022, the study analyzes the age characteristics of patients at initial screening. The subject group consisted of 8,429 individuals aged 45 to 69 years who had not previously encountered cardiovascular diseases and atrial fibrillation. The research found that the risk of developing AF significantly increases with patient age. A comparison of traditional anticoagulants, including warfarin, with new oral anticoagulants (NOACs) was also conducted. Based on data from major clinical trials, the efficacy, safety, and impact on patients’ quality of life of both drug groups are analyzed. The results confirm that NOACs possess a better efficacy and safety profile compared to warfarin, offering significant advantages, including a reduced risk of serious bleeding and improved quality of life for patients. The findings and conclusions can serve in the development of public health strategies and the proposal of targeted prevention measures, adapted to age groups most at risk

Друян, Л. И. Классификация внутрисердечных блокад с позиции электрофизиологических особенностей движения электрического импульса: обзор литературы / Л. И. Друян // Кардиология в Беларуси. – 2024. – Т. 16, № 3. – C. 378–384. (Classification of intracardiac blocks from the position of electrophysiological features of the movement of electrical impulse: a literature review)

In the existing literature on electrocardiography (ECG) there is a dual approach to understanding atrioventricular (AV) and intraventricular conduction, which causes discrepancies in the classification of intracardial blockades and creates difficulties in teaching ECG to students and physicians attending advanced training courses. Purpose. Propose a new version of the classification of intracardiac blockades, based on an electrophysiological understanding of the movement of electrical impulse (EI) from the sinus node (SA) to the terminal branches of the ventricular conduction system. I believe that it will help eliminate a number of contradictions, some of which will be discussed in this article. Materials and methods. By means of comparative analysis, a number of textbooks, monographs, journal articles describing the essence, classifi cation, electrocardiographic diagnosis of intracardial blockages have been studied. Results. It was found that the duration of the P-Q interval is interpreted differently from the point of new of the movement of EI through the conduction system of the heart. In some cases, the AV path of spreading of excitation is considered along the length from the SA to the AV-junction inclusive. On the ECG this path is refl ected by the P-Q interval (from the beginning, of the P wave to the beginning of the Q wave and in its absence to the R wave), that duration of which is from 0.12 to 0.20 seconds. The further path of movement of the EI, that is, from the AV-connection to the terminal branches of the ventricular conduction system is considered as intracardiac. It can be assumed that this understanding of intracardiac conduction is based on an anatomical approach, since the SA and AV nodes are located at the level of the atria and the common trunk of the His bundle and its branches are at the level of the ventricles of the heart. In other cases, the duration of the P-Q interval is considered from the SA node through the atria, AV-junction, His bundle, its branches to the terminal branches of the Purkinje fibers and it is also deployed on the ECG by the P-Q interval with the same normal parameters, presented above. The path of passage of EI has become signifi cantly longer, but the time of its movement remains the same. The term «impairment of intraventricular conduction» also is used in some cases in classifi cation AV conduction, in others – with blocking bundle branches of His, in others, it is indicated that about disturbances intraventricular conduction are said when “there should be no signs of blockade bundle branches of His on the ECG”. Thus, in some cases the same ECG changes are called AV block, and in other – intraventricular block. Since the evidence base for the component of the P-Q interval (that is AV conduction) is the His bundle electrogram, it is proposed to designate bundle branch of His block as AV block at the level of the His bundle branches, without using the term “intraventricular block”. Intraventricular blockage is considered to be bloking the movement of EI in the myocardium from Purkinje fibers (endocardium) to the epicardium. Conclusion. The classification of cardiac conduction disorders can be presented in the following version: I. Sinoatrial blocks. II. Atrioventricular blocks: 1) AV blocks at the atrial level or introatria; 2) AV blocks at the level AV junction; 3) AV block at the level bundle branches of His. III. Intraventricular blocks. Presented version of the classifi cation of intracardiac blockades will allow us to avoid the above terminological contradictions and realize a unified approach in understanding and interpreting AV and intraventricular blockades in the process of training students and doctors attending advanced training courses.

Разрыв задней стенки левого желудочка после протезирования митрального клапана: причины возникновения, профилактика, хирургическая тактика / С. В. Рычин [и др.] // Грудная и сердечно-сосудистая хирургия. – 2024. – Т. 66, № 2. – C. 148–156. (Left ventricle posterior wall rupture after mitral valve replacement: causes of occurrence, prevention, surgical strategy).

Left ventricle posterior wall rupture is a complication which surgeon can face after mitral valve replacement, it is rare but often fatal. First time this complication was described by Roberts and Morrow in 1967 and it was investigated during autopsy. Literature data splits in two categories: prevention methods (posterior mitral leaflet structures preservation, partial decalcification, mitral annulus reinforcement with pericardial patch, bioglue usage etc.) and repair methods. However, despite of existing methods of prevention and repair, this complication still exists with high mortality rate which varies from 36 to 100%.

Операция Кавашима у больных со сложными цианотичными врожденными пороками сердца в сочетании с синдромом висцеральной гетеротаксии и отсутствием печеночного сегмента нижней полой вены / И. А. Малинкин [и др.] // Грудная и сердечно-сосудистая хирургия. – 2024. – Т. 66, № 2. – C. 138–147. (Kawashima procedure in patients with complex cyanthotic congenital heart disease, combined with the visceral heterotaxy syndrome, functional single ventricle and interrupted inferior vena cava)

Patients with visceral heterotaxy syndrome, functionally a single ventricle and the absence of a hepatic segment of the inferior vena cava with azygos continuation constitute the most difficult group among patients with univentricular hemodynamics. Features of blood circulation, various combinations of intracardiac anomalies and malformations of internal organs make it difficult to choose treatment tactics and significantly affect immediate and long-term results. Over the past 40 years, surgical treatment of pathology has been the creation of a bidirectional cavopulmonary anastomosis (Kawashima operation). Up now, significant progress has been achieved, both in the results of the operation itself and in the long-term complications treatment. The available literature sources are represented by a relatively small number of reports containing an analysis of the results of treatment of limited clinical groups, heterogeneous in age and manifestations of congenital heart disease. Until now, the opinions of various authors differ on the issues of determining indications and contraindications to surgery, determining the tactics of surgical treatment, pathogenesis of development and prediction of postoperative complications. This literature review is devoted to generalizing the experience accumulated in the world, and analyzing the results of treatment in this extremely severe category of patients.

Кардиореабилитация: исследования эффективности, результаты, перспективы / В. Е. Владимирский [и др.] // Вопросы курортологии, физиотерапии и лечебной физической культуры. – 2023. – Т. 100, № 5. – С. 45–55. (Cardiac rehabilitation: investigation of efficacy, results, perspectives)

Previous research experience on cardiac rehabilitation programs as a part of general health care system has shown that they are an important part of the management of cardiovascular patients. Improving quality of life, reducing the severity of risk factors, increasing physical performance, slowing disease progression, decrease in morbidity and mortality indicate the clinical efficacy of cardiac rehabilitation and make it an integral part of therapeutic interventions. Heart rehabilitation is a 1st class recommendation in the majority of modern cardiovascular guidelines around the world.

Антюх, К. Ю. Неалкогольная жировая болезнь печени и кардиоваскулярные риски / К. Ю. Антюх // Неотложная кардиология и кардиоваскулярные риски. – 2023. – Т. 7, № 2. – С. 1991–1999. (Non-alcoholic fatty liver disease and cardiovascular risks)

Non-alcoholic fatty liver disease is a multifactorial disease with a complicated mechanism development, which is associated with metabolic disorders, the functions of various organs and systems, as well as the occurrence of a number of diseases, in particular atherosclerosis. According to research conducted in recent years, non-alcoholic fatty liver disease is a predictor of adverse cardiovascular events and can act as an independent risk factor for the development of diseases of the circulatory system, regardless of the presence of diabetes mellitus, dyslipidemia or obesity. The purpose of this work is to analyze the published research data on the epidemiology, etiopathogenesis, diagnosis and features of the clinical course of non-alcoholic fatty liver disease in patients with diseases of the circulatory system as well as to characterize the current state of the problem and to determine the direction for further research.

Медведева, Е. А. Распространенность «скрытых» форм хронической сердечной недостаточности / Е. А. Медведева, Н. Г. Ложкина, З. Х. Жилоков // Атеросклероз. – 2023. – Т. 19, № 4. – С. 457–468. (Prevalence of “hidden” forms of chronic heart failure)

The article discusses the prevalence of chronic heart failure and the possibility of its detection at an early, asymptomatic stage, when timely treatment can slow the progression of the disease. The data on the widely used and recognized biomarkers and their informative value for diagnostics of the “hidden: forms are presented, and also on the search of new markers. We used information on the topic from publications based on PubMed and Google Scholar databases, 5 years in depth.

Варданян, Я. Т. Кардиоваскулярные эффекты психотропных препаратов / Я. Т. Варданян // Клиническая медицина. – 2023. – Т. 101, № 9–10. – С. 467–473. (Cardiovascular eff ects of psychotropic drugs)

Research over the past decade indicates that some psychotropic drugs increase the risk of developing arrhythmias and sudden cardiac death. Many antidepressants and antipsychotic drugs have arrhythmogenic potential and are associated with QT interval prolongation and development of ventricular arrhythmia of the “torsades de pointes” type, while some psychotropic drugs are associated with changes in ECG phenotype of Brugada syndrome and development of polymorphic ventricular arrhythmias.

Костин, В. И. Роль метаболической терапии в лечении кардиологических пациентов пожилого и старческого возраста с позиции доказательной медицины / В. И. Костин, О. А. Шангина, В. Г. Шелихов // Клиническая геронтология. – 2023. – Т. 29, № 7–8. – С. 11–17. (Role of metabolic therapy in treatment of elderly and older cardiac patients from an evidence-based medicine perspective)

Drugs of «metabolic action» are considered to improve the energy metabolism of the cell. They are most widely used in cardiology. It is believed that an important advantage of metabolic drugs is the low frequency of undesirable hemodynamic reactions, good tolerability. This makes their use particularly promising in elderly and senile patients. At the same time, the expediency and effectiveness of metabolic therapy is one of the most controversial questions. There is uncertainty in some aspects of the theoretical justification of their mechanism of therapeutic action. In clinical conditions, a number of drugs from this group did not demonstrate the expected results.The study attempts to evaluate some drugs of this group from the standpoint of the theoretical validity of their use and clinical efficacy.The publications analysis shows that some metabolic drugs are able to influence laboratory, instrumental, functional, clinical indicators, indicators of the quality of life of elderly and senile cardiac patients. There is also certain theoretical possibility of improving the prognosis with the help of these drugs. However, so far, none of the drugs from this group has shown a convincing evidence base of its beneficial effect on the prognosis of patients. It can be assumed that some means of metabolic therapy can be used to improve the quality of life of patients. But on the other hand, adding them to modern multicomponent therapy standards may increase the risk of polypragmasia and side effects, which is especially likely and dangerous in elderly and senile patients. To determine the real place of metabolic drugs in cardiological practice and, especially in the treatment of elderly and senile patients, it is necessary to conduct large randomized trials.

Билирубин – многообещающая мишень при метаболических и атеросклеротических сердечно-сосудистых заболеваниях / О. Е. Горбунова [и др.] // Профилактическая медицина. – 2024. – Т. 27, № 1. – С. 121–127. (Bilirubin is a promising target for metabolic and atherosclerotic cardiovascular diseases)

Metabolic and atherosclerotic cardiovascular diseases are a global problem for humanity due to high morbidity, disability, and mortality, despite the continuous improvement of methods of diagnosis and treatment. Based on the analysis of new literature data on the antioxidant, metabolic, immunosuppressive, and endocrine functions of bilirubin, to identify promising areas for their use in the prevention, diagnosis, and treatment of metabolic and atherosclerotic cardiovascular diseases. The search for Russian- and English-language publications was performed in the PubMed, Medscape, Cochrane Library databases, and the eLibrary scientific electronic library. The depth of article search was 2014—2023. The analysis includes 60 publications that meet the selection criteria. The data presented in the review are often controversial. However, most studies have found an adverse effect of low blood bilirubin on the course and prognosis of many metabolic and atherosclerotic cardiovascular diseases, and the use of promising strategies to increase the level of bilirubin in the blood improved the results of therapeutic and surgical treatment. The lack of effectiveness of currently available strategies for the prevention and treatment of metabolic and atherosclerotic cardiovascular diseases enables considering the level of blood bilirubin as a new promising target for improving the results of prevention, diagnosis, and treatment of these diseases.

Хирургическое лечение постинфарктных аневризм левого желудочка на работающем сердце. Исторический и современный взгляд на проблему / В. Ю. Мерзляков [и др.] // Грудная и сердечно-сосудистая хирургия. – 2023. – Т. 65, № 5. – С. 522–531. (Surgical treatment of postinfarction left ventricle aneurysms on a beating heart. Historical and modern view of the problem)

The occurrence of postinfarction left ventricle aneurysm is one of the most common and serious complications of coronary artery disease and, in particular, acute myocardial infarction. Attempts at surgical treatment of this condition began in the middle of the last century. And for decades, the techniques of operations for post-infarction left ventricle aneurysms have been constantly improved and supplemented. The interest of surgeons in recent years has been attracted by the direction of reconstruction of aneurysms on a beating heart, that is, the rejection of cardioplegic arrest, that minimizes the consequences of surgery and improves the contractile function of the damaged ventricle. This literature review contains information about the evolution of surgical methods, the current state of the issue and indications for surgery for postinfarction left ventricle aneurysm. Literature search was carried out in accordance with the presented topic by keywords, authors, medical terms in the databases “PubMed”, “eLibrary”. Publications representing practical and theoretical interest, currently relevant, as well as allowing us to fully disclose the topic of the review, in particular, we were interested in surgical techniques that demonstrate positive results and help minimize complications in the intra- and postoperative periods. Articles that did not have sufficient information were excluded: incomplete version, closed access to the article.

Метаанализ клинических результатов гибридных реконструкций по сравнению c открытыми операциями при многоуровневом атеросклеротическом поражении артерий нижних конечностей / А. Г. Ваганов [и др.] // Грудная и сердечно-сосудистая хирургия. – 2023. – Т. 65, № 6. – С. 635–645. (Meta-analysis of the clinical results of hybrid reconstructions compared to open surgeries with multilevel atherosclerotic lesion of the arteries of the lower extremities)

The aim of the meta-analysis is to evaluate the effectiveness of the results of hybrid revascularization (GR) compared with open reconstructions (OR) on the arteries of the lower extremities. The meta-analysis was based on PRISMA recommendations. The search and selection of articles was carried out in the databases PubMed, Elibrary, Medscape, Web of Science and Cochrane Library. As a result, 4389 publications were found from 1971 to 2023. After screening and selection, the study included 12 nonrandomized (11 retrospective and 1 prospective) clinical trials. The results of treatment of 5292 patients were analyzed. The quality of articles was assessed using the Newcastle-Ottawa (NOS) scale. Review Manager 5.4 was used for statistical data processing when comparing study groups. The sum of the dichotomous data was reported with a 95% confidence interval (CI) as an odds ratio (OR). When studying the value of intraoperative blood loss, a significantly lower level of blood loss is noted when using hybrid arterial reconstructions. (OR 133.03; CI 62.36–203.70; p=0.0002). It was observed the groups differed in the frequency of femoropopliteal segment thrombosis, which was significantly lower in the group with hybrid interventions (OR 0.58; CI 1.08–18.95; p=0.04). The level of ABI after surgery was also higher in the group of hybrid reconstructions (p=0.02). When studying the terms of inpatient treatment, there is a significantly lower number of bed days in patients after hybrid reconstructions (OR 2.05; CI 1.06–3.05; p<0.0001). When evaluating the late postoperative period, there was no statistically significant difference in the number of amputations and the number of patients with intermittent claudication and critical ischemia. The use of hybrid methods for multilevel atherosclerotic lower limb arterial lesions will improve the direct results of surgical treatment.

Титов, Д. А. Повторные операции на аортальном клапане и восходящем отделе аорты: причины, хирургическое лечение / Д. А. Титов // Грудная и сердечно-сосудистая хирургия. – 2023. – Т. 65, № 6. – С. 646–660. (Reoperations on the aortic valve and ascending aorta: causes, surgical treatment)

With the increase in the number of clinics performing cardiac surgery, the improvement of diagnostics and the development of endovascular procedures, there has been an upward trend in the number of cardiac and vascular surgeries. The most common valvular heart defect is pathology of the aortic valve (AV), which is manifested by its stenosis or insufficiency. Among the main causes are structural changes in the valve leaflets due to rheumatic or degenerative lesions, congenital anomalies, infective endocarditis, and traumatic injury. To date, there is no effective drug therapy for the treatment of AV malformation, and surgical correction with implantation of various types of mechanical and biological prostheses, synthetic valve-containing conduits, AV reconstruction and aortic root prosthesis using donor prostheses (allografts) or pulmonary autograft (Ross operation) is the only effective treatment option. As the number of patients undergoing cardiac surgery increases and life expectancy increases, there will undoubtedly be an increase in the number of patients who will require reoperation due to dysfunction of mechanical and biological prostheses (thrombosis, fistula, pannus, prosthetic endocarditis, structural degeneration), failure of reconstructive surgeries, progression of valve defects not corrected at the primary operation.

Тетрада Фалло: место транспредсердной реконструкции выводного отдела правого желудочка с сохранением гипоплазированного кольца легочной артерии у детей младенческого возраста / А. А. Атмашкин [и др.] // Детские болезни сердца и сосудов. – 2023. – Т. 20, № 2. – С. 87–99. (Tetralogy of Fallot: the place of transatrial reconstruction of the right ventricular outflow tract with preservation of the hypoplastic pulmonary artery annulus in infants)

Tetralogy of Fallot (TOF) is one of the most studied malformations, as evidenced by the large number of published papers in both domestic and foreign literature. The choice of surgical treatment tactics should take into account late complications such as right ventricular dysfunction, pulmonary artery stenosis and pulmonary valve insufficiency, which may develop decades in the future and directly affect the quality of life. Pulmonary valve insufficiency after surgical intervention for TOF requiring pulmonary valve intervention is one of the causes of right ventricular dysfunction, atrial and ventricular arrhythmias leading to sudden cardiac death. Comparison of transannular plasty with other types of right ventricular outflow tract reconstruction, including transatrial-transpulmonary correction, as well as analysis of the use of different types of operations aimed at preservation of the pulmonary artery valve closure function should be considered extremely relevant at present.

Казаков, С. А. Пейсмекер-индуцированная тахикардия / С. А. Казаков // Здравоохранение. – 2024. – № 4. – С. 28–37. (Pacemaker-induced tachycardia)

The article is dedicated to pacemaker-induced tachycardia – a complication of functioning of antibra-diarrhythmic dual-chamber cardiac devices. Step-by-step counselling of patients using clinical approach and PBL-STOP algorithm is considered. Private issues of medical care based on publications of clinical electrophysiologists, recommendations of the European Society of Cardiology are presented.

Садыкова, Д. И. Современные представления о состоянии функции эндотелия у детей с сахарным диабетом 1-го типа / Д. И. Садыкова, М. Р. Шайдуллина, А. А. Аксенова // Детские болезни сердца и сосудов. – 2023. – Т. 20, № 3. – С. 171–177. (Modern concepts on the state of endothelial function in children with type 1 diabetes mellitus)

Type 1 diabetes is extremely common among children. The literature review presents current data on the prevalence, etiology, and pathogenesis of endothelial dysfunction in children with type 1 diabetes mellitus. Particular emphasis is placed on the importance of glycemic control from early childhood, the physiology of the vascular endothelium and pathophysiological processes in endothelial dysfunction, as well as current studies examining the correlation between dyslipidemia and increased markers of endothelial dysfunction and hyperglycemia are considered.

Пицко, Д. В. Применение адеметионина в общеврачебной практике: акцент на сердечно-сосудистый риск / Д. В. Пицко // Рецепт. – 2024. – Т. 27, № 2. – С. 188–195. (Use of ademethionine in general medical practice: focus on cardiovascular risk)

Recently, there has been a significant increase in the incidence of non-alcoholic fatty liver disease (NAFLD). There is literature data that NAFLD is an independent risk factor for the development of cardiovascular diseases and their complications. Causal factors for NAFLD-induced cardiovascular risk include oxidative stress, subclinical inflammation, insulin resistance, endothelial dysfunction, and impaired sulfur-containing amino acid metabolism. Risk factors such as arterial hypertension, dyslipidemia, obesity, and type 2 diabetes mellitus often coexist with NAFLD. Given the commonality of pathogenetic mechanisms, it is possible to assume that treatment of liver disease may have a preventive effect in terms of reducing cardiovascular risk. In this regard, this review analyzes the relationship between NAFLD and cardiovascular pathology and discusses a possible therapeutic strategy involving the use of ademetionine to correct cardiovascular risk in patients with NAFLD.

Клиническое значение экскресценций Лямбля: обзор литературы / Е. Л. Трисветова [и др.] // Кардиология в Беларуси. – 2024. – Т. 16, № 2. – C. 199–212. (Clinical significance of Lambl’s excrescences: literature review)

Lambl’s excrescences are rare anomalies, first described in the second half of the 19th century. The growths are found on native and prosthetic heart valves at any age and are equally common in men and women. Lambl’s excrescence is found on the left heart valve leaflets more frequently compared to localisation on the tricuspid valve and pulmonary valve. Damage to the endocardium of the flaps, resulting from significant mechanical stress and exposure to blood current, is thought to be the cause of the growths. Diagnosis of Lambl’s excrescences is often incidental, since the course in most cases is benign and asymptomatic. On echocardiographic examination, Lambl’s excrescences should be differentiated with other pathological processes occurring on the leaflets (papillary fibroelastoma, myxoma, bacterial and non-bacterial vegetations). Clinical signs, the results of imaging techniques that determine the structural features and relationship to the blood flow of formations, allow to identify diseases as the cause of overgrowths. Detachment of a fragment of Lambl’s excrescences or infection of the mass leads to the development of thromboembolic complications (transient ischaemic attack, ischaemic stroke, acute coronary syndrome, thromboembolism of peripheral vessels) or infective endocarditis. It is necessary to timely recognise Lambl’s excrescences in order to choose the tactics of patient management.

Рачок, С. М. Профилактика прогрессирования атеросклеротического процесса у пациентов, перенесших острый коронарный синдром: фокус на гиполипидемическую терапию (обзор литературы) / С. М. Рачок // Кардиология в Беларуси. – 2024. – Т. 16, № 2. – C. 213–221. (Prevention of atherosclerotic progression in patients with acute coronary syndrome: focus on hypolipidaemic therapy (literature review))

The pathological process leading to atherosclerosis is complex. At the same time, dyslipidaemia associated with increased levels of atherogenic lipoproteins in plasma or functional impairment of antiatherogenic lipoproteins fits perfectly into the concept of chronic inflammation and retains a key role in the development and progression of atherosclerosis. Treatment of dyslipidaemia in patients with acute coronary syndrome is performed according to current guidelines with a combination of pharmacological interventions and lifestyle modification. Currently used hypolipidaemic drugs, primarily statins, are the main drugs for secondary prevention of coronary heart disease due to their role in cholesterol lowering and pleiotropic effects.

Якубова, Л. В. Эффективность применения статинов для первичной и вторичной профилактики инсульта: обзор литературы / Л. В. Якубова // Кардиология в Беларуси. – 2024. – Т. 16, № 2. – C. 222–229. (Efficacy of statins for primary and secondary prevention of stroke: literature review)/strong>

Stroke is the second leading cause of death worldwide with an annual mortality of about 5.5 million people. People who have had an ischaemic stroke (IS) are at increased risk not only for recurrent stroke but also for cardiovascular events. Current American Heart Association (AHA)/American Stroke Association (ASA) guidelines recommend prescribing statins only for stroke of atherosclerotic aetiology, while European Stroke Organisation (ESO) guidelines recommend prescribing statins regardless of aetiology. The aim of this literature review was to analyse the evidence from studies on the validity of statins for primary and secondary prevention of stroke. The literature review we performed allowed us to draw the following conclusions: 1. The prescription of statins for primary stroke prevention should be based on known risk factors, low-density lipoprotein (LDL) levels and high-sensitivity C-reactive protein, which acts as a diagnostically significant biomarker of IS. 2. Patients with atrial fibrillation need long-term statins for both primary and secondary prevention of stroke, independent of anticoagulant therapy, because of the clear benefit of statin therapy in reducing the risk of ischaemic and haemorrhagic events and death. 3. The research evidence we have presented is strong in favour of the need to prescribe statins to all patients with a history of stroke, irrespective of its aetiology, as outlined in the ESO guidelines. 4. For patients who have had a IS/transient ischaemic attack, the target LDL cholesterol level is 1.8 mmol/l (70 mg/dl), in achieving which high-intensity statins are more effective than low- and moderate-intensity statins.

Стресс-эхокардиография в алгоритме диагностики острого коронарного синдрома без подъема сегмента ST низкого риска / Е. Е. Абраменко [и др.] // Кардиология. – 2024. – Т. 64, № 3. – С. 63–71. (Stress-echocardiography in low-risk acute coronary syndrome without persistent ST-segment elevation diagnostic algorithm)

This review addresses the capabilities of stress EchoCG as a simple, non-invasive, non-radiation method for diagnosing occult disorders of coronary blood flow in patients with non-ST-elevation acute coronary syndrome on a low-risk electrocardiogram. The capabilities of the enhanced stress EchoCG protocol are based on supplementing the standard detection of transient disturbances of local contractility, generally associated with coronary artery obstruction, with an assessment of the heart rate reserve, coronary reserve and other parameters. This approach is considered promising for a more complete characterization of heart function during exercise and an accurate prognosis of the clinical case, which allows determining the tactics for patient management not limited to selection for myocardial revascularization.

Милюков, В. Е. Морфофункциональный анализ роли эпикардиальной жировой ткани в формировании парадокса ожирения при хронической сердечной недостаточности / В. Е. Милюков, В. А. Брюханов, К. К. Нгуен // Кардиология. – 2024. – Т. 64, № 3. – С. 72–80. (Morphofunctional analysis of the role of epicardial adipose tissue in the formation of the obesity paradox in chronic heart failure)

Based on the available modern medical literature, the article summarizes data on the morpho-functional significance of epicardial adipose tissue (EAT) in health and heart failure, analyzes the likelihood and reliability of the formation of the obesity paradox, and also discusses its possible morpho-functional mechanisms. The authors reviewed and analyzed the consequences of the obesity paradox in the aspect of the normal EAT phenotype protectivity. The review proposed ways of further research in this direction aimed at a deep anatomical and physiological analysis and at determining the morpho-functional role of EAT in the adaptive mechanisms of myocardial trophic provision, which may be an important part of the pathogenetic connection between obesity and CHF and, therefore, can improve outcomes in such patients.

Антифибротические эффекты ингибиторов натрий-глюкозного котранспортера 2 типа у пациентов с сердечной недостаточностью / Ю. С. Игнатова [и др.] // Российский кардиологический журнал. – 2024. – Т. 29, № 1. – С. 82–88. (Antifibrotic effects of sodium-glucose cotransporter 2 inhibitors in patients with heart failure)

Heart failure (HF) is an urgent public health problem worldwide. A fundamental role in HF progression is played by fibrosis, which causes structural myocardial and vascular changes. In this regard, it seems relevant to search for pathogenetically justified HF therapy, aimed at slowing the myocardial fibrosis progression. The results of EMPA-REG OUTCOME study showed that glucose-lowering drugs, namely sodium-glucose cotransporter 2 (SGLT2) inhibitors, have a positive effect on HF course, reducing cardiovascular mortality and hospitalization rate of patients for decompensated HF. Large-scale studies showed the antifibrotic properties of SGLT2 inhibitors. The review article presents the results of experimental studies on the use of SGLT2 inhibitors in animals. A number of mechanisms for the implementation of the antifibrotic properties of SGLT2 inhibitors affecting the cardiovascular system have been described. It seems relevant to further study SGLT2 inhibitors in clinical trials in order to identify and correct the pathogenetic mechanisms of myocardial fibrosis.

ПревентС-Врач® – новая цифровая технология поддержки мероприятий по профилактике сердечно-сосудистых заболеваний в рутинной клинической практике / М. А. Кравченко [и др.] // Анналы клинической и экспериментальной неврологии. – 2024. – Т. 18, № 1. – С. 88–97. (PreventS-MD®: a new digital technology to maintain cardiovascular prevention in routine clinical practice)

Stroke, myocardial infarction (MI), and other main non-communicable diseases (NCDs) remain major causes of mortality and disability globally. Up to 80% of cardiovascular events and up to 60% of NCDs are associated with potentially controlled risk factors (RFs). State-of-the-art digital technologies can help bridge the gap between evidence-based prevention methods and their critically low availability in routine clinical practice. An innovative digital platform named PreventS-MD® is a specially developed tool for healthcare professionals to be used under time constraints. With PreventS-MD®, clinicians can estimate patient’s 10-year cardiovascular risk within several minutes. Then, they automatically get adapted results and recommendations to address identified RFs as well as graphical representation of specific RF contribution to overall stroke and MI risks. If some additional time is available, the clinician and the patient can collaboratively set customized achievable goals to correct modifiable RFs. An integrated analytical module provides healthcare managers with current digital risk profiles of the relevant population to evaluate prevention effectiveness and to forecast the load throughout the healthcare levels. PreventS-MD® has several unique advantages, including time-saving design, the function to activate motivated RF correction, individually tailored recommendations, and information on personally changed digital profiles of vascular risks. As cardiovascular diseases and main NCDs have a lot of common RFs, PreventS-MD® implemented into routine clinical practice will utilize a complex approach to the prevention of main NCDs, decreasing both stroke and MI burden and addressing complications of chronic pulmonary and kidney disease, tumors of any type, dementia, etc.

Особенности артериальной гипертензии в эру пандемии COVID-19: общность патогенетических звеньев АГ и SARS-CoV-2 / С. А. Бернс [и др.] // Кардиология. – 2024. – Т. 64, № 4. – С. 72–78. (Features of the course of arterial hypertension in the era of the COVID-19 pandemic: Common pathogenetic links between hypertension and SARS-CoV-2)

The aim of this review was to present the mechanism of infection with severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) and its possible effect on the course of arterial hypertension. Another aim was to evaluate the relationship of the renin-angiotensin-aldosterone system with the pathogenetic stages of infection caused by SARS-CoV-2 virus.