Vol 14, No 3 (2023)

OBJECTIVE: Our aim was to evaluate the impact of moderate prosthesis–patient mismatch on long-term results after aortic valve replacement in patients with severe aortic stenosis with paradoxically reduced gradients against the background of a reduced stroke volume of the left ventricle.

MATERIALS AND METHODS: We analyzed data from 88 patients with symptomatic severe aortic stenosis meeting the criteria: paradoxically reduced gradients against the background of a reduced stroke volume of the left ventricle. Patients were divided into 2 groups: Group 1 (n=42, mean age 67±4 years) with paradoxically reduced gradients against the background of reduced stroke volume of the left ventricle, with a moderate patient–prosthesis mismatch; Group 2 (n=46, mean age 68±6 years) with paradoxically reduced gradients against the background of reduced stroke volume of the left ventricle, without patient–prosthesis discrepancy. All patients underwent transthoracic echocardiographic evaluation.

RESULTS: The average follow-up period was 84 (quarterly interval 75±98) months, during the follow-up period 35 (40%) deaths were registered. There were no significant differences in in-hospital mortality: 2 (4.7%) and 2 (4.3%), respectively (p=0.2). In the long-term follow-up period, there was a significant difference in survival and hospitalization rates for exacerbation of heart failure between patients with and without patient–prosthesis mismatch: 46 and 71%, 37 and 72%, respectively (p <0.001). In the long-term follow-up period, patients with patient–prosthesis mismatch showed a trend towards slower regression of left ventricle mass and left atrial volume, as well as a slower recovery of global longitudinal deformation of the left ventricle and exercise tolerance compared with patients without patient–prosthesis mismatch. There were no significant differences in the incidence of stroke (90% and 91%; p=0.7). According to the results of Cox regression, the left ventricular stroke volume index and the aortic valve effective orifice area index were independent predictors of lethal events and the risk of hospitalization for exacerbation of heart failure.

CONCLUSION: Moderate patient–prosthesis mismatch in patients with paradoxically reduced gradients associated with reduced left ventricular stroke volume is independently associated with increased mortality and increased hospitalization for exacerbations of heart failure.

BACKGROUND: Chronic heart failure (CHF) is one of the most serious problems in cardiovascular diseases, requiring accurate diagnosis and treatment. The search for new laboratory markers of CHF can improve the accuracy of diagnosis and identify the severity of the patient’s condition.

AIM: Our aim was to study the relationship between the levels of free-circulating DNA (cfDNA) and brain natriuretic peptide (NT-proBNP) in the blood plasma of patients suffering from CHF with ejection fraction (EF), to investigate the relationship between these laboratory markers, and to evaluate the dynamics of changes in the studied parameters against the background of drug therapy.

MATERIALS AND METHODS: The study involved 67 patients of both sexes with a diagnosis of CHF, verified by clinical and functional methods. 23 people without established chronic diseases formed the control group. At the stage of inclusion in the study, all patients underwent: physical examination, general blood test, biochemical blood test with determination of lipid profile, glucose, creatinine, NT-proBNP and cfDNA levels, as well as electrocardiography (ECG), electrocardiography (ECHO-CG), radiography of organs chest, ultrasound of the abdominal organs, 6-minute walk test. The level of cfDNA was determined using the method of P.P. Laktionov, S.N. Tamkovich, E.Yu. Rykova (2005). Repeated blood sampling with assessment of cfDNA and NT-proBNP levels was carried out in the group of patients with reduced ejection fraction 5–7 months from the start of treatment/correction of previous therapy.

RESULTS: The study revealed significant differences in the levels of cfDNA in the blood plasma in patients with different EF (less than 40%, 40–49%, 50% or more). At the same time, an inverse relationship was established between cfDNA indicators and EF, as well as between the level of NT-proBNP and EF, that is, a progressive decrease in myocardial contractility is accompanied by a combined increase in the levels of the studied markers in the blood, reflecting the severity of the patient’s condition. In addition, the positive effect of drug therapy on cfDNA and NT-proBNP levels in the group of patients with EF <40% has been proven.

CONCLUSION: The identified patterns make it possible to consider the level of cfDNA in blood plasma as a potential biomarker of CHF, and also to use it for dynamic monitoring of patients.

Clinical decision support systems (CDSS) often outperform human capabilities for processing a large amount of information, dramatically simplifying the work of specialists and avoiding medical errors. The implementation of such systems is a complex task that requires high-tech developments. The annual increase in the development of such systems has a geometric progression. However, it is unclear if most of them will be integrated into clinical practice and recommendations. The use of CDSS to address various disease diagnosis, treatment, and prevention issues is demonstrated, and possible linkages between scientific clinical observations and CDSS are examined. Currently, many data gathering and processing systems use machine learning algorithms and convolutional technologies to create CDSS, resulting in data that exceeds the ability of human thinking to determine the logic of recommended decisions. This study presents the most studied modern CDSS, the possibilities of their application, and the implementation issues.

The review includes an analysis of the literature sources PubMed (MEDLINE), Embase, Cochrane Library, Google Scholar, and eLibrary databases for the last 5 years (2018–2022) and the current year 2023 concerning Internet technologies used in the psychological rehabilitation of patients with cardiovascular diseases. Several options for using the Internet in the psychological rehabilitation of patients with cardiovascular diseases are considered, including online resources for interactive information exchange and psychological support, Internet-based psychoeducation, online programs for improving psychological state, and remote psychocorrection. Modern Internet technologies are becoming increasingly important in patients with cardiovascular diseases, opening up new avenues for implementing psychological rehabilitation programs in cardiorehabilitation. Because of its accessibility and effectiveness in lowering anxiety and depressive symptoms, Internet programs based on cognitive behavioral psychotherapy are increasingly being used to improve the psychological state of patients with cardiovascular diseases. The use of Internet technologies in the psychological rehabilitation of patients with cardiovascular diseases helps patients adhere to cardiac rehabilitation. The results show the importance of incorporating Internet technologies into the psychological rehabilitation of patients with cardiovascular diseases and the need for further research to comprehensively study existing and developing new options for using the Internet in psychological rehabilitation.