Инструкции:

Russian Journal Of Cardiology, 2017, 1 (141)

Статьи

Русскоязычная версия

Address to the readers

Russ J Cardiol 2017, 1 (141): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 1 (141): 6

CLINICAL GUIDELINES

2016 ESC GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF ACUTE AND CHRONIC HEART FAILURE

The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)
Developed with the special contribution of the Heart Failure Association (HFA) of the ESC

Russ J Cardiol 2017, 1 (141): 7–81

dx.doi.org/10.15829/1560-4071-2017-1-7-81

Key words: Guidelines, Heart failure, Natriuretic peptides, Ejection fraction, Diagnosis, Pharmacotherapy, Neuro-hormonal antagonists, Cardiac resynchronization therapy, Mechanical circulatory support, Transplantation, Arrhythmias, Co-morbidities,

Hospitalization, Multidisciplinary management.

ORIGINAL ARTICLES

ANTIPLATELET TREATMENT IN ST ELEVATION ACUTE CORONARY SYNDROME UNDER REAL CLINICAL CIRCUMSTANCES: THE DYNAMICS OF THROMBOCYTE FUNCTION

Malinova L. I., Furman N. V., Dolotovskaya P. V., Puchinian N. F., Radaeva I.Yu.

Abstract

Aim. To evaluate the dynamics of thrombocyte functional activity (TFA) under antiplatelet treatment conditions which include the branded, and generic compounds as well, in ST elevation acute coronary syndrome patients (STEACS) in routine clinical practice.

Material and methods. The open-label prospective study was done, including STEACS patients stratified according to the kind of antiplatelet in-patient treatment (original and/or generics). As an endpoint, we used the surrogate — functional activity of thrombocytes (TFA), measured by impedance and luminescent aggregatometry at 1 and 7 day from STEACS onset.

Results. By the inclusion, baseline point all patients were comparable by TFA. On double antiplatelet therapy (DAT) by the 7th day of STEACS there was statistically significant difference of all ADP-induced thrombocyte aggregation. There was difference in ADP-induced platelet aggregation depending on the DAT variant, which included the original drug and generic.

Conclusion. In STEACS patients the level of aggregation activity of platelets does significantly differ from the kind of antiplatelet treatment. Usage of the branded and generic compounds of the came antiplatelet agent by the same regimen does differ by different grade and dynamics of platelets activeness suppression.

Russ J Cardiol 2017, 1 (141): 82–88

dx.doi.org/10.15829/1560-4071-2017-1-82-88

Key words: ST elevation acute coronary syndrome, antiplatelet treatment, functional activeness of platelets, generics, original compound.

SRI of Cardiology of the V. I . Razumovskiy Research Institute of Cardiology of Saratov Medical University, Saratov, Russia.

MANAGEMENT AND OUTCOMES IN ACUTE CORONARY SYNDROME WITH ATRIAL FIBRILLATION IN “NON-INVASIVE” CLINIC

Erlikh A. D., Tkachenko K. G., Gratsiansky N. A.

Abstract

Aim. To evaluate the management and outcomes in acute coronary syndrome patients (ACS) comorbid with atrial fibrillation (AF) during in-patient period and in 12 months from ACS onset.

Material and methods. Into multicenter prospective registry (CCH № 29 of Moscow), beginning December 2013, during 12 months, all consecutive patients included, with ACS, and AF on baseline ECG. Follow-up was continued during hospitalization and in 12 months from ACS (phone call).

Results. Totally, 234 patients included. Mean age 72,0±11,6 y. o., 65+73,5%, females — 68,8%, anamnesis of myocardial infarction (MI) — 35,9%, diabetes — 23,9%, known AF before ACS — 65,0%, non-ST-elevation ACS — 97,9%, Killip >I — 7,3%, ST depression on baseline ECG — 89,9%, high troponin level — 59,0%, GRACE risk of fatal outcome >140 points. — 75,2%, median CHA2DS2-Vasc — 5 pts. At discharge from hospital, 44% patients received double antiplatelet treatment (DAT), 38% — aspirin with oral anticoagulant (OAC), 33% — warfarin, 23% — new OAC (NOAC). During hospitalization (median 14 days) 7 patients died (3,0%). In 12 months the outcomes were followed in 210 patients (89,8%). By 12 months from ACS onset, 18,1% patients died, and in 12 months but after discharge — 15,3%. New MI after discharge had 1,5%, stroke — 2,5%, and bleeding — 3,5% patients. The part of fatal outcomes in 12 months did not differ in DAT or aspirin with OAC groups (12,1% vs 12,8%; p=0,88). The “remained” prescription rate (i. e. adherence) in 12 months after ACS was maximum for aspirin, OAC and NOAC (71%, 58%, 63%, resp.) and minimum for DAT and aspirin with OAC (20% and 27%, resp.). The independent predictors of death after discharge from hospital up to 12 months from ACS onset were the baseline hemoglobin <110 g/L (OR 16,00; 95% CI 2,57-99,50; р=0,003), non-treatment by antithrombotics before ACS (OR 7,22; 95% CI 2,20- 23,68; р=0,001), hospital risk by GRACE >140 pts. (OR 6,88; 95% CI 1,44-32,80; р=0,015) and non-prescription of aspirin in discharge (OR 3,21; 95% CI 1,20-8,61; р=0,02).

Conclusion. The results of observational study of ACS and AF patients, admitted to Moscow city “non-invasive” clinic, showed high rate of fatal outcomes in 12 months after ACS (18,1%), low adherence to the prescribed treatment after discharge. Also, in the group studied, there were predictors of fatal outcomes in 12 months after ACS.

Russ J Cardiol 2017, 1 (141): 89–94

dx.doi.org/10.15829/1560-4071-2017-1-89-94

Key words: acute coronary syndrome, atrial fibrillation, registry, treatment, outcomes.

FSCC of Physical-Chemical Medicine of FMBA of Russia, Moscow, Russia.

GALECTIN-3 AND NT-proBNP AS BIOMARKERS OF HEART FAILURE DECOMPENSATION

Duboglazova Yu. V., Drapkina O. M.

Abstract

Aim. To compare the levels of galectin-3 and N-terminal brain natriuretic peptide precursor (NT-proBNP) in heart failure patients with saved ejection fraction of the left ventricle (HF-sEF) and heart failure with low ejection fraction (HF-lEF). To study the possibilities for implementation of galectin-3 and NT-proBNP as markers of HF decompensation in HF-sEF

Material and methods. Totally, 30 patients with HF-sEF included (17 females, 13 males, mean age 65±8 y. o.) and 30 patients with HF-lEF (11 females, 19 males, mean age 63±11 y. o.). All patients underwent physical examination, 6-minute walking test, clinical condition assessment by clinical condition score (CCS), echocardiography (Echo), tissue doppler imaging, measurement of galectin-3 and NT-proBNP levels at admission.

Results. The difference of mean levels of NT-proBNP in HF-sEF and HF-lEF did not differ significantly (153,23±114,44 fM/ml and 142,45±90,82 fM/ml, resp., t=0,4, p=0,68). A direct correlation was found for HF clinics in both groups (r=0,46, p<0,05, 95% CI). In HF-sEF the negative correlation was found for the mean level of NT-proBNP and 6-minute walking test results by CCS, direct correlation between clinical condition of patients by CCS (r=0,048, p=0,02, 95% CI), direct correlation of clinical presentation and real systolic pressure in in pulmonary artery (r=0,4, p=0,03, 95% CI); negative correlation of the mean NT-proBNP and peak A velocity (r=-0,52, p=0,003, 95% CI). Mean level of galectin-3 in blood plasma in HF-sEF (0,98±1,93 hg/mL) is significantly higher than in HF-lEF (0,13±0,07 ng/mL) (t=2,41, p=0,01). There was no relation found for the main clinical presentation of HF and galectin-3 level in HF patients. In both groups there was no relation between the mean galectin-3 level and 6-minute test, and clinical condition by CCS. There was positive relation of ejection fraction of the left ventricle by Echo and mean level of galectin-3 (r=0,45, p=0,012, 95% CI).

Conclusion. The level of NT-proBNP does not differ in HF-sEF and HF-lEF patients and is related to the severity of CHF. Therefore, NT-proBNP might be used as a marker of CHF decompensation. Level of galecton-3 is significantly higher in HFsEF patients and does not relate on severity of CHF. Both markers can be used for diagnostics of CHF patients and to reveal HF-sEF before Echo is done.

Russ J Cardiol 2017, 1 (141): 95–101

dx.doi.org/10.15829/1560-4071-2017-1-95-101

Key words: heart failure with normal ejection fraction, NT-proBNP, galectin-3, biomarkers of heart failure.

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

LIFE QUALITY IN ONE YEAR AFTER MYOCARDIAL INFARCTION WITH INCOMPLETE REVASCULARI ZATION

Semiokhina A. S.1, Taratukhin Е. О.1, Bayandin N. L.2, Gordeev I. G.1, Vechorko V. I.2

Abstract

Aim. Life quality is an integral parameter of medical care efficacy. In incomplete revascularization after myocardial infarction the quality of life might change in relevance with the severity of residual lesion. The study is done with an aim to reveal the specifics of patients life quality in such clinical situation.

Material and methods. The investigation of 100 patients is done (mean age 63±0,9 y. o.) with acute ST-elevation myocardial infarction and incomplete revascularization, of those 20 underwent delayed surgery (percutaneous or bypass) — group 1; 54 had no further surgery (group 2); and 26 did not have primary revascularization — group 3. Life quality was assessed with the Medical Outcomes SF-36. The test was performed in 12 months after index event.

Results. Life quality of group 1 patients changes significantly after revascularization towards improvement of physical and psychological health components. Life quality parameters in the group 1 remain high, about a “full” health. In group 2 and 3

patients there is restriction of social contacts, decrease of communicating due to worse physical and emotional conditions.

Conclusion. After delayed revascularization, comparing to its absence or intervention only on infarct-related artery, the parameters of life quality post-MI are significantly better.

Russ J Cardiol 2017, 1 (141): 102–105

dx.doi.org/10.15829/1560-4071-2017-1-102-105

Key words: psychosomatics, life quality, myocardial infarction, patient-centered medicine, revascularization.

1N.I. Pirogov Russian National Research Medical University (RNRMU), Moscow; 2O.M. Filatov City Clinical Hospital 15, Moscow, Russia.

HIGH PREVALENCE OF ANXIETY AND 15-YEAR CARDIOVASCULAR RISK IN RUSSIA/SIBERIA INHABITANTS (WHO FRAMEWORK “MONICA-PSYCHOSOCIAL”)

Gafarov V. V.1,2, Gromova Е. А.1,2, Panov D. О.1,2, Gagulin I . V.1,2, Gafarova A. V.1,2

Abstract

Aim. To assess the influence of high level of personal anxiety (PA) on the differences in hazard ratios of myocardial infarction development and stroke in men and women in open population of Russia/Siberia.

Material and methods. Under the 3rd screening of WHO program “MONICApsychosocial” we investigated random representative selection of inhabitants of Novosibirsk city, age 25-64 year old, in the year 1994 (males n=657, females n=870). The program included registration of social and demographic data, personal anxiety assessment. During 16 years of follow-up novel cases number of myocardial infarction (MI) and strokes reached 15 cases in women 15 and 35; in men 30 and 22, respectively. Statistics was done with SPSS. Criteria χ2 was applied for hazard ratio (HR) calculation — Cox-regression. Significance of all analysis types was set with threshold at p≤0,05.

Results. In the open population of 25-64 y. o. PA was assessed in 59,9% of women and 50,9% of men. In monofactory Cox model in 16 years the HR of MI among persons with high PA was higher in women than in men (HR =4,19 and HR =3,7, resp.), and for stroke, reverse, in men higher than in women (HR =4,43 and HR =3,5, resp.). In multifactor Cox model, in persons 55-64 y. o. the influence of high PA on MI risk remained, which was higher in women than in men (HR =5,95, HR = 3,56, resp.). The highest HR for stroke, in high PA, was in divorced (HR =5,017) and widowed men (HR =3,848), at the age 55-64 y. o. (HR =5,8). Among women, there were no such correlations.

Conclusion. The prevalence of high PA among inhabitants was 50% higher in women, than in men. Risk of MI development during 16-year timeline was higher in women, and of stroke — in men.

Russ J Cardiol 2017, 1 (141): 106–113

dx.doi.org/10.15829/1560-4071-2017-1-106-113

Key words: risk, difference, high anxiety level, inhabitants, myocardial infarction, stroke.

1Scientific-Research Institute of Therapy and Prevention Medicine, Novosibirsk; 2Interdepartmental laboratory of epidemiology, Novosibirsk, Russia.

CLINIC AND PHARMACOTHERAPY

FIRST EXPERIENCE OF BOSENTAN IN COMPLEX MANAGEMENT OF A CHILD WITH VENA GALENI ANEURYSM

Trunina I. I.1,2, Sharykin А. S .1,2, Livshits М. I .3, Lavrova Т. R.1, Osmanov I. M.1

Abstract

During postnatal period, the causes of progressing heart failure are not only the inborn defects or cardiac rhythm disorders, but extracardiac diseases as well. Among such pathologies are the arterial-venous malformations of the brain vessels, including vena Galeni aneurysm. Inside the aneurysmatic sacks of the brain vessels, up to 80% of blood ejected from the left ventricle could be shunted, which leads then through the right chambers and causes heart failure and pulmonary hypertension. Recent drug treatment makes it to effectively treat pulmonary hypertension, compensate the signs of heart failure and stabilize the condition of a newborn before surgery. The case presented, is a bright evidence of this.

Russ J Cardiol 2017, 1 (141): 114–120

dx.doi.org/10.15829/1560-4071-2017-1-114-120

Key words: vena Galeni aneurysm, newborns, heart failure.

1Bashlyaeva Z. A. Pediatric City Clinical Hospital, Moscow; 2N. I . Pirogov Russian National Research Medical University (RNRMU), Moscow; 3Morozov Pediatric City Clinical Hospital, Moscow, Russia.

MARKERS OF ELECTRICAL INSTABILITY IN ASSESSMENT OF CORONARY REPERFUSION IN ST ELEVATION MYOCARDIAL INFARCTION

Oleynikov V. E .1, Duchina Е. V.1, Guskova Yu. А.1, Moiseeva I . Ya.1, Kulyutsin А. V.2

Abstract

Aim. Assessment of the reperfusion arrhythmias, parameters of myocardial electrical instability in patients at first day of ST elevation myocardial infarction (STEMI) after pharmacoinvasive reperfusion, and analysis of the arrhythmias according to the timing of revascularization and localization of infarction.

Material and methods. Totally, 130 patients studied, at the 1st day of STEMI, after pharmacoinvasive reperfusion. Patients underwent 24-hour telemetric registration of ECG in 12 leads with the complex “Astrocard-Telemetry” (ZAO “Meditek”, Russia).

The analysis of ventricular arrhythmias was done, of the heart rhythm turbulence (HRT), of delayed ventricular potentials (DVP), dispersion, standard deviation of dispersion and duration of QT by the end of T wave and by its peak.

Results. The more benign absolute values of independent turbulence onset (TO ) are revealed (p<0,001) and turbulence slope (TS) (p<0,05), as lower number of patients with pathological HRT in the group of inferior STEMI. Among patients after anterior STEMI there was more often DVP (p<0,05), as higher values of QTе disp, QTa disp, sd QTе, sd QТa (р<0,001). It is found that delayed revascularization is associated with worse TO values (p<0,05) and TS (p<0,001). A tendency revealed towards the increase of Qte by all time intervals (p<0,05) in patients with earlier performed reperfusion.

Conclusion. Delayed restoring of coronary flow makes it to register pathological HRT which represents the disordered vegetative regulation of cardiac function and points on electrical heterogeneity of myocardium. Anterior STEMI due to its size determines the disorders of electrical processes in cardiac muscle, which presents itself as DVP, adverse DVP values and increase of QTe disp, QTa disp, sd QTе and sd QТa.

Russ J Cardiol 2017, 1 (141): 121–127

dx.doi.org/10.15829/1560-4071-2017-1-121-127

Key words: delayed ventricular potentials, heart rate turbulence, QT interval, myocardial infarction, ventricular extrasystoly.

1Penza State University, Medical Institute, Penza; 2N.N.Burdenko Penza Regonal Clinical Hospital, Penza, Russia.

POSSIBILITIES OF ANXIETY-DEPRESSIVE DISORDERS TREATMENT IN PATIENTS WITH CHRONIC HEART FAILURE

Baranov A. P.1, Strutynskiy A. V.1, Oynotkinova O . Sh.1, Baranova A. A.1, Trishina V. V.1, Golubev Yu. Yu.1, Kruzhalov A. N.2

Abstract

Aim. To study the efficacy and safety of D-, L-gopantenic acid/Pantogam active in the complex treatment of congestive heart failure and coronary heart disease in patients with symptoms of anxiety-depressive disorder. Patients and methods. 82 patients with NYHA II-II heart failure, anxiety and depression were enrolled in the study.

Material and methods. The severity of psychological disorders and the efficacy of 8-week therapy with Pantogam active were assessed using Hamilton Depression Rating Scale (HDRS), Hospital Anxiety and Depression Scale (HADS), State Trait Anxiety Index (STAI), and Clinical Global Impression (CGI) Scale. The quality of life was evaluated using the Short Form 36 (SF-36) Health Survey. Global improvement or change of psychological symptoms by CGI Scale were considered as efficacy criteria. Standard diagnostic tools, i. e., echocardiography and 24-hour Holter monitoring, were applied as well.

Results. 8-week treatment with Pantogam active of patients with heart failure and depression greatly reduces the severity of anxiety-depressive disorders, improves physical activity tolerance and vegetative regulation of heart rhythm, and decreases heart rate in supraventricular and ventricular arrhythmias.

Conclusions. In heart failure patients, anxiety-depressive disorders are accompanied by significant disturbances of heart rhythm vegetative regulation, development of supraventricular and ventricular arrhythmias, physical activity intolerance, increased hospital admission rate, and decreased quality of life. 8-week treatment with Pantogam active due to its bimodal action significantly improves these symptoms and the quality of life.

Russ J Cardiol 2017, 1 (141): 128–135

dx.doi.org/10.15829/1560-4071-2017-1-128-135

Key words: anxiety, depression, heart failure, Pantogam active, heart rate variability.

For citation: Baranov A. P., Strutynskiy A. V., Oynotkinova O . S h. et al. Possibilities of anxiety-depressive disorders treatment in patients with chronic heart failure // RMJ. Cardiology. 2016. № 9. P. 572-578.

1N. I. Pirogov Russian National Research Medical University, Moscow; 2City Clinical Hospital No. 68, Moscow, Russia.

LITERATURE REVIEW

CARDIORENAL SYNDROME IN CHRONIC HEART FAILURE: PATHOGENESIS, DIAGNOSTICS, PROGNOSIS AND OPPORTUNITIES FOR TREATMENT

Medvedeva E . A.1, Shilyaeva N . V.2, Iskhakov E . N .2, Schukin Yu. V.2

Abstract

The review focuses on cardiorenal syndrome developing in patients with chronic heart failure. The specifics of pathogenesis is discussed, as diagnostics and prognosis, with emphasis on the opportunities of modern biomarker strategy. The complicated cardiorenal issues are discussed and perspectives of their further exploration for treatment tactics in cohort of heart failure patients.

Russ J Cardiol 2017, 1 (141): 136–141

dx.doi.org/10.15829/1560-4071-2017-1-136-141

Key words: cardiorenal syndrome, heart failure, renal dysfunction, biomarkers.

1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia; 2Samara State Medical University of the Ministry of Health, Samara, Russia.

27 января 2017 г.

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