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Russian Journal Of Cardiology, 2017, 7 (147)

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Русскоязычная версия

Address to the readers

Russ J Cardiol 2017, 7 (147): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 7 (147): 6

CLINICAL GUIDELINES

2016 ESC GUIDELINES FOR THE MANAGEMENT OF ATRIAL FIBRILLATION DEVELOPED IN COLLABORATION WITH EACTS

The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC)

Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC

Endorsed by the European Stroke Organisation (ESO)

Russ J Cardiol 2017, 7 (147): 7–86

dx.doi.org/10.15829/1560-4071-2017-7-7-86

Key words: Guidelines, Atrial fibrillation, Anticoagulation, Vitamin K antagonists, Non-vitamin K antagonist oral anticoagulants, Left atrial appendage occlusion, Rate control, Cardioversion, Rhythm control, Antiarrhythmic drugs, Upstream therapy, Catheter ablation, AF surgery, Valve repair, Pulmonary vein isolation, Left atrial ablation.

ORIGINAL ARTICLES

RIGHT VENTRICLE MYOCARDIUM CONTRACTILITY AS PARAMETER OF CARDIAC RESYNCHRONIZATION

EFFICACY

Lebedev D. I., Krivolapov S. N., Zavadovsky K. V., Sazonova S. I., Karpov R. S., Popov S. V.

Abstract

Aim. To evaluate the significance of the right ventricle (RV) myocardium contractility in assessment of cardiac resynchronization therapy (CRT).

Material and methods. Totally, 80 patients included, with dilation cardiomyopathy (49 males, 31 females), mean age 54±10,5 y. o.), heart failure (HF) of III functional class (FC) by NYHA, ejection fraction (EF) of the left ventricle (LV) was 30,1±3,8%,
6-minute walking distance — 290,5±64,3 m, end-diastolic volume (EDV) — 220,7±50,9 mL. Stable sinus rhythm was found in 45 patients, and chronic medication resistant atrial fibrillation — in 35. In patients, the disorders of intraventricular conduction were found as the His left bundle branch block with QRS width from 146 ms to 240 ms (183±32 ms). Implanting of the resynchronization device was done by standard method for biventricular electrocardiostimulation. Permanent atrial fibrillation patients, as 2nd step, underwent complete atrioventricular block formation. In all patients, by radionuclide equal tomoventriculography, the contractility was studied, of the left and right ventricle myocardium, before CRT and 12 moths post-procedure.

Results. Control study was conducted in 1 year; positive clinical dynamics was noticed: FC of HF decreased from III to II. Clinical responders were 69 patients (86,25%), did not respond 11 (13,75%). As the criteria of the “respond” on CRT we used increased 15% and more EF during 12 months. Among the responders, there was positive clinical dynamics: EF of LV increased from 30,1±3,8% to 42,8±4,8% (p≤0,001), LV EDV decreased from 220,7±50,9 to 197,9±47,8 mL (p≤0,005), in nonresponders EF LV remained almost unchanged: from 30,1±3,8% to 33,8±3,8% (p≤0,001), and EDV of LV increased: 220,7±50,9 to 227,8±27,8 mL (p≤0,001). All participants were retrospectively selected into 2 groups: responders and nonresponders on CRT. Radionuclide tomoventriculography was used for the changes for 12 months of LV and RV contractility investigation. Maximum filling rate and the mean filling velocity during 1/3 of diastole were significantly worse in the 2nd group patients, by 30% and 60%, respectively. Other parameters in the groups did not differ significantly.

Conclusion. Hence, the data points on the relation of RV contractility improvement by CRT with positive cardiac resynchronization, together with the improvement of the LV contractility. Resynchronization in severe chronic HF patients, with saved contractility of the right chambers, is more effective, and higher scintigraphical values of maximum filling rate and the mean filling velocity during 1/3 of diastole might be prognosis criteria of positive response on CRT.

Russ J Cardiol 2017, 7 (147): 87–92

dx.doi.org/10.15829/1560-4071-2017-7-87-92

Key words: non-ischemic cardiomyopathy, cardiac resynchronization therapy, severe heart failure, right ventricle.

Tomsk National Research Medical Center of the Russian Academy of Sciences, Scientific-Research Institute of Cardiology, Tomsk, Russia.

RELATION OF THE LATE ACTIVATION ZONE WITH THE LEFT VENTRICLE MYOCARIDUM CHANGES IN CANDIDATES FOR RESYNCHRONIZING THERAPY

Zubarev S.V., Chmelevsky M.P., Budanova M.A., Ryzhkov A.V., Trukshina M.A., Lebedeva V.K., Sitnikova M.Yu., Lebedev D.S.

Abstract

Aim. By non-invasive methods, to assess relations of the zone of late electrical activation with changes in the left ventricle (LV) myocardium structure in patients — candidates for cardiac resynchronizing therapy.

Material and methods. Totally, 37 patients included, with III functional class of chronic heart failure (CHF). In all patients, there was complete His left bundle branch block (LBBB) with QRS width 205 (190; 215) ms. Non-invasive electrophysiological charting (NEC) was done with the “Amycard 01C EP LAB” (EP Solutions SA, Switzerland), and magnetic-resonance imaging (MRI). At the first step, multichannel electrocardiography (ECG) was done. At the second step, MRI was done (MAGNETOM Trio A Tim 3 T, Siemens AG, Germany) with intravenous contrast “Gadovist” load. Changes in LV myocardium structure (post-inflammatory fibrosis or scar tissue) were evaluated by segments, within the delayed MRI contrasting. At the third stage, individual models of ventricles were built up. Activation of LV epicardium in LBBB was evaluated by NEC.

Results. Most oftenly the zone of late activation by NEC was found in the basal region on the border of posterior and lateral LV segments — 17 patients (46%) and in basal lateral LV segment — 8 (21%). By MRI, only post inflammatory fibrosis was found in 21 patient, among them in 5 the area of fibrosis was located on LV epicardium and overlapped the zone of late activation by NEC. Among 12 patients with ischemic heart disease 2 had scar on LV epicardium overlapping with the late activation zone. No one

of 4 patients with combination of post-inflammatory fibrosis and ischemic scar did not show overlap of structural changes on the epicardium with the late activation zone.

Conclusion. Combination of NEC and MRI in pre-operational period of patients investigation make it to relate structural changes in LV myocardium with the zone of its late electrical activation.

Russ J Cardiol 2017, 7 (147): 93–98

dx.doi.org/10.15829/1560-4071-2017-7-93-98

Key words: left ventricle, magnetic-resonance imaging, non-invasive electrophysioilogical study, complete His left bundle branch block.

Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.

CRYOBALLOON ABLATION FOR ATRIAL FIBRILLATION IN DIFFERENT ANATOMY OF PULMONARY VEINS

Chichkova T. Yu., Mamchur S. E., Kokov A. N., Bokhan N. S., Khomenko E. A., Mamchur I. N.

Abstract

Aim. To evaluate the results of cryo-ablation in a variety of pulmonary veins (PV) anatomy.

Material and methods. Into prospective randomized study, 94 patients were included, with tolerant to drug treatment atrial fibrillation (AF), age 55,9±9,8 y. o., of those 48 males and 46 females. The median of an arrhythmic anamnesis lasted for 4 (1,5; 5) years. Seven patients had undergone radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI), 5 had recurrent AF after former RFA. Seven — at the moment of admittance, had persistent AF. Under the framework of preoperational investigation, all patients underwent contrast multispiral computed tomography of the heart. The architectonics of the PV was assessed: number, diameter, specifics of opening, thrombi. Depending on the anatomy of the PV, patients were selected to 2 groups — typical and variant anatomy. The prevalence of a variety of PV anatomy was 13,8%. By the key clinical characteristics, the groups were comparable. All patients underwent cryoballoon isolation of the PV with the ArcticFront 28 mm and ArcticFront Advance 28 mm catheters. All patients with variants of PV anatomy underwent the procedure with the 2nd generation catheter. For verification of the PV isolation, Achieve catheter was used. In all cases of PV isolation it was verified as the enter and exit block, with no adenosine test.

Results. In the group of variation PV anatomy, in 11 cases, there was collector of the left PV or their opening into the left atrium (LA) by common ostium. There were no significant differences in a direct specifics of procedures: duration of ablation (75 (46,2; 105) vs 60 (52; 70) min, p=0,40) and duration of fluoroscopy (17 (16; 23,7) vs 20 (16,3; 23,8) min, p=0,64). The analysis of non-related groups showed significantly higher prevalence of complications development in the variation anatomy group, and the prevalence of nervus phrenicus palsy (NPP) (6,9 vs 3,7%) as vascular approach complications (3,19 vs 2,5%), were comparable (p>0,05). Also, in patients with the common ostium of PV there was pericarditis development more frequently during post-operation period, that led to anti-inflammatory treatment prescription. Long-term analysis shows the significant decrease of the method efficacy in variation PV anatomy, especially in presence of collector/vestibule of PV, even with the 2nd generation balloon usage.

Conclusion. Existence of a collector/vestibule of the left PV is associated with significant worsening of the long-term results of cryoballoon ablation, even in 2nd generation devices utilization.

Russ J Cardiol 2017, 7 (147): 99–104

dx.doi.org/10.15829/1560-4071-2017-7-99-104

Key words: atrial fibrillation, cryoballoon ablation, variants of pulmonary veins anatomy.

Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia.

ANTICOAGULATION IN ATRIAL FIBRILLATION PATIENTS AFTER CARDIOEMBOLIC STROKE: EVALUATION OF TREATMENT ADHERENCE IN REAL PRACTICE (COHORT STUDY “APOLLON”)

Zolotovskaya I. A.1,2, Davydkin I. L.1, Duplyakov D. V.1,3

Abstract

Atrial fibrillation (AF) in patients after cardioembolic stroke (CES) is associated with higher risk of recurrent tromboembolism and recurrent strokes. Basic prevention strategies for AF patients are directed to the usage of anticoagulants in the schemes of management.

Aim. To study the adherence to anticoagulation therapy of AF patients after CES, in real clinical practice.

Material and methods. From 01.10.2013 to 31.03.2015 the data was analyzed, of 1291 patients after CES, and of those 661 fulfilled the inclusion/exclusion criteria (36,9% of males and 63,1% of females, mean age 68 y. o.). During the 12-month

period of follow-up, 2 phone calls performed, in 180±5 days (V1) and 360±5 days (V2) from the stroke onset.

Results. In 2014 only 6,9% of participants were taking anticoagulants, in 2015 — 17,5%. Only a half (n=330) of those knew of AF they had; 26,2% regarded AF as a risk factor life threatening and related to recurrent stroke; 15,4% refused to follow clinician prescriptions on anticoagulation. As the main medication, 65,3% patients noted acetylsalicylic acid, and only 7,9% — various anticoagulants. Annual mortality was 16,0%.

Conclusion. In real clinical practice, AF patients after stroke have the same low awareness on anticoagulation necessity, as adherence, regardless of high annual mortality.

Russ J Cardiol 2017, 7 (147): 105–110

dx.doi.org/10.15829/1560-4071-2017-7-105-110

Key words: atrial fibrillation, stroke, prevention, education, anticoagulants, mortality.

1Samara State Medical University of the Ministry of Health, Samara; 2Samara Oblast City Polyclinics №9, Samara; 3Samara Oblast Clinical Dispensary of Cardiology, Samara, Russia.

RESULTS OF CONTINUOUS POSITIVE UPPER AIRWAY PRESSURE TREATMENT IN PATIENTS WITH ATRIAL FIBRILLATION AND OBSTRUCTIVE SLEEP APNEA

Pevzner A. V., Bayrambekov E. Sh., Litvin A. Yu., Elfimova E. M., Ermishkin V. V., Sokolov S. F., Golitsyn S. P.

Abstract

Aim. Evaluation of CPAP treatment (continuous positive upper airway pressure) in obstructive sleep apnea patients (OSA) and atrial fibrillation (AF) in comparison with antiarrhythmic medication therapy.

Material and methods. Totally, 36 patients included (58% males, mean age 61±11 y.) with AF and definite OSA by the data from cardiorespiratory monitoring. In 6 (17%) patients there was moderate level of respiratory disorders and in 30 (83%) — severe.

Twenty four (67%) patients had paroxysmal and 12 (33%) — persistent AF. All patients, to retain sinus rhythm and prevent AF relapses, were taking antiarrhythmic medications (AAM). Therapy by CPAP was recommended to all patients, but after familiarization nights (1-3), 18 agreed to continue this type of treatment at home (group 1), other 18 (group 2) were unable to apply CPAP due to low tolerance. During 12 month follow-up, comparative analysis was done, of AAM efficacy in both groups of patients. Groups did not differ significantly by the medications being taken.

Results. With CPAP therapy, in group 1 most patients (12, 67%) during 12 months did not develop AF relapses, and in the group 2 — only 6 (33%) did not have AF. It is worthy to mention than group 1 patients had potentially less chance for antiarrhythmic therapy success, if to consider traditional risk factors of AF, as they had higher body mass (body mass index 39,5 kg/m2 versus 34, p=0,07), more severe sleep respiration disorders (apnea-hypopnea index 50,8 events per hour versus 37,4, p=0,09) and larger left atrium (82 mL versus 60,5, p=0,02) comparing to group 2 patients. During 3-month CPAP treatment, in group 1 patients a significant decrease of P-wave dispersion was noted, by 30,8% (р=0,05).

Conclusion. Therapy with CPAP in moderate and severe OSA makes it to more than two times (from 33% to 67%) increase efficacy of antiarrhythmic drug treatment for AF. One of the mechanisms of antiarrhythmic action of CPAP againts AF might be a

decrease of atrial conduction time dispersion.

Russ J Cardiol 2017, 7 (147): 111–116

dx.doi.org/10.15829/1560-4071-2017-7-111-116

Key words: atrial fibrillation, sleep obstructive apnea syndrome, CPAP-therapy.

Myasnikov SRI of Clinical Cardiology, Russian Cardiological Research-and-Production Complex of the Ministry of Health, Moscow, Russia.

SPECKLE-TRACKING INTRACARDIAC ECHOCARDIOGRAPHY IN ATRIAL FIBRILLATION PATIENTS DURING RADIOFREQUENCY ISOLATION OF PULMONARY VEINS

Smorgon A. V., Lebedev D. I., Usenkov S. Yu., Dubanaev A. A., Archakov E. A., Batalov R. E., Shelemekhov A. E., Popov S. V.

Abstract

Aim. To evaluate the speckle-tracking echocardiography (STE) application in atrial fibrillation (AF) patients during catheter treatment, by the data from intracardiac echocardiography (ICE).

Material and methods. Totally, 30 patients included, with persistent and paroxysmal AF. In 25 (84%) the main disease was arterial hypertension, of those 14 (46%) had hypertension together with coronary heart disease. In 16% cases (4 patients) AF was idiopathic. All patients had indications for catheter treatment of the arrhythmia.

Results. Before the start of radiofrequency intervention (RFI), superior pulmonary vein (PV) deformation was 24,5±1,5%, after the intervention 17,5±1,1%, tissue deformation decreased by 7% (р<0,001); of the left inferior PV before RFI — 21,5±0,9%, after — 14,4±0,9%, tissue deformation decreased by 7,1% (р<0,001); right inferior PV before RFI — 21,2±1,3%, after — 14,9±1,1%, tissue deformation decreased by 6,2% (р<0,001); right inferior before RFI — 20,5±1,1%, after — 14,4±1,1%, deformation change 6,1% (р<0,001). Under the influence of RFI, velocity of upper PV deformation decreased by 8,1% (р<0,001), to -5,36±0,5%, after — 4,93±0,35%; in lower inferior PV decrease of velocity by 8,3% (р<0,001), before RFI -5,38±0,6%, after — 4,93±0,55%; right superior PV — decrease of PV deformation by 8,5% (р<0,001), before RFI -5,5±0,15%, after -5,0±0,33%; in right inferior 8,2% (р<0,001) before RFI -5,9±0,4%, after -5,4±0,4%.

Conclusion. Decrease of deformation by more than 6% and velocity of deformation by 8% after radiofrequency intervention are relevant signs of pulmonary veins ostiaisolation.

Russ J Cardiol 2017, 7 (147): 117–120

dx.doi.org/10.15829/1560-4071-2017-7-117-120

Key words: speckle-tracking echocardiography, intracardiac echocardiography, atrial fibrillation, pulmonary veins isolation.

Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia.

LEFT VENTRICLE TORSION IN AN IDIOPATHIC HIS LEFT BUNDLE BRANCH BLOCK

Pavlyukova E. N.1, Kuzhel D. А.2,3

Abstract

The role of left His bundle branch block (LBBB) in normal systolic function of the left ventricle (LV) remains under investigated for the global deformation and torsion.

Aim. To investigate on the global deformity of the LV in longitudinal direction by circumference, and its torsion, in patients with idiopathic LBBB with saved LV ejection fraction (EF).

Material and methods. Totally, 50 persons with idiopathic LBBB studied, with the mean duration of QRS 153±24,5 ms. Comparison group included 18 persons with no LBBB. All patients underwent echocardiography (Echo) with assessment of intracardiac hemodynamics, deformity measurement by Speckle tracking imaging, with evaluation of torsion and rotation dynamics of the LV.

Results. There were no significant differences in idiopathic LBBB group comparing to the controls, by the value of end-diastolic volume (respectively, 110,5±33,5 mL vs 95,3±23,5 mL, р=0,1) and EF LV (61,3±9,5% vs 64,4±9,4%, р=0,2). In idiopathic LBBB group comparing to controls, there was decrease of global LV deformation in longitudinal direction (respectively, -14,6±3,98% vs -8,4±3,10%, р=0,0006) and by circumference at basal segments (-7,02±4,40)% vs -10,6±4,18%, р=0,0075). It was found that in idiopathic LBBB there is disordered rotation at basal segments level (-2,95±4,36º vs -6,10±3,01º, р=0,019) and the torsion of LV as well (7,52±5,48º vs 13,1±5,18º, р=0,001).

Conclusion. Disordered conduction in LBBB is followed by impaired rotation and torsion, regardless of the saved systolic function.

Russ J Cardiol 2017, 7 (147): 121–124

dx.doi.org/10.15829/1560-4071-2017-7-121-124

Key words: rotation, torsion, left ventricle, left His bundle branch block.

1Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk; 2V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk; 3Krasnoyarskiy Kray Hospital № 2, Krasnoyarsk, Russia.

OPINION ON A PROBLEM

COMPARISON RESULTS OF THE INTRACARDIAC ELECTROPHYSIOLOGICAL STUDY IN PATIENTS WITH TYPICAL ATRIAL FLUTTER AND FIBRILLATION

Novikov P. S., Pevzner A. V., Shlevkov N. B., Maykov E. B., Mironov N. Yu., Sokolov S. F., Golitsyn S. P.

Abstract

Aim. Comparison study of the parameters of intracardiac electrophysiological study (EPS) in patients with the typical atrial flutter (TAF) and atrial fibrillation (AF), of the courses as isolated types of arrhythmia.

Material and methods. Totally, 82 patients included (59 (72%) males, mean age 55±10 y. o.), directed for catheter ablation procedure for TAF or AF. Depending on the anamnesis of arrhythmia, patients were selected to 4 groups: 1 — isolated TAF (n=26, 32%), 2 — AF with “spontaneous” TAF (n=27, 33%), 3 — AF and TAF, when the latter had been registered only under treatment by antiarrhythmics of IC and III classes (n=14, 17%), 4 — isolated AF (n=15, 18%). All patients underwent EPS within sinus rhythm and no antiarrhythmic therapy. During EPS the following parameters were defined: P-wave duration, time of inter- and intra-atrial conduction, effective refractory periods (ERP) in various areas of the atria. By the results of EPS, comparative statistical study performed of the listed parameters in the groups.

Results. Patients with TAF (groups 1, 2, 3), in difference with isolated AF (group 4) had significantly longer P-wave and inter-atrial conduction time. Analysis of ERP showed similar heterogeneity of the parameters in different areas of the atria in all studied groups: the lowest ERP is found in the lateral area of the right atrium, the highest — in the distal area of coronary sinus. Intergroup differences by these parameters were non-significant.

Conclusion. For TAF patients, as an isolated disorder or with AF, the characteristical is significant prolongation of the inter-atrial conduction time, that might expain tendency to tachiarrhythmias of re-entry genesis.

Russ J Cardiol 2017, 7 (147): 125–131

dx.doi.org/10.15829/1560-4071-2017-7-125-131

Key words: atrial flutter, atrial fibrillation, electrophysiological study.

Russian Cardiological Research-and-Production Complex of the Ministry of Health, Moscow, Russia.

CLINIC AND PHARMACOTHERAPY

ATRIAL FIBRILLATION AND HEART FAILURE: APPROACHES TO ANTITHROMBOTIC THERAPY

Tatarsky B. A.1, Popov S. V.2, Kazennova N. V.1

Abstract

The recent epidemiological data presented, on the prevalence, incidence of atrial fibrillation and comorbid heart failure. The main evidence provided on the risk increase for thromboembolic complications in this category of patients, efficacy data provided, as safety, of the direct oral anticoagulants in atrial fibrillation patients with heart failure, that might facilitate decisions on optimal anticoagulation for this category of patients.

Russ J Cardiol 2017, 7 (147): 132–138

dx.doi.org/10.15829/1560-4071-2017-7-132-138

Key words: atrial fibrillation, heart failure, direct oral anticoagulants.

1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia.

ADVANTAGES AND NOVELTY OF CLINICAL APPLICATION OF THE TRIPLE COMBINATION FOR ARTERIAL HYPERTENSION WITH DYSLIPIDEMIA: ACE INHIBITOR PERINDOPRIL WITH ROSUVASTATIN AND INDAPAMIDE

Maksimov M. L.1,2, Ermolaeva А. S.3, Dralova О. V.3

Abstract

Aim. To assess efficacy and safety of double combinations (angiotensine converting enzyme inhibitor (ACEi) + indapamide) and triple combinations (ACEi + statin + indapamide) in arterial hypertnesion (AH) patients with dyslipidemia (DL).

Material and methods. The study is based on the data analysis obtained during investigation and treatment of 75 patients at the age 40-65 y. o. with AH of I-II grades and high risk with DL (total cholesterol more 4,5 mM/L, and/or low density lipoproteides more than 2,5 mM/L).

Results. During the study, additional properties of statins are shown, if added to standard bi-component hypotensive treatment by ACEi + indapamide, in patients with high cardiovascular risk (CVR). There is improvement of hypotensive and angioprotection effects. The advantages presented, as an additional angioprotection effect, endothelial function improvement and significance of clinical application of triple combination ACEi + rosuvastatin + indapamide in DL patients with AH of higher CVR.

Conclusion. The data shows that combination of ACEi + statin + indapamide is able to most effectively decrease damage caused by inflammation on vascular endothelium. In the analogic by strength hypotensive action, within combinational therapy, there is summation of angioprotection effects of both drugs. Synergistic angioprotection action of combination therapy makes it to recommend triplecomponent combination of ACEi + statin + indapamide for broader implementation in AH of I-II grades patients and DL of higher CVR as a combination of the drugs of choice showing pathogenetic mechanisms of correction of arterial pressure, as metabolic disorders, and resulting in organoprotective effect of treatment. The main point of interest could be a fixed triple component combination of perindopril + rosuvastatin + indapamide.

Russ J Cardiol 2017, 7 (147): 139–150

dx.doi.org/10.15829/1560-4071-2017-7-139-150

Key words: triple combination, arterial hypertension, dyslipidemia, perindopril, rosuvastatin, indapamide.

1Scientific Center for Expertise of the Medical Utilities of the Ministry of Health, Moscow; 2Kazanskaya State Medical Academy, Kazan; 3I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.

PERSONALIZED APPROACH TO TREATMENT AND REHABILITATION OF CARDIOVASCULAR PATIENTS (ON THE MATERIALS OF ARTERIAL HYPERTENSION AND HEART FAILURE)

Ternovaya E. S.1, Volel B. A.1,2, Troshina D. V.1, Zakharov V. V.1, Kopylov F. Yu.1

Abstract

Aim. To evaluate the experience of the usage of Pantogam active (PIQ-PHARMA LLC, Russia) under the concept of personalized approach to correction of cognitive and emotional (anxiety and depression) disorders in arterial hypertension (AH) and chronic heart failure (CHF).

Material and methods. The analysis has been done, of three recent trials came out with the results showing efficacy of D-,L-Hopanthenic/rac-Hopanthenic acid (Pantogam active compound for non-cardiac pathology (AH and CHF). The endpoints of efficacy control were the grade of cognition reduction, emotional correction (anxiety and depression), life quality improvement. Also, the influence of the drug was evaluated, on the parameters of cardiovascular system.

Results. In the 3 studies, totally 232 patients participated, with cardiovascular diseases (CVD), of those 147 were controls. Duration of Pantogam active intake lasted for 4 to 12 weeks. Responders by the parameter of cognitive function were 78-100%, for emotional disorders — to 88%, for life quality improvement — 86%. Tolerance of the therapy was evaluated as good, and minimal side effects were reduced within the first week of treatment.

Conclusion. Application of Pantogam active for complex treatment of AH and CHF patients leads to correction of comorbid cognitive and emotional disorders, with the absence of tolerance, hyperstimulation and withdrawal syndrome, improves life quality, contributes to therapy effectiveness of main CVD and improvement of cardiovascular parameters (blood pressure, heart rate variability, exercise tolerance).

Russ J Cardiol 2017, 7 (147): 152–161

dx.doi.org/10.15829/1560-4071-2017-7-152-161

Key words: cognition disorders, emotional disorders, arterial hypertension, hypertension treatment, chronic heart failure, anxiety disorders, medical rehabilitation.

1I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 2Scientific Center for Mental Health, Moscow, Russia.

LITERATURE REVIEWS

THE UNRESOLVED ISSUES AND MODERN VIEW ON ATRIAL FIBRILLATION PATIENTS MANAGEMENT

Losik D. V., Bayramova S. A., Pokushalov E. A., Mikheenko I. L., Shabanov V. V., Romanov A. B.

Abstract

The article focuses on the main debating and unresolved issues on atrial fibrillation patients therapy, e. g. anticoagulation, antiarrhythmic, intervention and surgical tactics. The weaknesses and disadvantages are discussed, of the modern conservative and invasive strategies, as of the modern classification of atrial fibrillation; the issues on optimal rhythm control in atrial fibrillation, and early diagnostics. Each of these problems is related to the range of opportunities for better understanding and management.

Russ J Cardiol 2017, 7 (147): 162–170

dx.doi.org/10.15829/1560-4071-2017-7-162-170

Key words: atrial fibrillation, thromboembolism, anticoagulation therapy, antiarrhythmic therapy, catheter ablation, Holter ECG monitoring.

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

STATE OF THE ART PHARMACOLOGICAL THERAPY FOR ATRIAL FIBRILLATION

Kanorsky S. G., Kovalenko Yu. S.

Abstract

Pharmacological therapy remains the primary approach to atrial fibrillation (AF). Management of all AF patients includes the decision on rate or rhythm control. The latter means antiarrhythmic drugs application that are being selected primarily by safety reasons and depend on individual characteristics of patients. The article presents a brief description of efficacy and safety of antiarrhythmics themselves and other drugs for sinus rhythm control in AF. Novel data shows possibility to decrease stroke risk and mortality, and to cease anticoagulation in more thorough sinus rhythm retention.

Russ J Cardiol 2017, 7 (147): 171–177

dx.doi.org/10.15829/1560-4071-2017-7-171-177

Key words: atrial fibrillation, antiarrhythmic drugs, rate control, rhythm control.

Kubansky State Medical University of the Ministry of Health, Krasnodar, Russia.

OBESITY ASSOCIATED ATRIAL FIBRILLATION: EPICARDIAL FAT TISSUE IN ETIOPATHOGENESIS

Druzhilov М. А.1, Kuznetsova Т. Yu.2

Abstract

The established relationship in obesity and atrial fibrillation comorbidity, under the context of raising prevalence of both disorders, determines the search for new ways of underlying pathogenetic mechanisms. Nowadays, quite an amount of evidence has been collected, on the existence of relationships between ectopic visceral adipose tissue of the heart and atrial fibrillation. The article focuses on the role of epicardial adipose tissue in development and progression of atrial fibrillation, discussing possible pathogenetic chains of such association and potential clinical significance.

Russ J Cardiol 2017, 7 (147): 178–184

dx.doi.org/10.15829/1560-4071-2017-7-178-184

Key words: atrial fibrillation, obesity, epicardial fat tissue, thickness of epicardial adipous layer.

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

JUBILEE

Rostislav S. Karpov

Russ J Cardiol 2017, 7 (147): 185

23 августа 2017 г.
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