Vol 27, No 2 (2023): CARDIOVASCULAR DISEASES

Heart failure (HF) is a widespread disease and tends to increase. Despite the possibilities of modern therapy, the prognosis of patients with HF remains unfavorable. Foreign experience shows that the creation of specialized heart failure clinics improves the quality of care for patients with HF, reduces the frequency of repeated hospitalizations and death of patients. The Russian Federation has gained experience in creating such clinics, in particular, in Nizhny Novgorod, Ufa, St. Petersburg and a number of other cities. The article describes the organization of the work of the Center for HF on the basis of a multidisciplinary hospital in Moscow in period 01.11.2020-01.12.2022. The database included 2,400 patients hospitalized due to acute decompensation of chronic HF (ADCHF). The leading triggers of ADCHF in the studied patient population were an episode of atrial fibrillation/flutter (37 %), low adherence to treatment (25 %) and uncontrolled hypertension (17 %), exacerbation of concomitant diseases (11 %), infection (4 %). In 6 % of patients, the leading trigger could not be identified. The hospital stage included 950 (39.5 %) patients who, in the first 24 hours from the moment of hospitalization, underwent standard physical, laboratory and instrumental examination, including lung ultrasound, NT-proBNP, liver fibroelastometry, VEXUS protocol study, bioimpedance analysis of body composition, of which 496 (20.5 %) people passed the same studies at discharge. In the structure of patients hospitalized with ADCHF who were included in the hospital follow-up stage (n=950), patients with preserved (HFpEF) 42.5 % (n=404) and reduced ejection fraction (HFrEF) prevailed 36 % (n=342), patients with a mildly reduced (HFmrEF) ejection fraction were found in 21.5 %. 1,552 (64.5 %) patients refused additional studies and visits to the CH center, but agreed to outpatient follow-up in the form of telephone contacts. In 370 (15.4 %) patients, contact was lost after discharge. 240 (10 %) patients actively visit the HF center with a comprehensive assessment of congestion and correction of therapy at each visit. Conclusion. There are two stages in the treatment of patients with chronic HF. The first stage is hospital, the second one is outpatient. It is important not to make omissions in the prescribed drug therapy, which can lead to a fatal outcome. To this end, it is necessary to introduce a “seamless” model of medical care for patients with chronic HF, when the patient comes under the supervision of a multidisciplinary team that carries out timely monitoring.

Aortic-brachial stiffness mismatch is a potential new marker of a subclinical vascular damage that has never been studied in patients with rheumatic diseases. The aim of the study was to assess the frequency of arterial stiffness mismatch in rheumatoid arthritis (RA) and to evaluate its clinical associations. Materials and Methods. The study group included 85 patients with RA (males 22.4 %, aged 59.7 ± 14.3 years, hypertension in 65 %, mean disease activity score (DAS-28 (C-reactive protein) 3.7 ± 1.1), and the control group included 40 subjects matched by gender, age and risk factors. The study methods included measurements of clinical and ambulatory brachial and aortic blood pressure (BP) (BPLab-Vasotens), arterial stiffness parameters parameters (applanation tonometry, SphygmoCorAtCor), cardio-ankle vascular index (VaSera) and cardio-vascular risk assessments using the SCORE, American College of Cardiology/American Heart Association (ACC/AHA) 2013 pooled cohort equations and QRisk2 scoring systems. The arterial stiffness gradient was calculated as a ratio between carotid-femoral (cf) and carotid-radial (cr) pulse wave velocity, and its elevation of ≥ 1 was considered as arterial stiffness mismatch. A p-value of < 0.05 was considered significant. Results and Discussion. The mean stiffness gradient in RA patients without and with hypertension was 1.1 ± 0.1 and 1.4 ± 0.4, respectively (р < 0.001); in controls, 0.99 ± 0.2 and 1.3 ± 0.3, respectively (р < 0.001). The frequency of stiffness mismatch in the RA group was significantly higher compared to the controls in the whole study population (88.2 % vs 65 % (р = 0.002)) and in both normotensive and hypertensive subgroups (76.7 % vs 43.8 % (p = 0.03), and 94.5 % vs 79.2 % (p = 0.04), respectively). The same trend was observed in the subgroups with normal carotid-femoral pulse wave velocity: arterial stiffness mismatch was present in 82.1 % of RA patients vs. 51.9 % control subjects (p = 0.004). The stiffness gradient was associated with age (r = 0.63), hypertension duration (r = 0.56), cardio-vascular risk by the ACC/AHA 2013 (r = 0.69) and Qrisk2 (r = 0.7) scoring systems, nocturnal aortic systolic BP (r = 0.53), cardio-ankle vascular index (r = 0.60) and diurnal index of brachial systolic BP (r = -0.4). Significant differences in stiffness gradient values were observed in the subgroups based on elevation of aortic systolic BP and pulse wave velocity above individual reference values, aortic pulse pressure > 50 mmHg, cardio-ankle vascular index > 9, presence of high cardio-vascular risk, masked and nocturnal hypertension, and non-dipping. Conclusion. Patients with RA are characterized by higher frequency of arterial stiffness mismatch compared to controls, irrespective of the history of hypertension or the values of carotid-femoral pulse wave velocity. Arterial stiffness mismatch is associated with unfavorable 24-h BP profile, higher frequency of nocturnal hypertension and cardio-vascular risk.

Aortic valve lesion is a common cardiopathy, which may have very diverse causes, from degenerative, congenital and infectious diseases to autoimmune conditions. We present a rare case of Takayasu arteritis and severe heart lesion due to the myxomatous degeneration of the aortic and mitral valve cusps associated with the development of infectious endocarditis (IE) complicated by abscess, fistula, valve perforation and recurrent acute decompensated heart failure in a young female patient. A combined use of histopathological and PCR analyses of valve tissues was critically important for differential diagnosis of the valve lesions, as it made it possible to identify the true cause of the structural cardiopathy associated with myxomatous degeneration and a prior IE. The presence of Takayasu arteritis has played an indirect though apparently decisive role by creating conditions for the development of immunosuppression and determining the disease severity and progression rate.

Relevance. Irrational nutrition of a pregnant woman, unjustified drug load, inactivity, insufficient insolation, constitute a high risk of vitamin D deficiency. Vitamin D deficiency conditions correlate with the frequency of the pathological course of pregnancy and childbirth, dictating the need for timely correction from the standpoint of optimizing care for the child population. The aim of the study - evaluation of the possibility of predicting vitamin D deficiency conditions in children in the antenatal period using a complex of medical and statistical analysis methods. Materials and Methods. A prospective cohort study of 248 mother-child pairs was conducted. Pregnant women: the main group (148) - receiving vitamin D prophylactically at a dose of 1000 MG (Aquadetrim) when registering. The comparison group was those who did not receive vitamin D (100). Inclusion criteria: absence of exacerbation of chronic pathology, allergic reactions, malabsorption syndrome, obesity, diabetes, taking HA, antiepileptic drugs, hyperparathyroidism, severe infections. All women were examined at the end of the 3rd trimester and the postpartum period. Children were observed of 248 children born to pregnant women of two groups. All children were observed with the informed consent of their parents. The duration of observation is up to 3 years. An assessment of the somatic status and general clinical examinations were carried out. Risk factors were assessed using mathematical and statistical methods to compile a prognostic scenario for the development of vitamin D deficient conditions. Results and discussion. Based on the data obtained using the statistical analysis method, it was found that the pathological course of pregnancy and childbirth in women who received vitamin D during pregnancy according to the RR data, AtR were significantly less frequent. Newborns of the main group had higher mass-growth indicators, significantly less often insufficiency, vitamin D deficiency, neurological symptoms; subsequently, a lower incidence of allergic diseases, acute respiratory viral infections, changes in the bone system. Conclusions. Evaluation of the possibility of predicting vitamin D deficiency conditions in children in the antenatal period using a complex of medical and statistical analysis methods reduces the risk of: pathological course of pregnancy, childbirth, the frequency of vitamin D deficiency and deficiency in newborns, affecting mass-growth indicators at birth, neurological symptoms, allergic diseases, respiratory infections in infancy, changes in the bone system in young children. Prevention of the development of vitamin D deficiency conditions in the antenatal period makes it possible to optimize the care of the child population.

Relevance. Timely diagnosis is the basic criterion for the quality of medical care in emergency department. One of the promising directions in the prevention of diagnostic errors is the use in clinical practice of the expert decision support system (EDSS). The aim of this study was a comparative analysis of the diagnostic efficiency of EDSS in acute appendicitis (AA) at various stages of the differential diagnosis of acute abdominal pain (AAP). Materials and methods. The study performed a retrospective analysis of the diagnostic results of 150 patients with various forms of AA, followed by the processing of structured clinical, laboratory and instrumental data using the original version of EDSS. Results and Discussion. It has been established that EDSS unidirectionally and sequentially models the stages of a standard diagnostic program for examining a patient with AAP at all levels of automated assessment of symptoms and signs of AA. Depending on the final parameters of the indication, the EDSS makes it possible to differentiate the variants of AA clinical scenarios with the identification of categories of diagnostic complexity that occurred in surgical practice. The data of relevance and validity of EDSS in the differential diagnosis of AAP are presented. The role of the expert system for the intensification of the doctor’s clinical reasoning and the prevention of diagnostic errors in emergency abdominal surgery is noted. Conclusion. The data obtained indicate a comparable diagnostic efficiency of the proposed version of EDSS with the accuracy of the diagnosis of a surgeon. The results of the preclinical use of EDSS allow the clinician to recommend its use in the format of an interactive “cognitive assistant” in case of possible difficulties and doubts in the differential diagnosis of AAP.

Sports-related traumatic brain injuries (TBI) accounts for up to 20 % of all injuries that are obtained by athletes and its incidence rises annually due to rise in population involving in sports, growing popularity of extreme sports and high level of motivation to achieve record results among young sportsmen. The aim of the review is to present the potential benefits of using microwave radiothermometry and craniocerebral hypothermia technologies in sports-related TBI. The review considers most common form of traumatic brain injury in athletes - mild TBI, which in turn can provoke a wide range of complications and negative consequences in near and delayed periods after the injury. The main shortcomings of programs for complication prevention in treatment and rehabilitation of athletes after TBI are considered, which do not take into account the peculiarities of injury mechanisms, its significant differences from household, road or criminal injuries with brain damage. Lack of objective methods of instrumental diagnosis for injury severity is also described. In addition, pathophysiological component characteristics of sports TBI is accentuated: frequency of repetition, increasement of brain and body temperature, peripheral redistribution of blood flow and hypocapnia, which significantly affects cerebral blood flow. Based on the analysis of the available scientific literature, it is elicited that TBI is an independent cause of cerebral hyperthermia development, which significantly aggravates the consequences of the injury. Conclusions. The authors propose an innovative way to use microwave radiothermometry method as a diagnostic tool for sports-related TBI. In addition, the review highlights the main recommendations for complications prevention by using craniocerebral hypothermia technology, which reduces overall physical and cerebral hyperthermia, and augments the resistance of cerebral cortex neurons to hypoxia and trauma. However, the authors believe that the described approaches in sports medicine are not used purposefully due to lack of awareness of sports team doctors and coaches.

The article is dedicated to the memory of a Russian scientist, doctor, teacher, dean of the Faculty of Pediatrics, who stood at the origins of perinatal medicine from the standpoint of an innovative approach in diagnosis, therapy, prevention and training of future doctors. The aim of the article is to study the biography of the outstanding Russian scientist Maria Fedorovna Deshchekina, from the standpoint of a significant contribution to perinatal medicine. In the course of writing the article, comparative historical and analytical methods of historical and medical research were used using archival data from the 4th maternity hospital on Novatorov Street, house 3, Moscow, where Maria Fedorovna worked, memories of colleagues, students and relatives. The main results are the presentation of modern achievements in pediatrics on the foundations laid by Maria Fedorovna, who has high professionalism and innovative approaches. Medicine of the XXI century opens up wide opportunities in forecasting, prevention, therapy and rehabilitation. The modern stage of medical science development is based on powerful technological progress, advanced pharmacological research, breakthroughs in the field of genetics and nanotechnology. But behind the high achievements of the present are our dear Teachers, who laid the foundation for the future of medicine with their high professionalism. We should not lose these classical views, works, and approaches. The life and fate of the outstanding Russian doctor Maria Fedorovna Deshchekina is a vivid example of loyalty to the profession and service to people. In 2022, on the centennial anniversary of her birth, a conference was held and a book dedicated to the memory of Maria Fedorovna, a unique doctor, scientist, teacher, organizer, was published at the Federal State Educational Institution of the Russian Ministry of Health named after N.I. Pirogov. The founder of the conference is a student of Maria Fedorovna - Ilyenko Lidiya Ivanovna. Maria Fyodorovna’s life is closely connected with the 2nd MOLGMI (the Federal State Educational Institution of the Russian Ministry of Health named after N.I. Pirogov), the Department of Hospital Pediatrics and Maternity hospital No. 4. Moscow. She went from student to professor, head of the department, dean of the Pediatric Faculty. The results of her activities have developed into a certain concept, which we still adhere to. As Dean, Maria Fedorovna proved herself to be a talented teacher, psychologist and organizer, paying great attention to improving the pedagogical skills of teachers. It was during this period that methodological work was elevated to the rank of scientific and methodological, which led to a series of articles written in collaboration with the Department of Pedagogy. Neonatologists, obstetricians-gynecologists, neurologists and pediatricians know the name of Maria Fedorovna well, since she first described somatic manifestations of birth trauma and presented them in the form of syndromes. This classification is still in effect today and greatly facilitates the diagnosis. Based on the analysis, it can be concluded that the name of Maria Fedorovna Deshchekina is associated with many innovations that later became traditional for Russian pediatrics.