Vol 13, No 4 (2022)

Original articles

Psychological features of patients with Takotsubo syndrome: cross-sectional study

Evdokimov D.S., Feoktistova V.S., Semenova A.P., Boldueva S.A.


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.

CardioSomatics. 2022;13(4):184-191
pages 184-191 views

A comparison of the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis in patients with bicuspid and tricuspid aortic valve: retrospective comparative study

Bazylev V.V., Babukov R.M., Bartosh F.L., Levina A.V., Mikulyаk A.I.


Objective. We aimed to compare the diagnostic capabilities of the ratio of acceleration time to total left ventricular ejection time (AT/ET) in determining the severity of aortic stenosis (AS) in patients with bicuspid and tricuspid aortic valves (AV).

Material and methods. We retrospectively analyzed the data of 187 patients with moderate and severe AS who underwent diagnostic examination at the Penza Federal Center for Cardiovascular Surgery. The patients were divided into 2 groups based on whether their AV was tricuspid or bicuspid. Visual assessment of the AV structure was performed using transthoracic echocardiography (TTE). In indeterminate cases, computed tomography was used for the assessment.

Results. A comparative analysis of the echocardiographic characteristics of patients with tricuspid and bicuspid AV did not reveal a statistically significant difference between the patient groups (p ≤0.05). Linear regression analysis in patients with a tricuspid AV demonstrated a statistically significant correlation between AT/ET scores and peak gradient (Gmax) (r=0.68, р=0.03), mean gradient (Gmean) (r=0.78, р=0.01), effective orifice area (EOA) (r=0.7, р=0.03), and doppler velocity index (DVI) scores (r=0.72, р=0.02). In patients with a bicuspid AV, a similarly significant correlation was found between the AT/ET index and Gmax (r=0.67, р=0.02), Gmean (r=0.8, р <0.001), EOA (r=0.72, р=0.04), and DVI (r=0.75, р=0.01). The receiver operating characteristic analysis demonstrated a high predictive ability of AT/ET for severe aortic valve stenosis (with a value >0.35). The area under the curve in patients with tricuspid and bicuspid AV was 84 (p <0.001) and 86 (p <0.001), respectively. For determining severe AV stenosis in patients with a tricuspid AV, the sensitivity and specificity of AT/ET >0.35 was 84% and 75%, respectively; and in patients with a bicuspid AV, it was 87% and 78%, respectively.

Conclusion. The AT/ET ratio has comparable diagnostic capabilities in determining severe AS in patients with tricuspid and bicuspid AV structures. The AT/ET >0.35 is a highly sensitive parameter for defining severe AS for both morphologies of AV.

CardioSomatics. 2022;13(4):192-197
pages 192-197 views

Sodium-glucose cotransporter type 2 inhibitors in patients with heart failure with preserved ejection fraction: a systematic review and meta-analysis

Mezhonov E.M., Safiullina Z.M., Vyalkina Y.A., Shalaev S.V.


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.

CardioSomatics. 2022;13(4):198-205
pages 198-205 views


SFRP5 as a new cardiovascular biological marker: a literature review

Alieva A.M., Teplova N.V., Baykova I.E., Voronkova K.V., Shnakhova L.M., Makeeva L.M., Kotikova I.A., Nikitin I.G.


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.

CardioSomatics. 2022;13(4):206-212
pages 206-212 views

The fundus of the eye as a target organ in hypertension: a literature review

Barsukov A.V., Yasenovets M.V., Shcherbakova K.A., Iakovlev V.V., Chumak B.A., Borisova E.V., Maltsev D.S., Burnasheva M.A., Kulikov A.N.


This review discusses the current understanding of hypertensive retinopathy. It describes the pathomorphology of hypertensive retinopathy according to its grade. The main approaches to classification and elements of pathophysiology are briefly considered, and the clinical significance of hypertensive changes in the fundus is examined. The characteristics of traditional and innovative methods of assessing the retina, and their accuracy in predicting the course of hypertension is discussed. Data from our investigations with scanning laser ophthalmoscopy and optical coherence tomographic angiography are presented. Our data show that uncomplicated hypertension in middle-aged men and women is accompanied by a distinct reduction in the diameter of the retinal arterioles and an expansion of the foveal avascular zone at the level of the superficial capillary plexus of the retina. We review the literature and present the results of our observations, demonstrating the retinoprotective benefits of antihypertensive therapy.

CardioSomatics. 2022;13(4):213-222
pages 213-222 views

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