Clinical significance of the genealogical analysis method in victims of sudden cardiac death among the young population (1–35 years)
Aim. To evaluate the results of the genealogical analysis method in first-, second-, and third-degree relatives of victims of sudden cardiac death among the young population (1–35 years). Materials and Methods. In this study, the clinical-genealogical (pedigree) method was used to assess hereditary factors in first- to third-degree relatives of 24 victims of sudden cardiac death (SCD). The analysis began with the proband and covered 3–4 generations. Data were collected based on standardized interviews, medical records, and clinical information. For each family member, sex, age, diagnosis, disease onset, cases of sudden death, and consanguineous marriage were recorded. Pedigrees were constructed according to international genetic nomenclature, and the distribution of the disease across generations, inheritance pattern, and phenotypic characteristics were evaluated. Results. According to the results, the frequency of SCD differed across generations and was associated with age-related factors. In the first generation (grandparents), the frequency of SCD was the highest at 3.2%, decreased to 2.1% in the second generation, and was recorded at very low levels in subsequent generations. Although no cases of SCD were observed in the third generation (parents), the presence of clinical symptoms (arrhythmia, syncope) indicated the possibility of subclinical cardiac pathology. SCD was recorded in 1.3% of siblings, and its relatively early manifestation in terms of age confirms a familial predisposition. No statistically significant differences were found between most groups (p > 0.05), which can be explained by the limited sample size. Conclusion. The results showed that familial and hereditary factors play an important role in SCD. Genealogical analysis is an effective screening method for the early identification of high-risk individuals. Studies in a larger population are required to improve the reliability of the results.
Copyright (c) https://creativecommons.org/licenses/by/4.0
Application of GLP-1 Receptor Agonists in Cardiorenometabolic Syndrome
Cardiorenometabolic syndrome (CRMS) is one of the most important challenges in modern medicine and is considered a leading cause of morbidity and mortality worldwide. Major randomized clinical trials conducted over the past five years — SELECT (2023), FLOW (2024), and STEP-HFpEF (2023) — have provided fundamentally new insights into the cardiovascular and renal protective mechanisms of GLP-1 receptor agonists (GLP-1 RAs), particularly semaglutide. The effects of GLP-1 RAs extend beyond glycemic control and involve a multifaceted biological network targeting endothelial dysfunction, oxidative stress, NF-κB–mediated inflammation, activation of the renin–angiotensin–aldosterone system (RAAS), intraglomerular hyperfiltration, and visceral adiposity. Current clinical and mechanistic evidence provides sufficient rationale to consider this drug class as one of the key pillars of future CRMS management.
Impact of the Completeness of Coronary Revascularization on Quality-of-Life Recovery During Quadruple Therapy in Ischemic Cardiomyopathy
Aim. To determine the extent of quality-of-life (KCCQ-12) recovery over 6 months of treatment in patients with ischemic cardiomyopathy (ICM), its association with the completeness of coronary revascularization, and the independent factors determining this recovery. Materials and Methods. A total of 168 patients with ICM were included in this prospective single-center study. The Heart Team assigned patients to three groups: Group 1 — complete percutaneous coronary intervention (PCI) (n=58), Group 2 — incomplete PCI (n=54), and Group 3 — optimal medical therapy (OMT) only (n=56); all patients received an SGLT2 inhibitor. Continuous outcomes were analyzed using ANCOVA adjusted for baseline values and residual SYNTAX score, while predictors of response were assessed using logistic regression. Results. At 6 months, KCCQ-12 scores increased significantly in all groups (Group 1 +14.3; Group 2 +9.5; Group 3 +9.5 points; all within-group p<0.05); 53.7–63.8% of patients achieved a clinically meaningful improvement of ≥5 points. Adjusted between-group differences in KCCQ were not significant (Groups 1 vs 3: +3.28 points; 95% CI −12.8–19.3; p=0.69). Complete revascularization was associated with an additional increase in LVEF (Groups 1 vs 3: +5.01%; 95% CI 1.17–8.84; p=0.01). Change in KCCQ showed a weak but significant correlation with change in LVEF (Spearman r=0.158; p=0.040). The only independent predictor of a ≥10-point response was a lower baseline KCCQ score (OR 0.91 per point; 95% CI 0.88–0.94; p<0.001); completeness of revascularization was not independently associated with the response. Conclusion. Against the background of SGLT2 inhibitor-based quadruple therapy, quality of life in patients with ICM improved significantly and to a similar extent regardless of the completeness of revascularization, whereas complete revascularization provided additional left ventricular reverse remodeling. The greatest quality-of-life benefit was observed in patients with the most severe symptoms at baseline, supporting personalized, patient-centered decision-making.
Kansas City Cardiomyopathy Questionnaire
Lipid metabolism and modern approaches to lipid-lowering therapy
Lipid metabolism disorders are one of the leading risk factors for the development of atherosclerotic cardiovascular diseases and remain of high importance worldwide. Despite substantial advances in reducing low-density lipoprotein (LDL) cholesterol, many patients still have a residual cardiovascular risk associated with triglyceride-rich lipoproteins, remnant cholesterol, and Lp (a). This review summarizes current information on lipid metabolism, including exogenous and endogenous lipoprotein transport pathways, as well as modern strategies for lipid-lowering therapy, in particular drugs agents targeting PCSK9, ANGPTL3, ApoC III and LP(a). Special attention is paid to promising technologies based on small interfering RNAs, antisense oligonucleotides, and CRISP/Cas9 genomic editing. The collected data indicate that an deeper understanding of the mechanisms of lipid metabolism contributes to the development of innovative treatment methods that can more effectively control dyslipidemia and reduce the risk of cardiovascular complications.
Copyright (c) 2026 М.У. Яхъёева, Р.Б. Алиева, А.Б. Шек (Автор) https://creativecommons.org/licenses/by/4.0
The Impact of Nocturnal Obstructive Sleep Apnea Syndrome on Cerebrovascular Complications in Patients with Ischemic Heart Disease
Obstructive sleep apnea syndrome (OSAS) and ischemic heart disease (IHD) frequently coexist as comorbid conditions that mutually exacerbate one another. The aim of this review is to evaluate the impact of OSAS on cerebrovascular complications in patients with IHD based on a systematic review of the available literature. Ischemic heart disease (IHD) and sleep disorders, particularly obstructive sleep apnea syndrome (OSAS), represent one of the most significant challenges in contemporary medicine. Over the past decade, substantial evidence has demonstrated that the coexistence of these two conditions constitutes an independent risk factor for the development of cerebrovascular diseases. According to the World Health Organization (WHO), cardiovascular diseases accounted for approximately 31% of all global deaths in 2023. Meanwhile, the global prevalence of OSAS is estimated to range from 15% to 30%, with the condition occurring 2–3 times more frequently in men than in women. Among patients with IHD, the prevalence of OSAS is estimated to reach 40–60%. Cerebrovascular complications, including ischemic stroke, transient ischemic attack (TIA), subcortical leukoencephalopathy, and cognitive impairment, are particularly common in patients with concomitant IHD and OSAS. Pathophysiologically, these complications are associated with hypertension, endothelial dysfunction, oxidative stress, and sympathetic overactivation. However, the precise mechanisms underlying these associations remain incompletely understood.
Use of SGLT-2 Inhibitors in Acute Myocardial Infarction
Cardiorenometabolic syndrome (CRMS) is a multifactorial clinical condition reflecting complex and interrelated pathobiological processes involving the cardiovascular, renal, and metabolic systems. Its central mechanisms include visceral adiposity, insulin resistance, adipokine imbalance, chronic low-grade inflammation (metaflammation), and oxidative stress \cite{1, 2}. This pathological background contributes to the development of acute myocardial infarction (AMI) through endothelial dysfunction, reduced nitric oxide (NO) bioavailability, impaired microvascular perfusion, and destabilization of atherosclerotic plaques. In patients with CRMS, AMI differs from the classical ischemic model, as it is characterized not only by impaired coronary blood flow but also by an intense inflammatory response, activation of the immune system, and disturbances in cellular energy metabolism. During the early phase of infarction, damage-associated molecular patterns (DAMPs) activate Toll-like receptors, initiating the NF-κB signaling pathway and increasing the production of pro-inflammatory cytokines, including IL-1β, IL-6, and TNF-α. Furthermore, mitochondrial dysfunction and excessive generation of reactive oxygen species (ROS) amplify oxidative stress, promoting lipid peroxidation, DNA damage, and cardiomyocyte apoptosis. In recent years, sodium-glucose cotransporter-2 (SGLT2) inhibitors, particularly dapagliflozin, have attracted considerable attention as agents with broad cardiorenometabolic benefits. Their therapeutic effects are multifaceted and extend well beyond glycemic control. SGLT2 inhibitors exert cardioprotective effects by suppressing inflammatory signaling pathways (NF-κB and the NLRP3 inflammasome), reducing oxidative stress, restoring mitochondrial function, inhibiting the sodium-hydrogen exchanger-1 (NHE1), and decreasing intracellular calcium overload in cardiomyocytes \cite{9, 12}. This review systematically analyzes the role of SGLT2 inhibitors in the pathogenesis of AMI, their molecular, cellular, and systemic mechanisms of action, and their cardiorenometabolic efficacy based on evidence from contemporary clinical studies, including the DAPA-MI (Dapagliflozin in Myocardial Infarction) trial.
Angina pectoris and ischemia of non-obstructive coronary arteries (ANOCA/INOCA): a clinical case
Non-obstructive angina and ischemia of the coronary arteries (ANOCA/INOCA) is a condition in which there are signs of angina and/or ischemia in the absence of significant obstruction of the coronary arteries. This article presents a clinical case and includes a review of the literature. A 52-year-old female patient presented with typical anginal pain, a positive stress test, and no obstructive changes on coronary angiography. As a result of the analysis, a diagnosis of ANOCA/INOCA (microvascular angina) was made. The pathogenesis, diagnosis, and treatment strategies were reviewed. This case highlights the clinical significance of ANOCA/INOCA and demonstrates the importance of individualized therapy.
Copyright (c) 2026 Н.A. Усманова, К.Ф. Улугбердиева, Д.А. Гайназарова, Д.И. Қуддусов (Автор) https://creativecommons.org/licenses/by/4.0
Molecular Genetic Aspects of Sudden Death in Young Individuals
Sudden cardiac death (SCD) in young individuals is a significant medical and social problem, a substantial proportion of which is caused by inherited disorders of myocardial electrical activity. The aim of this review was to summarize current concepts of the molecular genetic mechanisms of sudden cardiac death in young patients. An analytical review was conducted of current national and international scientific publications, clinical guidelines, and molecular genetic research data devoted to inherited channelopathies. It was shown that the main causes of SCD in children and young adults are inherited channelopathies, including long and short QT syndromes, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and early ventricular repolarization syndrome. The role of mutations in ion channel genes and regulatory proteins in the formation of the arrhythmogenic substrate is described. Genetic heterogeneity and the overlapping involvement of individual genes in the pathogenesis of various forms of channelopathies are noted. Timely identification of molecular genetic markers of SCD and comprehensive clinical genetic risk assessment make it possible to improve the prevention of life-threatening arrhythmias and optimize the management of patients and their relatives.
Medical registries of patients after myocardial infarction and stroke: international experience and prospects for standardization for outpatient practice in Uzbekistan (with elements of criticism and proposals for the implementation of a national outpatient registry)
Patient registries following acute myocardial infarction (AMI) and stroke are a key tool for quality control, real-world clinical practice research, and secondary prevention management. This article examines international registry models (SWEDEHEART, ACTION Registry–GWTG, MINAP, Get With The Guidelines–Stroke, Riksstroke/SSNAP, etc.), their strengths and limitations, and the experience of Uzbekistan (national and regional ACS/AMI and stroke registries). Approaches to data standardization and a practical roadmap for launching an outpatient registry for post-AMI and post-stroke in Uzbekistan are proposed, taking into account the ongoing digitalization of healthcare (DMED, Electronic Polyclinic, e-registry) and the specifics of the primary care system.
Copyright (c) 2026 Р.Х Тригулова, Х.Г. Фозилов, Д.А. Алимова, Н.С. Мирахмедова, Д.Д. Сохибов (Автор) https://creativecommons.org/licenses/by/4.0
Clinical and functional characteristics of life support systems during and after coronary artery bypass grafting
Aim. To evaluate the clinical and functional characteristics of vital systems during and after coronary artery bypass grafting. Materials and methods. This study included 160 patients who underwent CABG with and without cardiopulmonary bypass at the Samarkand branch of the Republican Specialized Scientific-Practical Medical Center of Cardiology (2020–2026). Patients were divided into two groups: the main group (n=80), where an individualized algorithm using a multifactorial prognostic scale and ulinastatin was applied, and the control group (n=80), where standard management was used. Hemodynamic monitoring included HR, mean arterial pressure, CVP, stroke and cardiac indices, ejection fraction, cardiac output, and SVR across six stages from admission to discharge. Results. The main group showed improved outcomes: reduced myocardial afterload, stabilized HR and pressure, enhanced cardiac performance, and a shift from hypodynamic to eukinetic circulation. Conclusion. In high-risk patients, this approach reduced complication rates and ICU stay. An individualized strategy with ulinastatin ensures a more stable perioperative course and lowers complication risk.
Copyright (c) 2025 J.T. Yusupov, M.M. Matlubov , E.G. Hamdamova (Author) https://creativecommons.org/licenses/by/4.0
Clinical efficacy of combined treatment methods in uncontrolled arterial hypertension during pregnancy
Aim: To evaluate the effect of combined antihypertensive therapy on arterial blood pressure parameters in pregnant women with uncontrolled gestational arterial hypertension. Materials and methods: The study included 60 pregnant women diagnosed with gestational arterial hypertension according to the 2018 ESC recommendations, with a gestational age of 20–24 weeks. The patients were randomly divided into two groups: Group 1 (n = 30) — methyldopa (500–1000 mg) + metoprolol succinate (25–50 mg), Group 2 (n = 30) — methyldopa (500–1000 mg) + amlodipine (5–10 mg). In all patients, office arterial blood pressure was measured and 24-hour ambulatory blood pressure monitoring was performed before the initiation of antihypertensive therapy. Results: A significant decrease in systolic, diastolic, and mean arterial blood pressure was recorded in both groups (p < 0.0001). The degree of blood pressure reduction was higher in Group 2 in terms of systolic and diastolic parameters, which may be explained by the vasodilatory effect of amlodipine. Target systolic blood pressure was observed in 75% of patients in Group 1 and 87% of patients in Group 2, while target diastolic blood pressure was observed in 75% and 91% of patients, respectively. However, no statistically significant difference was found between the groups. Conclusion: Both combined antihypertensive therapy regimens ensured the achievement of target arterial blood pressure levels in pregnant women with gestational arterial hypertension. Although the methyldopa and amlodipine combination showed a greater tendency toward blood pressure reduction, larger studies are required to confirm these results.
Copyright (c) 2026 Мохинур Садуллоева, Феруза А. Закирова (Автор) https://creativecommons.org/licenses/by/4.0
The role of PITX2 rs6817105 and KCNN3 rs13376333 polymorphisms in the risk of atrial fibrillation complicating arterial hypertension.
Aim. To determine the association between polymorphisms of the PITX2 (rs6817105) and KCNN3 (rs13376333) genes and the development of atrial fibrillation (AF) in patients with arterial hypertension (AH) in the Uzbek population. Materials and methods. The study included 154 patients with AH. Among them, paroxysmal AF was initially diagnosed in 21 patients (13.64%), persistent AF in 44 patients (28.57%), and permanent AF in 89 patients (57.79%). At the beginning of the study, the mean age of patients with AH and AF was 64.1±10.35 years. The control group consisted of AH patients without AF (n=91), with a mean age of 56.03±12.18 years. Clinical and instrumental examinations, including ECG, echocardiography, and Holter monitoring, were performed. Molecular genetic analysis of isolated DNA was carried out using real-time PCR. The association of polymorphisms with AF was assessed using logistic regression analysis and various inheritance models. Statistical analysis was performed using Statistica 10.0 and SNPassoc (R) software. Results. The study revealed statistically significant associations between the risk of atrial fibrillation development and the PITX2 gene rs6817105 polymorphism as well as the KCNN3 gene rs13376333 polymorphism in Uzbek patients with arterial hypertension. The PITX2 rs6817105 polymorphism showed a strong association with atrial fibrillation: carriage of the minor C allele increased the risk of AF development 2.76-fold under the log-additive inheritance model (OR = 2.76; p = 3.27×10⁻⁷). The KCNN3 rs13376333 polymorphism also demonstrated a significant association with AF. The C allele was significantly more frequent in patients with rhythm disorders and increased the risk of AF development under the log-additive model (OR = 1.63; p = 0.020). Conclusion. For the first time, an association between the PITX2 gene rs6817105 polymorphism and the KCNN3 gene rs13376333 polymorphism with atrial fibrillation has been identified in AH patients of the Uzbek population. These findings confirm the importance of these genetic markers in the pathogenesis of atrial fibrillation complicated by arterial hypertension and emphasize the relevance of genetic testing in this group of patients.
Copyright (c) 2026 Z.T. Mashkurova, G.J. Abdullaeva, D.V. Zakirova, G.M. Radjabova, G.A. Khamidullaeva, A.A. Abdullaev, B.I. Rozibaev (Author) https://creativecommons.org/licenses/by/4.0
Therapeutic approaches to the management of women with gestational hypertension: a cardiologist’s perspective.
The need to expand knowledge about the early stages of gestational therapy for pregnant women with hypertensive disorders is driven by several factors. First, the selection of the optimal antihypertensive therapy regimen is limited by the feasibility of conducting large-scale studies in representative populations due to time constraints and the responsibility for the life of not only the mother but also the child. Second, current recommendations generally recommend initiating therapy by titrating a single drug regardless of blood pressure levels, limiting the use of combination regimens. Third, the identification of specific cardiac risks is limited by the timely implementation of an effective screening strategy.
Copyright (c) 2025 М.А. Садуллоева , Ф.А. Закирова , С.А. Икрамова , Р.Р. Хазраткулов , М.М. Рустамов (Автор) https://creativecommons.org/licenses/by/4.0
Association between disease severity and systemic inflammation in patients with dilated cardiomyopathy
Aim. The aim of this study was to investigate the relationship between clinical-hemodynamic parameters and inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-α) in patients with dilated cardiomyopathy. Materials and methods. The study included 42 patients (mean age 38.5±1.2 years) with dilated cardiomyopathy and chronic heart failure classified as NYHA functional class II–IV. The patients were divided into two groups: Group I – class II (n=12) and Group II – class III–IV (n=30). Results. As heart failure severity increased (class III–IV), serum levels of C-reactive protein (7.6±1.1 mg/L vs. 4.1±0.6 mg/L, p<0.05), IL-6 (7.5±0.8 pg/mL vs. 4.6±0.2 pg/mL, p<0.01), and TNF- α (8.1±0.9 pg/mL vs. 5.6±0.7 pg/mL, p<0.05) were significantly elevated. These changes were associated with left ventricular dilatation (LVEDD 58±1 mm, p<0.05) and reduced ejection fraction (34.7±1.8%, p<0.05). Conclusion. The findings suggest that inflammatory markers play a crucial role in assessing the severity and prognosis of dilated cardiomyopathy and chronic heart failure.
Copyright (c) 2025 Т.А. Абдуллаев, М.М. Рахматов, Х.А. Гуломов (Автор) https://creativecommons.org/licenses/by/4.0
Improving preventive measures for salt-sensitive arterial hypertension based on clinical characteristics in the Aral Sea region population
Aim. The aim of the work was to improve preventive measures based on the prevalence and clinical characteristics of salt-sensitive arterial hypertension in primary health care facilities among the Aral Sea region population. Materials and methods. The study included 1,021 patients with salt-sensitive arterial hypertension from family clinics affiliated with the Ellikkal’a District Medical Association. All patients underwent clinical and laboratory-instrumental examinations. Results. The results of our study showed that patients with a high salt tolerance had more pronounced clinical features of arterial hypertension than patients with a low salt tolerance. Conclusion. According to the conclusions of our study, periodic assessment of cardiovascular disease risk factors based on the PEN protocol and prevention in primary care settings effectively contribute to the regression of non-communicable diseases and improvement of health indicators in the population of this region.
Copyright (c) 2025 Х.Х. Атаниязов, Х.Г. Фозилов, Г.А. Хамидуллаева, Г.Ж. Абдуллаева (Автор) https://creativecommons.org/licenses/by/4.0
Exercise tolerance and quality of life in patients with chronic heart failure and obesity
Aim. To assess exercise tolerance and quality of life in patients with chronic heart failure (CHF) and obesity depending on the presence of metabolic syndrome (MS). Materials and methods. The study included patients with obesity and CHF (main group) and obese individuals without CHF (control group), stratified by the presence/absence of MS. Treadmill test parameters were evaluated (duration, maximal workload, VO₂, chronotropic index, heart rate increase, peak systolic blood pressure [SBP] and its increment), along with quality of life using the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the SF-36 survey. Results. Patients with MS demonstrated significantly lower exercise tolerance: reduced treadmill duration, VO₂, chronotropic index, and heart rate increase, accompanied by a greater increment of SBP. According to MLHFQ, patients with MS reported worse physical and emotional functioning and a higher total score (indicating poorer quality of life). On SF-36, MS was associated with reduced physical functioning and general health. Conclusion. The presence of MS in patients with CHF and obesity is associated with reduced exercise tolerance and impaired quality of life, underscoring the need for comprehensive cardiometabolic rehabilitation aimed at correcting metabolic disturbances and improving functional reserve.
Copyright (c) 2025 Н.Ф. Ташкенбаева (Автор) https://creativecommons.org/licenses/by/4.0
Adherence to drug therapy in patients after acute myocardial infarction: a systematic review of the literature
Aim. To systematically analyze current approaches to assessing and improving medication adherence in patients after acute myocardial infarction during outpatient follow-up, with a particular focus on factors influencing treatment adherence and the role of a multidisciplinary approach. Materials and Methods. A systematic review of the literature on medication adherence after acute myocardial infarction was conducted. Data from large international studies were analyzed, including a meta-analysis of 10 studies involving 106,002 patients, the 2023 American Heart Association scientific statement, the 2023 ESC and 2025 ACC/AHA guidelines, and current cardiac rehabilitation programs. Results. A meta-analysis showed that good adherence to drug therapy is associated with reduced all-cause mortality (odds ratio 0.56; 95% CI: 0.45-0.69), cardiovascular mortality (OR 0.66; 95% CI: 0.51-0.87), and hospitalization rates (OR 0.61; 95% CI: 0.45-0.82). Non-adherence to therapy occurs in 30% of patients after myocardial infarction. Shared decision making, structured cardiac rehabilitation programs, and the involvement of multidisciplinary teams significantly improve long-term treatment adherence. Conclusion. Adherence to drug therapy is a key factor in improving the prognosis of patients after acute myocardial infarction. A multidisciplinary approach, including shared decision making, patient education, pharmaceutical counseling, and the use of digital technologies, demonstrates the greatest effectiveness in improving adherence.
Copyright (c) 2025 Д.Д. Сохибов , Р.Х. Тригулова , Н.С. Мирахмедова (Автор) https://creativecommons.org/licenses/by/4.0
Clinical portrait of a patient who suffered a myocardial infarction and acute cerebrovascular accident, according to outpatient registry data
Purpose: to determine the clinical and epidemiological characteristics and laboratory and instrumental research indicators, the profile of cardiovascular risk factors in patients who have suffered myocardial infarction and stroke, and to establish their adherence to treatment before and after the reference event over a 12-year observation period. Materials and methods. An analysis of data from 410 patients who presented to an outpatient clinic between January 1, 2019, and December 31, 2022, with confirmed acute (recurrent) myocardial infarction and/or stroke was conducted. Statistical software packages (SPSS, SAS, STATISTIKA 10, Stata) and programming languages ​​(R, Python) were used. Results. Lipid metabolism disorders were detected in 36.8% (n=151). Hypolipidemic therapy was prescribed in 21.7% (n=89) of patients, and in the stroke group - 7.9% (n=18). In patients who had a history of MI and stroke, it was 45% (n=9). Among patients with MI (MI group), lipid-lowering therapy was prescribed in 38.5% (n=6). 2.4% (n=10) of excess weight decreased, 1.9% (n=8) of those who quit smoking, 3.4% (n=14) of those who achieved target lipidogram values, 0.2% (n=1) of those who adjusted their diet, and 0.2% (n=1) of those who improved physical activity. The highest level of compliance with recommended measures was observed in relation to the treatment of arterial hypertension - 88.5% (n=363). Conclusion. In patients who have had myocardial infarction and stroke, the following clinical, epidemiological and laboratory characteristics have been identified, as well as the prevalence of cardiovascular risk factors: smoking, alcohol abuse, arterial hypertension, dyslipidemia, obesity and diabetes mellitus.
Copyright (c) 2025 Н.Ф. Побиванцева , Н.Б. Конончук , О.В. Микульская , Е.А. Григоренко , Н.П. Митьковская (Автор) https://creativecommons.org/licenses/by/4.0
Prevalence of atherosclerotic lesions of the brachiocephalicarteries and their association with cardiovascular risk factors: a cross-sectional study in uzbekistan
Aim. To assess the prevalence of atherosclerotic lesions of the brachiocephalic arteries (BCA), their association with cardiovascular risk factors, and cardiovascular risk according to the SCORE scale in the population of Uzbekistan. Materials and methods. A cross-sectional study (conducted in 2025 using 2022 data) included 6,425 patients (47.6% men, 52.4% women; mean age 54.0 ± 23.1 years) at the Republican Specialized Scientific and Practical Medical Center of Cardiology, Uzbekistan. Carotid and brachiocephalic ultrasound was performed using a short protocol assessing stenosis in four segments [1]. The following parameters were analyzed: age, total cholesterol (TC), arterial hypertension (AH), smoking, systolic and diastolic blood pressure (SBP, DBP). Cardiovascular risk was determined using the SCORE system [2]. Statistical analysis was performed using SPSS 26. Results. BCA lesions were detected in 54.8% of patients. Age correlated with the presence of lesions (Spearman’s ρ = 0.219, p < 0.01), while TC did not (ρ = 0.032, p = 0.207). Men over 50 years had more extensive lesions (7.9% with four affected segments) compared to women (2.6%). According to the SCORE scale, men and patients over 50 years had a moderate to high cardiovascular risk (4–8%). Conclusion. Age is the key risk factor for atherosclerosis of the brachiocephalic arteries. The high prevalence of arterial hypertension emphasizes the need for preventive measures in Uzbekistan.
Copyright (c) 2025 Ф.М. Бекметова , М.Н. Хотамова , С.Я. Абдуллаева , Ш.А. Оринбаев (Автор) https://creativecommons.org/licenses/by/4.0
Effectiveness and prevention of complications of the use of a new generation biodegradable framework - magmaris in acute myocardial infarction
Aim. To evaluate the immediate clinical and angiographic success in patients with NSTEMI, who underwent percutaneous coronary intervention (PCI) with the installation of a new generation of resorbable scaffolds “Magmaris”. Materials and methods. Material and methods: clinical data of 64 patients with an acute form of coronary artery disease (49 men and 15 women) who were fitted with a biodegradable Magmaris frame were used. Anamnestic, general clinical, laboratory and coronary angiographic data were obtained from patients with acute forms of coronary artery disease who underwent percutaneous coronary intervention (PCI) with the installation of a Magmaris BVS frame as endovascular treatment. Results. Implantation of bioresorbable scaffolds "Magmaris" in patients with coronary artery disease was characterized by immediate good angiographic success in 100% of cases and clinical success in 95.8% of cases. Patients with low LVEF were characterized by a higher SYNTAX score (p <0.001), a greater number of multivessel lesions (p> 0.05), the involvement of a larger number of coronary basins (p> 0.05), and a greater number of stenotic segments per patient (p> 0.05) and, accordingly, a longer atherosclerotic lesion. This was confirmed by an inverse correlation (which did not reach the level of reliability), which may have been due to the small size of the sample under study. The presence of CKD, according to angiographic characteristics, was associated with a greater number of multivessel and complex (type "C" according to the ACC / ANA classification) lesions, a greater number of stenotic segments and, accordingly, the implantation of more devices, while the immediate angiographic success of the PCI procedure was 100%, but clinical success was 5.9% lower, than in patients without CKD. Comorbidity with type 2 diabetes, according to angiographic characteristics, was accompanied by a relatively longer and more severe type (type "C") of atherosclerotic lesions of the coronary arteries, despite the relatively lower incidence of multivessel lesions and a smaller number of stenotic segments. The presence of type 2 diabetes did not in any way affect the angiographic success of the PCI procedure (which was 100%), but worsened the clinical success by 11.1%. Conclusion. The primary results of evaluating the use of the bioresorbable scaffold "Magmaris" in our country turned out to be very encouraging. However, it is necessary to conduct further more in-depth studies in this direction, in particular, to study the issues of the influence of various risk factors or pathological conditions on angiographic characteristics and assess the safety and effectiveness of using the polymer scaffold "Magmaris".
Copyright (c) 2025 С.Ш. Холикулов, Н.П. Юлдошев, Aziz Eshpulatov (Автор) https://creativecommons.org/licenses/by/4.0
Influence of combined pathogenetic treatment on the dynamics of epicardial fat thickness in patients with cad and metabolic syndrome
Aim. To evaluate the influence of combined hypolipidemic therapy (statins in combination with ezetimibe and fenofibrate) and sodium-glucose cotransporter 2 inhibitors on epicardial fat thickness in patients with coronary heart disease and metabolic syndrome. Materials and methods: The study included 49 patients with coronary heart disease and metabolic syndrome who underwent treatment at the Republican Specialized Scientific and Practical Medical Center of Cardiology. The patients were divided into 2 groups: 1) intensive statin therapy in combination with ezetimibe, 2) with the addition of fenofibrate and SGLT2 inhibitors. All patients underwent biochemical tests and imaging marker assessments, followed by comparison of the dynamics within and between groups. Results. When comparing two groups receiving different types of therapy, both groups demonstrated a significant decrease in lipid parameters: LDL-C p<0.001, TC p<0.001, TG p<0.001. Additionally, the group treated with fenofibrate and SGLT2 inhibitors showed a more significant reduction in epicardial fat (11.4 mm in the first group and 10.4 mm in the second group, p<0.05). Conclusion: Pathogenetic therapy with the inclusion of fenofibrate and SGLT2 inhibitors more effectively reduces the level of EFT, as well as TG, VLDL-C, and the TG/HDL index.
sodium glucose co-transporter 2 inhibitors
Copyright (c) 2025 A.R. Kim, A.B. Shek, R.B. Alieva (Author) https://creativecommons.org/licenses/by/4.0
Sudden cardiac death in regularly training young athletes: risk factors and prevention
Sudden cardiac death (SCD) in young athletes engaged in regular intensive training represents a rare but highly significant clinical and social problem. Although the incidence is low, SCD typically occurs unexpectedly during physical exertion or shortly thereafter, often as the first manifestation of previously undiagnosed cardiovascular disease. The main etiological factors include hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, myocarditis, dilated cardiomyopathy, and primary electrical disorders such as long QT syndrome. Risk stratification is based on a comprehensive approach that involves clinical history, physical examination, resting and exercise electrocardiography (ECG), echocardiography, and, in selected cases, genetic testing. Recent consensus statements highlight the importance of improving ECG interpretation criteria to reduce false-positive results in athletes. Preventive strategies include pre-participation cardiovascular screening, continuous follow-up of high-risk groups, and timely intervention in suspected cases. Equally important are emergency measures, including cardiopulmonary resuscitation and rapid use of automated external defibrillators, which significantly improve survival outcomes. Awareness of potential risk factors, combined with optimized screening protocols and personalized decision-making, may reduce the incidence of SCD in the athletic population.
Copyright (c) 2025 E. Турсунов, Р. Д. Курбанов, Н.У. Закиров, Н.З. Сроджидинова, А. С. Расулов (Автор) https://creativecommons.org/licenses/by/4.0
Universality of SPC (Single-Pill Combination) A New Approach to the Treatment of Cardiovascular Diseases: From Guidelines to Real-World Clinical Practice
In the modern ESH (2023) and ESC (2024) guidelines on arterial hypertension (AH), the following key provisions for the use of combination therapies from the start of treatment have been clearly formulated for the first time: the use of single-pill combinations (SPCs) should be preferred at any stage of treatment, i.e., at the initiation of therapy with a combination of two drugs and at any other stage of treatment (Class I recommendation, Level of Evidence B). These statements have also been incorporated into the 2024 clinical guidelines on AH in adults by the Russian Cardiological Society (RCS) and the 2025 National Clinical Protocol on AH by the Ministry of Health of the Republic of Uzbekistan. This article presents a new approach to the treatment of cardiovascular diseases using universal SPCs in real-world clinical practice
Copyright (c) 2025 H. G. Fozilov, G. A. Khamidullayeva, G. J. Abdullayeva, G. U. Mullabayeva, N.R. Salimova, K. Y. Filipyak (Author) https://creativecommons.org/licenses/by/4.0
Improvement of percutaneous coronary intervention in patients with ischemic cardiomyopathy: a systematic literature review
Aim. To evaluate the effectiveness of percutaneous coronary intervention (PCI) in patients with ischemic cardiomyopathy and identify opportunities for its improvement, as well as to conduct a comparative analysis with coronary artery bypass grafting (CABG). Materials and methods. A systematic search of medical literature published from 2017 to 2025 was conducted using PubMed, Scopus, Web of Science, and Google Scholar databases. 110 sources from high-impact factor journals were analyzed, including key randomized controlled trials (STICH, REVIVED-BCIS2), meta-analyses, and systematic reviews on ischemic cardiomyopathy and revascularization methods. Results. Ischemic cardiomyopathy is the leading global cause of heart failure, in the treatment of which revascularization plays an important role alongside quadruple pharmacotherapy. PCI demonstrates superior stroke risk reduction compared to CABG, while CABG excels in reducing repeat revascularization needs and improving long-term survival. In patients achieving complete revascularization, mortality risk decreased by 34% and repeat revascularization risk by 33%. Conclusion. When choosing between PCI and CABG in patients with ischemic cardiomyopathy, patient clinical characteristics, coronary anatomy, and comorbidities must be considered. The degree of revascularization and myocardial viability are important factors determining clinical outcomes.
Copyright (c) 2025 Х.Г. Фозилов, А.М. Абдукамилов (Автор) https://creativecommons.org/licenses/by/4.0
Systematic Review of Different Reperfusion Therapy Methods in Patients with ST-Elevation Acute Coronary Syndrome: Literature Review
Aim. Systematic analysis and comparison of different reperfusion therapy methods in patients with ST-elevation acute coronary syndrome (STEMI), including primary percutaneous coronary intervention (pPCI) and thrombolytic therapy (TLT), with emphasis on time factor and COVID-19 pandemic impact. Materials and methods. A systematic review of prospective randomized and observational studies comparing pPCI and TLT effectiveness in STEMI patients was conducted. Data from major international trials including DANAMI-2 (1572 patients), PRAGUE-2, STAT, GISSI, ISACS-STEMI COVID-19, meta-analyses of 23 studies, and modern global longitudinal strain assessment methods were analyzed. Results. Meta-analysis of 23 randomized studies showed statistically significant pPCI advantages over TLT: 30-day mortality 8.0% vs 13.7% (p=0.0003), recurrent infarction 3.8% vs 7.0% (p<0.05), revascularization need 5.7% vs 25.2% (p<0.001). "Golden hour" concept was confirmed. COVID-19 pandemic led to 19-30.5% reduction in STEMI presentations and worse prognosis. Conclusion. pPCI demonstrates statistically significant advantages over TLT, however method selection should consider time factor and technical availability. Modern global longitudinal strain assessment methods improve prognostic accuracy.
Copyright (c) 2025 H.G. Fozilov, B.R. Atamuratov (Author) https://creativecommons.org/licenses/by/4.0
The impact of ulinastatin in complex therapy on the incidence of early postoperative complications after coronary artery bypass grafting
Aim. To evaluate the effectiveness of ulinastatin as part of complex therapy in reducing the incidence of early postoperative complications in patients with multivessel coronary artery disease after CABG. Materials and methods. The study included 160 patients treated in the cardiac surgery intensive care unit. They were divided into a main group (80 patients, who underwent risk prediction using a multifactorial scale and received ulinastatin) and a control group (80 patients, who received standard treatment). Research methods comprised clinical observation, application of the prognostic risk assessment scale, laboratory determination of inflammatory markers, and statistical analysis using Student’s t-test, the Mann–Whitney test, and Pearson’s correlation. Results. In the main group, the incidence of hyperthermia and pneumonia was 50% and 10%, compared with 100% and 12.5% in the control group. ARDS and multiple organ failure were three times less frequent (1.25% vs. 3.75%), mediastinitis occurred in 1.25% vs. 3.75%, and postoperative wound infection in 3.75% vs. 6.25%. No lethal outcomes were recorded in the main group, whereas mortality in the control group reached 2.5%. Conclusion. The combined use of a multifactorial risk prediction scale and ulinastatin reduces the severity of systemic inflammatory response, lowers the frequency of early complications, and prevents mortality after CABG.
Copyright (c) 2025 Ж.Т. Юсупов , М.М. Матлубов , Р.С. Кушназаров (Автор) https://creativecommons.org/licenses/by/4.0
Heart remodeling in the obstructive form of hypertrophic cardiomyopathy, efficacy of Morrow septal myectomy
Obstructive hypertrophic cardiomyopathy (OHCMP) is a disease characterized by cardiac remodeling due to genetic factors. OHCMP can cause the development of dynamic obstruction in the outflow tract of the left ventricle, diastolic dysfunction, mitral regurgitation, myocardial ischemia, and cardiac arrhythmias. Clinically, patients are manifested by symptoms of heart failure. OHCMP is the most common cause of sudden cardiac death, especially in young people and among athletes. According to the results of epidemiological observations conducted in the USA and European countries, sudden cardiac death in athletes under 35 years of age is associated with OHCMP in 30–40% of cases. Today, despite the availability of modern non-invasive methods of treating the disease, the effectiveness of the surgical method prevails. The article analyzes the data presented in the literature on the features of cardiac remodeling in this disease, the results of clinical studies conducted in this area, and the effectiveness of treatment methods
Copyright (c) 2025 N. Rasulova, T.A. Abdullaev, A.A. Khakimov (Author) https://creativecommons.org/licenses/by/4.0
Early biomarkers of endothelial dysfunction: clinical implications for the diagnosis and management of cardiovascular disease
This review synthesizes current evidence on early biomarkers of endothelial dysfunction (ED) in cardiovascular disease (CVD), emphasizing their role in diagnosis, prognosis, and management. ED, characterized by reduced nitric oxide bioavailability and increased inflammation, serves as a reversible precursor to atherosclerosis, thrombosis, and events like myocardial infarction. Established biomarkers, including adhesion molecules, cytokines, and inflammatory markers, reflect endothelial activation and predict CVD risk, with recent studies confirming their utility in hypertension. Emerging focus on L-arginine derivatives, particularly asymmetric dimethylarginine (ADMA), highlights its specificity as an endogenous nitric oxide synthase inhibitor, associated with vascular impairment in hypertension, diabetes, and CVD. Clinical trials, such as the AtheroGene and Framingham Offspring studies, demonstrate ADMA’s prognostic value for major adverse events. Future directions advocate integrating ADMA into multi-biomarker panels with AI and omics for personalized medicine, addressing gaps in standardization and early detection. Non-invasive techniques like flow-mediated dilation and ultrasound-derived markers complement biomarkers for subclinical CVD assessment. Overall, biomarker-driven strategies promise enhanced CVD prevention and tailored therapies.
Copyright (c) 2025 N.M. Nurillayeva, N.Z. Srozhidinova, M.A. Makhkamova, L. Khafizova (Author) https://creativecommons.org/licenses/by/4.0
The impact of revascularizatıon vıa stenting on left ventricular ejection fraction ın patients with myocardial infarction
Aim. To evaluate the one-year dynamic effect of complete or incomplete revascularization on left ventricular ejection fraction (LVEF) in patients with a history of myocardial infarction (MI) who have preserved or mildly reduced LVEF. Materials and methods. The study included 270 patients with a history of MI. All patients underwent transthoracic echocardiography and coronary angiography (CAG) based on clinical examination findings. Depending on the number of affected atherosclerotic coronary vessels and the extent of stenting performed, patients were divided into three groups: Complete revascularization (CR) (n=115), Incomplete revascularization (IR) (n=94), and No revascularization (NR) (n=61). After the procedure, all patients were discharged with standard treatment. After one year, follow-up echocardiographic assessment of LVEF was performed. Results. In the CR group, LVEF increased significantly from 54.0 [47.0; 59.7] to 55.7 [46.9; 61.4] (p = 0.017). In the IR group, LVEF increased from 53.9 [43.7; 56.4] to 55.7 [46.9; 61.4], but the change was not statistically significant (p = 0.458). In the NR group, LVEF decreased from 50.7 [45.0; 56.3] to 48.2 [41.8; 54.3] (p = 0.011). No statistically significant differences were observed between groups in terms of diastolic function parameters of the left ventricle. Conclusion. In post-infarction patients, complete anatomical revascularization of affected coronary arteries via stenting has a significantly positive impact on the improvement of LVEF.
Copyright (c) 2025 E.Y. Tursunov, R.D. Kurbanov, N.U. Zakirov (Author) https://creativecommons.org/licenses/by/4.0
Application of the Ross operation in children with congenital aortic valve pathology
Aim. To evaluate the clinical effectiveness and safety of the Ross procedure in children with congenital aortic valve disease. The main aim of the study was to determine the physiological and hemodynamic advantages of the Ross operation compared to conventional valve replacement techniques. Materials and methods. A total of 14 pediatric patients who underwent the Ross procedure at the Medion Innovation Center between 2022 and 2025 were analyzed. The primary diagnoses were aortic stenosis (n = 9) and aortic insufficiency (n = 5). In all cases, the full-root replacement technique was applied. Postoperative echocardiographic parameters, including transvalvular pressure gradient and degree of regurgitation, were assessed. Results. A significant improvement in postoperative hemodynamic parameters was observed in all patients. The mean aortic pressure gradient decreased from 45 ± 12 mm Hg to 8 ± 3 mm Hg, and no clinically significant regurgitation was detected. No early postoperative complications or autograft dysfunction were reported during the follow-up period. Conclusion. The Ross procedure is an effective and safe surgical method for treating congenital aortic valve pathology in children. It restores near-physiological hemodynamics, improves long-term outcomes, and reduces the need for reoperation. The results support broader implementation of the Ross procedure in pediatric cardiac surgery practice.
Copyright (c) 2025 Yu.S. Sinelnikov, A.R. Kayumov, Sh.Sh. Adilov, N.A. Zoirova, E.M. Ligin (Author https://creativecommons.org/licenses/by/4.0