5 articles
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and is frequently associated with cardiovascular and metabolic comorbidities. The phenotype of HFpEF patients is heterogeneous, and the impact of comorbidities on prognosis, exercise capacity, and functional status remains insufficiently elucidated.
The study aimed to characterize the clinical, functional, and comorbidity profiles of patients with HFpEF and to assess their influence on functional status, prognosis, and treatment response.
This was an observational, cross-sectional study including 206 patients with HFpEF (LVEF ≥50%) consecutively recruited from the General Cardiology Department of the Institute of Cardiology, aged ≥18 years, with an echocardiographically confirmed diagnosis. Demographic and anthropometric data, HFpEF etiology, hemodynamic biomarkers (NT-proBNP), functional status (NYHA), cardiovascular and non-cardiovascular comorbidities, and history of revascularization procedures (PCI, coronary bypass) were collected. Statistical analysis included descriptive statistics for continuous variables (mean ± SD, median, IQR), categorical variables (frequencies and percentages), and parametric/nonparametric tests for correlations and subgroup analyses, with statistical significance set at P < 0.05.
The study population showed a typical overweight/obese profile, with arterial hypertension and chronic coronary artery disease as predominant mechanisms. Cardiovascular and metabolic comorbidities influenced exercise capacity, functional status, and treatment response, identifying distinct phenotypic subgroups with differential prognostic impact. Elevated NT-proBNP levels reflected increased ventricular filling pressures and functional heterogeneity, underscoring the need for individualized management.
HFpEF is associated with a complex clinical profile dominated by hypertension, coronary artery disease, and metabolic comorbidities. Detailed assessment of comorbidities and biomarkers allows patient phenotyping and personalized therapeutic management. A multidisciplinary approach is essential for optimizing prognosis, exercise capacity, and quality of life in patients with HFpEF.
Chronic obstructive pulmonary disease is a major cause of morbidity and mortality worldwide, often associated with multiple comorbidities that may complicate its clinical course. These comorbidities can exacerbate respiratory symptoms, impair lung function, alter imaging findings, and significantly affect prognosis.
This analytical, observational, cross-sectional study included 80 patients with confirmed chronic obstructive pulmonary disease, divided into two equal subgroups according to spirometric severity: GOLD 1-2 (n = 40) and GOLD 3-4 (n = 40). Clinical, functional, and radiological parameters were evaluated. Comorbidity burden was assessed using validated composite indices: Charlson Comorbidity Index, COTE, COPDCoRi, CODEX, and COMCOLD. Associations between comorbidity scores, pulmonary function, high-resolution computed tomography findings, and clinical outcomes were analyzed using SPSS v22.0. A p-value < 0.05 was considered statistically significant.
The presence of comorbidities was high across all domains, with only minor differences between spirometric stages. Structural abnormalities (emphysema, bronchiectasis, pulmonary hypertension) were more prevalent in GOLD 3-4 patients. A strong correlation was observed between composite indices and parameters such as forced expiratory volume in 1 second,dyspnea, exacerbation rate, radiological findings, and GOLD stages. Logistic regression models showed that the combination of COPD-specific indices (COTE, CODEX, COPDCoRi) significantly outperformed the Charlson index in predicting severe COPD (AUC 0.86 vs. 0.63). High-resolution computed tomography findings variables also demonstrated strong predictive value (AUC 0.81).
Comorbidities play a central role in shaping chronic obstructive pulmonary disease severity and prognosis. The integration of composite comorbidity indices and imaging biomarkers enhances multidimensional patient stratification, aligning with GOLD 2024 recommendations for personalized care.
The objective was to evaluate the relationship of comorbid pathology with the clinical and ultrasound characteristics of the evolution of psoriatic arthritis in order to optimize the management.
In order to achieve the purpose and objectives of the study, a group of 92 patients with psoriatic arthritis was selected, established in accordance with the CASPAR diagnostic criteria (2006). The patients were treated in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital and of the Saint Trinity Municipal Clinical Hospital in Chisinau during 2017-2020. A type 1 cohort study is planned (prospective study with retrospective components).
Expression at the time of examination of the history data was observed in 54 (58,7%), clinical enthesitis was observed in 47 (51.1%) patients. During the clinical examination of patients, it was found that the frequency of TJC/14 was 11.3% (145/1288), SJC/14 – 4.5% (58/1288), which was 40% (58/145) among all painful joints. During clinical examination, it was found that the TJC of the upper limbs (74/736, 10.1%) and lower (71/552, 12.9%) do not differ significantly (χ2 = 2.489, p = 0.115). At the same time, the SJC of the lower limbs (43/552, 7.8%) was significantly higher than the upper one (15/736, 2.04%) (χ2 = 24.267, p < 0.001). According to ultrasound data, the number of joints examined was 228/1288 (17.7%), number of inflamed entheses – 90/1288 (6.9%), which was 39.5% among the detected synovitis (90/228). The number of enthesitis were 661/4968 (13.3%), of which 19.4% (128/661) of the entheses were vascularized.
According to ultrasound data, the frequency of detection of enthesitis and synovitis was significantly higher than during the clinical examination (p < 0.01). For its part, the psoriatic arthritis activity index (DAPSA) did not correlate with inflammatory changes detected during extensive ultrasound of large joints and entheses according to the "gray scale" and the use of Power-Doppler (p > 0.05). On the other hand, vascularization in the entheses is an index of activity independent of age and activity of psoriatic arthritis and psoriasis (p > 0.05), and it is a sign of active inflammation which correlates with laboratory markers of inflammation (hs-CRP, p < 0.05; ESR, p < 0.01).
The COVID-19 pandemic has a major negative impact on health and socio-economic well-being. Understanding the characteristics of COVID-19 disease and identifying the wide range of factors affecting health and quality of life can be the key to providing viable solutions to improve the management of patients and their physical and psycho-emotional rehabilitation. The purpose of the present study was to evaluate the influence of SARS CoV-2 infection on the health status of adults hospitalized with the diagnosis of COVID-19 in the Republic of Moldova.
The presented study is a retrospective, cohort, consisting of a sample of 7441 patients randomly selected, aged 18 y/o and older, hospitalized in 10 public medical institutions in Chisinau, Moldova. Diagnosis of COVID-19 was confirmed by detection of CoV-2 SARS RNA. The data in the patients' medical records were processed and stored according to the unified, pre-established form, prepared in accordance with the requirements of the software „Electronic Patient Record COVID-19”. The severity of COVID-19 disease was assessed using two principles: (1) according to the criteria of the National Clinical Protocol PCN-371; (2) according to the 7-point graduated scale developed by the WHO Special Committee (V.3.0, 3 March 2020) in randomized multicenter clinical trials.
Only 30.07% patients mentioned the presence of a close contact with a COVID-19 positive person. The average age of the patients in the study was 52.83 years. Mild form was diagnosed in 5.00% of patients, medium - 66.15%, severe –20.67%, critical-8.18%. The main complaints of patients were fever, fatigue or physical asthenia, cough, and headache. More than 1/4 of those hospitalized have severe or critical forms of COVID-19; more than 1/3 - require oxygen therapy, and every 6-th patient needs non-invasive high-flow oxygen ventilation or mechanical ventilation. Old age, male sex, chronic comorbidities increase statistically significantly the probability of patients having an unfavorable prognosis in COVID-19. 7.93% of patients died, according to the age group: every 2-nd patient over 90 years, every 3-rd over 80 years, every 5-th over 70 years, and every 9-th over 60 years died.
(1) The uncertainty of the source of infection lead to delay specific prophylactic public health measures; (2) In COVID-19, in a hospital-type medical management, the emphasis should be placed mainly on patients over the age of 50; (3) There is no specific clinical manifestation in COVID-19, that would allow to distinguish the disease from other pathologies; (4) Age over 60 y.o, male sex, and chronic cardiovascular diseases, diabetes mellitus, chronic kidneys diseases and malignant tumors unfavorable influence the evolution of COVID-19; (5) Antibiotic administration remains at a high level in hospitalized patients and is often unjustified and unnecessary.
Psoriatic arthritis (PsA) is a chronic musculoskeletal and cutaneous inflammatory disease that affects about 20-30% of patients with psoriasis. In addition to musculoskeletal and cutaneous manifestations, patients with PsA have a higher prevalence of comorbidities compared to the general population. More than half of patients with PsA have at least one comorbidity, with up to 40% of patients having more than three comorbidities.
To evaluate the relationship of cardiovascular comorbid pathology with the clinical and laboratory characteristics of the evolution of psoriatic arthritis and quality of life to optimize patient management tactics.
In order to achieve the purpose and objectives of the study, a group of 92 patients with psoriatic arthritis was selected, established in accordance with the CASPAR diagnostic criteria (2006). The patients were treated in the rheumatology and arthrology departments of the Republican Clinical Hospital „Timofei Moşneaga„ and of the Municipal Clinical Hospital „Saint Trinity” in Chisinau during 2017-2019. In order to achieve the purpose and objectives of the research, type 1 cohort study (prospective study with retrospective components) is planned.
In the study conducted by us in the 92 patients with PsA, different subjective and objective symptoms of heart damage were determined. This number does not include persons up to 18 years of age and after 60 years, with obesity (BMI>25 kg/m2), diabetes mellitus type I or II, hypertension and ischemic heart disease developed up to the onset of the underlying disease, congenital dyslipidemia, congenital and rheumatic valvulopatii, decompensated cirrhosis of the liver, long-term treatment with glucocorticosteroids (>1 month) or > 1 mg/kg/body (for 2 weeks).
The most common pathology was hypertension with a frequency of 38% (35 out of 92). With an established diagnosis of coronary heart disease: exertion angina pectoris - at 5.4% (5 out of 92) and postinfarct cardiosclerosis (CSPI) in 2.2% (2 out of 92) of patients, chronic heart failure (ICC) in 6.5% (6 out of 92) of patients. Combined cardiovascular pathology was observed in 16.3% (15 out of 92) of patients. Cerebrovascular disorders were detected in 3.3% (3 out of 92).
In patients with PsA of young and middle age, a high frequency of comorbid pathology was observed: in 60.9% of patients, more than one comorbid pathology was observed, with the highest frequency were recorded diseases of the musculoskeletal system (42.4%), cardiovascular (41.3%) and diseases of the digestive system (41.3%).