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JOURNAL "PULSE"
2022. Vol.24. №5
RESEARCH ARTICLE 3. Medical sciences
УДК 616-036.12
Corresponding Author: Lozhkina Natalya Gennadevna -professor, department of faculty therapy named after prof. G.D. Zaleski, Novosibirsk
State Medical University
E-mail: lozhkina.n@mail.ru
©Parkhomenko O.M., Lozhkina N.G., Voskoboinikov Yu.E. - 2022
Received: 07.05.2022 | Accepted: 19.05.2022
Doi: http://dx.doi.org/10.26787/nydha-2686-6838-2022-24-5-57-62
PERSONALIZED RISK ASSESSMENT OF RAPIDLY PROGRESSIVE ATHEROSCLEROSIS
Parkhomenko1 O.M., Lozhkina2 N. G., Voskoboinikov3 Yu.E.
1City Clinical Hospital № 1, Novosibirsk, Russian Federation 2Novosibirsk State Medical University», Novosibirsk, Russian Federation
3Novosibirsk State University of Architecture and Civil Engineering, Novosibirsk, Russian Federation
ПЕРСОНИФЦИРОВАННАЯ ОЦЕНКА РИСКА БЫСТРОПРОГРЕССИРУЩЕГО АТЕРО-СКЛЕРОЗА
Пархоменко1 O.M., Ложкина2 Н.Г., Воскобойников3 Ю.E.
1ГБУЗ Новосибирской области «Городская клиническая больница №1» г. Новосибирск, Российская Федерация 2ФГБОУ ВО «Новосибирский государственный медицинский университет», г. Новосибирск, Российская Федерация 3ФГБОУ ВО «Новосибирский государственный архитектурно-строительный университет (Сиб-стрин)», г. Новосибирск, Российская Федерация
Abstract. Вackground Progressive atherosclerosis is accompanied by unfavorable clinical outcomes, study and understanding of this process, creation of risk assessment method is necessary for individualization of approaches to treatment and prevention of this condition. Purpose of the study. Creation of risk assessment method of atherosclerosis progression for personalized approach to treatment, rehabilitation and secondary prevention. Patient Characteristics and Study Methods. A retrospective cohort study included 202patients with coronary heart disease: 147 men and 55 women. The mean age of the patients was 53.3±7.16 years. Group 1 included patients who had had myocardial infarction or unstable angina, emergency arterial stenting, stroke, peripheral artery thrombosis, critical ischemia, and lower extremity amputation within 2 years before study inclusion. Patients in the comparison group did not have these events. The influence of each of the studied parameters on the probability of fast progressing atherosclerosis was determined by factor and correlation analysis. Results. As a result of the study, an innovative method for predicting the risk of developing rapidly progressing atherosclerosis in a patient was developed, including determining the patient's age, the presence or absence of carotid stenosis by 50% or more of the vessel lumen on at least one side, body mass index obesity, history of stable angina pectoris, high-sensitivity C-reactive protein (hsSRP) and high-density lipoprotein cholesterol (HDL-cholesterol) serum concentrations. The sensitivity, specificity and accuracy of the proposed method are above 80%. An application for the registration of the invention was filed to the Russian Federal Service for Intellectual Property, Patents and Trademarks (Rospatent).
Conclusion. The proposed model was developed on the basis of studying the indexes in Russian patients. It shows the weight of one or another factor that influences the probability of rapidly progressing atherosclerosis. The model is easy to use and allows to individualize prophylaxis in this category of patients.
Аннотация. Актуальность. Прогрессирующий атеросклероз сопровождается неблагоприятными клиническими исходами, поэтому изучение и понимание этого процесса, создание метода оценки риска необходимо для индивидуализации подходов к лечению и профилактике этого состояния.
Цель исследования. Создание метода оценки риска прогрессирования атеросклероза для персонализированного подхода к лечению, реабилитации и вторичной профилактике.
Характеристика пациентов и методы исследования. В
ретроспективное когортное исследование включено 202 пациента с ишемической болезнью сердца: 147 мужчин и 55 женщин. Средний возраст пациентов составил 53,3±7,16 лет. В группу 1 вошли пациенты, перенесшие инфаркт миокарда или нестабильную стенокардию, экстренное стентирование коронарных и некоронарных артерий, инсульт, тромбоз периферических артерий, критическую ишемию и ампутацию нижней конечности в течение 2 лет до включения в исследование. У пациентов в группе сравнения этих событий не было. Влияние каждого из исследуемых параметров на вероятность быстрого прогрессирования атеросклероза определялось с помощью факторного и корреляционного анализа. Результаты. В результате исследования разработан инновационный метод прогнозирования риска развития быстропрогрессирующего атеросклероза у пациента, включающий определение возраста пациента, наличия или отсутствия стеноза сонной артерии на 50 % и более просвета сосуда хотя бы с одной стороны, ожирение, определяемое на основании индекса массы тела, наличия в анамнезе стабильной стенокардии, концентрации в сыворотке крови высокочувствительного С-реактивного белка (вчСРБ) и холестерина липопротеинов высокой плотности (ХС ЛПВП). Чувствительность, специфичность и точность предложенного метода превышают 80%. Подана заявка на регистрацию изобретения в Федеральную службу по интеллектуальной собственности, патентам и товарным знакам (Роспатент).
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Key words: coronary artery disease; rapidly progressive atherosclerosis; personalized risk.
Заключение. Предложенная модель разработана на основе изучения показателей у российских пациентов; она показывает вес того или иного фактора, влияющего на вероятность быстрого прогрессирования атеросклероза. Модель проста в использовании и позволяет индивидуализировать профилактику у данной категории пациентов.
Ключевые слова: ишемическая болезнь сердца; быстропрогрессирующий атеросклероз;
персонализированный риск.
Вackground. The syndrome of rapidly progressive or accelerated atherosclerosis, in contrast to the spontaneous course of the process, has attracted the attention of researchers in the last 2-3 decades [1]. In its development, in addition to classical risk factors, inflammation, patchy calcification, osteopontin, and a number of other mediators play a role [2]. Patients with rapidly progressive atherosclerosis are at highest risk for various ischemic events, requiring constant medical attention and specific, more aggressive lipid-lowering and antithrombotic therapy [3]. The study and understanding of the laws of atherosclerosis progression is necessary for the purpose of a personalized approach and optimization of the management of patients suffering from this syndrome.
Purpose of the study. Creation of a method for assessing the risk of progressive atherosclerosis for a personalized approach to treatment, rehabilitation and secondary prevention.
Patient Characterization and Research Methods.
Patient Characterization and Research Methods. A retrospective cohort study included 202 patients with coronary artery disease: 147 men and 55 women. The mean age of the patients was 53.3±7.16 years. The diagnosis of coronary artery disease was established according to a set of criteria developed by the European Society of Cardiology and the American College of Cardiology (2019, 2021), including: a) stenosis of the lumen of at least two coronary arteries by 50% or more according to selective coronary angiography; b) ECG changes in 2 or more consecutive leads (pathological Q, or the presence of QR, c) the presence of zones of local hypokinesis according to echocardiography [4, 5].
The retrospective covered 2 years from the date of inclusion of the patient in the study (the period from January 2019 to January 2020) with the determination of 100 clinical, instrumental, laboratory parameters that potentially affect the onset and progression of atherosclerosis (according to literature analysis). These examinations were carried out and evaluated at 2 points: the first at the time of the 1st previous ischemic event during a 2-year retrospective period, the second at the time the patient was included in the present study. 202 patients were divided into 2 groups. The first - active group (100 people) included patients who had type 1 myocardial infarction (MI) [6] (54 people) within 2
years prior to the study or the diagnosis of CAD was established according to selective coronary angiography: the presence lumen stenosis of at least two coronary arteries by 50 % or more (46 people) and an additional two (or more) cardiovascular events from the following: MI or unstable angina, emergency arterial stenting, stroke, peripheral arterial thrombosis, critical ischemia, and lower limb amputation. The combination of two or more of these cardiovascular events that occurred within two years indicated the rapid progression of atherosclerosis in these patients. The second (comparison group) included 102 patients with confirmed coronary heart disease in a similar way (55 people had only 1 type 1 MI in the past and 45 had coronary artery disease confirmed by selective coronary angiography, respectively), in whom two years before inclusion in the study there were no cardiovascular events from the above, which indicated the spontaneous course of atherosclerosis. All patients underwent clinical and instrumental examination according to the following program: clinical examination, electrocardiography, echocardiography, Holter monitoring, inflammatory cytokines and molecular genetic studies. Using the methods of factorial and correlation analysis, the influence of each of the studied indicators on the probability of an unfavorable annual forecast was determined in the work.
Methods of statistical analysis. SPSS statistical analysis program used.
Results. 6 following parameters (factors, independent variables) that are situable for requarements were selected from above 100 clinical, biochemical, and functional factors with the development of progressive atherosclerosis:
• significant correlation to the dependent variable - rapid progression of atherosclerosis, ie. an unfavorable outcome (pair correlation coefficient for the independent variable and an unfavorable outcome is more than 0.25);
• insignificant correlation of these dependent variables to each other - rapid progression of atherosclerosis, ie. an unfavorable outcome (coefficient of the pair correlation independent variables less than 0.25);
• the significance of the regression coefficients calculated in the SPSS package (the P-values of these
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coefficients do not exceed the traditionally accepted value of 0.05 in regression analysis). These variables were: the age of the patient - X1, stenosis of the carotid arteries 50 % or more than the lumen of the vessel on at least one side - X2, obesity more than 1 degree - X3, stable angina pectoris in history - X4, the level of C-reactive protein in mg / l - X5, the level of high-density lipoprotein cholesterol (HDL cholesterol) in mM / l - X6.
Three conditions for selecting the variables of the regression model pointed above prevent the appearance of the effect of multicollinearity of the regression model, which adversely affects the accuracy of the calculated coefficients of the model [7].
Constructing a logistic regression model
As the dependent variable Y - takes only two values (1 - rapid progression of atherosclerosis, i.e., unfavorable outcome, 0 - no rapid progression of atherosclerosis, i.e. favorable outcome), a regression logistic model was adopted that calculates the probability of an unfavorable outcome as a mathematical model to describe the process under study.
This probability is determined (taking into account the previously introduced certain variables X1 -X6) by the expression:
p (X ) = —W, (1)
l + e
where
z ( X ) = ß
ß,, j = U
j=i
(2)
6 - unknown coefficients of the
regression model, Xj,j = 1,...,6 - independent variables (factors) of the model represented above. It can be seen that p(X) - the value can vary from ( z (X) = - to ) to 1 (z (X) = + to) and therefore the
value p(X) is interpreted as the probability (theoretical probability) of an unfavorable outcome.
For the probability p(X) of an adverse event of
the form we formed an estimate was made p(X) according to the sample of the final volume:
p (X) =-t~6-v (3)
l + e
+Tbj ■ XJ j=l
We used the REGRESSION module of the SPSS statistical package to calculate the coefficients bj in equation (3) of
the logistic regression, which are estimates for the unknown coefficients. We used the Wald forward method (when the construction of the model began with a model with one variable, and then a new variable was introduced at each step, such that the model with this variable had the maximum value adjusted coefficient of determination
compared to other variables) to determine the most informative independent variables in the logistic regression model and the coefficients of these variables. The calculated coefficients are shown in Table 1.
Table 1.
Calculated coefficients of the regression equation (3)
Designations in SPSS package Notation in logistics models Odds bJ Р- value
VAR GGGG2 Xi -0.766 G.GGG
VAR GGGG4 X2 -3.119 G.GG8
VAR GGGG7 Хз -1.678 G.G12
VAR GGGG8 X4 4.G16 G.GGG
VAR GGGGll Х5 G.G82 G.G25
VAR GGGGl2 Хб -1.989 G.GG7
Constant b0 47.581 G.GGG
The significance of each calculated coefficient of the regression model is one of the values characterizing its accuracy. The coefficient is considered significant (i.e., may be present in the regression equation) if the corresponding P-value is less than 0.05. Table 1 shows the P-values calculated (on the last step of the Wald forward method) and their corresponding P-values. It can be seen that all the coefficients of the constructed regression equation are significant.
Let us substitute the coefficients bj from Table 1
into equation (3). We set a logistic regression equation that allows us to calculate an estimate of the probability
of an unfavorable outcome:
p (X ) =
. (4)
the following rule is used to predict the values of a variable (0 or 1):
[0, ifp (X) < Cp;
Y = i (5)
[1, ifp (X) > Cp, ()
where Cp - is the threshold value (0 < Cp < 1) . Obviously that the accuracy characteristics Cp of the
logistic regression model depend on the choice of the threshold value. In the literature (for example, [8]), the following coefficients are accepted as criteria for the accuracy of constructing a predictive model:
• sensitivity coefficient Ksens - assessment of the
probability of the correct prediction of an unfavorable outcome;
• coefficient of specificity Kspec - assessment of the
probability of the correct prediction of a favorable outcome;
• coefficient of accuracy Racc - an assessment of the
probability of the correct prediction of an unfavorable outcome and correct prediction of a favorable outcome.
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values: К = 94.1, К = 97.0, К
sens ' spec ' i
It was shown that at the optimal level Cp = 0.4 (this value was found from the condition of the maximum coefficient Racc) the coefficients got the following
= 95.5.
The values of these coefficients indicate the high predictive accuracy of the constructed regression model. Clinical case
Patient Yu., 59 years old, was brought by an ambulance to RSC No. 1 with acute myocardial infarction on 03/24/2019. The diagnosis was confirmed by a typical clinic, ECG, positive dynamics of myocardial necrosis markers, followed by CAG and PTCA with stenting of the infarct-associated artery.
Disease history. As ischemic history has been observed over the past 4 as a clinic of stable exertional angina (since April 2015). Six months after the current hospitalization, the observed patient had a primary myocardial infarction with a subsequent relapse 2 days later (09/01/18, relapse dated 09/03/2018).
Anamnesis of life. The patient has a burdened history of hypertension for 5 years with the blood pressure level of 140/90 against the background of antihypertensive therapy.
Objective status. The state of moderate severity, the skin is clean. Heart sounds are muffled, BP 140/90, HR-67 beats. per minute, the rhythm is correct, the borders of the heart are expanded to the left. Vesicular breathing in the lungs is carried out to all departments. NPV 18 min. The abdomen is soft, painless, no swelling. Body mass index (BMI) was 32 kg/m2. Examination data (given at the time of hospitalization from 09/01/18).
According to the results of the general blood test, no pathology is detected.
According to the results of the biochemical blood test, a syndrome of dyslipidemia is noted, manifested by an increase in the level of LDL cholesterol is noted-6 mmol / l, an increase of the triglycerides level 2.15 mmol / l; HDL cholesterol level 0.9 mmol/L. The level of C - reactive protein in the blood was determined 50 mg / l. Ultrasound of the brachiocephalic arteries found stenosis of the left carotid artery 60 %, on the right 40 %.
ECG: sinus rhythm, heart rate 69 per minute, acute stage of large-focal lower myocardial infarction.
According to coronary angiography: multivessel lesion. PNA stenosis 50 %, restenosis of the RCA stent 50 %, in the OA-VTK3 stent a single parietal thrombus, blocking the lumen of the vessel by less than 50 % was detected, at the place of origin of the d/3 OA.
According to the results of echocardiography: hypokinesis 3, 4, 5, 9, 10, 11, 15, 16, 13 segments, LV EF - 50 %.
Final clinical diagnosis: CAD, STEMI, the second Q-positive, inferior myocardial infarction from 03/24/2019. Killip I. KAG dated 03/24/2019. PICS (09/01/18, relapse dated 09/03/2018). Condition after CAG, PTCA with stenting of OA, RCA from 09/01/2019. Early OA stent thrombosis. CAG, thromboaspiration. PTCA with stenting of OA reocclusion from 09/03/2018. Stage III hypertension, risk 4. CHF I FC I (NYHA).
At the time of hospitalization, the patient took: aspirin 500 mg % TB per day, Lirta 75 mg 1 day with cancellation and transition to Brilint 90 mg 2 times a day, Esomeprazole 20 mg, Atorvastatin 40 mg, Losartan 50 mg 2 times e, Metoprolol 50 mg.
The presence of a myocardial infarction followed by a relapse (09/03/2018) and the second MI (03/24/2019) indicated the progression of atherosclerosis in this patient (09/01/18).
The values of X1-X6 of the patient were put into the formula given above (5), programmed in the Excel spreadsheet in the following form as of 09/01/18: X1 = 59 (patient's age 59 years); X2 = 1 (the patient had unilateral stenosis of the left carotid artery, 60 %); X3 = 0 (obesity stage I, BMI = 32 kg/m2); X4 = 1 (history of stable angina pectoris); X5 = 50 (the concentration of highly sensitive C-reactive protein in the blood is 50 mg/l); X6 = 0.9 (high-density lipoprotein cholesterol level is 0.9 mm/l).
The result we got was obtained p(X) was equal to 0.999, which, according to the proposed invention, indicated the rapid progression of atherosclerosis.
The prediction of the rapid progression of atherosclerosis according to the proposed method was correct. This clinical case demonstrates the effectiveness of the proposed method in terms of screening for the determination of progressive atherosclerosis.
The phenomenon of progressive atherosclerosis has been actively studied for the last 2-3 decades, that is undoubtedly associated with the development of invasive treatment methods and the spread of imaging examination methods [3].
Researchers study this phenomenon on the example of the coronary, cerebral arterial basins, as well as the arteries of the lower extremities. A. Mazzone analyzed the data of 77 patients with coronary artery disease: 45 with ACS and 32 with stable angina who underwent PCI [9]. Six months later, it was represented that 74 % of patients with ACS and 26 % of those were with stable angina pectoris had progression of coronary atherosclerosis. In the study by G. Ndrepepa, 605 patients with coronary artery disease were examined; progression of atherosclerosis in the coronary artery was found in 53 among for people (8.8 %) [3]. In a study by Y. Han, annual outcomes were studied in patients with
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STEMI who underwent PCI with stenting of the infarct-dependent coronary artery [10]. Progression of non-operated stenoses of the coronary artery during the year was found in a third of patients. The authors hypothesized that STEMI could potentiate the atherosclerotic process in intact coronary arteries.
A number of researchers have tried creating to create a method for identifying patients at risk for the rapid progression of atherosclerosis. So, Arefieva T.I. proposed to analyze a sample of the patient's peripheral venous blood to determine the concentration of interleukin-10 (IL-10) and interleukin-17 (IL-17) and, if the ratio of the concentration of IL-10 and IL-17 is less than 1.5, to conclude that there is a high risk of progression atherosclerosis. Bilenko M.V. et al observing the degree of stimulation of the atherogenic function of monocyte-derived macrophages from the blood of patients by the ability of macrophages to produce reactive oxygen species, oxidize low-density lipoproteins, absorb low-density lipoproteins, as well as they assess the decrease of the number of viable macrophages during incubation in a protein-free substrate. Phytic environment and on the basis of the values of the pabove parameters established by the authors of the method, a moderate or severe form of heart damage in a patient with coronary artery disease and a moderate or high predisposition of the patient to the progression of atherosclerosis are ascertained.These
methods can be used in specialized centers, they are expensive.
In the presented study, the author's method for assessing the risk of rapidly progressive atherosclerosis in which parameters determined within the framework of federal standards for the management of patients with coronary heart disease are used, it means its simplicity and accessibility. The proposed method defines a new treatment goal of treatment - the level of HDL cholesterol, in contrast to the existing one - the level of LDL cholesterol, which expands the prospects for the treatment of patients with coronary artery disease.
Conclusion. The obtained results make it possible to identify a group of patients with accelerated atherosclerosis syndrome in order to stratify the risk and optimal management for this complex category of patients. Early detection and prescription of intensive lipid-lowering and antithrombotic therapy, taking into account the new treatment goal - LDL cholesterol levels, will increase the life expectancy and quality of life of such patients.
Limitations in the interpretation of study results. The presented analysis was carried out on a sample of patients from a single clinic. The opinion of the authors on the described problem may not coincide with the opinion of other specialists in this field.
REFERENCES
БИБЛИОГРАФИЧЕСКИЙ список
[1]. Shah P., Bajaj S., Virk H., Bikkina M. Rapid progression of coronary atherosclerosis: a review // Thrombosis. 2015; 2: 1-6. DOI: 10.1155/2015/634983.
[2]. Li M., Ren C., Wu C., Li X., Li X., Mao W. Bioinformatics Analysis Reveals Diagnostic Markers and Vital Pathways Involved in Acute Coronary Syndrome // Cardiol Res Pract. 2020 Nov 6; 2020:3162581. doi: 10.1155/2020/3162581.
[3]. Ndrepepa G., Iijima R., Kufner S. et al. Association of progression or regression of coronary artery atherosclerosis with long-term prognosis // Am. Heart J. 2016. Vol. 177. P. 9-16. DOI: 10.1016/j.ahj.2016.03.016,
[4]. Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC) // Eur. Heart J. 2020. Vol. 41, Issue 3, 14 January 2020. P. 407-477. https://doi.org/10.1093/eurheartj/ehz425.
[5]. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines / M. Gulati, P.D. Levy, D. Mukherjee et al. // Circulation. 2021;144: e368-e454. https://doi.org/10.1161/CIR.0000000000001030.
[6]. Fourth universal definition of myocardial infarction (2018) / K. Thygesen et al. // Eur. Heart J. 2019. Vol. 40, Is. 3. P. 237-269.
[7]. Yu. E. Voskoboynikov. Econometrics in Excel: Paired and Multiple Regression Models. Tutorial // St. Petersburg: Publishing House Lan. 2016. 260 p.
[1]. Shah P., Bajaj S., Virk H., Bikkina M. Rapid progression of coronary atherosclerosis: a review // Thrombosis. 2015; 2: 1-6. DOI: 10.1155/2015/634983.
[2]. Li M., Ren C., Wu C., Li X., Li X., Mao W. Bioinformatics Analysis Reveals Diagnostic Markers and Vital Pathways Involved in Acute Coronary Syndrome // Cardiol Res Pract. 2020 Nov 6; 2020:3162581. Doi: 10.1155/2020/3162581.
[3]. Ndrepepa G., Iijima R., Kufner S. et al. Association of progression or regression of coronary artery atherosclerosis with long-term prognosis // Am. Heart J. 2016. Vol. 177. P. 9-16. DOI: 10.1016/j.ahj.2016.03.016,
[4]. Knuuti J., Wijns W., Saraste A. et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC // Eur. Heart J. 2020. Vol. 41, Issue 3, 14 January 2020. P. 407-477. https://doi.org/10.1093/eurheartj/ehz425.
[5]. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines / M. Gulati, P. D. Levy, D. Mukherjee et al. // Circulation. 2021;144: e368-e454. https://doi.org/10.1161/CIR.0000000000001030.
[6]. Fourth universal definition of myocardial infarction (2018) / K. Thygesen [et al.] // Eur. Heart J. 2019. Vol. 40, Is. 3. P. 237-269.
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JOURNAL "PULSE"
2022. Vol.24. №5
[8]
Mathematical and statistical processing of medical research data / V. I. Junkerov // St. Petersburg: VmedA, 2002. 266 p. ISBN 5-94277-011-5B,
Mazzone A., Parri M.S., Giannessi D. et al. Osteopontin plasma levels and accelerated atherosclerosis in patients with CAD undergoing PCI: a prospective clinical study // Coron. Artery Dis. 2011. Vol. 22 (3). P. 179-187. DOI: 10.1097/MCA.0b013e3283441d0b. Han Y., Jing J., Tu S. et al. ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis // Int. J. Cardiovasc. Imaging. 2014. Vol. 30 (2). P. 253-261. doi: 10.1007/s10554-013-0354-z. Patent RF № 2566288. Diagnostic technique for predisposition to atherosclerosis progression in patients with chronic ischemic heart disease as shown by peripheral blood interleukin-10 and interleukin-17 concentrations: publ. 20.10.2015 / Arefeva T. I. et al.
[12]. Patent RF №2408019. Instant severity diagnosis of ischemic heart damage in patient with chronic heart disease and propensity for progressing atherosclerosis: publ. 27.10.2010 / Bilenko M.V. et al.
[9]
[1G].
[11].
Эконометрика в Excel: парные и множественные регрессионные модели: учеб. пособие / Ю.Е. Воскобойников // Санкт-Петербург: Лань, 2016. 260 с.
Математическая и статистическая обработка данных медицинских исследований / В.И. Юнкеров, С.Г. Григорьев // Санкт-Петербург: ВМедА, 2002. 266 с. ISBN 5-94277-011-5В.
Mazzone A., Parri M.S., Giannessi D. et al. Osteopontin plasma levels and accelerated atherosclerosis in patients with CAD undergoing PCI: a prospective clinical study // Coron. Artery Dis. 2011. Vol. 22 (3). P. 179-187. DOI: 10.1097/MCA.0b013e3283441d0b. Han Y., Jing J., Tu S. et al. ST elevation acute myocardial infarction accelerates non-culprit coronary lesion atherosclerosis // Int. J. Cardiovasc. Imaging. 2014. Vol. 30 (2). P. 53-261. Doi: 10.1007/s10554-013-0354-z.
Патент № 2566288. Российская Федерация. Методика диагностики предрасположенности к прогрессированию атеросклероза у пациентов с хронической ишемической болезнью сердца по концентрациям интерлейкина-10 и интерлейкина-17 в периферической крови: заявл.: 2014.10.13; опубл. 20.10.2015 / Арефьева Т. И. и др. Патент № 2408019. Российская Федерация. Мгновенная диагностика тяжести ишемического поражения сердца у пациента с хронической болезнью сердца и склонностью к прогрессированию атеросклероза: заявл. ......08.06.2009; опубл. 27.12.2010 / Биленко М.В. и др.............
Author Contributions. Lozhkina N.G. — research concept and design, approval of the final version for publication, full responsibility for the content; Parkhomenko O.M — data collection and processing, text writing, literature review.
Conflict of Interest Statement. The authors declare no conflict of interest.
Lozhkina N.G. - SPIN ID: 5320-7554; ORCID ID: 0000-0002-4832-3197
Voskoboinikov Yu.E. - SPIN ID: 5803-4259, ORCID: 0000-0002-5282-6002
Parkhomenko O.M. - ORCID ID: 0000-0003-4736-6491
For citation: Parkhomenko O.M., Lozhkina N.G., Voskoboinikov Yu.E. PERSONALIZED RISK ASSESSMENT OF RAPIDLY PROGRESSIVE ATHEROSCLEROSIS // Medical & pharmaceutical journal «Pulse». - 2022. - Vol.24. №5. - pp. 57-62. Doi: http://dx.doi.org/10.26787/nydha-2686-6838-2022-24-5-57-62.
Для цитирования: Пархоменко O.M., Ложкина Н.Г., Воскобойников K).E. ПЕРСОНИФЦИРОВАННАЯ ОЦЕНКА РИСКА БЫСТРОПРОГРЕССИРУЩЕГО АТЕРО-СКЛЕРОЗА // Медико-фармацевтический журнал "Пульс". - 2022. - Т.24. №5. - С. 57-62. Doi: http://dx.doi.org/10.26787/nydha-2686-6838-2022-24-5-57-62.
