Yelena Rib

According to Globocan, in 2022, the highest incidence of hepatocellular carcinoma (HCC) was observed in Asia, which accounted for 75% of the global burden of liver cancer 1. In the Republic of Kazakhstan in 2022, the incidence of liver cancer was 5.1 per 100,000 population, with a mortality rate of 2.9, respectively. For the period 2014-2022, HCC had the lowest five-year survival rate among all malignant neoplasms in Kazakhstan2,3. The treatment of HCC across various stages involves a range of clinical strategies4. Sorafenib is currently the primary drug in the treatment of HCC 4,5 and doxorubicin is used in transarterial hepatic artery chemoembolization (TACE)8. However, their use results in cardiotoxicity leading to cancer therapeutics-related cardiac dysfunction (CTRCD)9. CRTCD manifests as cardiovascular disease symptoms in patients with HCC, reflecting irreversible structural changes in the myocardium10. BJMS, Vol. 24 No. 04 October’25 Page : 1189-1196

The purpose of this research: to conduct a retrospective analysis of patient data after transarterial chemoembolization of the hepatic artery. Methods. A retrospective study was carried out. In the general structure of oncological patients with liver cancer during the observed period, there were 456 patients, of which 137 underwent courses of transarterial chemoembolization of the hepatic artery, the prevailing majority of which are men - 81 people. The average age of patients in the sample was 64.6±7.82 years. Results. n the group of patients undergoing transarterial chemoembolization of the hepatic artery, in addition to primary liver cancer, there were also metastatic liver lesions - 42 cases, of which cancer of the rextosigmoid junction predominated (26 cases). The average duration of the disease was 19.2±5.2 months, the median was 17.6 months. The most common diseases were arterial hypertension (45 cases) and chronic heart failure (33 cases). 22 patients received targeted therapy, 33 patients received multicomponent chemotherapy, 113 patients received transarterial chemoembolization of the hepatic artery, and 12 patients underwent surgical treatment. Conclusions. According to the results of a retrospective analysis of patient data after transarterial chemoembolization of the hepatic artery, the most common comorbidities were arterial hypertension and chronic heart failure, most patients received doxorubicin and irinotecan more often.

Heart failure (HF) with mildly reduced ejection fraction (HFmrEF) was recently recognised as a distinct clinical entity. Although guideline diagnostic criteria for HFmrEF are well defined, there is substantial variation in clinical characteristics, pathophysiology and prognosis of this group of patients. The heterogeneity in clinical presentations of HFmrEF arises from diverse patients’ risk factors, coexisting comorbidities, which modify clinical signs and symptoms, and stage of the disease. On the other hand, HFmrEF shares common clinical features with other HF subgroups. However, the knowledge about the mechanisms and therapeutic approaches in HFmrEF is far from being completely understood. Therefore, HFmrEF represents one of the most intriguing areas of heart failure research. The aim of this review is therefore to highlight the diagnostic challenges in HFmrEF and to provide a constructive appraisal on the pathophysiology of HFmrEF, as well as to discuss the role of pharmacological and nonpharmacological treatment options in patients with HFmrEF.