Vol 31, No 4 (2025)

BACKGROUND: The multimorbidity of affective, cognitive, and cardiovascular diseases is an urgent issue of the contemporary medicine due to their severity, resistance to therapy, social maladjustment, and low quality of life. Common pathogenetic mechanisms, including endothelial dysfunction and disorders of the frontal and subcortical connections, enhance these conditions, increasing the risks of dementia and mortality.

AIM: To study the clinical and psychopathological structure of affective disorders and comorbid cognitive disorders in inpatients with cardiovascular diseases in various age groups.

METHODS: An observational, single-center study was conducted from January 2023 to June 2024 at the University Clinic of the Russian University of Medicine. The study involved 121 patients with cardiovascular diseases and non-psychotic mental disorders, including 47 (38.8%) with comorbid affective and cognitive disorders. The patients were divided into three age groups, 45–59, 60–74, and 75–90 years. Clinical psychopathological and psychometric (Hospital Anxiety and Depression Scale, Montreal Cognitive Assessment) and neuropsychological methods (clock drawing test, Luria’s method) were used. Statistical analysis was performed using Fisher’s exact test and Student’s t-test.

RESULTS: In 85.1% of patients, we detected organic emotional disorders, mainly with alarming symptoms. Significant differences in the clinical structure of affective disorders between the groups indicate age-related differences (p = 0.045). Cognitive disorders (visual and constructional praxis, attention, memory, abstract thinking) are associated with vascular changes and dysfunction of the frontal lobes. The Montreal Cognitive Assessment scores were in the range of 18–27; the average score in the 45–59 group (24.9 ± 0.3) was higher compared to the 60–74 (23.5 ± 0.2; p < 0.05) and 75–90 groups (23.4 ± 0.3; p < 0.05). Moderate cognitive disorders were detected in 55.3% of cases, severe cognitive disorders were detected in 19.2% of cases, and 25.5% of cases were within the normal range. Subjective cognitive complaints related to the risk of dementia were not confirmed by tests in 27.6% of cases. Attention and abstract thinking disorders increased with age (p < 0.05); whereas speech disorders showed no significant differences (p > 0.05).

CONCLUSION: The study highlights the importance of early diagnosis and an interdisciplinary approach to multimorbid conditions and a qualitative analysis of the psychopathological and pathopsychological structure of affective and cognitive disorders in cardiovascular cases. The limitation is the small sample size, requiring further research on a larger sample of patients.

BACKGROUND: Heart rate variability indicators in ice hockey athletes have been explored very poorly thus far. Investigating correlations between the indicators of heart rate variability and on-ice testing (the most efficient method for assessing special work capacity, energy supply, and adaptation of ice hockey players) is highly crucial given the labor intensity, high cost, and invasiveness of on-ice testing.

AIM: To study heart rate variability indicators in ice hockey defensemen during on-ice tests and to identify correlations between the metrics resulting from the examination using two methods.

METHODS: The study involved ten defensemen from a major league hockey team aged between 19 and 34 during the season of play. The study methods included: pulse measurement using the PolarTeamPro2 team system; determination of lactic acid content in blood using a photometric method; estimation of special work capacity, energy supply, and blood buffer capacity of players through on-ice testing; 5-minute rhythmocardiography using the KFS-01.001 Cardiometer-MT electrocardiograph (MIKARD-LANA, Russia). Results data were statistically processed using the Excel-2017 software.

RESULTS: Seven out of ten athletes (70%) had type 3 heart rate regulation according to Shlyk’s classification. Based on the median spectral indicators, it turned out that the central heart rate regulation circuit (low-frequency waves and very low-frequency waves) was dominant in defensemen. The total wave spectrum growth significantly correlated with the heart rate recovery indicators in the sample of defensemen (the correlation coefficient was −0.69) and suggested that the characteristics of the defensemen were close to the model characteristics of on-ice testing (correlation coefficient of 0.689). The value of the parasympathetic component of the wave spectrum (high-frequency waves) significantly negatively correlated with the test completion time (correlation coefficient of −0.48) (special work capacity) and blood lactate in on-ice testing (correlation coefficient of 0.515).

CONCLUSION: Improvements in the cardiovascular system’s adaptation to special ice work and the approximation of defensemen’s characteristics to model characteristics are closely related to an increase in overall heart rate variability and the central heart rate regulation circuit. The dynamics of heart rate variability indicators can be used as an operational control over ice hockey defensemen.

BACKGROUND: Advances in the diagnosis and treatment of myocardial infarction have triggered an ≥50% increase in the proportion of patients with preserved left ventricular ejection fraction. The relevance of using adrenergic beta-antagonists in this patient cohort remains a topic of active debate.

AIM: To study the two-year catamnesis of patients suffering from myocardial infarction with chronic heart failure and preserved left ventricular ejection fraction who either received or did not receive adrenergic beta-antagonists.

METHODS: The study encompassed 127 patients with myocardial infarction aged 53 (48; 60) years with preserved left ventricular ejection fraction. On days 4–9 of myocardial infarction and on its 12- and 24-month anniversary, echocardiography with assessment of global longitudinal strain, longitudinal electrocardiogram monitoring, measurement of N-terminal natriuretic hormone peptide concentration, and a 6-minute walk test were performed. The endpoint was chronic heart failure progression over subsequent 2 years.

RESULTS: The adrenergic beta-antagonist group included 98 patients (77%) who received adrenergic beta-antagonist therapy, whereas the remaining 29 patients (23%) who did not receive such therapy due to hypotension and bradycardia made up the no adrenergic beta-antagonist group. In the adrenergic beta-antagonist group, by the second year of the post-infarction period, there was an increase in the indexed values of end-diastolic and end-systolic volumes, a decrease in left ventricular ejection fraction by 3.1% (р = 0.00077) and global longitudinal strain by 2.4% (р = 0.0002); in the other group, these parameters remained flat. In patients of the adrenergic beta-antagonist group, a decrease in chronotropic load on the myocardium and an increase in the circadian index while maintaining its rigid level were recorded; in the no adrenergic beta-antagonist group of patients, an increase in chronotropic load and normalization of the circadian heart rhythm profile were observed as early as by the 12th month of observation. The number of patients with progressive chronic heart failure over 2 years of observation in both groups did not differ: 21% and 24%, respectively (the risk ratio is 0.659; the 95% confidence interval is 0.35–1.243).

CONCLUSION: In today’s context, with the use of reperfusion methods for treating patients with myocardial infarction, it is necessary to conduct large-scale randomized clinical trials studying the effect of adrenergic beta-antagonist therapy on the prognosis in patients with preserved left ventricular ejection fraction. According to the results of this study, no significant differences were found in the frequency of progression of chronic heart failure in groups of patients who had suffered myocardial infarction and preserved left ventricular ejection fraction. In the group of patients who did not receive adrenergic beta-antagonists, more stable myocardial volume and deformation characteristics were observed within 24 months of myocardial infarction.

BACKGROUND: Relative energy deficiency in sport (RED-S) and low energy availability are major issues in modern sports. The constant prevalence of energy expenditure on training and competition over energy intake is the main risk factor for these conditions to occur. Quantifying energy deficiency in everyday practice is rendered difficult, but questionnaires can be an effective tool for timely screening of low energy availability and RED-S.

AIM: To conduct a systematic review of questionnaires used to assess RED-S risk factors in athletes.

METHODS: The presented review was conducted in concert with the methodological guidelines found in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. A search was conducted through the PubMed, Google Scholar, Embase, Scopus, CINAHL, Medline Ovid, and SPORTDiscus electronic databases from January 2010 to February 2025. The review covered articles setting forth issues regarding the assessment of reproductive health and manifestations of RED-S.

RESULTS: Out of the 29 studies included in the review, ten unique questionnaires were found to identify athletes at risk of energy deficiency. Nine questionnaires were validated, three of which included only screening for eating disorders, without assessing other symptoms or training activity. Two questionnaires were most frequently used in studies and practice: the low energy availability in females questionnaire and the eating disorder examination questionnaire.

CONCLUSION: Questionnaires can be effective in identifying intentional energy restriction, early detection of gynecological pathology, and the risk of energy deficiency in female athletes. Questionnaires are screening tools but not methods for diagnosing RED-S.

The gut microbiota is a complex of microorganisms, mainly bacteria, inhabiting the human intestines. Microorganisms of the intestinal microflora influence metabolism, immunological reactivity, and pathogenesis of various diseases, such as diabetes mellitus, obesity, inflammatory bowel diseases, and others.

This article examines the influence of intestinal microflora on the development of type 2 diabetes mellitus and its treatment options.

A review of publications shows that microbiota imbalance may be associated with various metabolic disorders, which is confirmed by many studies. Active metabolites affecting the development of type 2 diabetes mellitus include short-chain fatty acids, imidazole propionate, trimethylamine N-oxide, branched-chain amino acids, and tryptophan metabolites. These compounds can affect the metabolic processes in the body, including insulin sensitivity, inflammatory reactions, and glucose metabolism, which may eventually contribute to the development of type 2 diabetes mellitus.

Studying the interaction of the gut microbiota with drugs is challenging as the underlying biological mechanisms are not fully understood.

The key discussed aspects also include the contemporary treatment landscape of type 2 diabetes mellitus associated with the microbiome, namely the use of metformin as a sugar-lowering drug; the use of pro- and prebiotics; dietary and lifestyle interventions; fecal microbiota transplantation, and smoking cessation. All these treatment options show ability in controlling microbiota to manage the disease and improve therapy outcomes. Further research in this area opens up opportunities for the development of innovative treatment strategies for type 2 diabetes mellitus focused on the health of the intestinal microflora. Understanding the impact of microbiota on metabolic disorders will help to develop personalized treatment approaches and lead to improved health in patients with type 2 diabetes mellitus.