Vol 27, No 1 (2025): Cardiology and Nephrology

Obstructive sleep apnea (OSA) is one of the most common conditions directly related to sleep and is associated with many cardiovascular complications. The prevalence of hypertension among patients with OSA significantly exceeds that in the general population. OSA can both lead to the occurrence of hypertension, complicate its course, and cause resistance to drug therapy. Also, OSA often leads to a change in the daily blood pressure (BP) profile with no physiological decrease or increase during sleep. Physicians should be alert to patients who are snoring and experiencing daytime sleepiness, especially if they are middle-aged, overweight men. An abnormal diurnal profile of BP and/or hypertension resistant to multicomponent antihypertensive therapy also indicates probable OSA in such patients. The diagnosis of OSA should always be confirmed using special instrumental examination methods. The most effective and safe treatment method for clinically significant OSA is non-invasive ventilation with constant positive airway pressure (CPAP therapy). Proper treatment of OSA often leads to normalizing the diurnal blood pressure profile, decreasing BP both during sleep and wakefulness, and restoring sensitivity to antihypertensive drug therapy.

Aim. To evaluate the results of intravenous use of iron carboxymaltosate in the short term before cardiac surgery in patients with iron deficiency.

Materials and methods. The retrospective study included data from the medical records of 113 patients with iron deficiency who underwent cardiac surgery. All patients were divided into two groups depending on the presence (60 people) or absence (53 people) of anemia in the preoperative period. The effect of iron carboxymaltosate infusion on the level of hemoglobin (Hb), ferritin, the need for transfusion of erythrocyte-containing blood components, the duration of the postoperative period, mortality and complications was analyzed.

Results. After iron carboxymaltosate infusion, an increase in ferritin levels was noted in group 1 to an average of 536.3±150.4 ng/ml, in group 2 – 640.6±231.5 ng/ml (p=0.7). The increase in Hb levels after iron carboxymaltosate infusion in group 1 averaged 5.1±3.2 g/l, in group 2 – 3.5±5.0g/l (p=0.0428). In the postoperative period group 1 patients received an average of 0.08±0.3 doses of erythrocyte-containing blood components versus 0.1±0.5 doses in group 2 (p=0.97). No deaths were recorded. The duration of treatment in the intensive care unit and the total duration of the postoperative period in both groups did not significantly differ. Surgical bleeding was recorded in 3 patients (5%) of group 1 and 2 patients (3.7%) of group 2 (p=0.372). Infectious complications were detected in 1 patient in each group (p=0.93).

Conclusion. The use of a single infusion of iron carboxymaltosate in a short time before cardiac surgery makes it possible to effectively restore ferritin concentration and increase Hb levels in cardiac surgery patients with and without anemia, without affecting the risk of infectious complications and death.

Background. Acute pericarditis is an inflammatory disease of the pericardium that requires timely and accurate diagnosis to prevent potentially dangerous complications. This article reviews the key aspects of diagnosis and treatment of acute pericarditis in real clinical practice. Due to nonspecific clinical picture and absence of special diagnostic methods, diagnosis of acute pericarditis may cause difficulties. In about one third of patients, the course of the disease is recurrent, which requires assessment of possible risk factors for recurrent episodes of acute pericarditis. The clinical practice of management of patients with OP in the Russian Federation is limited to the description of individual cases.

Aim. To evaluate the peculiarities of management and treatment of patients with OP in the hospital register.

Materials and methods. A retrospective study was carried out in Moscow hospitals Moscow City Hospital named after S.S. Yudin and Pirogov City Clinical Hospital №1 from January 2023 to September 2024. The protocol was approved by the ethical committee of the Sechenov First Moscow State Medical University (Sechenov University). The charts of patients diagnosed with OP were analyzed. Inclusion criteria: age ≥18 years, presence of 2 of 4 major criteria for OP. Patients with HIV, pregnancy, acute psychiatric conditions and severe chronic renal failure (pSCF<15 ml/min/1.73 m²) were excluded.

Results. Forty patients with OP were included. Consistency of diagnostic characteristics with the grand diagnostic criteria was assessed 1 of 4 grand criteria occurred in 7 (17%) cases; 2 of 4 occurred in 25 (63%) individuals, 3 of 4 in 8 (20%); complete compliance with all criteria was absent. 27 (68%) patients had ECG changes, ST segment elevation in 24 (60%), but only 3 (13%) had changes in all leads. PQ depression and pericardial friction murmur were not recorded. OP was diagnosed on the day of hospitalization in 29 (73%) patients, in 11 (27%) – on the 2nd day after CAG. Four (10%) developed acute heart failure requiring diuretics. Monotherapy with NSAIDs was used in 21 (53%) patients, combined therapy with NSAIDs + colchicine – in 6 (15%). Bacterial etiology of OP besides antibiotics also requires prescription of combination of NSAIDs/HCS + colchicine. In the discussed study, therapy with NSAIDs, GCS and colchicine was initiated only when antibiotic therapy was ineffective, which is not in accordance with clinical guidelines. The dosage of NSAIDs was in accordance with recommendations in 40% of cases, adequate dose of colchicine in 28%. Combination therapy at discharge was recommended in 21 (52.5%) cases; correct doses and timing were indicated in 18 (44%) and 7 (17.5%) patients.

Conclusion. The diagnosis of OP was more often made in the first day; in the rest, the delay in diagnosis was associated with troponin elevation and ST segment elevation on ECG, which requires CAG for differential diagnosis. The main errors of treatment: incorrect doses of NSAIDs/GCS, absence of colchicine in therapy and terms of its administration in discharge epicrises, as well as absence of information about physical load limitations.

Aim. To evaluate and compare the efficacy and safety of two triple fixed combinations (FC) of antihypertensive drugs, amlodipine/indapamide/perindopril and amlodipine/valsartan/hydrochlorothiazide (HCTZ), in managing the clinical course in patients with grade 2-3 hypertension and functional class II and III coronary artery disease.

Materials and methods. The study included 52 patients with uncontrolled hypertension with systolic blood pressure (SBP)≥160 mmHg and/or diastolic blood pressure (DBP)≥90 mmHg combined with stable effort angina who were taking two antihypertensive drugs at the beginning of the study. Depending on the treatment, the participants were divided into two groups: Group 1 included 27 subjects who received FC of amlodipine/indapamide/perindopril, and Group 2 included 25 subjects who received FC of amlodipine/valsartan/HCTZ. All patients also received β-blocker bisoprolol 5-10 mg and antiplatelet agent 75-100 mg.

Results. After 12 weeks of follow-up compared to baseline, there was a significant decrease in office BP in Groups 1 and 2: SBP by 34.50 and 32.03 mmHg (p<0.001 for both groups), with significant differences between the groups (p=0.045), DBP by 13.28 and 13.79 mmHg, respectively (p<0.001 for both groups), without significant differences between the groups (p=0.052). The heart rate decreased in both groups to 69.00 bpm, with no intergroup differences (p=0.061). In Groups 1 and 2, after 12 weeks of follow-up, arterial stiffness significantly improved compared to baseline: SBP in the aorta decreased by 23.50 and 27.00 mmHg (p<0.001 for both groups), DBP in the aorta decreased by 17.50 and 20.00 mmHg (p<0.001 for both groups), pulse pressure in the aorta decreased by 4.50 and 8.00 mmHg (p<0.001), augmentation index decreased by 9.00% and 10.00% (p<0.001 for both groups), pulse wave velocity decreased by 2.51 and 1.97 m/s (p<0.001 for both groups), with significant differences between groups (p=0.032), the ankle-brachial index decreased by 0.01 and 0.02 (p<0.001 for both groups), vascular age decreased by 5.00 years (p=0.001) and 3.00 years (p=0.025) [p=0.025 for comparison between groups], endothelial function improved by 24.5% (p=0.015) and 18.0% (p<0.001) [p=0.015 for comparison between groups]. The number of ischemia episodes significantly decreased in both groups: in Group 1 from 2.8±0.3 to 1.2±0.2 per week (p=0.021), in Group 2 from 2.5±0.6 to 1.5±0.3 (p=0.018), with no significant differences between the groups.

Conclusion. Both triple FCs – amlodipine/indapamide/perindopril and amlodipine/valsartan/HCTZ – effectively reduced office BP and improved vascular stiffness and endothelial function in patients with hypertension and coronary artery disease. FC of amlodipine/indapamide/perindopril provided a more pronounced reduction in office SBP, pulse wave velocity, and vascular age, as well as endothelial function improvement. Both regimens reduced the incidence of ischemic episodes, with no significant differences between the groups.