CardioSomatics

BACKGROUND: Arterial hypertension is often accompanied by stress, anxiety, and depression that worsen the quality of life and prognosis of the disease. Global data on high anxiety and depression highlight the need to assess them in people with hypertension. This study in the Ryazan region will reveal the social and economic impact on the mental health of hypertensive patients.

AIM: To assess the prevalence of stress, anxiety, and depression among hypertensive patients in the Ryazan Region, as well as their relationship with social and economic factors.

MATERIALS AND METHODS: This retrospective, observational study included 453 patients (284 women [62.7%] and 169 men [37.3%]) with confirmed arterial hypertension. Questionnaire survey included social and demographic characteristics and economic conditions. To measure stress effects, the Perceived Stress Scale (PSS-10) was used. The Hospital Anxiety and Depression Scale (HADS) was used to evaluate anxiety and depression.

RESULTS: Levels of stress, anxiety, and depression are higher in women compared to men (15.5 (11–20), 6 (4–9), and 5 (3–8) vs. 13 (9–17), 4 (2–7), and 4 (2–7), respectively; р <0.001, р <0.001, and р=0.002). Lonely people have higher levels of stress 16 (12–20), anxiety 6 (4–9), and depression 6 (3–9) compared to those living with their families (р=0.004, р=0.026, and р <0.001, respectively). Levels of stress, anxiety, and depression are statistically higher in people without high school or higher education than in those with such education. Levels of stress did not depend on employment compared to anxiety (5 (3–8) in employed and 6 (4–9,75) in unemployed people; р <0.001) and depression (5 (2–7) and 6 (3–9) respectively; р=0.001), which were higher in unemployed people.

CONCLUSION: Female gender, marital status, and low education are the factors contributing to increased stress, anxiety, and depression in patients with hypertension in the Ryazan region.

BACKGROUND: Recent studies show that lipoprotein (a), or Lp(a), plays a specific role in the development of atherosclerosis. Lp(a) promotes atherogenesis by increasing production of pro-inflammatory cytokines and depositing on the arterial wall. There are limited studies of Lp(a) in children with familial hypercholesterolemia (FH), and the results are not specified by age.

AIM: To determine serum Lp(a) in children with heterozygous FH for different age groups.

MATERIALS AND METHODS: A comparative, prospective, longitudinal, cohort study was conducted in 2017–2022. The study group included 243 children aged 5 to 17 years (Ме 11 [7.0–15.0]), of which 122 children had heterozygous FH. The control group included 121 healthy children. The control and study groups were divided into 3 age subgroups (5–7, 8–12, 13–17 years). Total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, and Lp(a) were determined in all children.

RESULTS: All first-degree relatives in the FH group had concomitant cardiovascular diseases (84.1% on the paternal side, 9.1% on the maternal side). Coronary artery disease was diagnosed in 84% (102) of parents, 89% (109) had atherosclerosis of brachiocephalic arteries, and 6.6% (8) had cerebrovascular accident (atherothrombotic stroke). The analysis revealed a significantly increased Lp(a) levels in FH patients (14.8 [6.3–24.3] mg/dL) compared to the control group (10.8 [5.5–14.8] mg/dL, p=0.0002). An individual serum Lp(a) analysis in the study and control groups showed that no healthy children had Lp(a) levels above 30 mg/dL. Among FH patients, 14.7% (18) had increased Lp(a) levels >30 mg/dL, and Lp(a) 50 mg/dL was noted in 4 of them. Children with FH and Lp(a) levels >30 mg/dL were found to be 3.5 times more likely (95% confidence interval: 1.14–10.33, p=0.0239) to have family members with the onset of acute coronary syndrome prior to 40 years of age.

CONCLUSION: High heritability estimates for Lp(a) highlights the need to measure it in patients with FH and offers an opportunity for reverse cascade screening to identify adult family members with FH at even greater risk of early cardiovascular accidents.

BACKGROUND: About half a million cases of acute coronary syndrome (ACS) are diagnosed in Russia every year. However, despite optimized treatment of patients with ACS, mortality remains high, which dictates the need to analyze the effectiveness of therapeutic measures.

AIM: To evaluate the real-world clinical features, treatment approaches, and outcomes in patients with ACS based on data from the long-term registry of the Regional Vascular Center.

MATERIALS AND METHODS: The study included consecutive 8 347 patients admitted to the Regional Vascular Center of the Republic of Karelia for ACS in 2008–2023. The clinical features, drug therapy, reperfusion interventions, complication rate, outcomes, and mortality were evaluated. The effectiveness of therapeutic measures in patients with ACS was analyzed using the obtained data and a 15-year real-world register.

RESULTS: The study included 8 247 patients, and there were more men (4 989 patients; 60.5%); 1 502 (18%) patients had a history of myocardial infarction; 4 741 (56.8%) were diagnosed with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In the study group, 4 481 (53.7%) emergency percutaneous coronary interventions (PCI) were performed for ACS. For ST-segment elevation acute coronary syndrome (STEACS), 2 928 (81.2%) patients had PCI, and 228 (7.8%) patients had thrombolytic therapy followed by PCI. Thrombolysis was performed in 113 (43%) and 150 (57%) patients before and after hospitalization, respectively. Efficacy criteria were determined in 57 (50.4%) and 107 (71.3%) patients with pre- and in-hospital interventions, respectively. Analysis of drug therapy for ACS showed that aspirin was prescribed in 8 255 (98.9%), β-blockers in 7 671 (91.9%), and statins in 8 138 (97.5%) cases. Life-threatening complications occurred in 1 out of 3 patients with STEACS and 1 out of 7 patients with NSTE-ACS. Cardiac arrest (p <0.0001), myocardial rupture (p=0.001), arrhythmias (p <0.0001), and cardiogenic shock (p <0.0001) were significantly more common in patients with STEACS, and pulmonary edema (p=0.005) was significantly more common in patients with NSTE-ACS. Hospital mortality was significantly higher in STEACS patients (p <0.0001).

The most common ACS outcome was myocardial infarction (2 955 (35.4%) patients with Q-wave MI and 2 045 (24.5%) patients with non-Q-wave MI). Unstable angina was diagnosed in 1 569 (18.8%) patients.

CONCLUSION: Fifteen-year register data showed a high percentage of reperfusion interventions for ACS and prescription of drugs that improve the prognosis. A high percentage of life-threatening complications was noted, especially in STEACS; however, hospital mortality is low if proper treatment is provided.

BACKGROUND: The clinical course, pathophysiology, and therapeutic options for valvular and subvalvular (accompanied by hypertrophic cardiomyopathy, HCM) aortic stenosis are well known separately, but the rare combination of severe aortic stenosis (AS) and obstructive HCM presents great diagnostic and treatment challenges. The combination of these diseases during transcatheter aortic valve implantation (TAVI) is associated with significantly worse hospital outcomes, including cardiogenic shock, renal failure, and death. There is evidence that TAVI without prior treatment of left ventricular outflow tract obstruction leads to higher mortality due to exacerbation of subvalvular obstruction.

AIM: To evaluate changes in hypertrophy of interventricular septum (IVS) in patients with a combination of AS and HCM following TAVI.

MATERIALS AND METHODS: The observational, retrospective, single-center, non-randomized study included 20 patients with diagnosed severe AS, preoperative IVS thickness ≥15 mm, and the preoperative ratio of IVS and left ventricular posterior wall thickness ≥1.3, following TAVI. Mean and maximum follow-up periods were 33 and 92 months, respectively. The primary endpoint was decreased IVS thickness following TAVI as determined by echocardiography.

RESULTS: The average age of patients was 72.4±5.5 years, more than half of the subjects were women. 60% of patients were diagnosed with coronary artery disease at the time of TAVI. Pre- and postoperative median IVS thicknesses were 17.7±2.2 and 14.4±3.2 mm, respectively. Long-term outcomes of TAVI included a significant decrease in hypertrophy of IVS (p=0.031) IVS thicknesses mainly decreased over the period up to 24 months after surgery. Cox regression analysis found that each year of patient’s age increased the risk of no postoperative decrease in IVS thickness after surgery by 12% every month.

CONCLUSION: There was a statistically significant decrease in hypertrophy of IVS in patients who underwent TAVI. In most cases, IVS thickness decreased within 2 years after surgery. Each year of patient’s age increased the risk of no postoperative decrease in IVS thicknesses by 12% every month.

The COVID-19 pandemic has affected the global population, causing significant economic effect, material damage, and irreparable human losses. Many countries were forced to promptly reorganize their healthcare system in order to save patients with COVID-19. The pathogenesis and specifics of the disease are not completely understood, but one pattern is particularly clear: COVID-19 tends to be more severe in people with obesity. Fatty tissue is known to support chronic low-grade inflammation and has its own endocrine activity. Over time, it became obvious that some patients still have consequences following the acute phase of COVID-19, which in some cases lead to irreversible changes in the body and reduced quality of life. This condition was called post-COVID syndrome. In this article, we review the long-term effects of COVID-19 on different body systems. We focused on pathogenic infection mechanisms and features of post-COVID syndrome in people with obesity.

Anticoagulant therapy for atrial fibrillation (AF) plays an important role in preventing thromboembolic events. This review discusses anticoagulant therapy in patients with AF and chronic anemia of varying severity. The search was carried out in PubMed and Library electronic databases from 2010 to 2023. Based on the analysis of full text literature, the authors concluded that currently oral anticoagulants in patients with AF and mild chronic anemia (Hb >90 g/L) and, according to some studies, in patients with moderate anemia (Hb >80 g/L) are considered reasonable. Patients with AF and moderate anemia (Hb 71–80 g/L) require an individualized approach to therapy with oral anticoagulants, since its benefit is not obvious in this subgroup, and the risk of hemorrhagic complications is high. Currently, severe anemia is a contraindication to oral anticoagulants in patients with AF.