Chronic Heart Failure in Patients Hospitalized in 2002 and 2021: Comparative Analysis of Prevalence, Clinical Course and Drug Therapy.

AIM: Comparative analysis of the prevalence of chronic heart failure (CHF), clinical and medical history data, and drug therapy of patients admitted to a cardiology hospital in 2002 and 2021. MATERIAL AND METHODS: The study analyzed the medical records of patients with a confirmed diagnosis of CHF who were admitted in 2002 (n=210) and 2021 (n=381) to a specialized cardiology hospital. RESULTS: According to medical records of 2021, the proportion of patients with a confirmed diagnosis of CHF (87.6%) in the cohort of patients admitted to a cardiology hospital was twice as high as in 2002 (46.4%; p<0.001). The majority of patients with CHF in the study sample were patients with preserved left ventricular ejection fraction (HFpEF). The proportion of such patients significantly increased to reach 75.9% in 2021 compared to 58.6% in 2002 (p<0.001). At the same time, the number of severe forms of CHF (NYHA functional class (FC) IV) decreased by 10% and was 13.2% in 2002 and 1.3% in 2021 (p<0.001). In the majority of patients, ischemic heart disease (98.1 and 91.1% in 2002 and 2021, respectively, p<0.001) and hypertension (80.5 and 98.2%, respectively, p<0.001) were diagnosed as the cause for CHF. Furthermore, the incidence of comorbidity increased significantly: atrial fibrillation was detected in 12.3% of patients in 2002 and 26.4% in 2021 (p < 0.001); type 2 diabetes mellitus, in 14.3 and 32% of patients (p <0.001); and obesity, in 33.3 and 43.7% of patients, respectively (p=0.018). The frequency of using the major groups of drugs increased during the analyzed period: renin-angiotensin-aldosterone system blockers were administered to 71.9% of patients in 2002 and to 87.7% in 2021 (p<0.001); beta-blockers were administered to 53.3 and 82.4% of patients (p<0.001); and mineralocorticoid receptor antagonists, to 1.9 and 18.6% of patients, respectively (p=0.004). CONCLUSION: In 2021, the proportion of patients with a confirmed diagnosis of CHF in the patient cohort admitted to a cardiology hospital was twice as high as in 2002; the phenotype with preserved left ventricular ejection fraction predominated in the CHF structure. During the analyzed twenty-year period, the prevalence of comorbidities increased among CHF patients. The prescription frequency of pathogenetic evidence-based therapy has significantly increased by 2021, however, it remains insufficient even in patients with CHF with reduced left ventricular ejection fraction.

[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.

[Repeated Coronary Artery Bypass Surgery 18 Years After the Primary Revascularization of Myocardium in a Patient With Acute Coronary Syndrome Without the Segment ST Elevation].

This article describes a clinical case of successful repeated coronary bypass grafting 18 years after the initial surgery in a patient with non-ST-elevation acute coronary syndrome.

Association of coronary microvascular dysfunction and cardiac muscle injury in acute myocardial infarction: results of comparison of dynamic SPECT and cardiac MRI.

Aim      To study the interrelation of changes in coronary microcirculation by data of dynamic single photon emission computed tomography (SPECT) and myocardial injury by data of magnetic resonance imaging (MRI) in patients with acute myocardial infarction (AMI).Material and methods  The study included patients admitted to the emergency cardiology department with new-onset AMI. Contrast-enhanced cardiac MRI was performed for all patients on day 2-7 of admission. Dynamic SPECT of the myocardium with evaluation of semiquantitative and quantitative parameters of perfusion was performed on day 7-10.Results All patients were divided into two groups based on the type of MR contrast agent accumulation: 1) patients with the ischemic type of contrast enhancement (n=34; 62 %); 2) patients with the non-ischemic type of contrast enhancement (n=21; 38 %). According to data of myocardial perfusion scintigraphy (MPS), the group of ischemic MR pattern had larger perfusion defects at rest and during a stress test. Moreover, this group was characterized by lower global stress-induced blood flow and absolute and relative myocardial flow reserve (MFR). When the study group was divided into patients with transmural (n=32; 58 %) and non-transmural (n=23; 42 %) accumulation of the MR-contrast agent, lower values of global stress-induced blood flow and of absolute and relative MFR were observed in the group of transmural MR-enhancement pattern. A moderate inverse correlation was found between the stress-induced myocardial blood flow and the volume of myocardial edema (r= -0.47), infarct area (r= -0.48) and microvascular obstruction area (r= -0.38).Conclusion      The variables of dynamic SPECT characterizing microcirculatory disorders that are independent on or due to injuries of the epicardial coronary vasculature reflect the severity and depth of structural changes of the myocardium in AMI. In this process, quantitative variables of myocardial perfusion are interrelated with the myocardial injury more closely than semiquantitative MPS indexes. The findings of the present study can also contribute to the heterogenicity of a patient group with acute coronary syndrome and AMI. Further study is required for understanding the prognostic significance of dynamic SPECT parameters.

[Complete atrioventricular block as the first manifestation of dermatomyositis].

Dermatomyositis is a rare systemic autoimmune disease characterized by primary damage of the skin and striated muscles with the development of chronic muscle weakness. Due to the polymorphic nature of the clinical picture, early diagnosis of dermatomyositis is challenging since patients may visit different specialists depending on predominating symptoms. This entails a late diagnosis and, as a result, the absence of necessary treatment. The article presents a clinical case of a late diagnosis of dermatomyositis, which resulted in the development of autoimmune myocarditis with complete atrioventricular block in a female patient.

[Intra-aortic balloon pump in patients with myocardial infarction and cardiogenic shock of stages A and B].

This article presents two clinical cases of patients with myocardial infarction and stage A (at risk) and B (beginning) cardiogenic shock who underwent intra-aortic balloon counterpulsation (IABP). In patients with a high risk of classic cardiogenic shock and/or the no-reflow phenomenon, stenting of the infarct-related coronary artery during this type of mechanical circulatory support was performed without complications. Theoretical and practical aspects of using IABP at different stages of cardiogenic shock are discussed.

[Regional Vascular Center in a COVID-19 pandemic: what changed in 2020 compared to 2019 in patients with ST Elevation Myocardial Infarction?]

AIM: To assess the effect of pandemic COVID-19 on the course of STEMI patients of the Regional Vascular Center in 2020, compared with the previous year. MATERIALS AND METHODS: Patients with acute coronary syndrome and, in particular, STEMI hospitalized at Regional Vascular Center in 2019 and 2020. RESULTS: In 2019, 981 patients with STEMI were admitted; in 2020 - 728 patients. The baseline clinical and demographic patients characteristics did not differ significantly. In 2020, the number of pneumonia has doubled, the number of mechanical ventilator support has increased by 20%; sepsis was diagnosed 5 times more often. However, patients in 2020 were less likely to develop delirium, minor and major bleeding. There were more patients admitted in the 1st day of the disease, and they were more frequently performed both primary angioplasty and angioplasty in general. Patients with STEMI in 2020 had more frequently registered pulmonary edema, cardiogenic shock and re-infarction. Lethality in the group of patients without angioplasty tended to be higher in 2020 compared with the previous year. None of 30 patients with COVID-19 died in our department, they were timely transferred either to COVID-hospital or to outpatient follow-up care. When analyzing various parameters during the spring and autumn periods, which were the peak periods for pneumonias in 2020, only mortality had a clear upward trend. CONCLUSION: The patient portrait of myocardial infarction in 2020 was dominated by pneumonia, sepsis, and re-infarction compared with the previous year. An upward trend in mortality was detected in those without angioplasty and those hospitalized in the spring and autumn wave of COVID-19. We believe that there are hidden mechanisms of pandemic effect on mortality in STEMI.

Subacute myocardial infarction detected by technetium-99m-labeled somatostatin analog scintigraphy.

Recently, the applicability of somatostatin receptor-targeted (SSTR-t) radiotracers for post-ischemic myocardial inflammation imaging has been shown using PET. Currently, there are no studies which demonstrate ability of SPECT and technetium-99m SSTR-t radiotracers to detect inflammation, which appears in response to acute myocardial infarction (AMI). A case of 51-year-old male with acute anterior myocardial infarction (AMI) with ST elevation has been presented. This patient on 7th day after AMI onset underwent SPECT/CT (by cardiac cadmium-zinc-telluride gamma-camera) with 99mTc-Tectrotide, cardiac MRI with gadolinium and, on 9th day after AMI, myocardial perfusion scintigraphy (MPS) at rest. Clear myocardial uptake of 99mTc-Tectrotide, predominantly in apical and intermediate anterior wall of left ventricle was detected. The uptake matched with areas of hypoperfusion (by SPECT) and myocardial injury (by MRI). This case demonstrated the applicability of technetium-99m-labeled SSTR-t radiotracers for post-infarction inflammation imaging. Currently assumed, that SSTR-t radiotracers reflect an increased number of activated macrophages infiltrating infarcted myocardium, which is not possible using any other imaging technique. Thus, potentially, SSTR scintigraphy may be useful for diagnosis and monitoring of myocardial post-infarction inflammation as well as for anti-inflammatory image-guide therapy assessment.

Impact of microvascular injury various types on function of left ventricular in patients with primary myocardial infarction with ST segment elevation.

AIM: To analyze the long-term effect of microvascular injury various types on the structural and functional parameters of the left ventricle assessed by echocardiography in patients with primary ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who underwent stenting of the infarct-associated coronary artery. Each patient included in the study underwent CMR imaging on the second day post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. Subsequently, all patients underwent the standard echocardiographic protocol on the 7th day and 3 months after MI. RESULTS: We divided all patients into 4 groups: the 1st group didn't have any phenomena of IMH and MVO, the 2nd group had only MVO, patients of the 3rd group had only IMH and in the 4th group there was a combination of MVO and IMH. LV ejection fraction was significantly lower in patients with combination of MVO and IMH, if compared to those without it. Correlation analysis showed a moderate inverse correlation between the MVO area and LV contractile function: the larger the area, the lower the LVEF (R=-0,60; p=0,000002). CONCLUSIONS: The combination of IMH and MVO is a predictor of a reduction in LVEF and an increase of volumetric measurements within 3 months after MI. In comparison with patients without microvascular injury isolated MVO is associated with lower LVEF. The size of MVO is directly correlated with the LV contractile function decrease. Isolated IMH was not associated with deterioration of left ventricular function.

[Central hemodynamic monitoring in patients with cardiogenic shock].

Cardiogenic shock is the pathology most commonly encountered by intensive care physicians. Its frequency averages 410% in STEMI (ST-elevation myocardial infarction) patients and 24% in NONSTEMI (non-ST-elevation myocardial infarction) patients. Effective shock therapy is impossible without understanding the hemodynamic mechanisms of its occurrence. Many authors emphasize that cardiac output is the most important indicator of cardiac function, which necessitates its monitoring. Meanwhile, the cardiac output monitoring is associated with a number of difficulties, including those related to the technology of recording this function. In this article, the authors emphasize the importance of measuring central hemodynamic parameters in patients with predominantly cardiogenic shock. We have tried to structure the knowledge about different techniques of central hemodynamics monitoring, considered advantages and disadvantages of each of them. We believe that the data obtained by hemodynamic monitoring should be closely studied and used, because sometimes multidirectional mechanisms may be involved in the genesis of shock; therefore, therapy should be based on the data obtained in a particular patient.

[Peripartum cardiomyopathy or takotsubo cardiomyopathy? The clinical case with arterial hypotension and pulmonary edema].

A 29-year old female patient without a history of cardiovascular diseases was admitted on emergency to a surgical hospital with acute calculous cholecystitis in 3 months after uncomplicated term birth. During laparoscopic cholecystectomy, she developed arterial hypotension with pulmonary edema, which required intravenous sympathomimetics. On the next day, after improvement of the condition and stabilization of hemodynamics, cardiac ultrasound showed diffuse left ventricular (LV) hypokinesis with the ejection fraction (EF) of 38 %. Electrocardiogram detected transient left bundle branch block followed by persistent negative T waves in leads I, aVL, and V2 V6. Troponin I concentration was increased to 1.2 ng /ml. Beta-blocker and angiotensin-converting enzyme inhibitor were administered. At 10 days, the LV contractile function completely recovered with LV EF of 59 %. Magnetic resonance imaging did not reveal any signs of myocardial infarction or myocarditis. A differential diagnosis was performed between peripartum cardiomyopathy and Takotsubo syndrome. Considering the fast recovery of LV systolic function, the patient was discharged with a diagnosis of Takotsubo syndrome.

The main pulse of the Siberian Traps expanded in size and composition.

Emplacement of large volumes of (sub)volcanic rocks during the main pulse of the Siberian Traps occurred within <1 m.y., coinciding with the end-Permian mass extinction. Volcanics from outside the main Siberian Traps, e.g. Taimyr and West Siberia, have since long been correlated, but existing geochronological data cannot resolve at a precision better than ~5 m.y. whether (sub)volcanic activity in these areas actually occurred during the main pulse or later. We report the first high precision U-Pb zircon geochronology from two alkaline ultramafic-felsic layered intrusive complexes from Taimyr, showing synchronicity between these and the main Siberian Traps (sub)volcanic pulse, and the presence of a second Dinerian-Smithian pulse. This is the first documentation of felsic intrusive magmatism occurring during the main pulse, testifying to the Siberian Trap's compositional diversity. Furthermore, the intrusions cut basal basalts of the Taimyr lava stratigraphy hence providing a minimum age of these basalts of 251.64 ± 0.11 Ma. Synchronicity of (sub)volcanic activity between Taimyr and the Siberian Traps imply that the total area of the Siberian Traps main pulse should include a ~300 000 km2 area north of Norilsk. The vast aerial extent of the (sub)volcanic activity during the Siberian Traps main pulse may explain the severe environmental consequences.

[Hemostatic Gene Polymorphisms in Acute Coronary Syndrome with Nonobstructive Coronary Atherosclerosis].

PURPOSE: to study distribution of genes of the coagulation system, unfavorable in relation to the risk of thrombosis, and their influence on serum parameters ofthe hemostasis system in patients with nonobstructive coronary atherosclerosis (NCA) and acute coronary syndrome (ACS). MATERIALS AND METHODS: We included in this nonrandomized open study patients with ACS older than 18 years with intact coronary arteries or confirmed at coronary angiography stenosis <50%. Genotypes of these patients were analyzed by 8 polymorphic variants of the hemostatic system genes which previously were found to be associated with the thrombophilia risk: F2 (20210 G>A) rs1799963, F5 (1691 G>A) rs6025, F7 (10976G>A) rs6046, F13 (163 G>T) rs5985, F1 (-455G>A) rs1800790, GP Ia - Ila (807C>t) rs1126643, GP Ilb-IIIa (1565 T>C) rs5918, PAI-I (-6755G>4G) rs1799889. Activities of protein C, Von Willebrand factor, plasminogen, and antithrombin III were also determined. RESULTS: Of 913 patients with ACS in 30 (3.3%) with mean age 54±11 years we detected NCA. Acute myocardial infarction (AMI) was diagnosed in 24 (80%), unstable angina - in 6 (20%) patients. Only in 1 patient we found no carriage of thrombosis associated genotypes. The frequency of occurrence of the heterozygous genotype of the factor V gene was 1 (3%). Heterozygous genotype of the factor XIII was registered significantly more often in patients with present atherosclerotic lesion compared with those with intact coronary arteries. Mean activity of protein C was 103% [90; 110], antithrombin III - 96% [88; 103], Von Willebrand factor - 137% [114; 162], plasminogen - 109% [102; 112]. At admission lowering of antithrombin III and protein C activities was detected in 4 cases (13%). In dynamics level of these parameters was restored. Elevation of Von Willebrand factor activity at admission was detected in 14 cases (14%) and remained elevated one year after the index event. There was no association between of fibrinogen level, protein C activity, rs1800790 and rs6025 gene polymorphisms, respectively. One-year mortality was 7% (n=2). For one year occurred 1 AIM recurrence (3%), heart failure developed in 15 patients (50%), 11 patients (37%) were repetitively hospitalized due to all causes. No association was revealed between activity of studied blood serum markers and 1 -year outcomes (death, re-AIM, rehospitalization). CONCLUSION: Among ACS patients 3.3% had NCA, what corresponded to the literature data. Carriage of at least 1 polymorphic variant of 8 thrombosis associated genes of the coagulation system was found in 97 % of patients with ACS and NCA. Distribution of these variants was like that in the European population and in patients with AIM at the background of stenosing atherosclerosis. Level of serum markers did not depend on distribution of polymorphic variants of the coagulation system genes, and presence of atherosclerotic coronary artery lesions. There was no association between hospital and long-term outcomes and distribution of polymorphic variants of thrombosis associated coagulation system genes, as well as levels of blood serum markers.

[Successful experience in the correction of post-infarction ventricular septal defect].

Rupture of the interventricular septum (MVP) as a complication of acute myocardial infarction is a rare event and associated with high mortality without timely surgical treatment. We present a case of a 68-year-old patient who had an acute myocardial infarc­ tion with ST-segment elevation complicated by a rupture of MVP. In this article we discusse the difficulties of patient management with this pathology and the problem of choice of treatment tactics.

[Multiplex analysis on the luminex platform in complex estimation of cardiovascular biomarker dynamics in patients with acute myocardial infarction.]

The multimarker approach more accurately reflects the key mechanisms of pathogenesis and biochemical interactions, compared with the use of individual indicators. It is a reason of steadily growing interest in the development and use of various combinations of biomarkers in assessing the prognosis and stratification of cardiovascular risk in patients with a wide range of cardiological profiles. Multiplex analysis technology on the Luminex platform is the best tool for the simultaneous quantitative determination of a complex of different biomarkers in a single. Using the MILLIPLEX® MAP Human Cardiovascular Disease Panel, a multiplefold increase of FABP, Troponin I, CK-MB, BNP, Nt-proBNP, BNP in the first 24 hours after MI, decreasing in 6 months with a high degree of confidence, was shown. There were no differences in the content of LIGHT between the stages of observation, as well as in comparison with the reference range. The content of LIGHT on the first day of MI showed strong positive associations with markers of damage of myocardium and myocardial stress. On the first day of MI, a significant increase in the content of ESM-1, decreasing in 6 months after MI to the reference values was found. Strong positive associations of ESM-1 with Troponin I and BNP levels were established. A significant increase of proinflammatory cytokine OSM on the first day of MI, decreasing in the late post-infarction period to reference values was shown. Correlation analysis revealed direct relationships of OSM with Troponin I, CK-MB, Nt-proBNP and BNP. The use of the MILLIPLEX® MAP Human Cardiovascular Disease Panel 1 diagnostic multimarker panel allowed for the simultaneous quantitative analysis of 11 biochemical parameters, associated with inflammation, atherogenesis, endothelial dysfunction, ischemia and myocardial necrosis. The results can be used to improve the effectiveness of complex diagnostics in patients with primary myocardial infarction with ST segment elevation.

[Inflammation as a universal pathogenetic link between injury, repair and regeneration, in acute coronary syndrome. From experiment to clinic].

Theory of atherogenesis and its complications underwent numerous changes. Today we observe that inflammation is a universal pathogenetic link between various processes such as atherosclerosis, rupture of atherosclerotic plaques and following myocardial infarction, post-infarction cardiac repair and heart failure. This review discusses examples, difficulties, and prospects of implementation of anti-inflammatory therapies in management of acute coronary syndrome and its complications.

[Cardiogenic Shock in Patients with Myocardial Infarction].

This review article contains presentation of modern diagnostic criteria and prognostic scales for cardiogenic shock in patients with myocardial infarction as well as analysis of current clinical guidelines. Main results of clinical trials underlying recommendations of these guidelines are discussed. The article focuses on controversial and unfounded recommendations and issues requiring further research.

[Detection of Antigens of Cardiotropic Viruses in Atherosclerotic Plaques in Patients with Fatal Myocardial Infarction].

AIM: To assess the frequency of detection of cardiotropic virus antigens in coronary artery atherosclerotic plaques in patients with fatal myocardial infarction (MI). MATERIALS AND METHODS: We examined fragments of coronary plaques of 12 patients with fatal type 1 MI. Immunohistochemistry (IHC) of plaques was performed with the paraffin blocks using antibodies to Herpes simplex virus (HSV)-1, HSV-2, HSV-6, cytomegalovirus (CMV), parvovirus B19, adenovirus, Epstein-Barr virus and enteroviruses. RESULTS: According to the IHC all patients had virus antigens. The most common virus agents in fragments of coronary plaques were HSV-6 (10 patients) and enteroviruses (5 patients). Antigens of CMV, parvovirus B19, adenovirus, Epstein-Barr virus were not detected in any case. CONCLUSIONS: In this study viral antigens in coronary artery atherosclerotic plaques were found in all victims of fatal MI. There was no difference in the frequency of detection and type of viral agents between plaques in culprit arteries and uncomplicated atherosclerotic plaques.

[Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock Due to Fulminant Myocarditis].

This article presents a clinical case of a 40-year-old woman with fulminant myocarditis which progressed rapidly to the development of cardiogenic shock resistant to standard intensive care, but with a positive response to extracorporeal membrane oxygenation.

[Dynamics of brain CD68+ and stabilin-1+ macrophage infiltration in patients with myocardial infarction].

Te aim of the study was to evaluate the temporal dynamics of brain CD68+ and stabilin-1+ macrophage infltration in patients with fatal myocardial infarction (MI) type 1. MATERIALS AND METHODS: Te study included 31 patients with fatal MI type I. Te control group comprised 10 patients of 18-40 age group who died from injuries incompatible with life. Patients with MI were divided into two groups. Group 1 comprised patients who died during the frst 72 hours of MI, group 2 comprised patients who died on days 4‒28. Macrophage infltration in the brain was assessed by immunohistochemical analysis. We used CD68 as a marker for the cells of the macrophage lineage and stabilin-1 as an M2-like macrophage biomarker. RESULTS: In group 1 the number of brain CD68+ macrophages was signifcantly higher than in the control group. In group 2 the intensity of brain CD68+ cells infltration was lower than in group 1 and higher than in the control group. Tere was a small amount of stabilin-1+ macrophages in the brain of healthy people, as well as of patients who died from MI. Tere were no signifcant differences in the number of stabilin-1+ cells between group 1 and group 2. Correlation analysis revealed the presence of positive correlation between the number of CD68 + macrophages in the infarct, peri-infarct, and non-infarct areas of the myocardium and the number of CD68+ macrophages in the brain in patients with MI. Tere were not correlations between the number of CD68 + and stabilin-1+ cells and the presence of diabetes mellitus, history of stroke, history of MI, and pre-infarction angina. CONCLUSION: Te number of brain CD68+ macrophages signifcantly increased during the frst three days of MI. Te number of brain stabilin-1+ macrophages did not increase and did not differ from the control values. We observed a positive correlation between the number of CD68+ macrophages in the brain and myocardium.