Vol 20, No 1 (2026)

Modern approaches to the treatment of patients with chronic thromboembolic pulmonary hypertension are based on a combination of pharmacotherapy and surgical methods. Transluminal balloon pulmonary angioplasty is a crucial interventional strategy, especially in patients who cannot undergo thromboendarterectomy or who experience residual pulmonary hypertension after surgery. Numerous studies have confirmed the high efficacy of transluminal balloon pulmonary angioplasty, demonstrating a significant reduction in pulmonary vascular resistance and pulmonary artery pressure. However, despite its proven therapeutic potential, the method is associated with the risk of serious complications. The most dangerous of these is lung ischemia-reperfusion injury, which can cause acute respiratory failure requiring mechanical ventilation or extracorporeal membrane oxygenation. Currently, preventive measures are being developed, including protocol improvements, stepwise dilation, use of intraoperative imaging, as well as preoperative administration of pulmonary hypertension-specific drugs. Effective and safe use of transluminal balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension requires strict patient selection, procedure performance in specialized centers, interdisciplinary decision-making, as well as readiness for timely diagnosis and management of complications in the early and late postoperative periods. Standardization of the procedure and development of algorithms aimed at reducing the risk of complications remain a promising direction.

Aim. To determine the frequency and risk factors for fractures in patients with sarcopenia aged 65 years and older living in the community dwellings.

Material and methods. This cross-sectional, single-center study included 230 people aged 65 years and older (70 men and 160 women, median age 75 (interquartile range 68–79) years) who received consultations in a medical institution in Saint Petersburg. The diagnosis of sarcopenia was made according to the EWGSOP2 (European Working Group on Sarcopenia in Older People 2) criteria (2018). Phosphorus-calcium metabolism and vitamin D level were assessed; physical activity was evaluated using the International Physical Activity Questionnaire (IPAQ), and depression was assessed using the Hospital Anxiety and Depression Scale (HADS). All patients underwent dual-energy X-ray absorptiometry to diagnose osteoporosis and received anti-osteoporotic therapy with bisphosphonates.

Results. A high fracture rate was found in patients with sarcopenia compared to patients without it (39.4 % versus 26.7 %; p < 0.01) due to proximal hip fractures (18.8 and 7.7 %, respectively; p < 0.01). Sarcopenia increased the risk of fractures 1.52-fold (95 % confidence interval (CI) 1.01–2.28; p = 0.049), and hip fractures by 2.28-fold (95 % CI 1.28–4.05; p = 0.003). The risk of fractures was higher in patients with low muscle strength (odds ratio (OR) 5.459; 95 % CI 1.918–6.561; p = 0.0023), low muscle mass (OR 3.284; 95 % CI 1.394–4.253; p = 0.0064), in those who fell and had a fear of falling (OR 2.639; 95 % CI 1.824–3.275; p = 0.0081 and OR 1.363; 95 % CI 1.003–1.853; p = 0.0476, respectively), body mass index < 25 kg / m² (OR 3.465; 95 % CI 1.55–4.482; p = 0.0065) and serum 25-OH vitamin D level < 20 ng / mL (OR 1.882; 95 % CI 1.172–3.224; p = 0.0067).

Conclusion. A high fracture rate was found in patients with sarcopenia due to hip fractures associated with low muscle strength and muscle mass, falls and fear of falling, body mass index, and serum vitamin D deficiency.

Aim. To identify clinical and instrumental predictors of post-hospitalization complications in patients with decompensation of chronic heart failure (CHF).

Material and methods. The study included 56 patients hospitalized due to decompensation of CHF (40 (71.4 %) men) aged between 61 and 88 years. Mean observation time was 9 ± 2.9 months. Depending on outcomes at primary endpoint (repeat hospitalization and / or death due to cardiovascular disease), 2 patient groups were formed: 30 patients with an event at the primary endpoint and 26 without it. All patients included in the study underwent bioimpedance analysis (InBody 770), echocardiography (Toshiba Applio 500), 6-minute walk test, quality of life assessment using the Minnesota Living with Heart Failure Questionnaire, and frailty screening using the “Age is not a liability” questionnaire. Bioimpedance analysis allowed to assess total body water, extracellular water, their ratio, body mass index, and percentage of fat tissue. The left ventricular global function index (LVGFI) was calculated using volumetric heart parameters measured during echocardiography.

Results. Mean LVGFI value in the group without complications was 15.8 ± 5.4 %; in the group with complications, 12 ± 3.8 %. Threshold LVGFI value for prediction of repeat hospitalization due to CHF within 1 year was 13.05 % with sensitivity of 67 % and specificity of 66 % (area under the ROC curve 0.706; 95 % confidence interval 0.567–0.845; p = 0.004). Bioimpedance signs of water retention at discharge did not show significant correlation with repeat hospitalizations due to CHF (p = 0.475). In patients with CHF and preserved left ventricular ejection function, LVGFI in the group with complications was lower than in the group without complications (p = 0.044). Obesity was not significantly associated with unfavorable outcomes in both the group with complications and the group without them (p = 0.732 and 0.412, respectively).

Conclusion. LVGFI value < 13.05 % is associated with repeat hospitalizations due to CHF in the 1^st year after a decompensation episode (sensitivity 67 %, specificity 66 %). Bioimpedance signs of water retention do not significantly correlate with repeat hospitalization due to CHF.

Aim. To evaluate the effect of combination treatment with an antidepressant and menopausal hormone therapy (MHT) on social and psychological adaptation, women’s health, and quality of life of patients after hysterectomy in the short- and long-term postoperative periods compared to MHT monotherapy.

Material and methods. 136 women with emotional disorders after hysterectomy were examined, randomly divided into 2 groups. The main group included 74 (54.4 %) women who were prescribed 17β-estradiol in combination with vortioxetine. The control group consisted of 62 (45.6 %) patients who received MHT only (17β-estradiol). The Hospital Anxiety and Depression Scale (HADS), Beck’s Depression Inventory (BDI), Hamilton Depression Rating Scale 17 (HDRS-17), and the Women’s Quality of Life questionnaire developed at V. I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology were used in the study. To evaluate the severity of menopausal disorders, the modified menopausal index was used.

Results. BDI score in the main patient group after 3 months was 3.82 ± 2.47 (p < 0.05) corresponding to the absence of clinically pronounced depression. In the comparison group, baseline BDI score corresponded to moderate depression and amounted to 13.06 ± 3.19; after therapy it decreased to mild depression with a value of 7.82 ± 3.51 (p < 0.05). After 12 months of MHT in combination with vortioxetine in the main group, baseline HDRS-17 score of 12.34 ± 1.95 decreased to 2.82 ± 1.69; in the comparison group, depression was initially characterized as moderate, and it significantly decreased 12.82 ± 1.98 to 5.80 ± 3.08 (p < 0.05). In the main group, 63 (85.1 %) patients gave a “good” assessment of their quality of life after a year, 7 (9.4 %) gave a “satisfactory” assessment, and 4 (5.5 %) gave a “poor” assessment of their quality of life. In the control group, 41 (66.2 %) patients gave a “good” assessment, 14 (22.6 %) gave “satisfactory” assessment, and 7 (11.2 %) gave “bad” assessment. One month after the hysterectomy, 39 (52.8 %) and 32 (51.7 %) patients in the main and control groups, respectively, showed signs of anxiety and depression. After 6 months, clinical manifestations of mixed anxiety-depressive disorder were detected in 21 (28.3 %) patients in the main and 22 (35.4 %) patients in control group, and 1 year later in 13 (17.5 %) and 18 (29 %), respectively.

Conclusion. The combined use of antidepressants and MHT after hysterectomy promotes restoration of the psychoemotional wellbeing and physical activity, significantly accelerates the recovery period after surgery, and improves overall quality of life.

Aim. To assess the prevalence of hypertension and adherence to healthy lifestyle using a survey of a representative group of adults.

Material and methods. Retrospective analysis of data from the Russian Longitudinal Monitoring Survey of the Higher School of Economics for 2023. The analysis included data from 8,435 respondents aged 18 years and older, of whom 38.3 % answered positively to the question about hypertension and 61.7 % answered negatively. The analysis included responses to questions about height, weight, history of myocardial infarction, and characteristics reflecting attitudes toward a healthy lifestyle.

Results. The frequency of positive responses regarding the presence of hypertension was 38.3 %, increasing with age: from 3.4 % among respondents aged 18–29.5 years to 97.7 % at the age of 80 and above. The average age of respondents with hypertension was 65.5 ± 13.4 years, without hypertension 42.1 ± 15.1 years; the proportion of respondents with a body mass index of 30 and above was 13.8 and 40 %, respectively (p < 0.0001). Respondents with hypertension more often reported diabetes mellitus, a history of stroke and / or myocardial infarction. The proportion of smokers among respondents with hypertension (16.4 %) was lower than among respondents without hypertension (28.7 %; the differences remained significant when taking into account age and sex; p < 0.0001). However, only 1.3 % of respondents without hypertension and 5.5 % with hypertension (p < 0.0001) met the “healthy lifestyle” criteria selected for the study. Age (p < 0.0001) and the presence of diabetes (p < 0.0001) were associated with adherence to a healthy lifestyle; sex, hypertension, body mass index (30 kg / m² or above), history of myocardial infarction and stroke were not independent factors.

Conclusion. The results indicate slight differences in the estimated prevalence of hypertension based on the survey data and the Russian Ministry of Health’s data on morbidity as well as very low level of adherence to healthy lifestyle among the respondents. However, adherence showed a tendency to increase with age and the prevalence of diseases.

Generalized osteoarthritis (GOA) is a clinical variant of osteoarthritis characterized by multiple joint involvement, including the joints of the hands, knees, hips, and the spinal joints. This article presents the evolution of the knowledge about GOA from the classic works of J.H. Kellgren and R. Moore (1952) to modern approaches addressing multi-joint osteoarthritis. Various definitions of multi-joint osteoarthritis are analyzed, demonstrating their dependence on the number of involved joint groups and their impact on the assessment of disease prevalence. Special attention is paid to the axial component of GOA: involvement of intervertebral discs and facet joints is considered as a single clinical and morphological phenotype with common pathophysiological mechanisms (inflammation, angiogenesis, extracellular matrix remodeling). Current diagnostic approaches are presented, including clinical assessment, instrumental methods, and promising biomarkers. A phenotype-oriented approach to the treatment of GOA is substantiated.

Aim. To demonstrate features of the clinical course and therapy of recurrent pericarditis after percutaneous coronary intervention as a type of post-cardiac injury syndrome.

Material and methods. Patient Sh., 76 years old, with coronary artery disease, developed exudative fibrinous pericarditis with subsequent recurrence after elective percutaneous coronary intervention with an attempted recanalization of a chronic total occlusion of the right coronary artery. Comprehensive laboratory and instrumental diagnostics were performed, and therapy with nonsteroidal anti-inflammatory drugs in combination with colchicine was initiated, followed by an assessment of the effectiveness of the administered therapy.

Results. Against the background of combined anti-inflammatory therapy with ibuprofen 800 mg three times daily and colchicine 0.5 mg twice daily for 4 months, a sustained clinical and laboratory effect was achieved, including clinical improvement, normalization of C-reactive protein levels, and regression of pericarditis manifestations according to echocardiographic data.

Conclusion. This case highlights that post-interventional pericarditis may occur even after elective percutaneous coronary intervention without overt mechanical complications and may become recurrent. Early recognition of post-cardiac injury syndrome, differential diagnosis with other conditions, and the use of prolonged colchicine-containing anti-inflammatory therapy are required.