Vol 97, No 4 (2025): Вопросы диагностики

Epidemiological data indicate a high prevalence of pulmonary embolism (PE) and a poor prognosis for this disease. The high rate of adverse outcomes of PE is due to the presence of multiple comorbidities in persons with this pathology and to errors in diagnosis and antithrombotic therapy. The review provides the most modern ideas about pre-test diagnosing patients with suspected PE. Clinical, laboratory, and instrumental risk stratification and early treatment approaches for PE are discussed in detail.

Aim. To analyze myocardial work in cardiac resynchronization therapy (CRT) and to determine the factors influence its positive dynamics.

Materials and methods. Global longitudinal strain (GLS) and myocardial work parameters including global constructive work (GCW), global wasted work (GWW), global work index (GWI) and global work efficiency (GWE) were analyzed in addition to standard transthoracic echocardiography (TTE) in 60 patients (mean age 61±10 years, 36 male) with left bundle branch block (LBBB), chronic heart failure (HF 2 [2; 3] FC (NYHA), decreased left ventricular ejection fraction (LF EF=28 [23; 31] %) before and 6 months after CRT implantation.. In all patients the segments with maximum and minimum WI value were determined and the difference in segments with maximal and minimal WI (Max-Min WI), as the indicator of myocardial work asymmetry was calculated.

Results. CRT led to reverse cardiac remodeling in 44 (73.3%) patients; clinical stabilization without positive TTE dynamics – in 11 (18.3%) patients, worsening or death – in 5 (8.3%) patients. In both groups of reverse remodeling and clinical stabilization CRT resulted in GWW reduction and thus GWE and GWI enhancement. However, the decrease in GWW in these patients is not accompanied by an increase in GCW and GLS, in contrast to patients with reverse remodeling, who developed statistically significant change in GCW and GLS during CRT. Patients with worsening or death were characterized by a minimal decrease in GWW in CRT (62,0 [9,7; 133,7] vs 149,5 [92.8; 206,2] mmHg% in patients with reverse remodeling and clinical stabilization; p=0,035). Max-Min WI turned out to be directly related to the LV EF change in CRT (r_xy=0,336; p=0,017) that makes this value to be one of possible predictors of reverse remodeling during CRT.

Conclusion. Wasted myocardial work can serve a contractile reserve, which represent a target for CRT. Its mobilization and decrease can lead to stable clinical status in patients even in the absence of reverse myocardial remodeling.

Background. To determine predictors of early and late right ventricular failure (RVF) according to transthoracic echocardiography (TTEchoCG) and right heart catheterisation (RHC) in patients with left ventricular assist device (LVAD).

Materials and methods. Twenty-three patients with LVAD were included in the study. Before implantation, all patients underwent TTEchoCG with comprehensive evaluation of the right ventricle (RV) using speckle-tracking echocardiography (STE) and 3D-echocardiography (3D-RVEF), as well as RHC with measurement of standard indices and calculation of pulmonary artery pulsatility index (PAPi).

Results. The highest area under the ROC curve was the RV ejection fraction determined by 3D-RVEF (0.841 with 95% CI 0.677–1.006, sensitivity 0.889, specificity 0.786; p<0.001) with a cut-off value ≤42% (OR 29.3 with 95% CI 2.6–336.4; p=0.007) and PAPi (area on ROC curve 0.869 with 95% CI 0.503–0.975, sensitivity 0.778, specificity 0.857; p<0.001,) with a threshold value ≤2.2 (OR 20 with 95% CI 1.2–333.3; p=0.035). The combination of these parameters was the most accurate prognostic model (sensitivity 0.778, specificity 1). The combination of echocardiographic parameters – 3D-RVEF and systolic velocity of the tricuspid valve fibrous ring according to tissue myocardial Doppler (TMD: S’ml) has similar sensitivity (0.778) and slightly lower specificity (0.929).

Conclusion. The optimal independent echocardiographic predictor of early RVF is 3D-RVEF. The combination of 3D-RVEF and PAPi proved to be the most accurate model, but the combination of 3D-RVEF and S’ml-TMD echocardiographic parameters alone is only slightly inferior in specificity, which allows preliminary assessment of the risk of RVF.

Background. Anemia is an essential component of comorbidity, being both a complication of chronic diseases and a factor in their progression. Comorbidity patients with low hemoglobin have a greater number of diseases, worse geriatric status parameters and the lowest survival. Especially negative consequences of a decrease in hemoglobin were noted in people of the older age group.

Aim. To investigate the relationship between anemia and comorbidity in patients aged 65 years and older.

Materials and methods. The results of a sub-analysis of the multicenter cross-sectional study EUCALYPTUS, which involved 4308 people (30% of men) aged 65 to 107 years (average age – 78 years), are presented. The comorbidity was assessed and the Charlson comorbidity index was calculated, and the complete blood count was studied.

Results. The frequency of comorbidity was 89%, anemia – 24%. The value of the Charlson comorbidity index in patients with anemia was greater than in those without anemia – 5 (4; 7) vs. 4 (3; 6) points (p<0.001). For every 1-point increase in Charlson index values, the odds of having anemia increase by 21% (odds ratio 1.21; 95% confidence interval 1.17–1.25; p<0.001). Multivariate regression analysis identified 9 independent predictors of anemia (age ≥82 years, male, history of myocardial infarction and stroke, peptic ulcer disease, atrial fibrillation, stage 4 and 5 chronic kidney disease, active cancer, no hypertension) with an odds ratio of 1.25 to 3.14. In the presence of 2–4 predictors, the risk of anemia increases 1.3–2.6 times, 5 predictors – almost 5 times, 6 or more – almost 13 times.

Conclusion. Comorbidity patients are at risk for the development of anemia, which requires timely treatment, including iron supplements if absolute or functional iron deficiency is confirmed.

Cardiac-specific (or myomiR) miRNA-499a (miR-499a) is a small (21–22 bp) non-coding RNA that is involved in the regulation of cardiac function both under normal and in various pathological conditions. Every year new studies expand the range of known biological processes that are regulated by miR-499a in the heart. In acute and chronic cardiovascular diseases accompanied by cardiomyocyte damage, miR-499a enters the bloodstream and can circulate there for a long time. At the same time, it is detected in plasma significantly earlier than traditional protein biomarkers, which makes it a new promising biomarker for early diagnosis and prognosis of heart diseases. This review describes the functions of human miR-499a and its involvement in the development of heart diseases. The data indicating the high diagnostic value of this miRNA in blood are presented.

HIV infection is associated with an increased risk of cardiovascular and kidney disease. Comorbidity is gradually becoming one of the main drivers for premature mortality in HIV patients: in Russia, from 2007 to 2022, mortality rates in HIV patients not related to opportunistic infections increased more than twofold. People living with HIV have all the common cardiovascular risk factors, moreover, special attention should be paid to kidney function, since its impact on cardiovascular disease (CVD) risk is frequently underestimated. In the current document, approaches to selection of antiretroviral therapy (ART) are reviewed in the context of HIV patients with concomitant CVD/high cardiovascular risk. Main factors of ART choice were analyzed for regimens based on 2nd generation integrase strand transfer inhibitors dolutegravir/bictegravir and non-nucleoside reverse transcriptase inhibitor doravirine, which are included in the national and main international clinical guidelines and are available in the Russian Federation. A detailed review of the ART selection criteria includes effectiveness of contemporary antiretrovirals in high viral load, poor cell immunity, expected patients’ adherence, drug resistance profile, along with comorbidities such as CVD, excess body weight, and kidney disease. In addition, topics related to interdisciplinary interaction between infectious disease, cardiology/internal medicine specialist in context of people living with HIV with concomitant CVD are also covered in the paper.

Cough, as a protective reflex, can become hypersensitive under pathological conditions (e.g. acute respiratory viral infections, acute bronchitis, asthma), significantly impairing patients’ quality of life. Modern therapeutic approaches often focus solely on symptomatic cough suppression, while targeting its pathogenetic mechanisms, including MCP-dependent inflammation, remains understudied. The article examines the innovative antitussive drug Eladis^®, designed to target chemokine-dependent mechanisms involved in the development of cough sensitization.

Aim. To conduct a systematic analysis of published data on the mechanisms of action, clinical efficacy, and safety of Eladis^®, a novel antitussive drug that inhibits MCP-dependent inflammation, based on experimental and clinical trial results (phases I–III).

Materials and methods. The review synthesizes experimental data from in vitro and in vivo studies (guinea pigs), demonstrating selective suppression of TRPA1-dependent cough via inhibition of Golgi-resident glutamyl cyclase. Clinical trials included: phase I: pharmacokinetics and safety assessment in healthy volunteers (n=32); phase II: evaluation of lung function in patients with partially controlled asthma (n=250); phase III: randomized placebo-controlled study in acute respiratory viral infections and acute bronchitis (n=250).

Conclusion. Eladis^® is a promising antitussive drug with a unique mechanism targeting MCP-dependent inflammation. It is effective for acute non-productive cough and offers new therapeutic potential for chronic respiratory diseases. Further research may expand its clinical applications.

The article highlights the stages of formation and development of colonoscopy from simple rectal examinations to modern video endoscopy. The development of imaging technologies has improved the early diagnosis and verification of colorectal cancer and inflammatory bowel disease, screening of colon tumors. Moreover, it was made possible to carry out minimally invasive interventions – taking a biopsy and performing a polypectomy. The prospects of the method and its place in clinical practice are discussed.