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Russian Journal of Cardiology 2016, 12 (140)

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Russ J Cardiol 2016, 12 (140): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2016, 12 (140): 6

ORIGINAL ARTICLES

ASSESSMENT OF THE LEFT VENTRICLE SYSTOLIC FUNCTION WITH ULTRASOUND 2D-STRAIN TECHNOLOGY IN ARTERIAL HYPERTENSION

Khadzegova А. B.1, Yuschuk Е. N.1, Gabitova R. G.2, Sinitsina I. А.1, Ivanova S . V.1, Vasyuk Yu. А.1

Abstract

Aim. The assessment of global longitudinal deformation and velocity of deformation of the left ventricle (LV) in arterial hypertension (AH) patients for diagnostics of preclinical systolic function disorders.

Material and methods. Totally, 105 AH patients investigated, age 53,3±5,7 y. o., and 35 age and gender matched almost healthy persons. All patients underwent standard clinical and functional investigation with evaluation of diastolic and systolic function with additional assessment of global longitudinal deformation of the LV.

Results. In AH the LV hypertrophy (LVH) more often was associated with the male gender and higher levels of arterial pressure, which required prescription of combination antihypertension therapy. In 19 (32,8%) of LVH patients there was increased volume of the left atrium more than 34 mL/m2, of E/e’ value more 10 and systolic pressure in pulmonary artery more 35 mmHg, that witnessed on the increase of pulmonary artery wedge pressure increase. Of those 9 (15,5%) patients with concentric LVH complained on dyspnea and exercise intolerance related to chronic heart failure and normal ejection fraction, but with decreased longitudinal deformation of LV (-16,3±0,8%). Global longitudinal deformation in normal geometry of the LV was -19,5±0,9% and was significantly higher than in concentric remodeling (-18,3±0,9%), concentric (-17,6±0,9%) and excentric (-18,7±0,7%) LVH.

Conclusion. In AH the application of 2D-strain makes it to reveal the disorders of longitudinal systolic LV function even before hypertrophy development, though more significant decrease of global longitudinal deformity of LV is marked in its concentric hypertrophy. In chronic heart failure with saved ejection fraction, together with disordered systolic LV function there is a decrease of its longitudinal deformation.

Russ J Cardiol 2016, 12 (140): 7–11

dx.doi.org/10.15829/1560-4071-2016-12-7-11

Key words: arterial hypertension, hypertrophy, longitudinal deformation, velocity of deformation, left ventricle.

1A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow; 2Noginsk CRH, Moscow, Russia.

HEART HEMODYNAMICS IN EARLY PERIOD OF ACUTE ST ELEVATION ANTERIOR MYOCARDIAL INFARCTION BY 2D SPECKLE TRACKING ECHOCARDIOGRAPHY

Kercheva М. А.1, Ryabova Т. R.1, Ryabov V. V.1,2,3, Karpov R. S .1,2,3

Abstract

Aim. To assess the changes in biomechanics of the heart at early stages post-acute ST-elevation myocardial infarction (MI) by 2D speckle tracking echocardiography.

Material and methods. Totally, 35 patients included (mean age — 58,46±10,2 year old) with acute Q-MI admitted within 24 hours from the disease onset. Echocardiography, including 2D speckle tracking regimen was done at the 3rd (T1), 7th (T2) and 14th (T3) day post-MI (Vivid E9 device). Patients were selected to two groups: with an adverse remodeling of the left ventricle (LVR+) by 14th day and without (LVR-).

Results. Urgent reperfusion was done in all patients, and in 72% within 6 hours. There was no significant dynamics of the standard echocardiography parameters — enddiastolic volume (EDV) and end-systolic volume (ESV), ejection fraction (EF), index of local contractility disorder (ILCD) of the LV. There was improved deformity — 2D global longitudinal strain (GLS) by T2 (p=0,048). Apical and basal rotation — without dynamics during all follow-up period. However, number of patients with normal and decreased value of basal rotation and its systolic velocity, as with normal and increased value of apical rotation and its systolic velocity, increased by T3 (p<0,05). There was increase of systolic twist velocity by T3. In LVR+ group there was improvement of ILCD and 2D GLS by T3. Systolic velocity of apical rotation and twist increased by T3, however all velocity parameters were significantly lower than in LVR-. Clinically the groups differed by the time of reperfusion: 5,48±3,58 vs 3,89±2,25 hours (р<0,05).

Conclusion. Changes in biomechanics of the heart by 2D speckle tracking echocardiography in patients with the use of modern and on-time pharmacoinvasive strategy at early post-infarction period represented the restoring of cardiac function, while standard parameters (ESV, EDV, EF LV) did not show dynamics. Improvement of 2D GLS was found even at T2 point. Among the values reflecting rotational characteristics of LV, the systolic velocity of apical rotation by T3. There was no dynamics in basal and apical rotation. The number of patients increased, with normal and increased apical rotation, as with decreased and normal basal rotation by T3. In LVR+ group myocardial reperfusion was achieved significantly later, there was improvement of 2D GLS and ILCD of LV by T3, as well as velocity values of apical rotation and twist.

Russ J Cardiol 2016, 12 (140): 12–17

dx.doi.org/10.15829/1560-4071-2016-12-12-17

Key words: 2D speckle tracking echocardiography, 2D longitudinal strain, basal rotation, apical rotation, acute myocardial infarction, heart remodelling.

1RI Cardiology, Tomsk; 2Siberian State Medical University (SSMU), Tomsk; 3National Research Tomsk State University, Tomsk, Russia.

SCANNING TRANSMISSION ELECTRON MICROSCOPY FOR QUANTITATIVE MAPPING OF MACROELEMENT CONTENTS OF CARDIAC TISSUE

Komisov А. А.1, Osipova О. А.1, Shepel R. N.2, Drapkina О. М.3, Osipov P. G.1, Plaksina К. G.1, Malay N. V.1

Abstract

Aim. Development of semiquantitative and quantitative nondestructing method to analyze the spread of chemical elements in myocardium mass up to 100 mg (autopsy).

Material and methods. The development was performed on biological specimens of cardiac autopsy of 18 healthy persons without cardiovascular pathology died in traffic accidents. Biological specimens were divided into 3 parts, of those 2 parts by

1 g and one — 0,1 g, respectively. Parts of 1 g mass were used for reference range grounding and fine tune of the detector, and the 0,1 g part was the studied specimen. Preparation of specimens was done by standard methodology. The results of macroelements concentration measurement were taken as reference range. Mapping of element contents was done with nanotechnologies: scanning (SEM FEIQuanta 200) and scanning-transmission (STEM; FEI NovaNanoSEM) electronic microscopy.

Results. As a result of the study, first time the method for quality improvement was defined for the mapping of macroelementary contents of biological specimens, i. e. tissues of human organs, with x-ray fluorescent analysis. The data makes it to study the spread of micro- and macroelements in myocardium that provides benefits in comparatory analysis, assessing dislocations, foci of pathological concentrations of elements in tissues of cardiovascular patients.

Conclusion. The method of macroelement contents mapping of biological specimens with x-ray fluorescence makes it to improve the precision of mapping of macroelementary contents in biological specimens 100 times up to 10-30 ppm, which is itself a quantitative mapping, and has benefits for practical implication in clinical medicine. The data makes it to study the spread of micro- and macroelements in myocardium, which opens the opportunity to do comparison of the spread, foci and regions of pathological concentration of chemical elements in the tissue of cardiovascular patients.

Russ J Cardiol 2016, 12 (140): 18–22

dx.doi.org/10.15829/1560-4071-2016-12-18-22

Key words: x-ray fluorescent analysis, macroelements, microelements, myocardium, mapping.

1Belgorod State National Research University, Belgorod; 2I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 3National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

APPLICATION OF PREDICTION SCORES IN CLINICAL MEDICINE

Belyalov F. I.

Abstract

The article takes into consideration the disease prediction scores. Benefits are considered, as restrictions of implementation to routine practice. The author has developed CardioExpert software for mobile devices, which includes a range of most needed scores of cardiovascular prediction and calculators.

Russ J Cardiol 2016, 12 (140): 23–27

dx.doi.org/10.15829/1560-4071-2016-12-23-27

Key words: prediction of cardiovascular diseases, medical scores.

Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia.

IMMEDIATE AND LONG-TERM RESULTS OF THE LEFT ATRIUM AURICLE OCCLUDER IMPLANTING

IN ATRIAL FIBRILLATION

Shugushev Z. Kh.1,2, Rodionova L. V.1,2, Ganeeva О. N.3, Morozova N. V.2, Maksimkin D. А.1,2

Abstract

Aim. To evaluate the safety and efficacy of the “WATCHMAN” occluder (OW) in atrial fibrillation patients (AF) during hospital period and in 12 months after the procedure.

Material and methods. Frоm 2013 to 2015 years, in the N. A. Semashko Central clinical hospital № 2 of “RZD”, 15 OW were implanted to patients with persistent AF of non-rheumatic origin, admitted for electro cardioversion, or electrophysiological

study and radiofrequency ablation, pacemaker implantation. Indications for endovascular intervention were the threat of repeated embolism, high bleeding risk, severe comorbidities, and inefficacy of antithrombotic therapy. From the study were excluded those with stenosis of the left atrioventricular space and thrombi in the left atrium auricle (LAA). During pre-surgery period, all patients underwent standard transthoracal and transesophageal echocardiography for assessment of the LAA anatomy, its size in four points of view and its position to the left upper pulmonary vein. For stroke risk assessment and of thromboemolic complications the score

CHA2DS2 was used and its new edition CHA2DS2-VASc. Before the discharge from clinic, all patients underwent transesophageal echocardiography, repeated in 6 weeks, 6 and 12 months.

Results. Mean age of patients was 52 year old. All patients had successful OW implanting. Interventions were done without general anesthesia, under local anesthesia. Mean duration of surgery was 42±11,3 min. To every patient one device was utilized. There were no replacements of OW for wrong sizing or other reasons. In 5 patients (anatomy as “chicken wing”) under angles 90-135º there was protrusion of lower border of OW found by 1/3 of the length. In patients with LAA OW sizes 33 and 27, there was residual flow registered under the lower border, of 5 mm and 2 mm diameter, respectively. There were no complications during operation and nearest post-operation period. In 12 months after the study there was not dislocation, embolization or position changes among the devices. The residual flow diameter in 33 mm implant patient decreased in 6 months from 5 to 2 mm, in the other — remained 2 mm. No patients had brain circulation disorders and other embolies.

Conclusion. The method of OW implanting into LA of non-rheumatic origin is effective method of embolic complications prevention, not followed by bleedings and making to prognosis improvement of this kind of patients, as to quit entire life anticoagulation.

Russ J Cardiol 2016, 12 (140): 28–32

dx.doi.org/10.15829/1560-4071-2016-12-28-32

Key words: left atrium auricle occluder, atrial fibrillation, thromboembolism.

1N.A. Semashko Central Clinical Hospital № 2 of “RGD”, Moscow; 2Peoples’ Friendship University of Russia, Moscow;
3A.V. Vishnevsky Surgery Institute, Moscow, Russia.

HIS LEFT BUNDLE BRANCH BLOCK — PREVALENCE AND RISK FACTORS FOR ELECTRICAL AND MECHANICAL DYSSYNCHRONY

Vozhdaeva Z. I.1, Sysuenkova E. V.1, Glukhova V. L.1, Duplyakov D. V.2,3, Khokhlunov S. M.2,3

Abstract

Aim. To study the risk factors of electrical and mechanical dyssynchrony development in complete left bundle branch block (CLBBB).

Material and methods. In the study, we included patients with CLBBB on screening electrocardiography (ECG) and admitted consequentially to cardiologist of FSBHI SMCC FMBA of Russia. All patients underwent standard investigation that included anamnesis, physical examination, lab tests, ECG, echocardiography (EchoCG). If indicated, stress-EchoCG, coronary arteriography, magneteresonance imaging (MRI) with Gadolinium were done. Mechanical dyssynchrony was assessed at three levels: atrioventricular, interventricular, intraventricular.

Results. The prevalence of novel CLBBB cases was 15,9 per 10000 ECGs, or 0,16%, among those 43,3% of patients had unsymptomatic or subclinical course. To the study we included 93 patients (49,5% were male), mean duration of QRS was 148,2±14,5 ms. Most influence on the development of electrical dyssynchrony had male gender (p=0,004), CHD in anamnesis (p=0,011), end-diastolic volume (EDV) of the left ventricle (LV) (p<0,001) and velocity of early phase LV filling E (p=0,006).

The values of mechanical dyssynchrony at atriovetricular (AVD), inter- (IVD) and intraventricular (NVD) levels were 46,18±6,78%, 65,23±17,04 ms и 87,22±30,51 ms. The relation revealed, of AVD from the following variables: male gender, surface of mitral regurgitation (Smr), velocity of blood flow in early diastolic filling of the LV (E), time of isovolumic relaxation of LV. IVD was found in 87 (93,5%) patients. Development of IVD was related to female gender, age, myocardium mass index of LV (MMILV) and peak E of early filling of LV. Technical possibility of MVD with 2D-EchoCG existed just in 40% of the participants due to zones of akinesis, hypokinesis and due to difficulties of correct positioning for localization.

Conclusion. CLBBB can be found on ECG of patients with a variety of cardiovascular diseases. Factors leading to electrical and mechanical dyssynchrony in CLBBB patients are seriously heterogeneous.

Russ J Cardiol 2016, 12 (140): 33–38

dx.doi.org/10.15829/1560-4071-2016-12-33-38

Key words: block of His left bundle branch, prevalence, predictors, mechanical dyssynchrony, heart failure.

1Samara medical clinical centre of Federal medical-biological Agency, Tolyatti; 2Samara Region Clinical Dispensary of Cardiology, Samara; 3Samara State Medical University of the Ministry of Health, Samara, Russia.

PREDICTION ROLE OF THE LEFT VENTRICLE REMODELLING IN ARTERIAL HYPERTENSION PATIENTS

Ivanova S. V., Vasyuk Yu. A., Shkolnik E. L., Khadzegova A. B., Sinitsina I. A.

Abstract

Aim. To study the influence of various geometric models of the left ventricle (LV) on long-term prognosis in arterial hypertension (AH).

Material and methods. Totally, 180 AH patients studied at the age 50,5±6,7 y. o., for 10 years of follow-up. All patients at the inclusion stage underwent standard clinical and functional investigation, 2D-echocardiography, 6-minute walking test, NT-proBNP.

Results. By EchoCG the LV hypertrophy (LVH) was found 1,8 times more frequently than by ECG. Normal geometry of the LV was found in 25,5%, concentric LVH — 42,8%, eccentric LVH — 11,7%.

Conclusion. By the multifactorial analysis, LVH was independent predictor of adverse prognosis and, in combination with other independent factors (age, male gender, 6-minute walking test, NT-proBNP level in plasma) did double the probability of an adverse cardiovascular risk.

Russ J Cardiol 2016, 12 (140): 39–44

dx.doi.org/10.15829/1560-4071-2016-12-39-44

Key words: arterial hypertension, hypertrophy and remodelling, left ventricle.

A. I. Evdokimov Moscow State University of Medicine and Dentistry (MSUMD), Moscow, Russia.

THE RELATION OF ATHEROGENIC OXIDATIVE-ANTIOXIDANT SHIFTS IN LOW DENSITY LIPOPROTEIDES WITH ADVERSE LONG-TERM PROGNOSIS IN MALES

Ragino Yu. I., Voevoda M. I., Malyutina S. K., Gafarov V. V., Shishkin S.V., Bogatyrev S.N., Scherbakova L.V., Polonskaya Ya. V.

Abstract

Aim. To study the baseline parameters of potentially atherogenic oxidativeantioxidant changes of low-density lipoproteides (LDL) with adverse 7-year longterm outcomes.

Material and methods. In male population (n=1024, aged 47-73 year-old) by biochemistry we assessed the values of baseline and catalyzation stimulated oxidation of peroxidated lipids products (LOP) in LDL, concentration of antioxidants in LDL (alpha-tocopherol, beta-carotene, retinol, xantines), concentration of antibodies to oxidized LDL (oxLDL). Then, during 7 years with the use of Registers we assessed endpoints: myocardial infarction, stroke, total and cardiovascular mortality.

Results. The significant associations revealed, of the baseline LDL products content (p=0,019, Hazard Ratio, HR=1,39) and resistance of LDL to oxidation at early stage (p=0,048, HR=1,18) with the stroke cases. Also, the significant relations found of beta-carotene in LDL (p=0,034, HR=0,98) and antibodies concentration against oxLDL (p=0,041, HR=0,99) with cardiovascular mortality cases in 7 year follow-up.

Conclusion. The data represents significant pathogenetic role of atherogenic oxidation-antioxidant changes of LDL in development of cardiovascular diseases and complications.

Russ J Cardiol 2016, 12 (140): 45–48

dx.doi.org/10.15829/1560-4071-2016-12-45-48

Key words: male population, oxidized low density lipoproteides, antioxidants, 7-year long-term results, stroke, cardiovascular mortality.

E. N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk, Russia.

MARKERS OF ACCELERATED CONVERSION OF DIABETES MELLITUS IN VARIOUS CARDIOVASCULAR

RISK PATIENTS

Mamedov M. N., Korneeva M. N.

Abstract

Aim. To assess the early disorders of carbohydrate metabolism and risk of diabetes development (DM) among males with different level of cardiovascular risk (CVR) by SCORE.

Material and methods. Totally, 300 men included, age 40-59 with one or more risk factors. Methods of study included questionnaires, standard clinical, instrumental and laboratory studies. Early disorders of carbohydrate metabolism were defined

with fasting glucose level and in 2 hours after load of 75 g of glucose. CVR was assessed by SCORE. Risk of DM was checked by FINDRISC.

Results. Early disorders of glucose metabolism were found as high fasting glycaemia (HFG), glucose intolerance (GI) and their comorbidity. In 28,3% of men there was HFG, its comorbidity with GI was found only in 12,3%. In the group of men with lower and moderate CVR prediabetes was diagnosed in 21% cases. Among high CVR persons by SCORE the prediabetes was found in 40% cases, and in the group of not very high risk almost in every second had HFG, and concomitance of HFG and GI — 15,2% cases. Among moderate CVR patients — every tenth, with high CVR every third, and in the group with very high CVR — every second had severe risk of DM development by FINDRISC.

Conclusion. Тhence the increase of CVR is associated with foretime increase of DM risk. In the groups of high and very high CVR the HFG was most common, but concomitance of HFG with GI two times less common. The results obtained might be

applied in the development of algorithms of correction of comorbidities in primary healthcare.

Russ J Cardiol 2016, 12 (140): 49–52

dx.doi.org/10.15829/1560-4071-2016-12-49-52

Key words: prediabetes, risk of diabetes, cardiovascular risk.

National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

CLINICAL SIGNIFICANCE OF PROTEIN GROWTH AND INJURY FACTORS IN ACUTE CORONARY SYNDROME

Kayumova G. H.1,2, Razin V. A.2

Abstract

Aim. As fundamentals for current study we layed upon the comparison tasks for concentration of pregnancy associated plasma protein (PAPP-A) and insulin-like growth factor 1 (IGF-1) in blood plasma of patients with acute coronary syndrome (ACS); confirmation of biological role of PAPP-A and IGF-1 as interacting components of intravascular injury and reparation of atherosclerotic plaque; clinical significance of PAPP-A and IGF-1 in ACS patients.

Material and methods. We measured concentrations of PAPP-A and IGF-1 in 71 patient with ACS, mean age 57 year old. The study group had a diagnosed myocardial infarction (MI) in 44 patients, and unstable angina in 27; 9 death cases. Synchronically, we measured PAPP-A and IGF-1 in the control and comparison group. Comparison group consisted of 40 arterial hypertension patients and with stable forms of ischemic heart disease. Controls were 20 almost healthy persons.

Results. The concentrations of PAPP-A and IGF-1 in ACS patients that were different from controls and comparison. In unstable angina patients PAPP-A is higher than in controls 3,56 times, and in MI 11,6 times. PAPP-A in MI is 3,2 times higher than in unstable angina. In unstable angina the highest found levels of IGF-1 are 1,2 times higher than in controls. The lowest IGF-1 were in lethal cases of MI, and were 1,27 lower than in controls.

Conclusion. PAPP-A and IGF-I are new biochemical markers of intravascular injury and reparation of atherosclerotic plaques, and can be applied in urgent cardiology as analyzers of destruction and morphological instability of atherosclerotic plaques in ACS.

Russ J Cardiol 2016, 12 (140): 53–57

dx.doi.org/10.15829/1560-4071-2016-12-53-57

Key words: acute coronary syndrome, myocardial infarction, pregnancy-associated plasma protein A, insulin-like growth factor 1, ischemic heart disease, unstable angina.

1VM-Clinic, multispecialty hospital, Ulyanovsk; 2Ulyanovsk State University, Ulyanovsk, Russia.

OUTPATIENT FOLLOW-UP OF THE LOWER EXTREMITIES ATHEROSCLEROSIS PATIENTS FROM CARDIOLOGIST POINT OF VIEW

Sumin A. N.1, Kosova М. А.2, Medvedeva Yu. D.2, Scheglova А. V.1, Makarov S. А.2, Artamonov G. V.1, Barbarash L. S.1

Abstract

Aim. To study clinical characteristics of patients with lower extremities atherosclerosis form cardiologist point of view.

Material and methods. Totally, 458 patients included (372 (79%) males and 84 (18,4%) females, median age 63 year-old, from 45 to 81) with obliterating atherosclerosis of lower extremities. Patients were examined by cardiologist under the framework of registry at Kemerovo Cardiovascular center, in 2009-2013. For the study, two groups were selected according to Russian classification of chronic lower extremities vessels ischemia (CLEI) stage by Fountain-Pokrovsky: Group 1 (n=196) with CLEI 1-2a stage, Group 2 (n=260) with CLEI 2b-4 stage.

Results. Among patients with obliterating lower extremities arteries diseases there was high prevalence of cardiocerebral pathology: myocardial infarction in anamnesis 34,4%, and clinical signs of angina in 48,5%, stroke anamnesis in 14,3% and

extracranial stenosis of arteries in 12,3%. Also, the prescribed cardiovascular protective therapy was not optimal: statins were being taken by 64,5%, betablockers by 65,6%, ACE inhibitors by 52,4%. There was no difference in the prevalence of cardiovascular pathology and received treatment among groups with various severity of obliteration of arteries.

Conclusion. For an improvement of secondary prevention, it is aim worthy to apply in patients with obliteration diseases of lower extremities the new organizational approaches at outpatient stage.

Russ J Cardiol 2016, 12 (140): 58–63

dx.doi.org/10.15829/1560-4071-2016-12-58-63

Key words: obliteration diseases of lower extremities, atherosclerosis.

1Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo; 2Kemerovo Cardiovasular Dispensary, Kemerovo, Russia.

ANALYSIS OF HEART RATE VARIABILITY AFTER EXERCISE WITH OSCILLATORY POLE

Ogata C. M.1, Abreu L. C.2, Vanderlei F. M.3, Navega M. T.1, Valenti V. E.1,4

Abstract

Aim. To evaluate the acute effects of exercise with oscillatory pole on cardiac autonomic modulation.

Material and methods. The study was performed on 18 young adult males aged between 18 and 25 years old. The subjects remained at rest for 10 minutes, after the rest period, the volunteers performed the exercises with the oscillatory pole. Immediately after the exercise protocol, the volunteers remained seated at rest for 30 minutes. We evaluated the geometric indexes of heart rate variability.

Results. The SD1 index increased 25-30 minutes after exercise compared to rest and the SD2 index decreased 5-10 minutes and 10-15 minutes compared with 15-20 minutes after exercise.

Conclusion. A single session of exercise with oscillatory pole increased the parasympathetic component of heart rate variability and reduced the overall variability of heart rate in the initial 15 minutes after exercise.

Russ J Cardiol 2016, 12 (140): 64–69

dx.doi.org/10.15829/1560-4071-2016-12-64-69

Key words: cardiovascular system, autonomic nervous system, exercise therapy, heart rate, oscillatory pole, young.

1Centro de Estudos do Sistema Nervoso Autônomo (CESNA), Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP Presidente Prudente, SP, Brasil; 2Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Santo André, SP, Brazil; 3Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP, Presidente Prudente, SP, Brazil; 4Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP, Presidente Prudente, SP, Brazil.

Corresponding author. Vitor E. Valenti. Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP, Rua Roberto Simonsen, 305 CEP 19060-900. Presidente Prudente, SP, Brazil. Marília, SP, Phone: +55 (18) 3221-4391.

E-mail: vitor.valenti@marilia.unesp.br

Received September 27, 2016

Revision received October 10, 2016

Accepted October 17, 2016

EXPERIMENTAL STUDY

FIRST TIME EXPERIMENTAL IMPLANTING OF LOCALLY DEVELOPED LEFT ATRIUM OCCLUDERS

Akhmedov S h. D.1, Batalov R. Е.1, Andreev S. L.1, Lugovsky V. А.1, Afanasiev S. А.1, Rebrova T . Yu.1, Vaizov V. Kh.1,
Rogovskaya Yu. V.1, Lotkov
А. I.2, Kudryashov А. N.3, Popov S. V.1

Abstract

Aim. To develop and preclinically test an occluder of the left atrium appendage (LAA) in experiment on big animals, as prevention treatment of ischemic strokes.

Material and methods. The study was done on the pigs “big white” breed, n=7, mass 98±4 kg. The locally Russian-made device and placement equipment were used. The length of occluder itself, packed, is 48 mm, opened — 28-32 mm and diameter 31-35 mm. The occluder was placed into LAA via puncture of femoral vein and interatrial septum under x-ray and ulltrasound control. After implanting of the occluder, during 16 weeks the behavior and appetite of animals were controlled. In prospective study the blood was collected for inflammatory response control, and ultrasound examination of the heart. Controls were 3 swings. In 16 weeks the animals were withdrawn from experiment for morpho-functional investigation of the heart. For cytotoxicity study, histology was done of limphatic nodes, liver and kidneys.

Results. By ultrasound imaging it was shown that occluder placement did not significantly influence hemodynamics of animals. Blood tests showed nonsignificant changes during the first weeks after surgery, with normalized values in 12 weeks. Autopsy and microscopy did not show significant inflammatory and degenerative changes in the heart, as in internal organs. There was satisfactory “ingrowth” of the occluder with smooth plain surface of endocardium from the side of the left atrium.

Conclusion. The experience of occluder preclinical test showed its construction and functional effectiveness for the aim of further usage in patients with high risk of cardioembolic strokes due to LAA thrombosis. The procedure of occluder implanting is simple if the personnel is skilled enough and there is proper equipment.

Russ J Cardiol 2016, 12 (140): 70–74

dx.doi.org/10.15829/1560-4071-2016-12-70-74

Key words: occluder, thromboembolism, umbrella device, cardiology, experiment.

1RI Cardiology, Tomsk; 2Institute of Physics of Strength and Material Science, Tomsk; 3JSC “Angioline”, Novosibirsk, Russia.

CLINIC AND PHARMACOTHERAPY

CARDIOVASCULAR COMPLICATIONS RISK AND VASCULAR AGE DYNAMICS IN LONG-TERM TREATMENT

OF ARTERIAL HYPERTENSION

Logacheva I. V.1, Baranova S. P.2, Safronova V. V.2, Ryazanova Т. А.1, Zajtsev D. S.2, Timonin D. V.2

Abstract

Aim. To evaluate the possibility for the novel scores implementation in everyday management by perindopril/amlodipine in arterial hypertension patients of high and very high risk.

Material and methods. Totally, 30 patients included, with AH of high and very high risk (12 males, 18 females) at the age 57,7±9,3 y. o., who, after the in-patient management of non-controlled AH by fixed combination of perindopril/amlodipine doses 10/5, 5/10, 10/10 mg, respectively, were treated and followed up for the next 2 years (with additional control in 1 year). During this period there was control of BP dynamics, intervisit variability of SBP/DBP, adherence to treatment, some of hemodynamics values (by EchoCG), lipids, creatinin and glucose of blood. Based on the proposed new expert systems (ASCORE scale, “vascular age” assessment scale) a clinician evaluated the dynamics of individual risk of cardiovascular complications and the “vascular age”.

Results. The outpatients had stage III AH, of those grade 2 AH was diagnosed in 26,7%, and grade 3 in 73,3%. In one year of treatment by perindopril/amlodipine in office visit the level of SBP/DBP was 162,8±7,7/91,5±2,4 mmHg; adherence to treatment — 63,4%. During the second year patients adhered to clinicians recommendation, with the target BP levels achieved (adherence 83,4%). There was significant decrease of intervisit variability of SBP (with the baseline 11,6±1,4 mmHg at in-patient and to 4,3±0,2 mmHg in 2 years of outpatient treatment; p<0,001). Lipid spectrum values and glucose decreased significantly. Probability of 5-year risk of cardiovascular complications (CVC) decreased from 16,1±1,1% (in-patient) to 9,2±2,0% (p<0,01) and 4,4±0,7% (p<0,01) in 1 and 2 years, respectively. The “vascular age” during admittance was 14,4 years higher than real (passport), and in

2 years the values of passport age and VS overlapped (p<0,01).

Conclusion. In real-practice circumstances we tested new European expert systems: 5-year risk score for cardiovascular events, and assessment of “vascular age” by SCORE, which demonstrated the probability of CVC risk decline and confirmed the concept of “vascular age” decrease under influence of effective antihypertension therapy. The fixed combination of perindopril/amlodipine, used during two years, showed clinical effectiveness in former non-controlled patients with AH, decreased the intervisit variability of BP, decreased individual risk of CVC and increased adherence to treatment.

Russ J Cardiol 2016, 12 (140): 75–83

dx.doi.org/10.15829/1560-4071-2016-12-75–83

Key words: perindopril/amlodipine, cardiovascular complications, vascular age.

1Izhevsk State Medical Academy, Izhevsk; 2Republic Clinical-Diagnostics Center of the Ministry of Health, Izhevsk, Russia.

CLINICAL EFFECTIVENESS OF THE MODIFIED RELEASE TRIMETAZIDINE IN MICROVASCULAR ANGINA

Galin P. Yu., Gubanova T. G.

Abstract

Aim. Assessment of clinical effectiveness of trimetazidine MR (Preductal MR®, Les Laboratoires Servier) in patients with microvascular angina.

Material and methods. Totally, 50 patients studied (mean age 55,16±3,82 y. o.) with microvascular angina primary (n=36) and secondary, related to arterial hypertension (n=14) and with remaining angina presentation of II-III FC at background of antianginal treatment of hemodynamic action. All patients, in addition to the performed treatment, were assigned with trimetazidine MR (TMR) with monthly control of antianginal efficacy during 6 months follow-up.

Results. The treatment led to significant decline of angina attacks from 21,24±12,57 to 5,44±3,11 (p<0,01) and dosages of short-acting nitrates from 18,08±13,87 to 2,86±2,66 (p<0,01) per month. So, the significant decrease in antianginal attacks was marked after one month of therapy and showed the raising effect by the 6th month of treatment. The effectivenes of TMR did not depend upon the condition of coronary arteries, gender, microvascular angina in more rapid reach of clinical effect in patients with the right type of myocardium circulation.

Conclusion. Introduction of Preductal MR® to the complex treatment of patients with microvascular angina does effectively control angina symptoms.

Russ J Cardiol 2016, 12 (140): 84–89

dx.doi.org/10.15829/1560-4071-2016-12-84-89

Key words: microvascular angina, antiischemic therapy, trimetazidine MR.

Orenburg State Medical University (OrSMU), Orenburg, Russia.

HYPOLIPIDEMIC AND PLEIOTROPIC EFFICACY OF ROSUVASTATIN IN ARTERIAL HYPERTENSION PATIENTS OF HIGH CARDIOVASCULAR RISK IN LONG-TERM OUTPATIENT FOLLOW-UP

Mikhin V.P.1, Zhilyaeva Yu.А.1, Vorotyntseva V.V.2, Nebieridze D.V.3, Akhmedzhanov N.М .3, Vasil’eva D.А.1, Chernyatina М.А.1, Gromnatsky N.I.1

Abstract

Aim. To evaluate the pleiotropical and hypolipidepmic efficacy of generic rosuvastatin (Rosucard) comparing with atorvastatin in arterial hypertension patients (AH) with high and very high cardiovascular risk (CVR) during the long-term usage in outpatient circumstances.

Material and methods. Totally, 114 patients studied (age 58,2±3,11 y. o.) with AH of II-III grades and with high or very high CVR by SCORE, taking antihypertension treatment with metoprolol, indapaminde, enalapril in effective dosages, who, during the previous 1 year of atorvastatin treatment (20 mg/day) did not reach the target level of cholesterol. Atorvastatin was replaced by rosuvastatin 10 mg/day for 1,5 year. If the mentioned dosage did not reach cholesterol and low-density lipoproteides (CLDL) to target levels by 6 weeks, dosage was increased to 20 mg/day, and then if again not achieved during next 6 weeks, to 40 mg/day.

Results. Introduction of rosuvastatin to the complex treatment was followed by further decrease of atherogenic lipids: cholesterol by 24%, CLDL by 53% and was followed with the decrease of vessel wall stiffness — decreased CAVI by 12%, augmentation index by 17%, improvement of the vasodilation endothelium function by 24%.

Conclusion. Rosucard has, together with hypolipidemic properties, the pleiotropic properties more prominent than in atorvastatin, that makes it to apply the drug in AH patients with high and very high CVR for prevention of cardiovascular complications

in outpatient practice.

Russ J Cardiol 2016, 12 (140): 90–96

dx.doi.org/10.15829/1560-4071-2016-12-90-96

Key words: atherosclerosis, hypercholesterolemia, statins, rosuvastatin, endothelial dysfunction, vessel wall stiffness, cardiovascular risk.

1Kursk State Medical University of the Ministry of Health, Kursk; 2Kursk City Clinical Hospital of Emergent Care, Kursk; 3National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

OPINION ON A PROBLEM

Management of patient with arterial fibrillation : what `s new?

Napalkov D . A., Sokolova A. A.

Abstract

The literary review consists of two parts. The first takes into consideration the renewed European guidelines of 2016 for atrial fibrillation patients management. The accent is made on the renewed approaches for anticoagulation treatment regardless the gender, on new points in the risks of haemorrhagic complications, renewed schemes of double and triple antithrombotic therapy after the percutaneous intervention and/or acute coronary syndrome and approaches for the restarting of anticoagulation after ischemic stroke. The second part focuses on the real clinical practice including three latest publications, which consider the safety of warfarin, dabigatran and rivaroxaban in patients with atrial fibrillation of non-valvular aetiology by the data from insurance companies. Based on the data provided, there is a conclusion on the benefit of dabigatran for more safety in all recommended

dosages.

Russ J Cardiol 2016, 12 (140): 97–102

dx.doi.org/10.15829/1560-4071-2016-12-97-102

Key words: atrial fibrillation, new oral anticoagulants, dabigatran, rivaroxaban, warfarin, real clinical practice, clinical guidelines.

I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.

COMBINATION OF ACE INHIBITOR WITH AGONIST OF I1-IMIDAZOLINE RECEPTORS: NEW OPPORTUNITIES FOR ANTIHYPERTENSIVE THERAPY

Nedogoda S. V.

Abstract

The number of patients with metabolic syndrome and obesity is continuously increasing. Specifics of arterial hypertension in obesity is related to activation of renin-angiotensin-aldosterone system and sympathetic system, inflammation, early and prominent target organs damage, which is significant to be considered in rational antihypertensive therapy. Also, combination treatment should positively influence the bodyweight of a patient, improve insuline sensitivity of the tissues and metabolic profile (carbohydrate and lipid metabolism). One of the solutions for this is prescription of combination treatment by perindopril and moxonidine, which is synergetic for the target level of blood pressure achievement, protection of organs, suppression of sympathic system and insulin resistance.

Russ J Cardiol 2016, 12 (140): 103–108

dx.doi.org/10.15829/1560-4071-2016-12-103-108

Key words: arterial hypertension, metabolic syndrome, insulin resistance, perindopril, moxonidine.

Volgograd State Medical University, Volgograd, Russia.

LITERATURE REVIEW

THE ALTERNATIVE TOOLS FOR PREDICTION OF CARDIOVASCULAR RISK IN OBESITY: FOCUS ON ARTERIAL STIFFNESS

Druzhilov М. А.1, Druzhilova О. Yu.1, Otmakhov V. V.1, Kuznetsova Т. Yu.2

Abstract

The raise in prevalence of obesity makes it an actual medical and social problem and one of the main factors of cardiovascular risk. In addition, not always the assessment of obesity based on body mass index and additional criteria by visceral fat tissue, means higher risk itself. The issue of “reverse epidemiology” of obesity raises the need for new pathological models of higher cardiovascular risk. The article is focused on review of literary data and on original data where arterial stiffness parameters are regarded as criteria for risk stratification in obesity patients.

Russ J Cardiol 2016, 12 (140): 109–114

dx.doi.org/10.15829/1560-4071-2016-12-109-114

Key words: obesity, cardiovascular risk, arterial stiffness, pulse wave velocity.

1Medical-Sanitary Institution of FSS in Karelia Republic, Petrozavodsk; 2Petrozavodsk State University, Petrozavodsk, Russia.

INFORMATION

Russian Journal of Cardiology: contents for 2016

Russ J Cardiol 2016, 12 (140): 115-122

26 декабря 2016 г.
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