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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 А.Р. Ким , А.Б. Шек , Р.Б. Алиева (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 Х.Г. Фозилов , Г.А. Хамидуллаева , Г.Дж. Абдуллаева , Г.У. Муллабаева , Н.Р. Салимова , К.Ю. Филипяк (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 Х.Г. Фозилов, Б.Р. Атамуратов (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 Н. Расулова, Т.А. Абдуллаев, А.А. Хакимов (Автор) 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 Н.М. Нуриллаева, Н.З. Срожидинова, М.А. Махкамова, Л. Хафизова (Автор) 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 Э.Я. Турсунов, Р.Д. Курбанов, Н.У. Закиров (Автор) 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 Ю.С. Синельников, А.Р. Каюмов, Ш.Ш. Адилов, Н.А. Зоирова, Е.М. Лыжин (Автор) https://creativecommons.org/licenses/by/4.0
The Role of Adipose Tissue Depots in the Pathogenesis of Coronary Artery Disease: Beyond Body Mass Index
In recent years, researchers have focused on the role of various adipose tissue depots in the development of coronary artery disease (CAD), extending beyond traditional obesity assessments based on body mass index (BMI). Visceral adipose tissue, epicardial fat, fatty liver disease (currently termed metabolic dysfunction-associated steatotic liver disease), and perivascular adipose tissue actively participate in CAD pathogenesis through mechanisms of systemic inflammation, oxidative stress, endothelial dysfunction, and atherosclerosis. Visceral fat, characterized by high metabolic activity, secretes proinflammatory cytokines that promote insulin resistance and atherosclerosis. Epicardial fat surrounding the coronary arteries exerts local effects by releasing adipokines that may accelerate the progression of atherosclerotic plaques. Fatty liver disease is associated with dyslipidemia and enhanced systemic inflammation, increasing cardiovascular risk. Perivascular adipose tissue regulates vascular tone and inflammation, and its dysfunction contributes to arterial stiffness and hypertension. The relevance of studying these adipose depots lies in the need to identify new biomarkers and targets for personalized prevention and treatment of CAD. Traditional obesity assessment methods such as BMI, fail to reflect adipose tissue distribution and metabolic activity, underscoring the importance of more detailed investigation into the role of various fat depots in cardiovascular pathology.
metabolic dysfunction-associated steatotic liver disease
Copyright (c) 2025 Д.Б. Юсупалиева , Р.Б. Алиева , Ш.С. Ахмедова , А.Б. Шек (Автор) https://creativecommons.org/licenses/by/4.0
The effect of antihypertensive drugs on cognitive functions
According to the World Health Organization data, 1.13 billion people worldwide suffer from arterial hypertension, with only 21% under proper control. Dementia currently negatively affects the quality of life of 55 million people worldwide, with one new case recorded every 3.2 seconds. Analyzing the effects of antihypertensive medications on cognitive function and evaluating protective mechanisms against dementia development is currently considered one of the urgent issues. There is reliable evidence that the effects of antihypertensive medications on cognitive function are related not only to blood pressure reduction but also to independent neuroprotective mechanisms. Angiotensin receptor blockers reduce dementia risk by 12-26% compared to other antihypertensive medications. Calcium channel blockers demonstrate 17% greater neuroprotective effects compared to other drug classes. ARBs and calcium channel blockers possess the best neuroprotective properties and are considered preferable for cognitive function protection. These effects occur independently of blood pressure reduction mechanisms.
Copyright (c) 2025 М.И. Атоева, Г.Ж. Абдуллаева, Х.Ф. Юсупова, И.В. Ибрагимова (Автор) https://creativecommons.org/licenses/by/4.0
Predictors of sudden cardiac death and the impact of coronary artery bypass grafting on their development
Sudden Cardiac Death (SCD) is one of the most severe and life-threatening manifestations of cardiovascular diseases and is among the leading causes of mortality worldwide. The primary pathogenic factors contributing to the development of this condition include ischemic heart disease (IHD), ventricular arrhythmias, reduced left ventricular ejection fraction (LVEF), and the formation of scar tissue in the myocardium. The mechanism underlying SCD is complex, involving a combination of myocardial ischemia, electrical instability, and morphological changes, all of which contribute to the onset of malignant arrhythmias. Coronary artery bypass grafting (CABG) is an effective revascularization technique in patients with ischemic heart disease. It not only alleviates symptoms but also significantly improves long-term prognosis by enhancing cardiac function. Studies have shown that CABG, particularly in patients with reduced LVEF, decreases overall mortality and the risk of developing SCD. In conclusion, CABG plays an important role in the prevention of SCD, but it is not a standalone solution. A thorough analysis of the underlying risk factors, early identification of high-risk patients, and the development of individualized, comprehensive preventive and therapeutic strategies represent the most effective approach in reducing SCD incidence.
Copyright (c) 2025 А.Ш. Расулов, Р.Д. Курбанов, Г.У. Муллабаева, Э.Я. Турсунов, А.Г. Кеворков, К.Ш. Сайфиддин Ходжи (Автор) https://creativecommons.org/licenses/by/4.0
The importance of lipoprotein(a) in the development of cardiovascular diseases
Aim. To study the impact of lipoprotein (a) levels on major cardiovascular events. Materials and methods. We examined the impact of lipoprotein(a) levels on major cardiovascular events based on a review of articles on this topic. Results. Based on a review of articles on this topic, it can be said that Lp(a) is a highly atherothrombogenic lipoprotein associated with atherosclerotic cardiovascular diseases and their complications, in particular, ischemic heart disease and aortic valve stenosis. Conclusion. Lipoprotein (a) levels may serve as a criterion for determining residual risk during hypolipidemic therapy.
Copyright (c) 2025 Р.Е. Жемуратова , А.Б. Шек (Автор) https://creativecommons.org/licenses/by/4.0
Short and Medium-term Efficacy and Safety of “Sinotech+” (Uzbekistan) Stent in Primary Stenting for Patients with Acute Coronary Syndrome with ST-Segment Elevation
Aim. To evaluate the efficacy and safety of the Uzbekistan-manufactured “Sinotech+” stent during primary percutaneous coronary intervention (pPCI) in patients presenting with ST-elevation acute coronary syndrome (STEMI). Materials and methods. The study was conducted at the X-ray Endovascular Treatment Department of Cardiovascular Diseases at the RSSPMCC. Between January and June 2025, all 31 patients diagnosed with STEMI underwent pPCI procedures. "Sinotech+" stents were implanted in 17 patients (54.8%), while "Resolute Integrity" stents were implanted in 14 patients (45.2%). Patients who received "Sinotech+" stent implantation were analyzed. Results. Coronary lesion distribution was as follows: single-vessel disease in 5 patients (29.4%), two- vessel disease in 7 patients (41.2%), and multi-vessel disease in 5 patients (29.4%). Pre-procedural coronary flow assessment using the TIMI (Thrombolysis in Myocardial Infarction) perfusion scale revealed TIMI-0 flow in 9 patients (53%) and TIMI-1 flow in 8 patients (47%). Following pPCI, TIMI-3 flow was achieved in 14 patients (82.4%), while TIMI-2 flow was achieved in the remaining 3 patients (17.6%). These results demonstrated 100% technical success (stent deployment and vessel opening) and 82.4% angiographic success (achieving TIMI-3 flow), indicating high clinical efficacy of primary PCI using “Sinotech+” stents. Conclusion. The Uzbekistan-manufactured “Sinotech+” stent demonstrated high efficacy and safety in patients presenting with STEMI. No complications (thrombosis, restenosis, recurrent myocardial infarction, repeat revascularization) were observed during clinical follow-up.
Copyright (c) 2025 Х .Фозилов, Б. Атамуратов, Б. Юлдашов (Автор) https://creativecommons.org/licenses/by/4.0
Speckle-tracking echocardiography in assessing staged cardiac remodeling in ischemic heart failure
Aim. To assess the features of global staged remodeling of the heart chambers in patients with ischemic chronic heart failure, depending on the degree of left ventricular ejection fraction (LVEF) reduction, using two-dimensional echocardiography with myocardial deformation analysis. Materials and methods. The study included 96 patients with a confirmed diagnosis of CHF according to current criteria. Patients were divided into three groups based on LVEF: Group I – LVEF >50% (n=46, preserved systolic function); Group II – LVEF 40-49% (n=24, mildly reduced systolic function); Group III – LVEF <40% (n=26, significantly reduced systolic function). Global longitudinal strain (GLS) of the LV was significantly lower in patients with reduced ejection fraction. Results. In the group with LVEF >50%, the mean GLS was 17.0 ± 2.8%, while in those with LVEF 40–49% and <40%, values decreased to 12.6 ± 2.1% and 9.4 ± 2.2%, respectively (p < 0.001). A similar trend was observed for GLS measured in 4-, 2-, and 3-chamber views. These findings indicate high sensitivity of GLS to impaired myocardial contractility and confirm its clinical significance in assessing LV functional status.The assessment of LA function using 2D speckle-tracking echocardiography in the reservoir, conduit, and contractile phases also revealed a significant decrease in absolute parameters: LASr (reservoir phase) - 35.5 ± 8.3% (LVEF >50%) →17.8 ± 11.2% (LVEF <40%), *p* < 0.001; LASct (conduit phase) - 17.6 ± 5.4% → 8.8 ± 6.5%, *p*< 0.001; LAScd (contractile phase) - 18.7 ± 5.9% → 8.7 ± 4.6%, *p* < 0.001. In patients with LVEF>50%, RV longitudinal strain parameters were highest (RVFWLS - 21.3 ± 4.0%; RV GLS - 18.1 ± 3.2%), while in LVEF 40–49%, they decreased (19.9 ± 2.8% and 16.0 ± 2.7%, respectively), and in LVEF <40%, the most pronounced decline was observed (RVFWLS: 14.0 ± 4.1%; RV GLS: 10.5 ± 3.1%), with significant intergroup differences (p=0.001). Conclusion. Patients with ischemic CHF exhibit progressive remodeling of all heart chambers (LV, LA, and RV), with worsening functional impairment as LVEF declines. LV global longitudinal strain (GLS), as well as LA (LASr, LASct, LAScd) and RV (RVFWLS, RV GLS) deformation parameters, demonstrate high sensitivity to hemodynamic changes and may serve as early markers of CHF progression. Speckle-tracking echocardiography is an informative non-invasive method for assessing subclinical myocardial dysfunction and may be useful for risk stratification and therapy monitoring in patients with varying degrees of CHF severity.
Copyright (c) 2025 Ф.М. Бекметова , Х.Г. Фозилов , Р.Ш. Бекбулатова , Ш.У. Хошимов , Ш.А. Оринбаев (Автор) https://creativecommons.org/licenses/by/4.0
Benefits and risks of implementing the Neuromed AI medical decision support system in the cardiology service of the Republic of Uzbekistan.
Aim: Clinical testing of the NeuromedAI Cardio intelligent system, designed to automate routine tasks of cardiologists and improve the quality of medical care; Materials and methods. The study used the NeuromedAI Cardio intelligent system and a questionnaire, including 28 questions aimed at expert assessment of the potential benefits of the system for doctors. The questionnaire helped to define the main requirements for the system, as well as formulate recommendations for improving the model. In particular, areas were identified for enriching the training dataset and further training the model in order to improve the accuracy of responses; Results. As part of a pilot study of the Neuromed system conducted in 2024, an anonymous survey of 21 cardiologists was organized. The average experience of the participants was 17 ± 11.1 years. Analysis of the questionnaires showed that during interaction with the system, specialists asked a total of 400 questions, which reflects a high level of interest in the technology and its active testing in the professional environment; Conclusion. Based on the obtained results, it is planned to develop recommendations for adapting the system for implementation in the practice of primary health care in the Republic of Uzbekistan. It is expected that the adapted system will improve the accuracy of diagnosis and the effectiveness of treatment at the primary level, which will be reflected in the improvement of key indicators of public health and will receive positive feedback from health workers.
Copyright (c) 2025 Х.Г. Фозилов, Р.Х. Тригулова (Автор) https://creativecommons.org/licenses/by/4.0
An integrated approach to determining the risk of developing preeclampsia in pregnant women with hypertensive conditions
Aim. Hypertensive disorders complicate one in ten pregnancies, which necessitates the development of new standards for determining the risk of preeclampsia and heart failure in pregnant women. To determine early clinical markers in pregnant women with gestational arterial hypertension (GAH) as sensitive diagnostic criteria for the development of hypertensive complications. Materials and methods. The study included 91 pregnant women of the 2nd-3rd trimesters, divided into groups: healthy pregnant women (n=44) and with GAH (n=47) according to the ESC Guidelines 2018. Physical examination, blood pressure measurement, BMI calculation, detailed blood tests including lipidogram, coagulogram, determination of prolactin and NT-proBNP, echocardiography, vascular stress test to assess endothelial function were performed. Results. Pregnant women with GAH were found to have morphofunctional changes in the heart, early signs of endothelial dysfunction, lipid and carbohydrate metabolism disorders. Microalbuminuria demonstrated high diagnostic value for detecting early renal dysfunction. The prognostic significance of prolactin and NT-proBNP levels was established. Conclusion. Comprehensive early monitoring of clinical and biochemical parameters of pregnant women with GAG is necessary for timely detection of preeclampsia predictors. The results contribute to the improvement of diagnostic and preventive standards for the management of this cohort of patients.
Copyright (c) 2025 M. Садуллоева, Ф.А. Закирова , М.У. Турсунова , А.А. Абдухакимов , С.А. Икрамова , В.Х. Джураева (Автор) https://creativecommons.org/licenses/by/4.0
Gender-specific features of dilated cardiomyopathy in the uzbek population
Dilated cardiomyopathy (DCM) is one of the most common non-ischemic myocardial disease characterized by systolic dysfunction and cardiac chamber dilation. Gender-specific features of DCM progression and prognosis remain understudied. Aim. To evaluate gender-specific characteristics of medical history, clinical presentation, and functional parameters in patients with DCM in the Uzbek population. Materials and methods. A retrospective analysis included 269 DCM patients (180 men, 89 women) treated at the Republican Specialized Scientific-Practical Medical Center of Cardiology from 2010 to 2017. Data on age at diagnosis, disease duration, hospitalizations, NYHA class, hemodynamics, and six-minute walking test were assessed. Statistical analysis involved t-test and χ2 test (p < 0.05). Results. Women were younger at diagnosis (33.7 vs. 41.3 years; p < 0.001), had shorter disease duration (p = 0.041), and were hospitalized more frequently (75% vs. 65%; p = 0.041). No significant differences were found in NYHA class, blood pressure, or respiratory parameters. Men demonstrated better physical endurance (p = 0.191). Conclusion. Significant gender differences were identified, underscoring the need for personalized management of DCM patients.
Copyright (c) 2025 Т.A. Абдуллаев , И.А. Цой , Х.А. Гуломов , С.Т. Мирзарахимова , О.К. Худойберганов , М.М. Рахматов (Автор) https://creativecommons.org/licenses/by/4.0
Epidemiology and Cardiovascular Risk Assessment in Patients with Carotid Artery Atherosclerosis in the Republic of Uzbekistan: A Cross-Sectional Population-Based Study
Aim. Atherosclerosis of the carotid artery basin is a key pathogenic factor in ischemic stroke. In the context of a lack of local epidemiological data, studying the prevalence of lesions and associated risk factors in the Republic of Uzbekistan is of particular importance. The aim of the study was to assess the prevalence of atherosclerotic lesions in the carotid arteries, identify associated risk factors, and perform cardiovascular risk stratification using the SCORE scale among the adult population of Uzbekistan, taking into account gender, age, and regional characteristics. Materials and Methods. A population-based cross-sectional study was conducted at the Republican Specialized Scientific and Practical Medical Center of Cardiology (Tashkent). The analysis included data from 6,425 adult patients who underwent ultrasound duplex scanning of the carotid arteries. Demographic indicators, blood pressure levels, lipid profile, smoking status, presence of arterial hypertension (AH), and 10-year cardiovascular risk according to the SCORE scale were assessed. For statistical analysis, univariate and multivariate logistic regression models were used. Results. Atherosclerotic lesions of the carotid arteries were significantly more frequently detected in men over 50 years of age (p<0.05). The strongest correlation was found with arterial hypertension (r=0.85; p<0.001). Smoking and elevated systolic blood pressure showed a moderate association with plaque presence (p<0.01). Mean SCORE values in certain regions (Samarkand and Navoi regions) reached Conclusion. These findings emphasize the need to implement targeted preventive programs aimed at controlling hypertension and reducing smoking prevalence in high-risk groups.
Copyright (c) 2025 Ф.М. Бекметова , Х.Г. Фозилов , С.Я. Абдуллаева , М.Н. Хотамова , А.Ш. Алманова , Ш.Н. Дониёров (Автор) https://creativecommons.org/licenses/by/4.0
Comprehensive assessment of inflammatory, epigenetic, and cardioimaging biomarkers in the progressive course of coronary heart disease
Aim. In this study, the prognostic significance of a multibiomarker model, including epigenetic markers (miR-155), inflammatory cytokines (TNF-α, IL-1β) and noninvasive cardiovisualizing patterns, was evaluated for assessing the risk of progressive coronary heart disease (CHD). Materials and methods. A comprehensive assessment of correlations between the parameters of coronary atherosclerosis according to contrast MSCT angiography (coronary calcium index, degree of stenosis, remodeling index, index of involvement-SIS, density, volume and mass of plaques) and biomarker levels was carried out in 152 patients with stable and unstable forms of coronary artery disease. miR-155 expression was determined by real-time polymerase chain reaction on a Rotor–Gene Q device, and concentrations of proinflammatory cytokines were determined by enzyme immunoassay. Results. A comprehensive assessment of correlations between the parameters of coronary atherosclerosis according to contrast MSCT angiography (coronary calcium index, degree of stenosis, remodeling index, index of involvement-SIS, density, volume and mass of plaques) and biomarker levels was carried out in 152 patients with stable and unstable forms of coronary artery disease. miR-155 expression was determined by real-time polymerase chain reaction on a Rotor–Gene Q device, and concentrations of proinflammatory cytokines were determined by enzyme immunoassay. Conclusion. The data obtained confirm that this multibiomarker panel is a promising tool for early detection, risk assessment, and the development of individual management strategies for patients with coronary heart disease. Combined assessment of epigenetic, inflammatory, and cardiovisual biomarkers can improve risk stratification and aid in clinical decision-making.
Copyright (c) 2025 Ф.Б. Абдумаликова , Н.М. Нуриллаева , Б.Г. Курбанова (Автор) https://creativecommons.org/licenses/by/4.0
The significance of the triglyceride/high-density lipoprotein cholesterol index as a predictor of major cardiovascular events
Aim. To study the influence of the TG/HDL-C index on the development of major cardiovascular events in patients with coronary artery disease. Materials and methods. The study included 221 patients with a diagnosis of coronary artery disease, progressive angina pectoris, hospitalized in the department of coronary heart disease and dyslipidemia. All patients were determined biochemical parameters and imaging markers. Results. When comparing patients with and without metabolic syndrome, the latter had a higher TG/HDL-C index (p<0.001), as well as CVD (p<0.001). In addition, a 3-year follow-up showed that an increase in TG/HDL-C above a certain point (Yuden index 5.1) with a statistically significant result led to a more frequent development of MACE (p<0.001), revascularization (p<0.05). Based on the results of the study, a multiple logistic regression model was built using 4 significant variables - EFT, Age, Lp(a) and TG/HDL-C. Conclusion. The triglycerides/high-density lipoprotein cholesterol index can serve as an additional criterion in the selection of lipid-lowering therapy to reduce the residual risk, with an increase in which the addition of fenofibrate should be considered.
Copyright (c) 2025 А.Р. Ким, Р.Б. Алиева, А.Б. Шек (Автор) https://creativecommons.org/licenses/by/4.0
The role of high-tech noninvasive cardiovisualization methods in early diagnosis and prognosis of coronary artery disease
Modern data on the possibilities and importance of advanced noninvasive imaging methods in the early detection of coronary artery disease (CAD) and assessment of the risk of its progression, such as multispiral computed tomographic angiography (MSCT-AG) of the coronary arteries, are systematized. The article discusses in detail the contribution of MSCT-AH to the comprehensive assessment of coronary atherosclerosis. The importance of quantitative analysis of coronary calcium as an important predictor of adverse cardiovascular events is emphasized. The possibilities of the method are discussed in the accurate assessment of the degree of coronary artery stenosis, as well as in the detailed characterization of atherosclerotic plaques, including their structure, density and detection of signs of instability. Special attention is paid to the assessment of the vascular remodeling index, which reflects adaptive or pathological changes in the vascular wall in response to plaque formation. A critically important aspect is the determination of the fractional blood flow reserve (FFR), calculated on the basis of MSCT-AG data, which makes it possible to noninvasively assess the hemodynamic significance of stenoses, which is of paramount importance in the destabilization of coronary atherosclerosis and the choice of optimal treatment tactics.
Copyright (c) 2025 Б.Г. Курбанова, Ф.Б. Абдумаликов, С.О. Жураева (Автор) https://creativecommons.org/licenses/by/4.0
Modern Approaches to Imaging Features of Unstable Atherosclerotic Plaques in the Carotid Arteries: A Literature Review
*]:pointer-events-auto scroll-mt-(--header-height)" dir="auto" tabindex="-1" data-turn-id="71425f87-c44c-4fa0-b8b7-d225ef83fa94" data-testid="conversation-turn-15" data-scroll-anchor="false" data-turn="user"> Carotid artery atherosclerosis is one of the leading causes of ischemic stroke and other cardiovascular complications. Rupture of an unstable atherosclerotic plaque can lead to acute cerebrovascular events, making timely diagnosis and risk assessment critically important. This review discusses current imaging methods for detecting signs of plaque instability, including magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and ultrasound (US). Special attention is given to the diagnostic capabilities and advantages of each modality, as well as their combined use to enhance the accuracy of vascular event prediction. Research findings indicate that hybrid approaches—such as US + MRI or CT + PET—can achieve up to 93% accuracy in identifying unstable plaques. Imaging techniques provide detailed assessments of plaque morphology, lipid core, fibrous cap thickness, inflammation, and neovascularization. Advanced technologies, including elastography and artificial intelligence for image analysis, are opening new prospects for diagnosing and monitoring patients with atherosclerosis. Thus, implementing comprehensive imaging strategies enables early identification of high-risk stroke patients, improving the effectiveness of cardiovascular disease prevention and treatment. *]:pointer-events-auto [content-visibility:auto] supports-[content-visibility:auto]:[contain-intrinsic-size:auto_100lvh] scroll-mt-[calc(var(--header-height)+min(200px,max(70px,20svh)))]" dir="auto" tabindex="-1" data-turn-id="request-6906f4eb-6a98-8328-8a7e-f3b3d26d57b7-1" data-testid="conversation-turn-16" data-scroll-anchor="true" data-turn="assistant">
Copyright (c) 2025 М.Х. Ходжибеков , Ф.М. Бекметова , А.Ш. Алманова (Автор) https://creativecommons.org/licenses/by/4.0
Vascular complications in patients with type 2 diabetes mellitus and arterial hypertension: risk factors and prevention
Type 2 diabetes mellitus and arterial hypertension in patients represent a significant challenge in modern medicine. The article examines the pathogenesis, clinical features, and complications of these comorbid conditions. The combination of type 2 diabetes and arterial hypertension leads to accelerated development of micro- and macrovascular complications. Prolonged elevation of blood pressure contributes to a diabetogenic effect and increases the risk of vascular complications. Key features—salt sensitivity, albuminuria, isolated systolic hypertension, and orthostatic hypotension—further complicate the situation. The authors discuss the results of recent studies on the prevention and treatment of these complications, emphasizing the importance of maintaining blood pressure within target levels and adopting an individualized therapeutic approach. Metabolic control and lifestyle modification provide additional opportunities for prevention. In conclusion, it is noted that a systemic and comprehensive approach is essential to prevent complications in patients with type 2 diabetes and arterial hypertension.
circadian rhythm of arterial blood pressure
Copyright (c) 2024 https://creativecommons.org/licenses/by/4.0
Comparison of the effectiveness of the original and generic forms of clopidogrel in patients with coronary artery disease (CAD).4o
Background. To evaluate the antiaggregation activity and clinical tolerability of Areplex (75 mg, ADAMED, Poland) compared to Plavix (75 mg, Sanofi-Winthrop Industrie, France) in CAD patients. Materials and methods. A blinded, randomized, two-parallel-group study included 40 patients with stable angina (FC I-IV). Platelet aggregation was assessed using the AP 2110 analyzer (SOLAR) with ADP (5 µmol/L) and arachidonic acid (0.5 mg/mL) inducers after a 300 mg loading dose. Results. At 24 hours post-dose, both groups showed significant reductions in aggregation degree and rate (p<0.05), with no intergroup differences (p>0.05). Safety profiles were comparable, with no adverse events reported. Conclusion. Areplex demonstrated bioequivalence to Plavix, with good tolerability, supporting its use as an effective antiplatelet agent in CAD patients.
Copyright (c) 2025 Guzal U.Mullabaeva, Umid T.Khairullaev https://creativecommons.org/licenses/by/4.0
Polypill in Cardiovascular Disease Prevention: Efficacy and Perspectives
Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. To enhance the effectiveness of prevention, the concept of a polypill containing multiple active pharmaceutical components has been introduced. This review explores the role of the polypill in primary and secondary prevention, along with its advantages and limitations. In primary prevention, the polypill may help reduce the risk of developing hypertension, dyslipidemia, and thrombosis. In secondary prevention, it aids in lowering the likelihood of recurrent cardiovascular events such as myocardial infarction and stroke. Additionally, the polypill improves medication adherence and reduces overall healthcare costs
Copyright (c) 2025 Ш.С. Файзуллаев, Г.А. Хамидуллаева, Г.Дж. Абдуллаева, Х.Ф. Юсупова (Автор) https://creativecommons.org/licenses/by/4.0
Systematic Review of Valve Surgery with Continuous Coronary Perfusion on Beating Heart in Patients with Low Left Ventricular Ejection Fraction.
Aim. Beating-heart continuous coronary perfusion (BHCCP) is an alternative to cardioplegic arrest in valve surgery, potentially reducing ischemic reperfusion injury, especially in high-risk patients with low left ventricular ejection fraction (LVEF). Materials and methods. A systematic review of prospective and observational studies was conducted, focusing on BHCCP versus cardioplegia in valve surgery, with emphasis on patients with LVEF <35%. Results. Studies (e.g., Matsumoto et al., 2002) showed no significant difference in mortality or major complications, but BHCCP reduced myocardial damage markers (e.g., Troponin I, CK-MB) by 20–40% compared to cardioplegia. Clinical outcomes remained comparable across groups. Conclusion. BHCCP is a safe alternative to cardioplegia, with potential benefits in myocardial protection, though high-quality randomized trials are needed to confirm clinical superiority.
Copyright (c) 2025 У.Т. Хайруллаев , Г.У. Муллабаева , И.М. Шарипов (Автор) https://creativecommons.org/licenses/by/4.0
Cardiological approaches to the diagnosis and treatment of patients with combined atherosclerotic stenosis of the carotid and coronary arteries
Background. During the literature review, it becomes evident that approaches to the early diagnosis and treatment of atherosclerosis are undergoing significant changes worldwide. Unfortunately, isolated atherosclerotic involvement of a single vascular territory is rarely encountered nowadays. On the contrary, it is increasingly common to observe atherosclerotic lesions affecting multiple vascular beds in the same patient. From this perspective, modern advances in the diagnostics of multifocal atherosclerotic disease and novel approaches to the treatment of atherosclerosis have fundamentally altered the conventional understanding of this pathology. Materials and methods. Within the framework of our study, we included 105 patients examined and treated from 2019 to 2024 at the Republican Specialized Center of Surgical Angioneurology. All had hemodynamically significant stenosis of the carotid arteries and were diagnosed with either asymptomatic ischemic heart disease or stable angina pectoris (Functional Class I–II). Patients underwent both standard and specialized diagnostic procedures, including ECG, 24-hour Holter ECG monitoring, echocardiography, ultrasound examinations, CT, MRI, angiography (MSCT angiography, coronary angiography), as well as myocardial MRI stress perfusion. Results. In patients treated according to the developed algorithm, incidences of stroke, heart failure, acute coronary syndrome, and myocardial infarction were lower compared to the control group. In the main group, perioperative complications decreased to 2%, and long-term complications to 2.6%. Patient improvement was higher in the main group (53.9%) versus the control group (40.5%). A stratified approach in cases of combined carotid and coronary artery stenosis helped reduce complications and increase treatment efficacy. Conclusion. Carotid artery stenosis accompanied by asymptomatic coronary lesions most often involves two or more diseased vessels; isolated atherosclerotic processes are rare. At least four risk factors are typically present, the most common being hypertension, obesity, physical inactivity, hyperlipidemia, or diabetes mellitus. When myocardial MRI stress perfusion indicates ischemia or shows a perfusion reserve 2, performing coronary stenting first can help prevent cardiac complications during carotid reconstruction.
Copyright (c) 2025 Ш.И. Каримов, А.А. Юлбарисов, Д.Х. Нурматов, Х.К. Алидижанов, Б.Т. Носиржонов (Автор) https://creativecommons.org/licenses/by/4.0
Clınıcal and laboratory dıfferences between stentıng and optımal medıcal therapy ın the treatment of coronary artery dısease.
The objective was to study the relationship between risk factors and clinical-laboratory indicators in patients receiving treatment for ischemic heart disease with stenting and optimized medical therapy. The study included 70 patients, 37 receiving optimized medical therapy and 33 who had undergone stenting. Biochemical indicators, including cholesterol, triglyceride, and fasting glucose levels, as well as functional indicators such as ejection fraction, were analyzed. No statistically significant differences were found between the groups in terms of biochemical and functional indicators. Both treatment approaches demonstrated similar effectiveness. Stenting remains an important method of treatment, while optimized medical therapy also proves to be effective.
Copyright (c) 2024 A.X. Абдусаматов, H.M. Нуриллаева (Автор) https://creativecommons.org/licenses/by/4.0
Surgical treatment of post-infarction ventricular septal defect and left ventricular aneurysm
The article focuses on the possibilities of modern surgical interventions for conditions including post-infarction ventricular septal rupture (PIVSR) repair, left ventricular reconstruction, and coronary artery bypass grafting. Current clinical case highlights the relevance of mechanical complications of acute myocardial infarction, which, despite advances in cardiology and cardiac surgery, are still associated with high mortality. The development and standardization of surgical correction methods for these conditions, including optimal timing of surgery, remain important areas for improving treatment outcomes in patients with severe forms of myocardial infarction. The described clinical case illustrates the complexity and multi-stage process of treating patients with PIVSR, from diagnosis to the postoperative period. Data on the clinical condition, instrumental and laboratory research methods (echocardiography, coronary ventriculography), a detailed description of the performed surgical procedure, and the results of surgical intervention are presented, which can serve as a valuable guide for clinicians encountering similar cases in their practice. The need for continued accumulation of clinical material and research in this area is indicated in order to optimize the results of surgical treatment for patients in this severe category.
mechanical complications of myocardial infarction
postinfarction ventricular septal rupture
Copyright (c) 2025 К.Х. Рахмонов , Д.Ш. Жугинисов , Д.Е. Мусин , Э.А. Олимов , Ё.У. Низамов (Автор) https://creativecommons.org/licenses/by/4.0
Clinical case of pseudo-Wellens syndrome caused by pulmonary embolism
Pseudo-Wellens' syndrome is a rare clinical condition that mimics Wellens' syndrome. This article presents a case of pseudo-Wellens syndrome associated with pulmonary embolism (PE). A female patient was admitted to the emergency room one hour post-syncope, experiencing recurrent episodes of loss of consciousness and shortness of breath. Examination revealed elevated levels of C-reactive protein, D-dimer, interleukin-6 (IL-6), and N-terminal pro-brain natriuretic peptide (NT-proBNP). Electrocardiography (ECG) showed T-wave inversions in leads V1-V6. Coronary angiography ruled out significant stenosis, while computed tomography pulmonary angiography (CTPA) confirmed acute PE. The patient underwent fibrinolysis with 50 mg of tenecteplase. Upon discharge, the patient was recommended to take warfarin at a dose of 7.5 mg/day as anticoagulant therapy.
left anterior descending coronary artery
Copyright (c) 2024 А.И. Куватов, Ш.А. Оринбаев , М.У. Турсунова , Ф.А. Закирова , М.А. Садуллоева (Автор) https://creativecommons.org/licenses/by/4.0
Correlation analysis of the interdependence between identified risk factors of ischemic heart disease and vitamin d levels
Objective. To assess the relationship between vitamin D levels and risk factors for IHD; Materials and methods. A total of 70 patients with IHD risk factors were examined and divided into groups with normal (n = 29) and deficient (n = 41) vitamin D levels. A correlation analysis of cardiovascular parameters was conducted; Results. A negative correlation was found between vitamin D levels and total cholesterol and LDL. In the control group, a correlation with diabetes mellitus was observed. No significant correlations were found in the vitamin D deficiency group; Conclusion. Vitamin D may influence lipid metabolism and IHD risk factors, but this relationship is variable and requires further research.
Copyright (c) 2025 Н.Ш. Абдусаматова, Н.М. Нуриллаева (Автор) https://creativecommons.org/licenses/by/4.0