Dyspnea is one of the most common symptoms in patients with various diseases. Dyspnea in stable ischemic heart disease (IHD), especially in a patient with prior myocardial infarction, is in most cases considered as a manifestation of congestive heart failure (CHF). And often practicing physicians do not think about the possibility of another genesis of dyspnea in their patients. This may lead to overdiagnosis of CHF. The review presents data on the occurrence, prognostic significance, classification features, as well as methods of dyspnea evaluation in therapeutic patients. The peculiarities of dyspnea genesis in patients with IHD, CHF, as well as in elderly patients are described. The absence of a universal and accessible method of dyspnea assessment complicates its differential diagnosis, especially in patients with a combination of pathology of respiratory and cardiovascular systems. Further research is needed to develop methods of complex assessment of dyspnea in patients with cardiovascular and other diseases in different age groups.

Heart failure is considered as a terminal stage of the cardiovascular continuum, beginning with exposure to risk factors followed by the development of asymptomatic cardiovascular damage, progressing to clinically manifest disease. Conventional risk factors such as arterial hypertension, dyslipidemia, obesity, and diabetes mellitus, on the one hand, directly cause structural and functional changes in the heart, and on the other hand, contribute to the development and progression of atherosclerosis. Despite the fact that the multifocal nature of atherosclerosis is well known, research data on the role of peripheral arterial atherosclerosis in the development of heart failure are extremely limited. The study of potential relationships between atherosclerosis of peripheral arteries and heart failure is relevant in all sex and age groups of patients.

Objective: to evaluate the significance of preoperative plasma galectin-3 levels for predicting postoperative atrial fibrillation (AFP) in a cohort of patients who underwent elective heart surgery.

Materials and methods: this prospective observational single-center cohort study was conducted at the Research Institute – Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky, Krasnodar. In the period from September 1, 2023 to February 1, 2024, all patients admitted for elective coronary artery bypass grafting and/or valve surgery (valve replacement or reconstruction) were included in this study. In the early postoperative period, POAF developed in 158 patients, who formed the main group A, and from 436 patients with sinus rhythm, a control group B was generated using a random number generator, comparable with the main group in the number of observed patients and amounted to 160 patients.

Results: the onset of POAF from the beginning of the operation is 66.2±41.7 hours (on average, on the 3rd day, minimum 1 hour, maximum 166.5 hours, i.e. on the 7th day). When comparing laboratory data in patients before the operation (blood sampling was performed 12–24 hours before cardiac surgery), a statistically significant factor associated with the development of POAF was the level of galectin-3 in the blood (2.1±1.99 ng/ml in patients from group A, 1.87±1.64 ng/ml in patients from group B, p 0.01). Moreover, the blood galectin-3 level in patients with POAF significantly increased in the early postoperative period (up to 2.75±2.1 ng/ml, p <0.001), which was confirmed by the ROC curve (the area under the AUC curve was 0.522 (AUC: 0.522, 95% CI: 0.457–0.588; P =0.033)).

Conclusions: preoperative plasma galectin-3 levels have an independent value for predicting POAF and can serve as a useful prognostic parameter in a multimodal approach to risk assessment in the era of personalized treatment.

Objective: to evaluate the feature of microcirculation condition and left ventricle remodulation type in patients with arterial hypertension (AH) and lower extremity arteries atherosclerosis (LEAA).

Materials and methods: one hundred patients from 45 to 65 years old were included in this research. The main group consisted of 50 patients with arterial hypertension and lower extremity arteries atherosclerosis and the control group included 50 patients with AH and without LEAA. Laser doppler flowmetry and echocardiography were performed for all patients.

Results: there were lower values of microcirculation index (26,54[10,51–29,25] vs 37,3[26,59–40,24], р=0,0001), Am (0,25[0,22–0,32] vs 0,36[0,35–0,48], р=0,001) и Аe (0,47[0,42–0,47] vs 0,50[0,50–0,58], р=0,001), capillary reserve (134,5[126,7–151,8] vs 166,4[153,2–166,4], р=0,001). Breathe test index (41[17,93–77,74] vs 47,7[19,93–47,76], р=0,013) and higher value of bypass indicator (1,95[0,63–2,26] vs 1,31[1,13–1,31], р=0,0001) in patients with arterial hypertension and lower extremity arteries atherosclerosis compared to patients with isolated AH. Spastic (46% vs 14% р=0,0002) and spastic–atonic (30% vs 0%, р=0,0001) microcirculation types were reliably more often in main group compared to control group, whereas normal (0 vs 38%, p=0,0001) and stagnant (24% vs 48%, р=0,001) types were reliably rare. Concentric (62% vs 38%, р=0,004) and eccentric (8% vs 0%, р=0,0001) left ventricle hypertrophy (LVH) were found veraciously more frequently in patients with arterial hypertension and LEAA than in patient with AH and without LEAA. The binary logistic regression model was performed. It was determined that LVH risk was higher due to microcirculation index and capillary reserve decreasing in patients with arterial hypertension and lower extremity arteries atherosclerosis.

Conclusion: spastic and spastic–atonic microcirculation types were reliably more often in main group compared to control group Endothelial disfunction, decreased tissue perfusion increased microcirculatory bypass and blood stagnation were detected in patients with AH and LEAA compared to patients with isolated AH. Concentric and eccentric left ventricle hypertrophy were found veraciously more frequently in patients with arterial hypertension and LEAA than in patient with AH and without LEAA and the risk of LVH was depended on microcirculation index and capillary reserve in patients of the main group.

Objective: to determine the relationship between parameters body composition, clinical status, laboratory parameters and severity of painful symptoms in patients with chronic heart failure.

Materials and methods: the study involved 298 patients with CHF. The body composition was assessed: the presence of sarcopenia and obesity (with the calculation of the muscle mass index IMM/BMI), functional class, left ventricular ejection fraction, markers galectin-3, hsСRP, Na-proBNP, Bartel index. A 10-point Edmont scale was used to assess the severity of painful symptoms. A factor analysis was performed, as well as a Pearson correlation analysis.

Results: the study revealed 5 components: A factor of adequacy of muscle functions, a factor of systolic dysfunction, a factor of impaired functional status, a factor of functional activity, and an age factor. The conducted correlation analysis showed the presence of links between the components and the severity of painful symptoms of moderate and mild severity.

Conclusion: the body composition of patients is associated with the severity of painful symptoms in patients with CHF who need palliative care. It is necessary to take into account body composition when developing algorithms for managing patients with CHF at the stage of palliative care.

Objective: to compare metabolic parameters and adipokine levels in cardiorenal metabolic syndrome (CRMS) stages 1 and 2 in young individuals aged 25–44 years.

Materials and methods: a cross-sectional study based on a prospective cohort study included 120 people aged 25–44 years: group 1 (controls) — young individuals without cardiometabolic risk factors, stage 0 (n=40), group 2 — young individuals with CMS stage 1 (n=40), group 3 — young individuals with CMS stage 2 (n=40).

Results: the most significant differences in the groups with stage 1 and 2 CRMS were observed for HOMA-IR index, glycosylated hemoglobin, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, triglycerides, and uric acid in comparison with the control group. The most common cardiometabolic risk factors in the group with stage 2 CRMS were overweight/obesity, hyperlipidemia, hyperglycemia, arterial hypertension, hyperuricemia, and a burdened heredity for cardiovascular diseases. The serum concentration of leptin was highest in women with stage 1 and 2 CRMS, whereas the serum concentration of adiponectin was lower in all individuals with stage 1 and 2 CRMS than in the control group, with no gender differences.

Conclusion: modern approaches to the stages of CRMS contribute to the integration of cardiovascular diseases and metabolic disorders as components of a single pathophysiological process. They also allow a comprehensive and quantitative assessment of the likelihood of cardiovascular disease and type 2 diabetes mellitus. Measuring serum cytokine levels can serve as an effective tool for assessing overall cardiometabolic risk and predicting the development of cardiovascular diseases and type 2 diabetes mellitus.

Objective: to determine the level of cerebral natriuretic peptide (CNP) and markers of systemic inflammation in the dynamics of treatment of CAP in patients with GERD.

Materials and methods: 84 patients with CAP were studied at an average age (42.3±2.9) years, including 44 men and 40 women who were treated in a therapeutic hospital. All patients with VP had a mild course. Among patients with CAP, 48 were diagnosed with GERD (main group), 36 patients had no symptoms of GERD (comparison group 1). Comparison group 2 consisted of 36 patients with GERD without CAP. In addition to conventional examination methods, all patients with CAP and GERD were assessed for CRP, procalcitonin (PCT), BNP (by its stable fragment NTproBNP), interleukins (IL)-1, IL-6, IL-8 at the start of therapy and before discharge.

Results: in all patients with CAP in combination with GERD, respiratory and dyspeptic symptoms were noted, along with symptoms of intoxication. Electrocardiography in patients with CAP in combination with GERD diagnosed low voltage voltage of QRS complexes, right ventricular extrasystoles, violations of the processes of repolarization of the left ventricle. During laboratory examination in patients with САP combined with GERD, a significant increase in the level of CRP, PCT, and proinflammatory cytokines was observed, which characterized a pronounced systemic inflammatory syndrome. At the same time, by discharge in patients with CAP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remained elevated, despite clinical recovery from CAP. Positive correlations were found between CRP and proinflammatory cytokines, which weakened by discharge. In patients with CAP combined with GERD and with only CAP, at the beginning of treatment, the level of NTproBNP was within the reference values, and by discharge it increased by 1.2 times, more significantly in patients with CAP combined with GERD.

Conclusions: the clinical course of САP in patients with GERD is characterized by respiratory and dyspeptic syndromes, as well as more frequent ECG changes in the form of extrasystole. In patients with САP combined with GERD, there is a pronounced systemic inflammatory syndrome with a significant increase in the concentration of CRP, PCT and proinflammatory cytokines in the blood compared with patients with САP without GERD. At the same time, by discharge in patients with САP combined with GERD, blood levels of CRP and IL-1, IL-6 and IL-8 remain elevated, despite clinical recovery from САP. An increase in the level of MNUP (according to a stable fragment of NTproBN) in patients with САP combined with GERD, which appeared during clinical recovery from САP, taking into account its pathogenetic role, should be considered as a risk factor for myocardial involvement in the preserved inflammatory process, which determines careful monitoring of the dynamics of CRP, MNUP (NTproBN), proinflammatory cytokines and the state of myocardial infarction in patients with GERD who underwent САP during the dispensary observation.

Aim: To study the variants of morphological changes in the lung using material from pathological autopsies of patients with blood diseases who died of COVID-19.

Materials and Methods: A retrospective morphological analysis of histological preparations of lung tissue was performed in a cohort of patients with blood diseases, using standard histological staining with haematoxylin and eosin and assessment of the state of alveolocytes of type 1 and 2, Mallory and Van Gieson staining to assess the state of connective tissue. The leukocyte profile of the lung tissue was studied by immunohistochemical analysis using antibodies of differentiation clones (CD) 4, 8, 20, 34 and collagen type IV.

Results: 22 fatal cases of patients with blood diseases who died of COVID-19 were analysed (13 men and 9 women); the mean age was 63 years. The selected cohort included non-neoplastic (myelodysplastic syndrome with multilineage dysplasia) and neoplastic blood disorders (chronic lymphocytic leukaemia, acute myeloid leukaemia, acute lymphoblastic leukaemia, multiple myeloma). Morphometric analysis revealed certain differences in the condition of the lung tissue. In the group with myelodysplasia, the morphological picture of lung tissue damage in COVID-19 is characterised by the destruction of alveolar tissue, the presence of single alveolocytes and the absence of neutrophils and macrophages. In chronic lymphocytic leukaemia, a disruption in the formation of hyaline membranes and the development of mycetomas, the appearance of lymphocytes of different sizes were observed. In lymphoma, the development of thrombus formation was observed against a background of decollagenisation of the vessel wall. In multiple myeloma, multinucleated alveolocytes formed as a result of viral metamorphosis were seen. In untreated patients, blasts were detected at the onset of acute myeloid leukaemia. Despite the diversity of the cohort, the immune response showed a universal response in the form of disappearance of CD4 and expression of CD8 and CD34 leukocytes in all cases considered. An individual feature in multiple myeloma was the positive expression of CD20+ leukocytes in lung tissue.

Conclusions: Lung damage in COVID-19 is characterised by differences in the state of the morphological picture depending on the oncohematological disease and the universality of the immune response, with a difference in patients with multiple myeloma in the form of increased expression of CD20+, probably due to the pathogenesis of myeloma and the accumulation of pathological clones of leukocytes.

Objective: identification of risk factors for long-term pain syndrome in patients with total hip replacement (TEP) and the possibility of managing them.

Material and methods: 122 patients were examined. Inclusion criteria: men and women aged 55-67 years, suffering from stage III osteoarthritis of the hip joint (OA TBS), compensated type 2 diabetes mellitus (DM), who signed an informed consent for dynamic follow-up. All patients were divided into 2 groups: group 1 (n=62) had a combination of OA TBS+DM, group 2 (n=60) included patients with OA TBS without DM. All the examined patients underwent an assessment of concomitant pathology, an anthropometric study with the calculation of body mass index, a study of morphometric parameters of the heart by echocardiography, as well as the calculation of glomerular filtration rate using the CKD-EPI formula. The presence of pain syndrome was assessed for more than 3 months after surgery. Statistical processing of the obtained data was performed using the package of licensed statistical programs STATISTICA 6.0 (StatSoftInc., USA).

Results: in our study, the risk of pain syndrome increased for more than 3 months: age, concomitant pathology (diabetes mellitus, hypertension, coronary heart disease, varicose veins of the lower extremities with thrombosis), duration of osteoarthritis of the hip joint, decreased GFR. In our work, the proportion of people with GFR <60 ml/min/1.73 m² was significantly higher among patients with OA TBS+DM, as well as with a duration of OA TBS for more than 10 years and the presence of DM, which can be explained by the negative effect on the kidneys of taking painkillers with long-term OA, as well as the influence of high levels blood glucose (against the background of concomitant diabetes) on the glomerular apparatus. Among patients with OA TBS+DM without SYSADOA, the proportion of people with GFR<60 ml/min/1.73 m2 was 3.1 times higher than among people with OA TBS without DM+ SYSADOA (p<0.05).

Conclusions: monitoring the intake of nonsteroidal anti-inflammatory drugs in the preoperative period, correction of concomitant pathology, as well as compliance with national recommendations for the treatment of coxarthrosis in terms of taking SYSADOA and physical exercises will reduce the risk of prolonged pain syndrome in the postoperative period of hip TEP.

Objective: to assess the effect of COVID-19 on the progression of NAFLD.

Materials and methods: a retrospective cohort study included 73 patients with NAFLD, of whom 22 had COVID-19 between March 2020 and February 2021. The diagnosis of NAFLD was established on the basis of clinical, laboratory and instrumental data. Anthropometric parameters, indicators of lipid and carbohydrate metabolism, markers of liver damage and systemic inflammation were evaluated. Transient elastography was used to determine the stage of liver fibrosis. 

Results: in patients with NAFLD who underwent COVID-19, there was a significant increase in body mass index (BMI) by 1.8 ± 0.9 kg/m² (p<0.001) and waist circumference by 4.3 ± 2.1 cm (p<0.001) compared with baseline values. At the same time, in the control group, the increase in BMI was only 0.4 ± 0.6 kg/m² (p= 0.132), and FROM — 1.1 ± 1.4 cm (p=0.083). The differences in the dynamics of anthropometric parameters between the main and control groups were statistically significant (p<0.001). ALT and AST levels in the group of patients with COVID-19 were higher than in the control group by 32.4% (p=0.002) and 28.7% (p=0.007), respectively. HOMA-IR and triglyceride indices also showed a statistically significant increase, compared with baseline data, by 38.6% (p<0.001) and 21.9% (p=0.011). The proportion of patients with liver fibrosis progression at stage 1 was 29.6% in the COVID-19 group versus 12.4% in the control group (HR=2.93; 95% CI: 1.76-4.88; p<0.001). Multivariate analysis showed that the severity of COVID-19 (HR=2.17; 95% CI: 1.24-3.79; p=0.006) and the initial stage of fibrosis (HR=1.84; 95% CI: 1.11-3.05; p=0.018) are independent predictors of NAFLD progression. 

Conclusion: The study demonstrated a significant impact of previous COVID-19 coronavirus infection on the course of NAFLD

Objective: to assess the effect of antiviral therapy on the clinical course and survival in patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C.

Materials and methods: a retrospective analysis of the medical histories of 325 patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C, who were on the waiting list for liver transplantation from 2014 to 2024. The patients were divided into 2 groups: patients who received antiviral therapy (n=273), and patients who did not receive antiviral therapy (n=52).

Results: in the group of patients who received antiviral therapy, 219 (80.2%) patients were alive at the time of the diagnosis, including 57 (20.8%) people achieved liver function compensation and were excluded from the waiting list for liver transplantation; 42 (15.3%) patients underwent liver transplantation. The dynamics of clinical and laboratory indicators in patients from this group improved. In the group of patients who did not receive antiviral therapy, 2 (3.8%) patients were alive at the time of the examination, none of the patients had achieved liver function recompensation. The dynamics of clinical and laboratory indicators in patients of this group worsened.

Conclusion: antiviral therapy has a positive effect on the survival of patients with cirrhosis of the liver in the outcome of chronic viral hepatitis C, as well as on the clinical course and laboratory parameters, which necessitates the earliest possible implementation of this therapy. Clinical and laboratory monitoring of these patients is also needed to prevent re-infection with viral hepatitis C, early detection of decompensation of liver function, and the occurrence of hepatocellular carcinoma.

Objective: to conduct a comparative assessment of adherence to the treatment of pregnant and non-pregnant reproductive age.

Material and methods: 115 women (60 pregnant and 55 non-pregnant) of reproductive age from 18 to 49 years old were examined. All patients completed an online electronic questionnaire of quantitative adherence to treatment with further automatic calculation of results and issuance of a conclusion. The prognosis of adherence to lifestyle modification (LSM), adherence to medical support (MS), adherence to drug therapy (DT), total adherence to treatment (TAT) was assessed depending on age, education, labor status, bad habits, the number of births, the presence of hypertension (AH), obesity, extragenital pathology. Adherence was assessed as low in terms of < 50%, mean 50–75%, and high > 75%.

Results: adherence to LSM in pregnant women corresponded to a mean level, and non-pregnant to a low level. Low adherence to LSM was found in 33.3% of pregnant and 58.2% of non-pregnant women. TAT values in both groups were in the range of mean adherence, but were higher in pregnant women. In the structure of TAT in pregnant women, unlike non-pregnant women, there was a lower level (21.7% versus 38.2%) and more often a high level (28.3% versus 10.9%). The adherence values of MS and DT and the level distribution did not differ between the groups. In the pregnant group, patients with secondary education and who did not drink alcohol demonstrated a high level of adherence to MS. In the non-pregnant group, only DT adheres to women with secondary education and no smoking were committed compared to smokers and patients with higher education.

Conclusion: the current method of determining adherence to treatment is the electronic questionnaire. Adherence to LSM and TAT was significantly higher in pregnant women and corresponded to the mean level, adherence rates to MS and DT did not differ between groups and were also at the mean level. In all examined women, there was no relationship between adherence to LSM, TAT, MS, DT and the studied de facto frames: age, number of births, labor status, presence of AH, obesity. More committed to treatment were pregnant and non-pregnant women with secondary education and no “bad” habits.

To enhance the clinical awareness and vigilance of healthcare professionals, such as therapists, cardiologists and neurologists, in the detection of ATTR amyloidosis among patients suffering from multi-organ damage, particularly in cases where heart failure with a preserved ejection fraction is progressing and resistant to standard treatment

This article analyzes two clinical observations of patients with stenotic and occlusive atherosclerotic lesions of the brachiocephalic arteries in various combinations. Both patients had a stroke-free course and early formation of the syndrome of moderate cognitive disorders. In the course of working with patients, a thorough analysis of complaints, anamnesis of the disease, clinical and neuropsychological examination was carried out, an expanded volume of studies was performed: general clinical, biochemical, ultrasound, magnetic resonance, angiographic. Based on the data obtained, a diagnosis was made and surgical treatment was performed. A subsequent detailed neurological examination, which included a neuropsychological examination, revealed an increase in the total score on the Montreal cognitive function assessment scale and a positive trend in indicators of control functions. The results of the analysis of these cases emphasize the importance of early detection and an integrated approach to therapy to improve the quality of life of patients and prevent further progression of cognitive deficits.