Научно-исследовательский институт комплексных проблем сердечно-сосудистых заболеваний (НИИ КПССЗ
Highlights. A rare case of pulmonary valve infective endocarditis in a patient without medical and social risk factors is reported. The presented treatment strategy is of particular interest to general physicians, cardiologists, and cardiac surgeons.The incidence of isolated pulmonary valve infective endocarditis is extremely rare in the general population. Thus, clinical physicians do not have their own experience in the differential diagnosis of this pathology. There is a prejudice that Abstract infective endocarditis involving the right side of the heart is commonly associated with intravenous drug abuse. Healthcare professionals lack caution when making this diagnosis in patients. We report a rare clinical case of pulmonary valve infective endocarditis in a patient without medical and social risk factors.
Th e aim of the research. To analyse the structure of complications in patients with coronary artery disease and different musculoskeletal disorders (MSD) undergoing elective coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Material and methods. From 2019 to 2020, a single-centre cohort study was conducted on 387 stable coronary artery disease patients aged over 50 before elective CABG. The following MSD were assessed: sarcopenia, osteopenia, and osteosarcopenia. Patients were divided into four groups according to the MSD type: group I included 52 (13.4 %) patients with sarcopenia, group II included 28 (7.2 %) patients with osteopenia, group III was composed of 25 (6.5 %) patients with osteosarcopenia, and group IV included 282 (72.9 %) patients without MSD. Patients underwent CABG using cardiopulmonary bypass. Cardiovascular, infectious and non-infectious complications, death, a composite endpoint including cardiovascular complications and death, as well as the total number of complications were analysed. Results. Infectious complications were revealed in 23 (5.9 %) patients. Th e highest frequency of infectious complications was noted in patients with osteosarcopenia while the lowest frequency was found in patients without MSD (24 % vs 5.8 % in group I, 7.1 % in group II, 4.3 % in group IV). The highest number of surgical complications was noted in patients with sarcopenia and osteosarcopenia (17.3 % in group I, 7.1 % in group II, 12 % in group III, 5.3 % in group IV; p = 0.002). The composite endpoint was significantly more prevalent in patients with osteopenia (32.1 vs. 9.6 % in group I, 12 % in group III, and 12.8 % in group IV). Th ere were no statistically signifi cant diff erences in the total number of complications between the groups of patients with MSD. Th e complications were 2-fold more likely to occur in patients with osteopenia and osteosarcopenia compared to patients without MSD. Moreover, MSD increased the risk of the composite endpoint by 1.7 times (odds ratio (OR) 1.73, 95 % confi dence interval (CI) 1.04-2.89; p = 0.035); osteopenia increased the risk of the combined endpoint by 3 times (OR 3.01, 95 % CI 1.02-8.9; p = 0.046). Surgical complications were associated with baseline MSD (OR 1.71, 95 % CI 1.06-2.76; p = 0.026); sarcopenia increased the risk of surgical complications by 2 times (OR 2.02, 95 % CI 1.05-3.88; p = 0.034). Conclusion. The frequency of complications in patients with MSD was 1.79-fold higher compared with patients without MSD. Cardiovascular and infectious complications as well as complications associated with surgical treatment were more common in patients with MSD. MSD can be used as a risk factor for the development of in-hospital complications because the presence of these disorders increases the risk of cardiovascular complications, non-infectious complications and death by 1.7 times. Moreover, osteopenia was associated with a threefold increase in the composite endpoint risk, while sarcopenia doubled the risk of non-infectious complications.
Highlights. Patients with coronary artery disease and age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) who underwent elective on-pump coronary artery bypass grafting are at higher risk of developing cardiovascular complications, non-infectious complications, and death.Musculoskeletal disorders (sarcopenia, osteopenic syndrome, osteosarcopenia) in combination with traditional predictors (age, diabetes mellitus, prior myocardial infarction and stroke, cancer) are risk factors for unfavorable prognosis of postoperative period of coronary artery bypass grafting. Aim. To assess risk factors for unfavorable prognosis in patients with coronary artery disease (CAD) undergoing elective on-pump coronary artery bypass grafting, taking into account age-related disorders (sarcopenia, osteopenic syndrome, osteosarcopenia).Methods. This single-center study included 387 CAD patients admitted for elective coronary artery bypass grafting. Taking into account the diagnosed age-related disorders, four groups of patients were formed. The first group consisted of 52 (13.4%) patients with sarcopenia, the second group was comprised of 28 (7.2%) patients with osteopenia (osteopenia/osteoporosis), the third group included 25 (6.5%) patients with osteosarcopenia, and the fourth group consisted of 282 (72.9%) participants with coronary artery disease and without musculoskeletal disorders (MSD). Risk factors for a composite endpoint (myocardial infarction, stroke, paroxysmal atrial fibrillation, cardiac rhythm disturbances) and death, and noninfectious complications (resternotomy for bleeding, pneumothorax aspiration and thoracentesis) were assessed.Results. The composite endpoint occurred more frequently in patients with osteopenia (group I – 9.6%, group II – 32.1%, group III – 12%, group IV – 12.8%; p = 0.029), and non-infectious complications occurred more frequently in patients with sarcopenia and osteosarcopenia (group I – 17.3%, group II – 7.1%, group III – 12%, group IV – 5.3%; p = 0.002). MSD were associated with the risk of composite endpoint (odds ratio (OR) 1.73, p = 0.035), and osteopenia increased it three-fold (OR 3.01, p = 0.046). Moreover, MSD were associated with higher risk of non-infectious complications (OR 1.71, p = 0.026), especially in patients with sarcopenia (OR 2.02, p = 0.034). The assessment of risk factors for unfavorable prognosis highlighted the presence of osteopenic syndrome (100 CU), prior stroke (88 CU) and myocardial infarction (85 CU). The risk of non-infectious complications was associated with prior ischemic events (ranking level for myocardial infarction – 100 CU, stroke – 75 CU), and MSD (89 CU) and its types (osteosarcopenia – 77 CU, osteopenia – 69 CU, sarcopenia – 52 CU).Conclusion. Age-related disorders in combination with MSD increase the risk of a composite endpoint and non-infectious complications by one to three times.
Background. No specific time frames are specified in the guidelines for smoking cessation for patients preparing for cardiovascular intervention. Current smoking is an adverse prognostic factor according to the Russian and foreign legal documents, but the recommendations do not specify the timing of smoking cessation, even though it could help minimize postoperative complications and improve the prognosis. Aim. To analyze doctors' opinions on the necessity and timing of smoking cessation for patients before scheduled cardiovascular surgery. Material and methods. 320 specialists 250 (78.1%) general practitioners and 70 (21.9%) surgeons, were surveyed, each participant had at least 10 years of experience performing preoperative program before coronary artery bypass graft surgeries or other interventions and providing postoperative rehabilitation. The questionnaire included seven questions reflecting the doctors' opinion on the feasibility, timing and limiting factors of smoking cessation in patients referred for planned coronary artery bypass graft surgery. Results. Most of the respondents 218 (68.1%) people would recommend patients to stop smoking during preoperative period; fewer specialists 102 (31.9%), would advise them to quit smoking after surgery. The majority of respondents, 166 (76.2%) doctors, believe that patients should quit smoking 2 months before the operation. A third of respondents said it would be appropriate to stop smoking after surgical treatment: 31 (30.4%) specialists recommended it immediately after the operation; 43 (42.1%) within the first month. The majority of respondents noted an increased risk of patients health deterioration, such as: increased cough according to 200 (62.5%) specialists; sputum secretion 85 (26.6%); shortness of breath 25 (7.8%); and 10 (3.1%) doctors mentioned the risk of developing withdrawal syndrome and anxiety. All of those are the reasons why experts consider not recommending patient to stop smoking during preoperative period. Conclusion. Doctors, involved in the caring for and management of cardiac surgery patients, do not have unanimous opinion on the time frames of smoking cessation.
Aim. To measure respiratory muscle strength (RMS) in patients with coronary heart disease (CHD) and different musculoskeletal disorders (MSD).Material and methods. Patients were divided in four groups according to the MSD. Group I included 52 (13.4%) patients with sarcopenia, group II included 28 (7.2%) patients with osteopenia, group III included 25 (6.5%) patients with osteosarcopenia, group IV included 282 (72.9%) patients without MSD. All patients underwent the assessment of maximal expiratory (МЕР) and maximal inspiratory mouth pressures (MIP).Results. The mean RMS values were lower than the normative values, and the strength of the expiratory muscles was 1.25 times lower compared to the inspiratory muscles. Both of these parameters were within the normal range in 191 (49.3%) patients, and lower values were noted in 196 (50.7%). An isolated decrease in MIP was observed in 24.8% of patients, an isolated decrease in МЕР in 6.5%, a combined decrease in MIP and МЕР in 19.4% of patients. Comparative analysis of МЕР and MIP (depending on the MSD) did not demonstrate statistically significant differences. Lower МЕР (76.9%) and MIP (75%) values were noted mainly in the group of patients with sarcopenia. A similar pattern was notes in patients with osteosarcopenia and in patients without MSD. Normative values of RMS were observed in patients with osteopenia. Correlation analysis revealed a unidirectional relationship between RMS and the parameters of muscle function (hand grip strength, muscle area and musculoskeletal index) and a multidirectional relationship between МЕР and BMI (r -0.743, p=0.013), MIP and patient age (r -0.624, p=0.021).Conclusion. Respiratory muscle weakness was diagnosed in half of the patients with coronary heart disease. There were no statistically significant differences in RMS between patients with MSD and isolated CHD, despite lower values in the group with MSD. Correlation analysis revealed an association between RMS and muscle function.
Aim. To analyze the differences in detection rate of prefrailty and frailty syndrome (FS) in male and female patients with multivessel coronary artery disease (CAD) undergoing elective coronary artery bypass grafting (CABG).Material and methods. The study included 387 patients admitted for elective primary CABG. Screening for prefrailty and FS in patients before surgery was performed using the questionnaire "Age is not a drawback".Results. In the age group of 45 to 59 years, 25% of females and only 6% of males had signs of FS, while 25% of women and 34% of men did not present with signs of frailty and prefrailty. Half of middle-aged women and 60% of middle-aged men had prefrailty. Between the ages of 60 and 74, only 14% of women and 24% of men were not frail. Elderly women are more likely than elderly men to present with signs of FS (p=0,040). The symptoms of prefrailty in elderly patients were detected at equal rate in men and women (59% and 60%, respectively). All senile-aged patients presented with the signs of prefrailty or FS.Conclusion. Patients with multivessel CAD present with manifestation of frailty in senile, elderly, and middle age. At the same time, middle-aged and elderly women with the higher rates of comorbid disorders require special attention.
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