CardioSomatics

Objective. We aimed to assess the psychological state and personality-adaptive potential in patients with Takotsubo syndrome (TS), and to use the results to construct a prognostic model for the risk of developing the disease.

Materials and methods. A total of 38 patients with TS were examined 10–14 days after the disease onset. The mean age of the men was 63.8±14.73 years, and the women, 33 (86.8%) years. The control group included 40 people; their average age was 66.6±10.4 years, of which 39 (97.5%) were women. Their psychological state and stress resistance were assessed using the following tests and questionnaires: G. Eysenck's personality questionnaire; the hardiness survey; the N.V. Kirsheva and N.V. Ryabchikov personality stress resistance self-test; the scale of perceived stress; the PSM-25 Lemur–Tessier–Fillion psychological stress measure; the Spielberger–Khanin anxiety scale; the Hamilton Anxiety Scale; the Hospital Anxiety and Depression scale; the Beck Depression Scale; and the Montgomery–Asberg depression rating scale.

Results. G. Eysenck's personality questionnaire showed that patients with TS had a higher level of neuroticism (14.6±3.7 and 11.4±4.1, respectively; p <0.01) and tendency to introversion (9.4±3.3 and 12.4±3.5, respectively; p <0.001) than the control group. According to the Spielberger–Khanin psychometric scale, reactive anxiety was higher in the TS group (46.4±9.1 and 37.0±11.4, respectively; p <0.0001), and there was also a tendency toward personal anxiety (45.1±7.3 and 41.8±11.1, respectively; p >0.05). For all three analyzed scales designed to assess internal anxiety, it was found that in patients with TS, this component of the psyche was more pronounced (HARS: 21.8±4.8 and 16.1±5.4, respectively; p <0.0001; HADS: 13.1±3.6 and 7.4±3.0, respectively; p <0.0001). Depression, ranging from mild to severe, was more common in patients with TS, according to all questionnaires (HADS: 100% and 40%, respectively; p <0.05; BDI: 73.7% and 27%, respectively; p <0.05; MADRS: 97.4% and 62.5%, respectively, p <0.05). According to the hardiness test, the TS group had low indicators of overall hardiness (71.4±18.0 and 82.6±19.7, respectively; p <0.05), involvement (32.5±9.1 and 36.8±8.9, respectively; p <0.05), and control (23.3±7.3 and 29.2±7.8, respectively; p <0.01) compared to the control group. Stress resistance was also significantly lower in patients with TS (38.9±6.4 and 34.1±7.3, respectively; p <0.001). Based on the data from the questionnaires and scales, using the classification tree method, an integral model for predicting the development of TS with a high predictive value (96%) was built.

Conclusion. Anxiety and depressive disorders make a significant contribution to the development of TS. Personality traits like introversion, neuroticism, and increased susceptibility to stress with low stress resistance and hardiness also play a role. This suggests the need for timely diagnosis of psychological disorders and their correction in people with this personality type, especially postmenopausal women. Prompt intervention may help prevent or reduce the risk of developing the disease.

Background. Epidemiological studies show that mortality among patients with heart failure and preserved left ventricular ejection fraction remains high. In recent clinical studies, inhibitors of sodium-glucose cotransporter type 2 are showing promise in reducing cardiovascular complications in patients with chronic heart failure who need effective drug treatment.

Aim. We aimed to analyze published randomized controlled clinical trials evaluating the effectiveness of sodium-glucose cotransporter type 2 inhibitors, added to standard therapy, in a group of patients with chronic heart failure and a left ventricular ejection fraction over 40%.

Materials and methods. A systematic review and meta-analysis of the scientific literature were performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of the PubMed database for the period from January 2021 to December 2022 was performed. The search keywords included the following MeSH terms: “heart failure preserved ejection fraction” or “HFpEF” and “empagliflozin” or “dapagliflozin” or “SGLT2.” The search did not use filters for language or type of study. All statistical analyses were performed using the RevMan version 5.4 (Copenhagen, the Nordic Cochrane Centre, The Cochrane Collaboration, 2014).

Results. The initial search retrieved 481 publications. After further screening and exclusions for non-compliance with the inclusion criteria, two clinical studies were included. There were 12 251 patients in total, 6128 received sodium-glucose cotransporter type 2 inhibitors, 6123 received placebo. Patients treated with these drugs were 20% less likely to have a combined endpoint (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.72–0.87; p <0.001). This was primarily due to a 26% decrease in the frequency of hospitalization for acute decompensation of heart failure (OR 0.74, 95% CI 0.66–0.83; p <0.001). There was a trend toward decreased mortality from cardiovascular causes (OR 0.88, 95% CI 0.77–1.01; p=0.06), while no effect was observed on all-cause mortality (OR 0.96, 95% CI 0.87–1.06; p=0.38).

Conclusions. The meta-analysis shows the potential of sodium-glucose cotransporter type 2 inhibitors to reduce hospitalization for acute decompensation of heart failure in patients with a moderately reduced and preserved left ventricular ejection fraction.

Research into new biological markers may help early diagnosis and effective therapy for cardiology patients. The use of biomarkers to evaluate patients has made a major impact in oncology, but is still in its infancy in the cardiology field. Studies on secreted frizzled-related protein 5 (SFRP5) have revealed its potential use as a marker of cardiovascular pathology. Preclinical studies have highlighted the important role this protein plays in many biological processes. It reduces the proliferation and migration of cardiac fibroblasts and suppresses the Wnt5A/JNK signaling pathway thus reducing the severity of oxidative stress and inflammation. It normalizes nitric oxide production and has several other effects. However, recent clinical studies of SFRP5 have produced conflicting data. Nevertheless, this protein shows promise as a marker for several metabolic and cardiovascular diseases. Preliminary data also suggest SFRP5 may be a therapeutic target. Further study of SFRP5 and its role in cardiovascular pathology is necessary, and will create new diagnostic and prognostic possibilities for this biological marker.