V V Maleyev

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 (rxy=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.

We present a clinical case of familial LMNA-associated cardiomyopathy, confirmed by whole genome sequencing. The typical for lamin-associated cardiomyopathy indicates pathogenic nature of the mutation in the first exon of LMNA gene, previously considered a mutation of unknown clinical significance. The presented clinical case demonstrates a radical change in patient treatment strategies in the context of the widespread introduction of molecular genetic research methods into practice.

Aim. To study the lipid-lowering and pleiotropic effects of statin monotherapy and combination with ezetimibe in patients in the postinfarction period, depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL cholesterol) for 24 weeks. Materials and methods. 114 patients with myocardial infarction were included. Treatment was started with statin monotherapy, with insufficient efficacy, ezetimibe was added. After 24 weeks, the 1st group included 38 people, the 2nd – 76 patients. On 7–10th days and 24 weeks later, the lipid profile, the N-terminal fragment of the precursor of the cerebral natriuretic peptide (NT-proBNP) were determined, speckle-tracking echocardiography, ultrasound examination of the carotid arteries (CA) with RF technology were performed. Results. At week 24, the patients were divided depending on the achievement/non-achievement of the LDL cholesterol target. The highly effective therapy group (HET) included 52 patients, the insufficiently effective therapy group (IET) consisted of 62 people. The ratio of the chances of achieving LDL cholesterol with the addition of ezetimibe to a statin was 3.4 [1.8; 6.6] (p0.001). In the HET group, by the 24th week, NT-proBNP decreased by 59.6% (p=0.045); in the IET group – by 52.2% (p=0.042). According to echocardiography data, after 24 weeks in the HET group, an increase in global constructive work GCW by 9.1% (p=0.036) and the global work index GWI by 8.2% (p=0.041) was revealed without dynamics of indicators in the comparison group. In the study of the CA, the thickness of the intima-media complex in the HET and IET groups regressed by 9.5% and 6.8% respectively (p0.05). Only in the HET group did the common CA stiffness indicators improve. Conclusion. The achievement of LDL cholesterol control on the background of combined lipid-lowering therapy in patients in the postinfarction period is characterized by the most pronounced organoprotective effect.

William Osler is one of the most honored and influential physicians in the English medicine late 19th early 20th century, who has made a great contribution on development of medical science and it’s teaching. The scope of his multifaceted personality goes far beyond the characteristics of an outstanding doctor and scientist. The historical essay presents various aspects of the Osler’s personality, highlighting his uniqueness as a doctor, teacher and philosopher.

This study is aimed at investigating epileptic seizures, one of the consequences of traumatic brain injury (TBI). Immediate and early post-traumatic seizures, as well as late post-traumatic epileptic seizures or post-traumatic epilepsy, can have different pathogenetic bases. The following key risk factors associated with post-traumatic epilepsy are known: duration of unconsciousness, gunshot wounds, intracranial hemorrhage, diffuse axonal injury, prolonged (more than 3 days) post-traumatic amnesia, acute subdural hematoma with surgical evacuation, immediate and early post-traumatic epileptic seizures, fracture of the skull bones. The role of genetic factors in post-traumatic seizures is poorly understood due to the complexity and multiple causal mechanisms. This paper addresses the role of genetic factors in the occurrence and severity of epileptic events in patients with TBI. In particular, we investigated the role of the Cys112Arg single nucleotide polymorphism of the apolipoprotein E gene. Apolipoprotein E is known for its role in the transport and metabolism of lipids and, therefore, the development of cardiovascular diseases; it is also associated with Alzheimer's disease and has recently been studied in the context of association with epilepsy. The study shows an association between this polymorphism and the risk of immediate and early epileptic seizures in patients with severe TBI.

The study evaluated the impact of HCV infection on the prognosis in patients with hematological malignancies. A total of 96 patients with anti-HCV antibodies were enrolled, with the age of 37.8 (3.0–81.0) years old, 39.6% had non-Hodgkin’s lymphoma. Chronic hepatitis C (CHC) was diagnosed in 46.9% patients prior to malignancy development, in 38.5% patients simultaneously with malignancy, and in 14.6% patients during malignancy treatment. Clinical and biochemical signs of HCH were mild in most of the patients, minimal liver fibrosis (F0–1 by METAVIR system) was discovered in 47.3% patients, severe fibrosis or cirrhosis (F3–4) was diagnosed in 40% of participants. Only 20 (20.8%) of patients received antiviral therapy against HCV prior to enrollment. Regression analysis demonstrated that age 55 years old, late onset of antiviral therapy, and poor nutritional status were significant predictors of death from hematological malignancy. Survey conducted among physicians of hematological oncology hospitals in Saint-Petersburg revealed gaps in knowledge on presentation and risks of HCV infection, as well as on opportunities of modern antiviral therapy.

A description of a COVID-19 patient with the development of exudative pericarditis complicated by cardiac tamponade is provid. A peculiarity of this case is the presence of an underlying disease in the patient (chronic lymphocytic leukemia), which was in remission for 1.5 years after chemotherapy. Another feature of the patient was the relatively small area of lung damage and the hemorrhagic nature of the pericardial effusion, which persisted for a long time. The insignificant activity of inflammatory markers was noteworthy. Possible mechanisms of development and features of the course of exudative pericarditis in the described patient, issues of diagnosis and treatment of this category of patients are discusse.

The article describes a clinical observation of a severe course of a sporadic case of foodborne botulism in a woman at 32 weeks gestation with a successful resolution of pregnancy by independent childbirth. No adverse effects of botulism on pregnancy, delivery, and fetal development were noted. Anti-botulinum serum was administered to the patient no earlier than 96 hours from the onset of the disease. The paper analyzes the clinical picture of botulism, on the basis of which it is necessary to carry out a differential diagnosis.