Akhmetzhan Galimzhanov

Free full text is available Introduction Percutaneous coronary interventions (PCI) are often performed in multimorbid patients with heterogeneous characteristics and variable clinical outcomes. We aimed to identify distinct clinical phenotypes utilizing machine learning and explore their relationship with long-term recurrent and weighted outcomes. Methods This prospective observational cohort study enrolled all-comer PCI patients in 2020‐2021. Multiple imputation k-means clustering was utilized to detect specific phenotypes. The study endpoints were patient-oriented and device oriented composite endpoints (POCE, DOCE), its individual components, and major bleeding. We applied semiparametric regression models for recurrent and weighted endpoints. Results The study included a total of 643 patients. We unveiled three phenotype clusters: 1) inflammatory (n = 44, with high white blood cell counts, high values of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio), 2) high erythrocyte sedimentation rate (ESR) (n = 204), and 3) non-inflammatory (n = 395). For ACS-only population, we four distinct phenotypes (high-CRP, high-ESR, high aspartate-aminotransferase, and normal). For all-comer PCI patients, identified phenotypes had a higher risk of POCE (mean ratio (MR) 1.42 (95% confidence interval (CI) 1.11–1.81) and MR 2.01 (95% CI 1.58–2.56), respectively), DOCE (MR 1.61 (95% CI 1.20–2.16), MR 2.60 (95%CI 1.94–3.48), respectively), and stroke (hazard ratio (HR) 2.86 (95% CI 1.10–7.4), 6.83 (95% CI 2.01–23.2)). Similarly, high-ESR and high-CRP phenotypes of ACS patients were significantly associated with the development of clinical composite outcomes. Conclusion Machine learning unveiled three distinct phenotype clusters in patients after PCI that were linked with the risk of recurrent and weighted clinical endpoints.

Free full text is available
Introduction
Percutaneous coronary interventions (PCI) are often performed in multimorbid patients with heterogeneous characteristics and variable clinical outcomes. We aimed to identify distinct clinical phenotypes utilizing machine learning and explore their relationship with long-term recurrent and weighted outcomes.

Methods
This prospective observational cohort study enrolled all-comer PCI patients in 2020‐2021. Multiple imputation k-means clustering was utilized to detect specific phenotypes. The study endpoints were patient-oriented and device oriented composite endpoints (POCE, DOCE), its individual components, and major bleeding. We applied semiparametric regression models for recurrent and weighted endpoints.

Results
The study included a total of 643 patients. We unveiled three phenotype clusters: 1) inflammatory (n = 44, with high white blood cell counts, high values of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio), 2) high erythrocyte sedimentation rate (ESR) (n = 204), and 3) non-inflammatory (n = 395). For ACS-only population, we four distinct phenotypes (high-CRP, high-ESR, high aspartate-aminotransferase, and normal). For all-comer PCI patients, identified phenotypes had a higher risk of POCE (mean ratio (MR) 1.42 (95% confidence interval (CI) 1.11–1.81) and MR 2.01 (95% CI 1.58–2.56), respectively), DOCE (MR 1.61 (95% CI 1.20–2.16), MR 2.60 (95%CI 1.94–3.48), respectively), and stroke (hazard ratio (HR) 2.86 (95% CI 1.10–7.4), 6.83 (95% CI 2.01–23.2)). Similarly, high-ESR and high-CRP phenotypes of ACS patients were significantly associated with the development of clinical composite outcomes.

Conclusion
Machine learning unveiled three distinct phenotype clusters in patients after PCI that were linked with the risk of recurrent and weighted clinical endpoints.

Major statements of new international agreement on classification, clinical, radiological and pathological characteristics of idiopathic idiopathic pulmonary fibrosis, developed by European respiratory and American thoracic societies experts in 2011 year, were presented in this article. The recommendations for practical use of diagnostic algorithm and for differential diagnosis of idiopathic interstitial pneumonias were made. Unusual clinical case of idiopathic pulmonary fibrosis, which requare to differiate with idiopathic pulmonary hemochromatosis, Randu-Osler disease, was described in this article.

Supplemental Material, sj-pdf-1-ang-10.1177_00033197211070908 for The Prognostic Utility of Mean Platelet Volume in Patients With Acute Coronary Syndrome: A Systematic Review With Meta-Analyses by Akhmetzhan Galimzhanov, Erhan Tenekecioglu, Farida Rustamova, Han Naung Tun and Mamas A. Mamas in Angiology

Updated European guidelines for the management of atrial fibrillation were published on the 27 of August, 2016. This document is remarkable for new recommendations, especially about anticoagulation therapy. Key points of these guidelines and the possibility of their use in our country are described in the article.<br>Objective: to find out essential evidence-based key points of the 2016 guidelines and to investigate the possibility of their use in Kazakhstan. Materials and methods: To achieve these goals major differences between 2016, 2012, 2010 guidelines were analyzed. Then, to find out investigations, that support key points of the 2016 guidelines, a literature review in PubMed, MEDLINE, Web of Science, Scopus databases were carried out. The following key words was used: atrial fibrillation, European guidelines, anticoagulation, warfarin, novel antagonist oral anticoagulants. Results and conclusions: Aforementioned document is remarkable for inculcation of new essential re...

45-year-old male, a farmer, presented to a multidisciplinary hospital with a complain of increasing shortness of breath at rest, accompanied by a dry cough productive of clear sputum, pain in knee joints in the morning, weakness and lower-limb edema. He had sufferred from progressive dyspnoe for about 2-3 years with subsequent addition of other symptoms. The patient reported several episodes of nasal bleeding. There was a history of myocardial infarction for 7 years, arterial hypertension for 10 years (taking enalapril plus amlodipine) and a habit of smoking for 20 years. The patient had sought medical attention at out-patient clinic 2 months before and was referred to a tuberculosis hospital due to pathological findings on chest X-ray. After exclusion of tuberculosis, he was transferred to our hospital. At physical examination, there were diffuse cyanosis, telangiectases on the chest skin, clubbing, the barrel chest, pulmonary rales in the lower parts of both lungs, leftward and do...

Updated European guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation were published in 2017. All the new and changed recommendations was analysed in order to investigate the possibility of their application in our country.<br>Objective: to reveal essential evidence-based updated points of the 2017 guidelines that can be implemented in the settings of Kazakhstan health care system. Materials and methods: the first stage of the review was performing a comparative analysis of old (2012) and updated versions of the European guidelines. Then, to investigate the possibility of their application in our country, the search of Asian and Kazakhstan trials was carried out in PubMed, Cochrane Library, Trip, ScienceDirect. To build search queries, the following key words was used: acute coronary syndrome, myocardial infarction, guidelines, coronary angiography, stenting. Results and conclusions: Aforementioned document is remarkable...

ABSTRACT BACKGROUND: The evidence for optimal blood pressure (BP) targets in Asian patients with hypertension is insufficient and controversial. Western guidelines should be used with caution in clinical practice until there is supporting evidence. OBJECTIVE: Systematically synthesize the evidence on the efficacy of achieving the strict 2018 European Society of Cardiology (ESC) guideline BP targets versus standard BP targets in Asian patients. DATA SOURCES: We searched PubMed, Web of Science, Scopus, the Cochrane Central Register of controlled trials, and additional databases to retrieve relevant Asian studies. STUDY SELECTION: Randomized controlled trials (RCTs) and observational studies that reported clinical endpoints, had a minimal follow-up period of one year and included Asian patients older than 18 years with essential hypertension. DATA EXTRACTION: Two investigators independently conducted the study selection with any discrepancies resolved between team members. DATA SYNTHESIS: We selected 15 studies for analysis (4 RCTs, 7 observational studies, and 4 post-hoc analyses). The evidence for the strict BP targets in elderly patients was insufficient. In middle-aged patients, the meta-analysis of observational studies revealed a significant reduction in major adverse cardiac events (MACCE) (hazard ratio (HR)=0.78; 95% confidence interval (CI: 0.74-0.81). For studies that reported results for patients of any age, the tight systolic BP-lowering therapy was associated with a decrease in MACCE (HR=0.80; 95% CI: 0.69-0.92), stroke (HR=0.82; 95% CI: 0.71-0.94), but not in cardiac events (HR=0.91; 95% CI: 0.72-1.14, P=.41), all-cause (HR=0.80; 95% CI: 0.57-1.13) and cardiovascular mortality (HR=0.73; 95% CI: 0.40-1.33, P=.30). Similar findings were obtained for the strict diastolic BP targets. CONCLUSION: Our findings provide evidence for Asian patients that support the efficacy of the strict antihypertensive treatment with BP targets proposed by the 2018 ESC hypertension guidelines for the prevention of cardiovascular events. However, these data were obtained from only observational studies and the results were not confirmed by RCTs, probably due to insufficient power. Therefore, further high-quality RCTs are crucial. LIMITATIONS: Use of aggregated data, the subgroup and meta-regression analyses are inconclusive, limited to English language, unable to estimate summary measures for some outcomes, publication bias difficult to assess, and unclear that results could be extrapolated. REGISTRATION: The protocol registered in PROSPERO (CRD42018115570). CONFLICT OF INTEREST: None.

Mean platelet volume (MPV) is a hematological index that is routinely measured in clinical settings. Although many studies have been conducted to investigate the prognostic significance of MPV in acute coronary syndromes (ACS), the findings have been inconsistent. The goal of this study was to systematically review all current evidence on the association between admission MPV and clinical outcomes after ACS. PubMed, Scopus, Web of Science, and other databases were searched. The primary endpoints were major adverse cardiovascular events (MACE) and mortality. We applied a Knapp and Hartung adjustment, prediction interval calculations and permutation tests during pairwise meta-analyses. A one-stage dose–response meta-analysis was also conducted. The meta-analysis consisted of 41 studies with 33443 participants. Mean platelet volume, as a continuous variable, was associated with the risk of long-term mortality (hazard ratio 1.33, 95% CI 1.19–1.48). After conducting permutation tests and...

Citation: Galimzhanov AM, Sabitov YT, Azizov BS. The implications of of blood pressure targets from the 2018 European Society of Cardiology hypertension guidelines in Asian patients: a systematic review and meta-analysis. Ann Saudi Med 2020; 40(3): 234-254. BACKGROUND: The evidence for optimal blood pressure (BP) targets in Asian patients with hypertension is insufficient and controversial. Western guidelines should be used with caution in clinical practice until there is supporting evidence. OBJECTIVE: Systematically synthesize the evidence on the efficacy of achieving the strict 2018 European Society of Cardiology (ESC) guideline BP targets versus standard BP targets in Asian patients. DATA SOURCES: We searched PubMed, Web of Science, Scopus, the Cochrane Central Register of controlled trials, and additional databases to retrieve relevant Asian studies. STUDY SELECTION: Randomized controlled trials (RCTs) and observational studies that reported clinical endpoints, had a minimal follow-up period of one year and included Asian patients older than 18 years with essential hypertension. DATA EXTRACTION: Two investigators independently conducted the study selection with any discrepancies resolved between team members. DATA SYNTHESIS: We selected 15 studies for analysis (4 RCTs, 7 observational studies, and 4 post-hoc analyses). The evidence for the strict BP targets in elderly patients was insufficient. In middle-aged patients, the meta-analysis of observational studies revealed a significant reduction in major adverse cardiac events (MACCE) (hazard ratio (HR)=0.78; 95% confidence interval (CI: 0.74-0.81). For studies that reported results for patients of any age, the tight systolic BP-lowering therapy was associated with a decrease in MACCE (HR=0.80; 95% CI: 0.69-0.92), stroke (HR=0.82; 95% CI: 0.71-0.94), but not in cardiac events (HR=0.91; 95% CI: 0.72-1.14, P=.41), all-cause (HR=0.80; 95% CI: 0.57-1.13) and cardiovascular mortality (HR=0.73; 95% CI: 0.40-1.33, P=.30). Similar findings were obtained for the strict diastolic BP targets. CONCLUSION: Our findings provide evidence for Asian patients that support the efficacy of the strict antihypertensive treatment with BP targets proposed by the 2018 ESC hypertension guidelines for the prevention of cardiovascular events. However, these data were obtained from only observational studies and the results were not confirmed by RCTs, probably due to insufficient power. Therefore, further high-quality RCTs are crucial.

Updated European guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation were published in 2017. All the new and changed recommendations was analysed in order to investigate the possibility of their application in our country.
Objective: to reveal essential evidence-based updated points of the 2017 guidelines that can be implemented in the settings of Kazakhstan health care system. Materials and methods: the first stage of the review was performing a comparative analysis of old (2012) and updated versions of the European guidelines. Then, to investigate the possibility of their application in our country, the search of Asian and Kazakhstan trials was carried out in PubMed, Cochrane Library, Trip, ScienceDirect. To build search queries, the following key words was used: acute coronary syndrome, myocardial infarction, guidelines, coronary angiography, stenting. Results and conclusions: Aforementioned document is remarkable for inclusion of new essential recommendations, which can be listed in the next statements: 1. the combination of right bundle branch block with clinical symptoms of myocardial ischaemia is an indication for urgent coronary angiography; 2. time quality indicators of care for patients with acute myocardial infarction have been reassesed, which will be crucial for Kazakhstan; 3. the recommendations on preferred use of radial access has been strengthened from IIa to IА, which is supported by numerous investigations in Asia;
4. routine thrombus aspiration is not recommended, and this strategy is proved in Asia;
5. the recommendation on preferred stenting with new-generation drug-eluting stents compared with bare-metal stents is underscored, and this recommendation is reasonable in Asia, although with a weaker level of evidence;
6. routine use of deferred stenting is not recommended, and this strategy is proved in Asia;
7. routine percutaneous coronary intervention of a infarct-related artery is not recommended in stable asymptomatic patients after 48 hour from symptoms onset;
8. routine revascularization of non-infarct-related lesions should be considered in patients with multivessel disease before hospital discharge, and this recommendation is reasonable in Asia, although with a weaker level of evidence;
9. oxygen is indicated in patients with hypoxaemia SaO2 < 90% (IC) and routine oxygen is not recommended (III);
10. the importance of aggressive lipid-lowering therapy depending on the level of low-density lipoprotein has been underlined, and this strategy proved its effectiveness in real-world clinical settings in Asian countries;
11. the safety of early discharge has been emphasized, but the possibility of implemention of this strategy in Kazakhstan should be elucidated in further studies. Overall, there is a strong necessity for performing high-quality trials in Kazakhstan in order to compose own valid clinical guidelines.

Updated European guidelines for the management of atrial fibrillation were published on the 27 of August, 2016. This document is remarkable for new recommendations, especially about anticoagulation therapy. Key points of these guidelines and the possibility of their use in our country are described in the article.
Objective: to find out essential evidence-based key points of the 2016 guidelines and to investigate the possibility of their use in Kazakhstan. Materials and methods: To achieve these goals major differences between 2016, 2012, 2010 guidelines were analyzed. Then, to find out investigations, that support key points of the 2016 guidelines, a literature review in PubMed, MEDLINE, Web of Science, Scopus databases were carried out. The following key words was used: atrial fibrillation, European guidelines, anticoagulation, warfarin, novel antagonist oral anticoagulants. Results and conclusions: Aforementioned document is remarkable for inculcation of new essential recommendations, which can be listed in the next statements: 1. The prognostic value of the screening to determine silent atrial fibrillation has been highlighted. 2. EHRA symptom scale has been modified. 3. Changes in the CHA2 DS2-VASc scale using were introduced depend on gender. 4. Antiplatelet therapy is not recommended to prevent a stroke. 5. The role of novel anticoagulant has been strengthened in comparison with warfarin. 6. Edoxaban has been introduced as a recommended novel anticoagulant. 7. The possibility of the treatment with oral anticoagulant after intracranial haemorrhage has been scrutinized. 8. Algorithm about the use of oral anticoagulant after ischemic stroke has been developed. 9. The possibility of use double anticoagulant therapy instead of triple therapy among patients with atrial fibrillations after percutaneous coronary intervention has been proposed. 10. Statins are not recommended for primary prevention of atrial fibrillation. Overall, this evidence-based approach will enable to improve the management of atrial fibrillation in Kazakhstan.

45-year-old male, a farmer, presented to a multidisciplinary hospital with a complain of increasing shortness of breath at rest, accompanied by a dry cough productive of clear sputum, pain in knee joints in the morning, weakness and lower-limb edema. He had sufferred from progressive dyspnoe for about 2-3 years with subsequent addition of other symptoms. The patient reported several episodes of nasal bleeding. There was a history of myocardial infarction for 7 years, arterial hypertension for 10 years (taking enalapril plus amlodipine) and a habit of smoking for 20 years. The patient had sought medical attention at out-patient clinic 2 months before and was referred to a tuberculosis hospital due to pathological findings on chest X-ray. After exclusion of tuberculosis, he was transferred to our hospital. At physical examination, there were diffuse cyanosis, telangiectases on the chest skin, clubbing, the barrel chest, pulmonary rales in the lower parts of both lungs, leftward and downward deviation of heart apex, BP 120/80 mmHg, Ps 75. The laboratory assessment revealed leukocytosis 11.6 and hyperlipidemia. The electrocardiogram showed sinus rhythm, HR of 89 bpm, left ventriclular hypertrophy. The echocardiogram demonstrated hypokinesia of basal wall of left ventricle, EF normal. Chest X-ray showed crowded pulmonary vasculature, especially in the lower parts. The computed tomography scan demonstrated reticular abnormality, honeycombing and traction bronchiectasis with basal predomonance. Aftercareful consideration, we excluded idiopathic pulmonary hemochromatosis, Randu-Osler disease, HFpEF, chronic obstructive lung disease as major causes of patient's problems. Taking into account an algorithm proposed by an Official ATS/ERS/JRS/ALAT Statement, we diagnosed idiopathic pulmonary fibrosis and administered glucocorticosteroid, which improved considerably patient's condition.