medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-368medsovet-8616Research ArticleХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬCHRONIC HEART FAILUREДифференциальный диагноз острого коронарного синдрома без элевации сегмента ST у пациента среднего возрастаDifferential diagnosis of acute coronary syndrome without ST-segment elevation in a middle-aged patienthttps://orcid.org/0009-0000-0492-9878ЧерниковА. О.ChernikovA. O.

Черников Артем Олегович, старший лаборант кафедры интервенционной кардиологии и кардиореабилитации факультета дополнительного профессионального образования Института непрерывного образования и профессионального развития, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; 117997, Россия, Москва, ул. Островитянова, д. 1; врач-кардиолог отделения реанимации и интенсивной терапии для больных с острым инфарктом миокарда, Городская клиническая больница №1 имени Н.И. Пирогова

117997, Москва, ул. Островитянова, д. 1,

119049, Москва, Ленинский проспект, д. 8

Artem O. Chernikov, Senior Laboratory Assistant at the Department of Interventional Cardiology and Cardiac Rehabilitation, Faculty of Additional Professional Education, Institute of Continuing Education and Professional Development, Pirogov Russian National Research Medical University; Cardiologist of the Intensive Care Unit for Patients with Acute Myocardial Infarction, City Clinical Hospital No. 1 named after N.I. Pirogov

1, Ostrovityanov St., Moscow, 117997,

8, Lenin Ave., Moscow, 117049

chernikovtema@mail.ruhttps://orcid.org/0000-0002-2256-1840ЧернышоваВ. А.ChernyshovaV. A.

Чернышова Вероника Александровна, врач-кардиолог

119049, Москва, Ленинский проспект, д. 8

Veronica A. Chernyshova, Cardiologist

8, Lenin Ave., Moscow, 117049

rusvero@mail.ruhttps://orcid.org/0000-0003-4918-3795КонстантиноваЕ. В.KonstantinovaE. V.

Константинова Екатерина Владимировна, д.м.н., доцент кафедры факультетской терапии имени акад. А.И. Нестерова лечебного факультета, профессор кафедры интервенционной кардиологии и кардиореабилитации факультета дополнительного профессионального образования Института непрерывного образования и профессионального развития, Российский национальный исследовательский медицинский университет имени Н.И. Пирогова; врач-кардиолог, Городская клиническая больница №1 имени Н.И. Пирогова

117997, Москва, ул. Островитянова, д. 1,

119049, Москва, Ленинский проспект, д. 8

Ekaterina V. Konstantinova, Dr. Sci. (Med.), Associate Professor of the Department of Faculty Therapy Named After Acad. A.I. Nesterov, Faculty of Medicine, Professor of the Department of Interventional Cardiology and Cardiac Rehabilitation, Faculty of Additional Professional Education, Institute of Continuing Education and Professional Development, Pirogov Russian National Research Medical University; Cardiologist, City Clinical Hospital No. 1 named after N.I. Pirogov

1, Ostrovityanov St., Moscow, 117997,

8, Lenin Ave., Moscow, 117049

katekons@mail.ruhttps://orcid.org/0009-0006-3655-1586ВеликоцкийА. А.VelikotskyA. A.

Великоцкий Антон Александрович, врач-рентгенхирург

119049, Москва, Ленинский проспект, д. 8

Anton A. Velikotsky, X-Ray Surgeon

8, Lenin Ave., Moscow, 117049

vel_aa@mail.ruhttps://orcid.org/0009-0007-4694-6140ПлощенковЕ. В.PloshchenkovE. V.

Площенков Евгений Валерьевич, заведующий отделением рентгенхирургических методов диагностики и лечении

119049, Москва, Ленинский проспект, д. 8

Evgeniy V. Ploshchenkov, Head of Department of X-ray Surgical Diagnostic Methods and Treatment

8, Lenin Ave., Moscow, 117049

Jenya-09@inbox.ruРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Городская клиническая больница №1 имени Н.И. ПироговаРоссияPirogov Russian National Research Medical University; City Clinical Hospital No. 1 named after N.I. Pirogov;Russian FederationГородская клиническая больница №1 имени Н.И. ПироговаРоссияCity Clinical Hospital No. 1 named after N.I. PirogovRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. Пирогова; Городская клиническая больница №1 имени Н.И. ПироговаРоссияPirogov Russian National Research Medical University; City Clinical Hospital No. 1 named after N.I. PirogovRussian Federation20243010202401692100Copyright © Черников А.О., Чернышова В.А., Константинова Е.В., Великоцкий А.А., Площенков Е.В., 20242024Черников А.О., Чернышова В.А., Константинова Е.В., Великоцкий А.А., Площенков Е.В.Chernikov A.O., Chernyshova V.A., Konstantinova E.V., Velikotsky A.A., Ploshchenkov E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8616

Острый коронарный синдром (ОКС) представляет собой предварительный диагноз, который в процессе диагностического поиска трансформируется в диагноз «инфаркт миокарда», «нестабильная стенокардия» или в иной диагноз. Если у пациента имеются критерии инфаркта миокарда (согласно четвертому универсальному определению инфаркта миокарда) при наличии стенозирующего атеротромбоза в инфаркт-связанной коронарной артерии, диагностируется инфаркт миокарда 1-го типа или в большинстве оставшихся случаев – инфаркт миокарда 2-го типа. Отдельно выделяют острое повреждение миокарда при ряде состояний. В представленном случае пациент 54 лет, имевший в анамнезе артериальную гипертонию и сахарный диабет, не приверженный лечению и страдающий ожирением, курильщик, госпитализирован с типичными, впервые возникшими стенокардитическими болями в грудной клетке и ишемическим изменениями на ЭКГ по скорой помощи с направительным диагнозом «ОКС без элевации сегмента ST». В процессе обследования диагноз неоднократно менялся: «ОКС без элевации сегмента ST», «ИБС: инфаркт миокарда без элевации сегмента ST», «Инфаркт миокарда без обструктивного поражения коронарных артерий (ИМБОКА)», «Кальцинированный аортальный стеноз тяжелой степени. Анемия. Инфаркт миокарда 2-го типа». Особенностью данного случая является дебют высокоградиентного аортального стеноза у мужчины среднего возраста с клинической картиной ОКС и высоким уровнем тропонина в крови. В статье обсуждаются причины, по которым тяжелый аортальный стеноз может манифестировать как инфаркт миокарда с характерным повышением в крови уровня кардиоспецифического тропонина, несмотря на интактные коронарные сосуды. Обсуждается дифференциальная диагностика причины повреждения миокарда, поскольку правильное диагностическое суждение непосредственно определяет стратегию ведения пациента.

Acute Coronary Syndrome (ACS) is an initial diagnosis, which is transformed into the diagnosis of “myocardial infarction”, “unstable angina” or other diagnosis during the diagnostic process. If a patient meets the criteria for myocardial infarction (according to the Fourth Universal Definition of Myocardial Infarction), in the presence of atherothrombosis in the infarct-related coronary artery, Type 1 myocardial infarction is diagnosed. In most of the remaining cases Type 2 myocardial infarction is diagnosed. Acute myocardial injury due to various conditions is separately classified. In the presented case, a 54-year-old patient with a history of arterial hypertension and diabetes mellitus, not adherent to treatment and suffering from obesity, a smoker, was hospitalized with typical new-onset angina pectoris and ischemic changes on the ECG, by ambulance, with the initial diagnosis of “ACS without ST-segment elevation”. The diagnosis changed several times during the examination: “ACS without ST-segment elevation”, “CAD: myocardial infarction without ST-segment elevation”, “Myocardial infarction with non-obstructive coronary arteries (MINOCA)”, “Severe calcified aortic stenosis. Anemia. Type 2 myocardial infarction”. The peculiarity of this case is the debut of high-gradient aortic stenosis in a middle-aged man with clinical manifestations of ACS and high blood troponin level. Causes of severe aortic stenosis manifestation as myocardial infarction with elevation of cardiac-specific troponin in the blood, despite intact coronary vessels, are discussed in this article. The differential diagnosis of myocardial injury is discussed, as the correct diagnostic judgment directly determines the patient’s management strategy.

инфаркт миокарда 2-го типаострое повреждение миокардаинфаркт миокарда без обструкции коронарного руслакальцинированный аортальный стенозпротезирование аортального клапанаacute coronary syndrometype 2 myocardial infarctionacute myocardial injurymyocardial infarction with nonobstructive coronary arteriescalcified aortic stenosisaortic valve replacementReferencesБарбараш ОЛ, Дупляков ДВ, Затейщиков ДА, Панченко ЕП, Шахнович РМ, Явелов ИС и др. Острый коронарный синдром без подъема сегмента ST электрокардиограммы. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(4):4449. https://doi.org/10.15829/1560-4071-2021-4449.Barbarash OL, Duplyakov DV, Zateischikov DA, Panchenko EP, Shakhnovich RM, Yavelov IS et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4449.Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024;13(1):55–161. https://doi.org/10.1093/ehjacc/zuad107.Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care. 2024;13(1):55–161. https://doi.org/10.1093/ehjacc/zuad107.Аверков ОВ, Барбараш ОЛ, Бойцов СА, Васильева ЕЮ, Драпкина ОМ, Галявич АС и др. Дифференцированный подход в диагностике, формулировке диагноза, ведении больных и статистическом учете инфаркта миокарда 2-го типа (согласованная позиция). Российский кардиологический журнал. 2019;(6):7–21. https://doi.org/10.15829/1560-4071-2019-6-7-21.Averkov OV, Barbarash OL, Boytsov SA, Vasilieva EYu, Drapkina OM, Galyavich AS et al. Differentiated approach in diagnostics, diagnosis formulation, case management and statistical accounting of type 2 myocardial infarction (Position Paper). Russian Journal of Cardiology. 2019;(6):7–21. (In Russ.) https://doi.org/10.15829/1560-4071-2019-6-7-21.Sandoval Y, Thygesen K. Myocardial infarction type 2 and myocardial injury. Clin Chem. 2017;63:101–107. https://doi.org/10.1373/clinchem.2016.255521.Sandoval Y, Thygesen K. Myocardial infarction type 2 and myocardial injury. Clin Chem. 2017;63:101–107. https://doi.org/10.1373/clinchem.2016.255521.Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019;139(18):e891–e908. https://doi.org/10.1161/CIR.0000000000000670.Tamis-Holland JE, Jneid H, Reynolds HR, Agewall S, Brilakis ES, Brown TM et al. Contemporary Diagnosis and Management of Patients With Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease: A Scientific Statement From the American Heart Association. Circulation. 2019;139(18):e891–e908. https://doi.org/10.1161/CIR.0000000000000670.Шерашов АВ, Шилова АС, Першина ЕС, Щекочихин ДЮ, Свет АВ, Гиляров МЮ. Инфаркт миокарда без признаков обструктивного атеросклероза коронарных артерий. Кардиология. 2020;60(3):89–95. https://doi.org/10.18087/cardio.2020.3.n881.Sherashov AV, Shilova AS, Pershina ES, Shchekochikhin DYu, Svet AV, Gilyarov MYu. Myocardial infarction with nonobstructive coronary arteries. Kardiologiya. 2020;60(3):89–95. (In Russ.) https://doi.org/10.18087/cardio.2020.3.n881.Барбараш ОЛ, Кашталап ВВ, Быкова ИС, Эрлих АД. Подходы к диагностике и лечению пациентов с острым коронарным синдромом без подъема сегмента ST в российских стационарах. Результаты регистра РЕКОРД-З. Сибирский журнал клинической и экспериментальной медицины. 2017;32(3):88–94. https://doi.org/10.29001/2073-8552-2017-32-3-88-94.Barbarash OI, Kashtalap VV, Bykova IS, Ehrlich AD. Approaches to diagnosis and treatment of patients with non-ST-segment elevation acute coronary syndrome in Russian hospitals. RECORD-3 Registry Data. The Siberian Journal of Clinical and Experimental Medicine. 2017;32(3):88–94. (In Russ.) https://doi.org/10.29001/2073-8552-2017-32-3-88-94.Braunwald E. On the natural history of severe aortic stenosis. J Am Coll Cardiol. 1990;15(5):1018–1020. https://doi.org/10.1016/0735-1097(90)90235-h.Braunwald E. On the natural history of severe aortic stenosis. J Am Coll Cardiol. 1990;15(5):1018–1020. https://doi.org/10.1016/0735-1097(90)90235-h.Badran AA, Vohra HA, Livesey SA. Unoperated severe aortic stenosis: decision making in an adult UK-based population. Ann R Coll Surg Engl. 2012;94(6):416–421. https://doi.org/10.1308/003588412X13171221591817.Badran AA, Vohra HA, Livesey SA. Unoperated severe aortic stenosis: decision making in an adult UK-based population. Ann R Coll Surg Engl. 2012;94(6):416–421. https://doi.org/10.1308/003588412X13171221591817.Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524. https://doi.org/10.1016/j.rec.2022.05.006.Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Rev Esp Cardiol (Engl Ed). 2022;75(6):524. https://doi.org/10.1016/j.rec.2022.05.006.Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M et al. Universal definition of myocardial infarction. Circulation. 2007;116(22):2634–2653. https://doi.org/10.1161/CIRCULATIONAHA.107.187397.Thygesen K, Alpert JS, White HD, Jaffe AS, Apple FS, Galvani M et al. Universal definition of myocardial infarction. Circulation. 2007;116(22):2634–2653. https://doi.org/10.1161/CIRCULATIONAHA.107.187397.Arora S, Strassle PD, Qamar A, Wheeler EN, Levine AL, Misenheimer JA et al. Impact of Type 2 Myocardial Infarction (MI) on Hospital-Level MI Outcomes: Implications for Quality and Public Reporting. J Am Heart Assoc. 2018;7(7):e008661. https://doi.org/10.1161/JAHA.118.008661.Arora S, Strassle PD, Qamar A, Wheeler EN, Levine AL, Misenheimer JA et al. Impact of Type 2 Myocardial Infarction (MI) on Hospital-Level MI Outcomes: Implications for Quality and Public Reporting. J Am Heart Assoc. 2018;7(7):e008661. https://doi.org/10.1161/JAHA.118.008661.Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231–1243. https://doi.org/10.1016/s0195-668x(03)00201-x.Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003;24(13):1231–1243. https://doi.org/10.1016/s0195-668x(03)00201-x.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20):e618–e651. https://doi.org/10.1161/CIR.0000000000000617.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD. Fourth Universal Definition of Myocardial Infarction (2018). Circulation. 2018;138(20):e618–e651. https://doi.org/10.1161/CIR.0000000000000617.Stein GY, Herscovici G, Korenfeld R, Matetzky S, Gottlieb S, Alon D et al. Type-II myocardial infarction – patient characteristics, management and outcomes. PLoS ONE. 2014;9(1):e84285. https://doi.org/10.1371/journal.pone.0084285.Stein GY, Herscovici G, Korenfeld R, Matetzky S, Gottlieb S, Alon D et al. Type-II myocardial infarction – patient characteristics, management and outcomes. PLoS ONE. 2014;9(1):e84285. https://doi.org/10.1371/journal.pone.0084285.Chapman AR, Shah ASV, Lee KK, Anand A, Francis O, Adamson P et al. Long-Term Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury. Circulation. 2018;137(12):1236–1245. https://doi.org/10.1161/CIRCULATIONAHA.117.031806.Chapman AR, Shah ASV, Lee KK, Anand A, Francis O, Adamson P et al. LongTerm Outcomes in Patients With Type 2 Myocardial Infarction and Myocardial Injury. Circulation. 2018;137(12):1236–1245. https://doi.org/10.1161/CIRCULATIONAHA.117.031806.Spatz ES, Curry LA, Masoudi FA, Zhou S, Strait KM, Gross CP et al. The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System: A Taxonomy for Young Women With Acute Myocardial Infarction. Circulation. 2015;132(18):1710–1718. https://doi.org/10.1161/CIRCULATIONAHA.115.016502.Spatz ES, Curry LA, Masoudi FA, Zhou S, Strait KM, Gross CP et al. The Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) Classification System: A Taxonomy for Young Women With Acute Myocardial Infarction. Circulation. 2015;132(18):1710–1718. https://doi.org/10.1161/CIRCULATIONAHA.115.016502.Baron T, Hambraeus K, Sundström J, Erlinge D, Jernberg T, Lindahl B. Type 2 myocardial infarction in clinical practice. Heart. 2015;101(2):101–106. https://doi.org/10.1136/heartjnl-2014-306093.Baron T, Hambraeus K, Sundström J, Erlinge D, Jernberg T, Lindahl B. Type 2 myocardial infarction in clinical practice. Heart. 2015;101(2):101–106. https://doi.org/10.1136/heartjnl-2014-306093.Maayah M, Grubman S, Allen S, Ye Z, Park DY, Vemmou E et al. Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing. Diagnostics (Basel). 2024;14(5):503. https://doi.org/10.3390/diagnostics14050503.Maayah M, Grubman S, Allen S, Ye Z, Park DY, Vemmou E et al. Clinical Interpretation of Serum Troponin in the Era of High-Sensitivity Testing. Diagnostics (Basel). 2024;14(5):503. https://doi.org/10.3390/diagnostics14050503.Stein EJ, Fearon WF, Elmariah S, Kim JB, Kapadia S, Kumbhani DJ et al. Left Ventricular Hypertrophy and Biomarkers of Cardiac Damage and Stress in Aortic Stenosis. J Am Heart Assoc. 2022;11(7):e023466. https://doi.org/10.1161/JAHA.121.023466.Stein EJ, Fearon WF, Elmariah S, Kim JB, Kapadia S, Kumbhani DJ et al. Left Ventricular Hypertrophy and Biomarkers of Cardiac Damage and Stress in Aortic Stenosis. J Am Heart Assoc. 2022;11(7):e023466. https://doi.org/10.1161/JAHA.121.023466.Simard L, Côté N, Dagenais F, Mathieu P, Couture C, Trahan S et al. Sex-Related Discordance Between Aortic Valve Calcification and Hemodynamic Severity of Aortic Stenosis: Is Valvular Fibrosis the Explanation? Circ Res. 2017;120(4):681–691. https://doi.org/10.1161/CIRCRESAHA.116.309306.Simard L, Côté N, Dagenais F, Mathieu P, Couture C, Trahan S et al. SexRelated Discordance Between Aortic Valve Calcification and Hemodynamic Severity of Aortic Stenosis: Is Valvular Fibrosis the Explanation? Circ Res. 2017;120(4):681–691. https://doi.org/10.1161/CIRCRESAHA.116.309306.Rader F, Sachdev E, Arsanjani R, Siegel RJ. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications. Am J Med. 2015;128(4):344–352. https://doi.org/10.1016/j.amjmed.2014.10.054.Rader F, Sachdev E, Arsanjani R, Siegel RJ. Left ventricular hypertrophy in valvular aortic stenosis: mechanisms and clinical implications. Am J Med. 2015;128(4):344–352. https://doi.org/10.1016/j.amjmed.2014.10.054.Chin CW, Shah AS, McAllister DA, Joanna Cowell S, Alam S, Langrish JP et al. High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis. Eur Heart J. 2014;35(34):2312–2321. https://doi.org/10.1093/eurheartj/ehu189.Chin CW, Shah AS, McAllister DA, Joanna Cowell S, Alam S, Langrish JP et al. High-sensitivity troponin I concentrations are a marker of an advanced hypertrophic response and adverse outcomes in patients with aortic stenosis. Eur Heart J. 2014;35(34):2312–2321. https://doi.org/10.1093/eurheartj/ehu189.McConkey HZR, Marber M, Chiribiri A, Pibarot P, Redwood SR, Prendergast BD. Coronary Microcirculation in Aortic Stenosis. Circ Cardiovasc Interv. 2019;12(8):e007547. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007547.McConkey HZR, Marber M, Chiribiri A, Pibarot P, Redwood SR, Prendergast BD. Coronary Microcirculation in Aortic Stenosis. Circ Cardiovasc Interv. 2019;12(8):e007547. https://doi.org/10.1161/CIRCINTERVENTIONS.118.007547.Zelis JM, Tonino PAL, Pijls NHJ, De Bruyne B, Kirkeeide RL, Gould KL, Johnson NP. Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions. J Interv Cardiol. 2020;2020:4603169. https://doi.org/10.1155/2020/4603169.Zelis JM, Tonino PAL, Pijls NHJ, De Bruyne B, Kirkeeide RL, Gould KL, Johnson NP. Coronary Microcirculation in Aortic Stenosis: Pathophysiology, Invasive Assessment, and Future Directions. J Interv Cardiol. 2020;2020:4603169. https://doi.org/10.1155/2020/4603169.Treibel TA, López B, González A, Menacho K, Schofield RS, Ravassa S et al. Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients. Eur Heart J. 2018;39(8):699–709. https://doi.org/10.1093/eurheartj/ehx353.Treibel TA, López B, González A, Menacho K, Schofield RS, Ravassa S et al. Reappraising myocardial fibrosis in severe aortic stenosis: an invasive and non-invasive study in 133 patients. Eur Heart J. 2018;39(8):699–709. https://doi.org/10.1093/eurheartj/ehx353.Steadman CD, Jerosch‐Herold M, Grundy B, Rafelt S, Ng LL, Squire IB et al. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2012;5(2):182–189. https://doi.org/10.1016/j.jcmg.2011.09.022.Steadman CD, Jerosch‐Herold M, Grundy B, Rafelt S, Ng LL, Squire IB et al. Determinants and functional significance of myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2012;5(2):182–189. https://doi.org/10.1016/j.jcmg.2011.09.022.Mahmod M, Chan K, Raman B, Westaby J, Dass S, Petrou M et al. Histological evidence for impaired myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2019;12(11):2276–2278. https://doi.org/10.1016/j.jcmg.2019.05.032.Mahmod M, Chan K, Raman B, Westaby J, Dass S, Petrou M et al. Histological evidence for impaired myocardial perfusion reserve in severe aortic stenosis. JACC Cardiovasc Imaging. 2019;12(11):2276–2278. https://doi.org/10.1016/j.jcmg.2019.05.032.Salama A, Ibrahim G, Fikry M, Elsannan MH, Eltahlawi M. Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery. Indian J Thorac Cardiovasc Surg. 2024;40(2):142–150. https://doi.org/10.1007/s12055-023-01594-5.Salama A, Ibrahim G, Fikry M, Elsannan MH, Eltahlawi M. Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery. Indian J Thorac Cardiovasc Surg. 2024;40(2):142–150. https://doi.org/10.1007/s12055-023-01594-5.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA et al. Четвертое универсальное определение инфаркта миокарда (2018). Российский кардиологический журнал. 2019;(3):107–138. Режим доступа: https://russjcardiol.elpub.ru/jour/article/view/3259.Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA et al. Fourth universal definition of myocardial infarction (2018). Russian Journal of Cardiology. 2019;(3):107–138. (In Russ.) Available at: https://russjcardiol.elpub.ru/jour/article/view/3259.Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38(3):143–153. https://doi.org/10.1093/eurheartj/ehw149.Agewall S, Beltrame JF, Reynolds HR, Niessner A, Rosano G, Caforio AL et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38(3):143–153. https://doi.org/10.1093/eurheartj/ehw149.Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003;349(4):343–349. https://doi.org/10.1056/NEJMoa022831.Vincentelli A, Susen S, Le Tourneau T, Six I, Fabre O, Juthier F et al. Acquired von Willebrand syndrome in aortic stenosis. N Engl J Med. 2003;349(4):343–349. https://doi.org/10.1056/NEJMoa022831.Frank S, Johnson A, Ross JJr. Natural history of valvular aortic stenosis. Br Heart J. 1973;35(1):41–46. https://doi.org/10.1136/hrt.35.1.41.Frank S, Johnson A, Ross JJr. Natural history of valvular aortic stenosis. Br Heart J. 1973;35(1):41–46. https://doi.org/10.1136/hrt.35.1.41.Kelly TA, Rothbart RM, Cooper CM, Kaiser DL, Smucker ML, Gibson RS. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol. 1988;61(1):123–130. https://doi.org/10.1016/0002-9149(88)91317-3.Kelly TA, Rothbart RM, Cooper CM, Kaiser DL, Smucker ML, Gibson RS. Comparison of outcome of asymptomatic to symptomatic patients older than 20 years of age with valvular aortic stenosis. Am J Cardiol. 1988;61(1):123–130. https://doi.org/10.1016/0002-9149(88)91317-3.Dweck MR, Boon NA, Newby DE. Calcific aortic stenosis: a disease of the valve and the myocardium. J Am Coll Cardiol. 2012;60(19):1854–1863. https://doi.org/10.1016/j.jacc.2012.02.093.Dweck MR, Boon NA, Newby DE. Calcific aortic stenosis: a disease of the valve and the myocardium. J Am Coll Cardiol. 2012;60(19):1854–1863. https://doi.org/10.1016/j.jacc.2012.02.093.Lim P, Monin JL, Monchi M, Garot J, Pasquet A, Hittinger L et al. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide. Eur Heart J. 2004;25(22):2048–2053. https://doi.org/10.1016/j.ehj.2004.09.033.Lim P, Monin JL, Monchi M, Garot J, Pasquet A, Hittinger L et al. Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide. Eur Heart J. 2004;25(22):2048–2053. https://doi.org/10.1016/j.ehj.2004.09.033.Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e35–e71. https://doi.org/10.1161/CIR.0000000000000932.Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;143(5):e35–e71. https://doi.org/10.1161/CIR.0000000000000932.BBavry AA. Placement of aortic transcatheter valves 3 – PARTNER 3. American College of Cardiology; 2023. Available at: https://www.acc.org/Latest-inCardiology/Clinical-Trials/2019/03/15/18/29/PARTNER-3.BBavry AA. Placement of aortic transcatheter valves 3 – PARTNER 3. American College of Cardiology; 2023. Available at: https://www.acc.org/Latest-inCardiology/Clinical-Trials/2019/03/15/18/29/PARTNER-3.Kumbhani DJ. Evolut surgical replacement and transcatheter aortic valve implantation in low risk patients – Evolut Low Risk. American College of Cardiology; 2023. Available at: https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2019/03/15/18/34/EVOLUT-Low-Risk.Kumbhani DJ. Evolut surgical replacement and transcatheter aortic valve implantation in low risk patients – Evolut Low Risk. American College of Cardiology; 2023. Available at: https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2019/03/15/18/34/EVOLUT-Low-Risk.Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther. 2020;10(1):59–71. https://doi.org/10.21037/cdt.2019.09.12.Braghiroli J, Kapoor K, Thielhelm TP, Ferreira T, Cohen MG. Transcatheter aortic valve replacement in low risk patients: a review of PARTNER 3 and Evolut low risk trials. Cardiovasc Diagn Ther. 2020;10(1):59–71. https://doi.org/10.21037/cdt.2019.09.12.Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients. Ann Thorac Surg. 2016;102(2):573–579. https://doi.org/10.1016/j.athoracsur.2016.01.105.Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L. Comparison of EuroSCORE II, Original EuroSCORE, and The Society of Thoracic Surgeons Risk Score in Cardiac Surgery Patients. Ann Thorac Surg. 2016;102(2):573–579. https://doi.org/10.1016/j.athoracsur.2016.01.105.Гайфулин РА, Иванов СВ, Гайфулина ЕН. Стратификация предоперационного риска у больных пожилого возраста в кардиохирургической клинике. Кардиоваскулярная терапия и профилактика. 2020;19(2):2272. https://doi.org/10.15829/1728-8800-2019-2272.Gaifullin RA, Ivanov SV, Gaifullina EN. Stratification of preoperative risk in elderly patients in cardiac surgery clinic. Cardiovascular Therapy and Prevention (Russian Federation). 2020;19(2):2272. (In Russ.) https://doi.org/10.15829/1728-8800-2019-2272.O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V et al. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results. Ann Thorac Surg. 2018;105(5):1419–1428. https://doi.org/10.1016/j.athoracsur.2018.03.003.O’Brien SM, Feng L, He X, Xian Y, Jacobs JP, Badhwar V et al. The Society of Thoracic Surgeons 2018 Adult Cardiac Surgery Risk Models: Part 2-Statistical Methods and Results. Ann Thorac Surg. 2018;105(5):1419–1428. https://doi.org/10.1016/j.athoracsur.2018.03.003.

The authors declare that there are no conflicts of interest present.