Vol 16, No 4 (2025)

BACKGROUND: Despite advances in the treatment of myocardial infarction, it remains one of the leading causes of the development of heart failure. Cardiac rehabilitation is aimed at minimizing the time required for recovery of physical, social, and psychological functioning after a cardiac event. One of the promising rehabilitation strategies for patients after myocardial infarction is the use of intermittent hypoxic–hyperoxic training (IHHT).

AIM: To evaluate the effect of IHHT, added to a standard rehabilitation program, on exercise tolerance, NT-proBNP levels, arterial stiffness parameters, and cognitive function in older patients with myocardial infarction at the second inpatient stage of rehabilitation and chronic heart failure.

METHODS: A single-center, prospective, randomized, controlled, single-blind study with parallel groups was conducted. A total of 102 patients were enrolled and randomized into two groups: the main group (n = 51) received standard rehabilitation combined with IHHT using the ReOxy device, whereas the control group (n = 51) received standard rehabilitation only. The IHHT course consisted of 10 daily sessions (5 sessions per week for 2 weeks), each lasting 40 minutes. The primary endpoint was the change in six-minute walk test distance. Secondary endpoints included changes in NT-proBNP concentration, cognitive function assessed using the Montreal Cognitive Assessment (MoCA), and arterial stiffness evaluated by the cardio-ankle vascular index (CAVI) using the VaSera VS-1500N system. Statistical analysis was performed using GraphPad Prism 8.

RESULTS: The groups were comparable in baseline clinical and demographic characteristics (p > 0.05). The addition of IHHT to the rehabilitation program resulted in a significantly greater increase in six-minute walk distance compared with standard rehabilitation alone (51.0 [33.0; 86.0] m vs 30.0 [22.5; 56.0] m, p = 0.0001), as well as a greater reduction in NT-proBNP levels (250.7 [115.7; 564.1] vs 192.9 [109.45; 290.5], p = 0.0243). The IHHT group also demonstrated a more pronounced improvement in cognitive function according to the MoCA score (3.0 [2.0; 4.5] points vs 2.0 [1.0; 3.0] points, p = 0.0005). A trend toward a greater reduction in the right cardio-ankle vascular index (R-CAVI) was observed in the IHHT group compared with controls (Δ −0.5 [0.0; 1.1] vs Δ −0.2 [0.0; 0.7], p = 0.05). No significant between-group differences were found for left CAVI (L-CAVI) or ankle–brachial index.

CONCLUSION: The addition of IHHT to standard rehabilitation in patients with myocardial infarction and chronic heart failure improves exercise tolerance and cognitive function.

BACKGROUND: Elevated triglyceride levels—hypertriglyceridemia, representing an imbalance of lipid parameters—play a key role in contemporary lipid metabolism research and are associated with an increased risk of atherosclerotic cardiovascular disease. An insufficient response to lipid-lowering therapy is of major clinical importance in the management of cardiology patients and requires optimization under real-world clinical practice conditions.

AIM: To evaluate the effectiveness of lipid-lowering therapy in a population of cardiology patients aged 18–90 years with hypertriglyceridemia in real-world clinical practice at an outpatient urban cardiology medical center.

METHODS: This retrospective study included 693 cardiology patients aged 18–90 years with hypertriglyceridemia. Clinical diagnoses were established based on medical records, anthropometric measurements, and laboratory test results.

RESULTS: Lipid-lowering therapy was administered to 459 patients (66.2%). Initiation of lipid-lowering therapy was required in 42 patients (6.1%). Adjustment of the therapeutic regimen was performed in 184 patients (36.7%) receiving pharmacological treatment. Target triglyceride levels were achieved in 309 patients (44.6%), total cholesterol targets in 106 (15.3%), low-density lipoprotein cholesterol targets in 201 (29.0%), high-density lipoprotein cholesterol targets in 362 (52.2%), and non-high-density lipoprotein cholesterol targets in 186 patients (26.8%).

CONCLUSION: The effectiveness of lipid-lowering therapy among patients with hypertriglyceridemia was insufficient, indicating the need for more aggressive pharmacotherapy of this lipid metabolism disorder in the management of cardiology patients. Initiation and intensification of triglyceride-lowering therapy in routine clinical care, as well as increased physician awareness of hypertriglyceridemia, appear warranted.

Most causes of sudden cardiac death are associated with cardiac rhythm disturbances, which often develop in the setting of Brugada syndrome. This condition is linked to mutations in approximately 20 genes; however, such genetic abnormalities cannot be identified in all patients. At present, increasing attention is being paid to noncoding ribonucleic acids (RNAs), which are involved in transcriptional, posttranscriptional, and epigenetic regulation. These include microRNAs and long noncoding RNAs that regulate the expression of genes encoding ion channel components and also participate in the maturation and differentiation of stem cells into cardiomyocytes. The principal noncoding RNAs identified in Brugada syndrome are microRNAs. They contribute to disease pathogenesis through interactions with ion channels and may serve as biomarkers for timely diagnosis and prevention of life-threatening arrhythmias and fatal events. Thus, the search for optimal biomarkers and clarification of their diagnostic role in Brugada syndrome may provide a basis for early detection and pathogenetically justified therapeutic strategies. This review presents a current overview of the potential use of microRNAs in the early diagnosis of Brugada syndrome.

Despite the end of the COVID-19 pandemic, many patients continue to experience adverse sequelae of the disease, including cardiometabolic disturbances. The spectrum of symptoms associated with long COVID is broad and heterogeneous, necessitating a deeper understanding of the underlying mechanisms. One of the proposed mechanisms contributing to long COVID is transient postviral mitochondrial dysfunction. It is hypothesized that SARS-CoV-2, either directly or indirectly via systemic inflammation, induces metabolic reprogramming of cells, leading to impaired oxidative phosphorylation, reduced ATP production, and increased generation of reactive oxygen species (ROS). Under conditions of metabolic reprogramming, cells preferentially rely on glycolysis for lactate production. Elevated blood lactate levels at low exercise intensity are indicative of mitochondrial dysfunction. Cardiorespiratory fitness is directly related to the integrated function of multiple physiological systems and is considered a reflection of overall health status. The most objective and accurate measure of cardiorespiratory fitness is the direct assessment of maximal oxygen uptake (VO₂max) using cardiopulmonary exercise testing (CPET). Accordingly, monitoring blood lactate levels in conjunction with peak oxygen consumption assessed by CPET may be effectively used in the design of future research studies. The search, selection, and analysis of relevant sources were conducted using scientific databases including cyberleninka.ru, elibrary.ru, link.springer.com, frontiersin.org, pubmed.ncbi.nlm.nih.gov, Google Scholar, and others, with the aim of systematizing current evidence supporting mitochondrial dysfunction as a key pathogenetic mechanism of long COVID.

BACKGROUND: Ochronosis is a rare disorder caused by an inherited defect in tyrosine metabolism, in which the biochemical degradation pathway is interrupted at the stage of homogentisic acid formation. The clinical manifestations of the disease include homogentisic aciduria (presenting in infancy), gradual development of ochronosis after 20–30 years of age, and degenerative ochronotic arthropathy, typically occurring in the fourth decade of life. In addition, involvement of the cardiovascular system and the urinary tract may be observed. Management of ochronosis requires a comprehensive approach that includes both pharmacological and non-pharmacological interventions. Reports of clinical cases of ochronosis in the Russian scientific data remain limited.

CASE DESCRIPTION: This article presents a clinical case of ochronosis with involvement of the cardiac valvular apparatus and the musculoskeletal system in an 80-year-old woman with a history of comorbidities. Musculoskeletal condition had been present since 2007. Pronounced cutaneous manifestations appeared in 2023 (pigmentation changes of the auricles, cheeks, and sclerae). The patient underwent multiple surgical interventions for musculoskeletal disorders. In 2023, targeted laboratory investigations were performed for the first time to confirm ochronosis: 3-methylcrotonylglycine, 8.37 mmol/mol; homogentisic acid, 95.93 mmol/mol creatinine; and p-hydroxyphenyllactic acid, 6.24 mmol/mol creatinine, thereby confirming the diagnosis. Modern imaging and laboratory methods were key to the accurate diagnosis of this condition.

CONCLUSION: Improving awareness of ochronosis among physicians of various specialties is essential for its early detection. Timely diagnosis of ochronosis enables initiation of treatment at earlier stages, which may reduce the risk of complications and improve patients’ quality of life.