Vol 11, No 2 (2025)

Cardiovascular diseases have a direct dependence with vascular stiffness and indexes of the daily profile of blood pressure (BP), increasing cardiovascular risk, especially in elderly patients with senile asthenia syndrome (SAS).

The aim: to identify peculiarities of the daily profile of BP and vascular stiffness in patients with arterial hypertension (AH) and chronic heart failure (CHF) depending on the presence of SAS.

Material and methods. 161 respondents with AH and CHF (82 females and 79 males) aged 80 to 91 years were involved in the study. Taking into account the presence of SAS, they were divided into 2 groups: 1st – patients with AH, CHF and SAS (n = 84), 2nd – patients with AH and CHF without SAS (n = 77). To diagnose SAS, questionnaire “Age is not a hindrance” was used and a comprehensive geriatric assessment was carried out. All patients underwent 24-hour BP monitoring with determination of the indexes of the daily BP profile, vascular stiffness and central aortic pressure.

Results. In patients with arterial hypertension, CHF and SAS presence, comparatively to patients without SAS, statistically significantly lower values of systolic BP (SBP) at night (p = 0.026) and diastolic BP during the day and night (p < 0.001 and p < 0.001, respectively), higher values of variability of SBP (p = 0.004 and p < 0.001, respectively) and pulse BP (PBP; p < 0.001 and p = 0.029, respectively) during the day and night were observed, as well as a significantly higher percentage of the daily index of SBP by the night-peaker type (p = 0.048). Analysis of vascular stiffness revealed significantly lower RWTT values (p < 0.001) and higher PWVao (p = 0.001), ASI (p < 0.001) and AASI (p = 0.002) in comorbid patients with SAS, which indicates increased vascular stiffness in this group of patients. When assessing central aortic pressure in patients with SAS comparatively to patients without this syndrome, statistically significantly lower SADao values (p = 0.004) and higher PADao and AIxao levels (p = 0.027 and p < 0.001, respectively) were revealed.

Conclusion. In patients with AH and CHF aged ≥ 80 years, the development of SAS was accompanied by more pronounced changes in the parameters of the daily BP profile, as well as the elastic characteristics of blood vessels, which suggests a higher risk of cardiovascular complications in case of this combined pathology.

Post-COVID syndrome (PCS) has a high prevalence rate (from 4 to 80%) and is represented by more than 200 symptoms, including shortness of breath. At the same time, the structure of risk factors, pathogenetic mechanisms of prolonged PCS have not been sufficiently studied. Study of these issues is a promising direction in therapy, which can help in preventing the occurrence of PCS and ensuring its effective treatment.

The aim: to determine the prevalence, peculiarities of clinical course and risk factors for long-lasting PCS development in patients with dyspnea.

Material and methods. A screening cross-sectional clinical study was performed. 887 patients applied to outpatient clinic due to shortness of breath after a new coronavirus infection (NCVI) from March 2020 to August 2023. The study included 205 individuals, who were divided into 3 groups: 1st – 62 patients with PCS > 3 months; 2nd – 52 patients with PCS < 3 months; 3rd – 91 patients without PCS.

Results. The average duration of the period after a new coronavirus infection in studied patients was 7.3 [3.2; 12.8] months. Patients in the group with PCS ≥ 3 months had statistically significantly higher mean values for NCVI with hospitalization, NCVI with pneumonia, NCVI accompanied by weakness, NCVI with general feeling of being unwell, NCVI with cognitive impairment, NCVI with dyspnea, NCVI with significant lung damage. An increase of D-dimer level increased the odds ratio (OR) of developing PCS lasting > 3 months by 4 times, and an increase of N-terminal fragment of the B-type brain natriuretic peptide (NT-proBNP) – by 9.4 times comparatively to the group of patients without PCS. An increase in the concentration of tumor necrosis factor-alpha increased the OR of developing PCS lasting < 3 months by 8 times comparatively to the group of patients without PCS.

Conclusion. The severity of NCVI clinical course with hospitalization, pneumonia, appearance of pulmonary fibrosis affects the formation of long-lasting PCS. Risk factors for the development of long-lasting PCS include increased levels of D-dimer, NT-proBNP, increased body mass index, left ventricular myocardial hypertrophy.

According to the data of modern epidemiological studies, a stable tendency towards an increase in the prevalence of traditional cardiovascular risk (CVR) factors in young persons is forming, the significance of which in the development of chronic non-communicable diseases in this cohort of patients is complicated by the lack of validated prognostic models. Scientific research works indicate the possibility of using lung volumes as an integral prognostic marker in various age cohorts of conditionally healthy patients.

The aim: to study prognostic lung volume values in different cohorts of individuals depending on age and degree of cardiovascular risk according to the SCORE2 and Framingham-30 scales.

Material and methods. 145 individuals aged 20 to 60 years were included in the study. CVR was calculated using the SCORE2 and Framingham-30 scales. The participants underwent spirometry without a bronchodilator test, with estimation of the volume of formed exhalation in 1 second (FEV₁), forced vital capacity (FVC) and their ratio. Correlations between the values of these lung volumes and the category of cardiovascular risk were assessed.

Results. According to SCORE2 scale, 3.6% of respondents belonged to the low-risk category, while the majority of participants belonged to the moderate or high risk categories. The SCORE2 CVR category had no significant associations with lung volume parameters, with the exception of the lower limit of normal (LLN) of FEV₁/FVC (p < 0.001). As expected, a 1% increase in SCORE2 was accompanied by a 1.4% decrease in the LLN of the FEV₁/FVC ratio. When analyzing the risk by Framingham-30 scale with the addition of lipid panel parameters and including individuals aged 20 years and over, a decrease in lung volumes was most significantly associated with high CVR (p < 0.05). An increase in the Framingham-30 risk (with lipid panel data) correlated with a 0.07% decrease in the LLN of FEV₁/FVC (ρ = -0.8; p < 0.001).

Conclusion. Correlations between lung function parameters and 30-year CVR were found. Combining the Framingham-30 scale and lung volumes is a promising direction for further study of these correlations and creation of an expanded algorithm for risk assessment in younger individuals.

Prevalence and significance of anemia in COVID-19, especially in post-COVID period, have not been studied sufficiently. Data on the frequency and prognostic role of this condition in patients in the post-COVID period are contradictory. One of the promising directions in cardiology and therapy is the study of anemia development predictors in patients with shortness of breath who have had a novel coronavirus infection (NCVI).

The aim: to determine predictors of anemia development in patients with shortness of breath in long-lasting post-COVID syndrome.

Material and methods. From March 2020 to August 2023, 878 patients visited a pulmonologist in outpatient clinic for dyspnea ≥ 3 months after NCVI. 205 persons of them who met the inclusion criteria and had no exclusion criteria were selected for the study. Anemia was registered in 35 (17.1%) of them (Group 1), the remaining 170 (82.9%) participants did not have this condition (Group 2).

Results. Patients who underwent NCVI in the group with hemoglobin level of ≤ 129 g/l in males and ≤ 119 g/l in females had a statistically significantly lower level of serum iron in the limit of normal range. A strong direct correlation was found between hemoglobin and serum iron (r = 0.479, p < 0.05). Patients with anemia were statistically more likely to have in anamnesis NCVI with pneumonia, NCVI with pneumonia and hospitalization, NCVI with intensive care unit stay, as well as a prolonged clinical course of NCVI of ≥ 12 weeks. In addition, in the 1st group of the study, a statistically significantly lower glomerular filtration rate in the range of 45–59 ml / min. / 1.73 m² was recorded.

Conclusion. The development of anemia was associated with more severe forms of previous NCVI complicated by pneumonia with hospitalization. Anemia more often developed in patients over 60 years old, it was accompanied by metabolic disorders and concomitant pathology.

Acute forms of coronary heart disease remain to be the leading cause of morbidity and mortality. Inflammation and condition of the intestinal microbiota may be underestimated factors of residual risk.

The aim: to determine the level of certain proinflammatory serum markers and condition of the colon microbiota in patients with ST-elevation myocardial infarction (STEMI) in different age groups.

Material and methods. The study included 65 patients: group 1 – 11 males with STEMI aged 25–44 years, group 2 – 54 individuals with STEMI aged 45-60 years (87% male patients). The control group for cytokine levels (group 3) included 25 healthy individuals (64% males). In addition to routine tests, study participants had measurement of their levels of interleukins 6, 1β, 18, C-reactive protein, tumor necrosis factor-alpha, monocyte chemotactic protein-1, and fatty acid binding protein (FABP). Intestinal microbiota was analyzed using a bacteriological method.

Results. Reliable differences between patients with STEMI of different ages were obtained for the content of FABP in the blood: its values in the 1st, 2nd, and control groups were 0.07 [0.06; 0.1], 0.14 [0.08; 0.27] and 0.07 [0.07; 0.08] pg/ml, respectively (p_1–2 = 0.004, p_2–3 = 0.000). Two main study groups differed significantly in the level of proinflammatory cytokines from the control group. Patients in group 2 were characterized by a decrease in the number of lactobacilli relatively to the age-related norm (59.2 versus 66.7%, p = 0.002), an increase in opportunistic pathogens, Candida spp. and Staphylococcus spp. In this group, Escherichia coli with normal enzymatic activity was less common than in group 1 (64.8 versus 100%, p = 0.0007). Patients in group 1 more often had an increase in the number of Clostridium spp. (83.3 versus 14.8%, p = 0.000), atypical forms of E. coli (78.8 versus 42.6%, p = 0.00) and Klebsiella pneumoniae (16.7 versus 11.1%, p = 0.000).

Conclusion. Data indicating a unidirectional reaction of proinflammatory molecules in patients with STEMI of different ages are obtained. Quantitative changes in the main intestinal microorganisms without any significant differences in this index in patients of different age groups were found.

Chronic obstructive pulmonary disease (COPD) is a global health problem characterized by high prevalence, disability, and mortality rates. Coexistence of COPD and cardiovascular diseases significantly aggravates the patient’s clinical status and outcomes. Current review contains analysis, structures, the results of original studies, meta-analyses, and systematic reviews on the comorbidity of COPD and cardiovascular disease are structured and summarized, to form an entire picture of knowledge based on the current evidentiary basis and highlight aspects requiring further studies. A search for relevant literature sources was performed from 2015 to February 2025 in PubMed, Medline, China National Knowledge Infrastructure data bases. New data on the mechanisms of comorbidity development and peculiarities of COPD manifestation in case of common cardiovascular pathology were analyzed. Modern principles of treatment and prevention of the combination of COPD and cardiovascular diseases, requiring additional evidence that could be obtained in future randomized trials are introduced.

Granulomatosis with polyangiitis (GPA) is a rare autoimmune disease affecting small and medium-caliber arteries and mainly affecting the ENT organs, lungs and kidneys. Pregnancy in GPA patients is rare due to the development of the disease in most females over the age of 40–50 years. At the same time, when these conditions are combined, there is a high risk of exacerbation of GPA, which is life-threatening for the mother and requires the use of aggressive immunosuppression with potentially teratogenic drugs, which further increases the risk of complications for the fetus. Management of such a pregnancy requires careful monitoring and an interdisciplinary approach. Article contains a clinical observation of a young patient with severe lung damage associated with GPA, including the stages of diagnosis, selection of therapy, pregnancy and postpartum period. The aim of describing the presented clinical case is to illustrate the possibilities of a favorable pregnancy outcome for the mother and child when planning it during the period of GPA remission.

Allergic bronchopulmonary aspergillosis (ABPA) is a chronic infectious-allergic disease of the respiratory system caused by fungi of the family Aspergillus and taking clinical course as progressive bronchial asthma (BA). When examining patients suffering from chronic polypous rhinosinusitis (CPRS) with comorbid asthma and peripheral eosinophilia, it is necessary to exclude ABPA. Current article demonstrates the complexity of differential diagnosis of ABPA and severe asthma in female patient with CPRS and intolerance to nonsteroidal anti-inflammatory drugs receiving mepolizumab. It is necessary to make a screening examination for ABPA in patients with Th2 cell inflammation who have a combination of asthma, CPRS and peripheral eosinophilia, as a risk group for bronchopulmonary aspergillosis development. Such an examination is especially relevant among candidates for genetically engineered biological therapy, since the detection of ABPA will require correction or a radical change in their therapy.

The article contains information on conceptual framework, estimates factors determining the level of patient compliance, and presents measures to increase adherence to treatment. Practical recommendations for healthcare workers to improve patient compliance are introduced. Priority areas for the development of medical science in the field of improving the quality of medical technologies by increasing patient compliance are outlined.

At the interdisciplinary round table of experts held last year in Saint Petersburg, its participants comprehensively considered the problem of non-specific lower back pain (NSLBP) – one of the main reasons for patients to visit their general practitioners. During the meeting, issues of epidemiology, pathogenesis, diagnosis, treatment and prevention of acute and chronic NSLBP in primary health care unit were discussed. Diagnosis of the acute form of the disease is based on a survey and physical examination, as well as the exclusion of symptoms of life-threatening pathology (“red flags”). The main method of drug treatment is the use of non-steroidal anti-inflammatory drugs and central muscle relaxants. It is also advisable to use complex preparations of vitamins B₁, B₆ and B₁₂. In addition to a physical examination, diagnosis of chronic NSLBP requires visualization of the spine, neurological examination, the use of questionnaires to screen for signs of dysfunctional pain and psychoemotional disorders. Along with non-drug methods, therapy includes the use of non-steroidal anti-inflammatory drugs, antidepressants, and in some situations, “weak” opioids. In case of signs of osteoarthritis of the facet and sacroiliac joints, the prescription symptomatic slow acting drugs for osteoarthritis is justified. The use of pharmaconutraceuticals can also be discussed. The absence of a therapeutic effect in the next 2–4 weeks from the start of treatment requires consultation with specialists in spinal pathology (rheumatologists, neurologists, neurosurgeons).

Resolution of the Expert Council was approved 25.01.2024 by the bureau of presidium of the all-Russian public organization “Russian Scientific Medical Society of Internal Medicine” (RSMSIM), 24.06.2024 – by the presidium of the RSMSIM.