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Russian Journal Of Cardiology, 2017, 8 (148)

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Russ J Cardiol 2017, 8 (148): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 8 (148): 6

ORIGINAL ARTICLES

CLINICAL OUTCOMES OF PERCUTANEOUS CORONARY INTERVENTION WITH DRUG ELUTING STENT IN STABLE ANGINA PATIENTS

Tomilova D. I., Karpov Yu. A., Lopukhova V. V.

Abstract

Aim. To evaluate the occurence of cardiovascular events (CVE) and influence of lipid parameters on it, as other clinical and instrumental factors of coronary heart disease (CHD) patients during 5 years after selective percutaneous coronary intervention (PCI) with drug eluting stenting (DES).

Material and methods. In the study, 574 patients included, with stable angina (81% males, mean age 60,3 y. o.), hospitalized to the FSBI RCSPC of MHRF for selective PCI with implantation of DES. Patients were prescribed the therapy according to stable angina guidelines, including statins. The analysis was done, of various clinical and instrumental and laboratory parameters for evaluation of prognostic significance. The endpoints were assessed: lethal cases from cardiovascular, as from all causes, non-fatal myocardial infarction (MI), non-fatal stroke, repeated coronary revascularization, that happened after discharge.

Results. During the entire follow-up (average 53,5 months), CVE were registered in 24% cases. Totally, died 29 patients (5,1%), of those 4 (0,7%) — from non-cardiac causes, and repeat revascularization was done in 84 (14,6%) patients, non-fatal MI and stroke developed in 17 (3,0%) and 8 (1,3%), respectively. The risk factors were defined, that are related with the rate of fatal outcomes: smoking, brachiocephalic atherosclerosis, stroke in anamnesis, significant lesion of circumflex artery (CA) and its branches. Non-fatal stroke developed more oftenly in patients with higher body mass index (BMI) (32,2±2,56 versus 28,15±4,22, p=0,0164). Non-fatal MI more oftenly registered in patients with higher number and length of implanted stents (p=0,0018 and p<0,0001, resp.). By the end of follow-up, there were 66,2% patients on statins treatment. Target low density lipoproteides cholesterol (LDL-C) level (<1,8 mM/L) was found in 8,7%, median LDL-C level was 2,8 mM/L. There were no significant differences in LDL-C between those taking statins and discontinued, during 5 years. There was no significant relation of lipid profile values with CVE as well. The number of fatal cases was higher in the group of patients with lower baseline high density lipoproteide cholesterol.

Conclusion. Adverse events were found in about quarter of patients. Most of patients did not reach the target LDL-C. There was no significant relation in baseline LDL-C and its level in 5 years, with the occurence of MI, stroke, repeat revascularizations, all cause deaths. This can be explained by the absence of significant differences in LDL-C levels in patients continuing and discontinued statins during the follow-up, and is related to the use of insufficient statins dosages and low adherence to statin treatment.

Russ J Cardiol 2017, 8 (148): 7–12

http://dx.doi.org/10.15829/1560-4071-2017-8-7-12

Key words: percutaneous coronary intervention, long term follow-up, cholesterol of high density lipoproteides, statins.

Russian Cardiological Research-and-Production Complex of the Ministry of Health, Institute of Clinical Cardiology named after A. L. Myasnikov, Moscow, Russia.

FACTORS OF LIFE QUALITY IMPROVEMENT AFTER HEART TRANSPLANTATION: PREDICTIVE SIGNIFICANCE OF CARDIOPULMONARY EXERCISE TEST

Kamenskaya O. V., Loginova I. Yu., Doronin D. V., Chernyavsky A. M., Karaskov A. M.

Abstract

Aim. Evaluation of prognostic significance of the parameters of cardiopulmonary exercise test in life quality improvement for the post-cardiac transplantation patients.

Material and methods. Into the study, 40 patients included, with severe chronic heart failure (CHF), included in the waiting list for cardiac transplantation. Before and after orthotopic heart transplantation (OHT), clinical status was evaluated, cardiopulmonary exercise testing parameters (CET) and life quality by SF-36.

Results. After OHT the significant life quality improvement noted, by the scale “Physical health” from 36 (32-45) points before surgery to 52 (49-55) points (p<0,05) and “Psychological health” from 38 (34-50) to 51 (50-56) points. In 13% cases life quality improvement was not noted. Among the CET parameters, significant relation with life quality improvement by “Physical” scale showed the preoperation level of exercise tolerance (ОR 2,10 (1,08-9,80), p=0,001), peak of oxygen consumption (OR 1,20 (0,97-2,61), p=0,037), efficacy of oxygen consumption in exertion (OR 0,68 (0,36-1,27), p=0,047). Also, it was shown that life quality increase after OHT depends on efficacy of oxygen consumption baseline return in first minute (OR 1,13 (1,02-1,27), p=0,024). Any relations of CET with “Psychological” life quality by SF-36 were not noted.

Conclusion. Exercise tolerance, peak oxygen consumption, exertion ventilator efficacy, efficacy of oxygen consumption baseline return after exercise, by CET in severe CHF patients, have high predictive value in evaluation of probability of life quality improvement by the scale “Physical health” of SF-36 after cardiac transplantation.

Russ J Cardiol 2017, 8 (148): 13–18

http://dx.doi.org/10.15829/1560-4071-2017-8-13-18

Key words: orthotopic cardiac transplantation; cardiopulmonary exercise test; life quality.

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

RESULTS OF THE MODIFIED LEFT VENTRICLE RECONSTRUCTION WITH EVALUATION OF GEOMETRIC PARAMETERS IN POSTINFARCTION ANEURYSM OF THE HEART

Babokin V. E., Pronina V. P., Mishchenko Yu. V., Ananko V. A., Martakov M. A.

Abstract

Modern times, surgeons of the entire world utilize the technics of left ventricular reconstruction (LVR) developed by professor Dor V. However, oftenly the left ventricle (LV) presents with a spheric shape in postoperation period, by echocardiography. When, normally, geometry of the LV is conceptualized as a stretched ellipse with longitudinal axis directed from apex to the base of the heart.

Aim. To evaluate effectiveness of modified LVR using Z-suture to create the LV apex in patients with postinfarction heart aneurysms.

Material and methods. Twelve patients with anterior-septal localization of the LV aneurysm having myocardial infarction in anamnesis more than 6 months, with LV ejection fraction less 45%, underwent the modified LVR with Z-suture. Efficacy of the

correction was assessed by echocardiography data in short term period till 1 month after the operation, comparing with pre-surgery data.

Results. In all patients surgery proceeded successfully. Sphericity index significantly decreased in diastolic phase at basal level from 0,83±0,17 to 0,63±0,11 (p=0,05) and at apical level from 0,56±0,12 to 0,37±0,09 (p=0,01). Conical index increased at basal level from 1,26±0,06 to 1,67±0,40 (p=0,05), at middle-apical level from 1,34±0,30 to 1,4±0,34 (p=0,05).

Conclusion. The modified left ventricular reconstruction with Z-suture forms the ellipsoid heart shape and is an effective method of surgery of postinfarction LV aneurysm.

Russ J Cardiol 2017, 8 (148): 19–23

http://dx.doi.org/10.15829/1560-4071-2017-8-19-23

Key words: left ventricle aneurysm, left ventricle reconstruction, echocardiography, conical index, sphericity index

Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russia.

COMPARISON OF THE DISORDERED MECHANICAL FUNCTION OF THE LEFT ATRIUM AFTER ANTRAL ISOLATION OF PULMONARY VEINS BY RADIOFREQUENCY OR CRYOBALLOON ABLATION

Mamchur I. N., Chichkova T . Yu., Mamchur S . E., Bokhan N. S ., Romanova M. P., Khomenko E. A.

Abstract

Aim. To assess and compare mechanical functioning of the left atrium before and just after cryoballoon or radiofrequency ablation.

Material and methods. Totally, 43 patients included, with sympthomatic atrial fibrillation resistant to drug treatment. Of those 21 — for cryoballoon ablation (mean age 57,8±8,7 y. o., 11 males and 10 females) and 22 candidates for radiofrequency ablation, at the age 54,4±11 y. o., 16 males and 6 females. Before procedure, just after and on the 5th day, transthoracal echocardiography was performed, with measurement of Doppler parameters of intracardiac hemodynamics, as mechanical function of the left atrium assessment, including 3D imaging.

Results. By the data from transthoracal echocardiography and direct intraoperation manometry, the significant disorders of the left atrium (LA) mechanical function were found in both treatment groups, with some differences. Pulmonary veins (PV) isolation by any method does not influence diastolic and systolic function of the left ventricle, that confirmed by invasive measurements of the end-diastolic pressure in LV, as the changes of volumes and ejection fraction by echocardiography. Therefore transmitral blood flow dynamics, as PV and pulmonary artery flow, related to PV isolation procedure, is a result of the LA functioning disorder due to its passive dilatability and active contractility decrease, dysfunction of the PV sleeves, increase of pulmonary vascular resistance. The significant decrease found in LA pumping function, more prominent in radiofrequency group just after the procedure, with further improvement to the 5th day after procedure. Also, mean pulmonary artery pressure increase, and till the 5th day in radiofrequency group it was significantly higher than in cryoablation group.

Conclusion. Both cryo and radio ablation procedures of PV isolation significantly impact on the mechanical functioning of the LA, however cryo ablation leads to less severe disorder at short follow-up.

Russ J Cardiol 2017, 8 (148): 24–30

http://dx.doi.org/10.15829/1560-4071-2017-8-24-30

Key words: atrial fibrillation, cryoablation, radiofrequency ablation, pulmonary veins isolation, left atrium, mechanical function, contractility.

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

LIFE QUALITY OF PATIENTS ACCORDING TO GENDER AND THE FORM OF NON-ST-ELEVATION ACUTE CORONARY SYNDROME

Ayrapetian M. A., Luchinkina E. E., Gordeev I. G., Taratukhin E. O.

Abstract

Aim. To assess the specifics of psychoemotional state of adult patients with non ST elevation acute coronary syndrome (NSTEACS) in 6 months post hospitalization.

Material and methods. Totally, 101 patient included, with non-obstructive lesion of coronary flow. Groups were formed by gender: group 1 — 51 females, group 2 — 50 males. Mean age: women 50,5±4,7 y. o., men 46,7±6,8 y. o. Patients were also selected to subgroups by NSTEACS type: subgroup A — unstable angina (UA), subgroup B — myocardial infarction. Patients were questionned by phone in 6 months after discharge. The questionnaire included key points about health, emotional balance, physical activity and life quality.

Results. There are gender differences in life quality constituents between men and women. In questions on general health state 6% of women replied that are not satisfied with their health, in men — 2%; satisfactorily graded their health state 27% of women and 38% of men, good — 47% and 46%, excellent — 20% and 14%, respectively. Pre-morbid physical activity at work was saved in 45% of men and 32% of women; active life style retained 47% of women and 42% of men. Men more often felt hopelessness (43% and 12%; p<0,01), as women mostly pointed on irritability and sleeplessness (35% and 28%; p>0,05) and were unsatisfied with their psychological state (31% and 6%; p<0,05). In both groups patients experienced the feeling of lost worth of living, women — more often (7% and 4%; p>0,05), however men noted loss of interest to former habits (13% и 22%; р>0,05). The specifics in subtypes of NSTEACS was also noted.

Conclusion. Regardless an individuality of the meanings of life quality, experiences, coping, there is gender specifics, as specifics in NSTEACS subtype. The specifics can be included as a part of patient-centered work with post-ACS patients.

Russ J Cardiol 2017, 8 (148): 31–35

http://dx.doi.org/10.15829/1560-4071-2017-8-31-35

Key words: myocardial infarction, gender differences, CHD in women, life quality, psychoemotional state, risk factors, patient-centered medicine.

N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.

DECOMPENSATED CHRONIC HEART FAILURE COURSE IN DIABETES PATIENTS

Mamedov M. N.1, Mardanov B. U.1,2, Poprygo M. V.2

Abstract

Aim. To investigate on clinical, hemodynamic and laboratory specifics of heart failure course in diabetes mellitus type 2 (DM2) patients and non-diabetic, hospitalized due to acute decompensation of chronic heart failure (CHF).

Material and methods. Totally, 134 patients included, hospitalized to cardiology. All patients were selected to 2 groups: I (CHF and DM2, n=66; age 61,8±7,2 y. o., 28 males, 38 females), and group II (CHF non-DM, n=68; 62,3±7,7 y. o., 33 males, 35 females). Symptom assessments were done, with the score of clinical state in CHF (SCSC), electrocardiography (ECG) resting in 12 leads; transthoracal echocardioscopy; laboratory blood tests; chest x-ray; 6-minute walking test.

Results. Patients with CHF and DM2 were characterized by comparatively high functional class of CHF, severity of symptoms (by SCSC 13,7±2,2 versus 11,1±2,2 points, p<0,05) and more prominent morphofunctional changes of the heart: significant decrease in ejection fraction of the left ventricle (LV) by 5,5% and increase of deceleration time in early diastolic filling, followed by the decrease of E/A. The specifics found was followed by disordered biochemical parameters in DM2. Anamnesis of CHF and DM2 in the cohort made it to find out an insufficient (less than 80%) control of glycemia among CHF and DM2 patients regardless long lasting course of glycemia disorder.

Conclusion. Results of the conducted study demonstrate negative character of impact of DM2 on CHF course of ischemic and non-ischemic origin.

Russ J Cardiol 2017, 8 (148): 36–41

http://dx.doi.org/10.15829/1560-4071-2017-8-36-41

Key words: chronic heart failure, diabetes mellitus, clinical condition, left ventricle functioning.

1National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2Domodedovskaya Central City Hospital, Domodedovo, Russia.

METHODS OF DIAGNOSTICS AND TREATMENT

EFFICACY OF SIROLIMUS ELUTING STENTS IMPLANTATION IN DIFFUSE (LONG AND EXTREMELY LONG) CORONARY ATHEROSCLEROTIC LESIONS

Babunashvili А. М.1, Kartashov D. S .1, Babokin V. Е.2, Ozashvili I. G.2, Yudin I. Е.3

Abstract

Aim. Comparison of efficacy of stents coated with sirolimus (group I — 116 patients), and bare metallic stents (group II — 117 patients) in treatment of diffuse (long) atherosclerotic lesions in coronary arteries.

Material and methods. The groups were comparable by main parameters. Diabetes was found in 19% and 13,7%, respectively; multivessel lesion in 87,1% and 80,4%; vessel caliber less than 2,75 mm — 46,5% and 23,9%, respectively. Length of the lesion was 25,9±6,6 mm (28-93 mm) in group I and 22,1±7,8 mm (26-102 mm) in group II. Totally, 473 stents implanted into 232 arteries (2,1 per artery): group I — 184 stents in 116 arteries (overlap of 2> stents in 87,9% cases) and 289 in 117 in group II (superposition of stents in 87,1%).

Results. The direct success at short term was noted in 113 patients in group I (97,4%) and in 116 in group II (99,1%) (p=0,74). In both groups there were no cases of acute thrombosis of stents. Subacute thrombosis (in 1-3 weeks) was noted in 2 patients (1,7%) in group I and in 1 (0,85%) in group II (p=0,47). Long term angiographic restenosis was noted in 12 patients from group I (10,6%) and in 66 in group II (56,9%) (p<0,0025). Also, in group II 47 patients from 66 had diffuse restenosis (71,2%), as in group I there was no diffuse restenosis. Survival rate with no MACE or angina in 12 months was 79,8% in group I, and 31% in group II.

Russ J Cardiol 2017, 8 (148): 42–50

http://dx.doi.org/10.15829/1560-4071-2017-8-42-50

Key words: diffuse atherosclerosis, long lesions of coronary arteries, drug eluting stents, sirolimus.

1The Center of Endosurgery and Lithotripsy, Moscow; 2Moscow Regional Research and Clinical Institute (MONIKI), Moscow; 3I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia.

SHORT TERM RESULTS OF TRANSCATHETER AORTIC VALVE REPLACEMENT WITH TRANSAORTAL

APPROACH

Bogachev-Prokofiev A. V., Sharifulin R. M., Zubarev D. D., Zhuravleva I. Yu., Karaskov A. M.

Abstract

Aim. Transcatheter replacement of the aortic valve with transfemoral approach is the procedure of choice in patients with aortic valve defects and high to very high operatrional risk. If transfemoral approach is not applicable, alternative approaches implemented. The most rarely used is transaortal approach. The data was analyzed, of the direct transaortal approach for aortic valve replacement.

Material and methods. During the years 2015-2017, 11 procedures performed, of transcatheter aortic valve replacement, with transaortal approach. In 10 cases, the operation was done with the right-sided anterior minithoracotomy, in 1 — with ministernotomy.

Results. Thirty-day mortality was 9,1%. There were no conversions of surgical approach. In one patient (9,1%) there was paraprosthesis regurgitation, in the other — no such regurgitation, or non-significant. There were no hemorrhagic complications or complications of the surgery. One patient received permanent pacemaker for developed complete atrioventricular block.

Conclusion. Direct transaortal approach makes it to safely and effectively perform transcatheter implantation of aortic valve and might be an alternative in the cases of impossible transfemoral approach.

Russ J Cardiol 2017, 8 (148): 51–58

http://dx.doi.org/10.15829/1560-4071-2017-8-51-58

Key words: aortic valve, aortal stenosis, transcatheter aortic valve replacement.

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

PULMONARY VENTILATION AND GAS EXCHANGE EFFICIENCY IN RISK ASSESSMENT FOR CHRONIC

POSTTHROMBOEMBOLIC PULMONARY HYPERTENSION

Loginova I. Yu., Kamenskaya O. V., Chernyavsky A. M., Novikova N. V., Lomivorotov V. V., Karaskov A. M..

Abstract

Aim. To evaluate prognostic significance of diffusion capacity of the lungs and efficacy of pulmonary gas exchange in risk assessment of perioperational and early postoperational complications in patients with chronic post-thromboembolic pulmonary hypertension (CPH).

Material and methods. Totally, 131 patient included, with CPH, who had undergone thrombo-endarterectomy from the branches of pulmonary artery. Before the surgery, together with standard investigation, the following methods were applied: body pletismography, lung diffusion capacity assessment, ventilation efficiency assessment. The relation was analyzed, of the parameters of pulmonary functional tests with the results of surgical treatment of CPH patients.

Results. CPH patients present with a low level of pulmonary diffusion capacity and ventilation efficiency. Among the parameters of pulmonary functional tests, diffusion ability of the lungs shows the highest prediction significance in surgical risk assessment for CPH treatment. The relation found, for diffusion ability of the lungs and risk of respiratory failure (ОR 0,94 (0,91-0,99), p=0,004), heart failure (ОR 0,93 (0,87-1,00), p=0,023), short term post-operaton mortality (ОR 0,95 (0,89-0,99), p=0,034) and long-term mortality (ОR 0,94 (0,79-0,99), p=0,030). Efficacy of pulmonary ventilation showed significant relation only with the development of respiratory failure (ОR 0,91 (0,82-1,00), p=0,038)

Conclusion. Decline of pulmonary diffusion ability to 45% and lower from expected level increases the risk of respiratory and heart failure development in early postoperation period, as the risk of in-hospital death and mortality throughout 1 year follow-up after thrombo-endarterectomy from the branches of pulmonary artery.

Russ J Cardiol 2017, 8 (148): 59–64

http://dx.doi.org/10.15829/1560-4071-2017-8-59-64

Key words: chronic thromboembolic pulmonary hypertension, diffusion ability of the lungs, lung function tests.

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

A CASE OF THE LEFT ATRIUM APPENDAGE OCCLUSION, SUGGESTIONS ON THE CLINICAL FIELD DEVELOPMENT

Davtian K. V., Kalemberg A. A., Simonian G. Yu., Shatakhtsian V. S ., Topchian A. G.

Abstract

Aim. To evaluate the possibility of hybrid procedure that includes single-moment cryoballoon isolation of pulmonary veins (PV) ostia and implantation of occluder into the left atrium appendage (LAA) in patients of high thromboembolic and hemorrhagic risk and prominent symptoms in atrial fibrillation (AF) paroxysms.

Material and methods. From 2012 to 2016 y., 72 procedures performed, of LAA occluder implantation for patients with high thromboembolic and hemorrhagic risk (mean age 68±7,4 y. o., 48 females, 24 males, mean rate by CHA2DS2VASc 4,82±1,48 points), of those 3 underwent single-moment cryoballoon isolation of the PV ostia without electrical isolation of LAA. The parameters of the intervention were assessed, and prevalence of intra-operation complications in AF patients that included single-moment catheter cryoballoon isolation of PV ostia and implantation of LAA occluding device, in comparison with isolated LAA occluder implantation.

Results. Occluding device implantation was successful in 100% cases. Periprocedural efficacy of PV ostia isolation was 100%. In both groups, intraoperational complications were absent. Mean heparin time and dosage of contrast in the hybrid intervention group were higher: 94,3±6,8 min vs 59,7±19,95 min (p<0,05), 196,8±20,82 mL vs 124,6±30,24 mL (p<0,05), respectively.

Conclusion. Performing of the hybrid intervention that includes single-moment catheter isolation of PV ostia and implantation of the occluding device into LAA increases mean procedure duration and contrast load in comparison to isolated LAA occluder implantation, with no operational risk increase.

Russ J Cardiol 2017, 8 (148): 65–69

http://dx.doi.org/10.15829/1560-4071-2017-8-65-69

Key words: atrial fibrillation, left atrium appendage, stroke prevention, cryoballoon ablation, anticoagulation therapy.

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

IMPACT OF COLLATERAL CIRCULATION ON BLOOD SUPPLY AND FUNCTION OF MYOCARDIUM

Fomichev A. V., Chernyavsky A. M., Tarkova A. R., Ibragimov R. U., Kareva Yu. E., Minin S . M., Nikitin N. A.

Abstract

Aim. To evaluate perfusion and functioning of myocardium in occluded coronary artery with various types of collateral blood flow.

Material and methods. Ninety patients with three-vessel disease and obligate occlusion of the right coronary artery (RCA) according to the type of collateral flow development, were selected to 2 groups: first — 44 patients (49%) with I and II grades by Rentrop, second — 46 patients (51%) with grade III Rentrop collaterals. Perfusion scintigraphy data was analysed, with echocardiography and tissue Doppler.

Results. Worsening of perfusion of myocardium inferior wall was found in patient of group 2 with non-significant defect of perfusion in 1st group patient. Stable perfusion defect in group 1 was 9,8±3,5%, in group 2 — 4,1±1,7%. While comparing tissue Doppler values, change in longitudinal deformation of inferior wall in the group with worse collaterals was -4,1±2,6, in group 2 -6,8±2,7. While assessing segmentary contractility of the inferior wall of the left ventricle, lower number of hypokinesis segments was found in group 2.

Conclusion. Chronic occlusion of coronary artery with a weak collaterals is followed by worse parameters of local perfusion and function of myocardium. In a good condition of collaterals, regardless the non-significant perfusion disorders in myocardium at rest, there are prominent stress-defects and local contractility disorders of myocardium.

Russ J Cardiol 2017, 8 (148): 70–74

http://dx.doi.org/10.15829/1560-4071-2017-8-70-74

Key words: coronary heart disease, collateral blood supply, chronic occlusion of coronary arteries.

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

THREE-DIMENSIONAL MODEL OF LEFT CHAMBERS OF THE HEART BASED ON ECHOCARDIOGRAPHY DATA: AN INSTRUMENT FOR DEVELOPMENT OF TRANSCATHETER VALVES

Zhuravleva I. Yu.1, Sharifulin R. М.1, Bogachev-Prokofiev А. V.1, Nushtaev D. V.2, Malakhova О. Yu.1, Demidov D. P.1, Karaskov А. М.1

Abstract

Aim. Comparative analysis of the acquired with EchoCG method parameters of the left chambers of the heart and of mitral valve in normal state and in restrictive type of failure with further building up three-dimensional models of these variants of the fibrous anulus geometry, and of the left atrium, left ventricle and its outgoing tract.

Material and methods. The study was done using 3D transthoracal and transesophageal EchoCG on Philips iE33 (Philips Healthcare, USA) in 30 patients with unchanged mitral valve (n=15) and in ischemic mitral regurgitation (n=15). Spatial configuration of the anulus fibrosus was investigated, and mitral valve, spatial and volumetric parameters of the left atrium and left ventricle. Data was processed in SciLab 4.1.2 software and exported to CATIA 5 modelling system, where the acquired curves were combined to 2 solid thin-wall models, and after linking of the surfaces — to a hard-bodied model with required thickness of the walls.

Results. All studied parameters revealed significant differences (p<0,001) in groups comparison. In restrictive type of insufficiency, sizes of fibrous anulus increase: intercomissural diameter by 22%, front-back — by 13%, perimeter — by 28%, surface — by 79%. End systolic and diastolic volumes of the LV increase more than 2 times, which is related with more prominent sphericity of the LV, than normally. Increase of LA more than 1,5 times also combines with its geometry change towards sphere. Three dimensional computer model of the left heart chambers changed as a result of ischemic mitral failure, is created. The model can be implemented in creation, analysis and prediction of medical devices for the position and/or realized as the full-sized mockups, test systems and phantoms for development and education.

Conclusion. The investigation of mitral valve characteristics and of the left heart chambers by method of 3D transthoracal and transesophageal echocardiography makes it to obtain the baseline data necessary for creation of 3D computed models of the anatomic area normal and disordered. Such models can be implemented in the development of implanted devices constructions, preliminary tests of medical devices and in training.

Russ J Cardiol 2017, 8 (148): 75–81

http://dx.doi.org/10.15829/1560-4071-2017-8-75-81

Key words: left chambers of the heart, three-dimensional models, transcatheter valves.

1E.N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk; 2LLC “TESIS”, Moscow, Russia.

LEFT ATRIAL ELECTROANATOMIC SUBSTRATE AS A PREDICTOR OF ATRIAL FIBRILLATION RECURRENCE AFTER CIRCULAR RADIOFREQUENCY PULMONARY VEINS ISOLATION. OBSERVATIONAL PROSPECTIVE STUDY RESULTS

Orshanskaya V. S., Kamenev A. V., Belyakova L. A., Mikhaylov E. N., Lebedev D. S .

Abstract

Aim. To evaluate an extent of left arrial (LA) electroanatomical substrate (EAS) by the method of high density contact mapping in patients with atrial fibrillation (AF) and estimate its impact on recurrence rate following circular radiofrequency pulmonary veins (PV) isolation in prospective observational study.

Material and methods. Totally 181 high symptomatic subjects with paroxysmal (142 pts) and persistent (39 pts) AF, who underwent circular RF PVI were enrolled. We created and prospectively analyzed LA electroanatomical high density bipolar maps. Bipolar signals ≤0.75mV, associated with local conduction velocity delay <1 m/s were tagged on LA maps and considered as EAS. Relative EAS areas outside PV ostia were consistently measured. All of the patients were followed up at least for 3 years and AF recurrence rate and redo procedures were recorded.

Results. A mean relative EAS area was 13.8±10.3% and 32.6±18.5% in patients with paroxysmal and persistent AF, respectively (P=0,02). During a mean follow-up of 32±7 months, AF recurrence was diagnosed in 69 (38%) of patients. Following a redo ablation in 51 (28%) of patients, subsequent AF recurrence developed in 31 pts (19%). Multivariate analysis showed that only relative EAS areas was independently associated with AF recurrence (HR 1.05, CI 95% 1.02-1.09, P=0.002) and ach 10% increase in the extent of relative EAS area was associated with a 1.6-fold elevation of AF recurrence rate after the index ablation. But the impact of the EAS on clinical outcome after redo ablation was even higher (HR =1,09, p=0,0018) and each 10% increase in the extent of relative EAS area was associated with a 2.4-fold elevation of AF recurrence rate after a redo ablation.

Conclusion. The present study suggests that an extent of LA EAS in patients undergoing PVI — is a significant and independent predictor of AF recurrence. This data can have important role for further development and personalization of strategy of interventional treatment in patients with AF.

Russ J Cardiol 2017, 8 (148): 82–89

http://dx.doi.org/10.15829/1560-4071-2017-8-82-89

Key words: atrial fibrillation, circular isolation of pulmonary veins, risk of atrial fibrillation relapse, high density contact mapping, electroanatomical substrate.

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

OPINION ON A PROBLEM

QRS COMPLEX FRAGMENTATION — AN IMPORTANT MARKER OF ABNORMAL DEPOLARIZATION

Parmon E. V., Gordeeva M. S ., Kurilenko T . A., Berngardt E. R.

Abstract

Aim. To investigate on the QRS complex fragmentation (fQRS) in patients with idiopathic ventricular arrhythmias (VA) .

Material and methods. Totally, 125 patients, selected into 2 groups: 1st group — 100 patients (mean age 46,4±14,1 y., 69 females) with idiopathic VRD. Patients had predominating daytime arrhythmia (63%), more oftenly — monomorphic ventricular exstrasystolic complexes (VE) (59%), in 39% patients — paroxysms of nonsustained ventricular tachicardia. Structural pathology of myocardium was ruled out based on electrocardiography data, echocardiography, in some cases — magnetic resonance. Second, control group — 25 pts. (69,0±11 y. o., 12 females) with VRD of ischemic origin (coronary heart disease, myocardial infarction in anamnesis). In this group, polymorphic (84%) daytime (68%) VE predominated, and in 25% — nonsustained ventricular tachicardia. Analysis was done with Holter ECG in 12 leads (“KTResult 2”, “Inkart” JSC).

Results. In the 1st group, fQRS of sinus complexes was registered in 2 patients (2%) and was transient. Relations in 24-hour dynamics of fQRS were not found. FQRS in VE was registered in 25 patients (25%). One patient had fQRS of sinus complexes as well as fQRS in VE. In 17 patients (68%) fQRS was found in VE. In controls, fQRS of sinus complexes was found in 6 patients (24%), fQRS of VE — in 23 (92%) and was permanent.

Conclusion. The phenomenon of fQRS can be found during routine instrumental investigation (standard ECG or Holter ECG), and is more common for CHD patients, being significant criteria for repolarization processes evaluation. Looking for fQRS in patients with idiopathic VRD, probably, is related to dysbalance of autonomous nervous regulation that leads to electrical instability of myocardium. It cannot be ruled out that fQRS might be an early marker of cardiomyopathies. It is necessary to investigate on this phenomenon further and to find its place in risk stratification of sudden cardiac death of patients with no structural heart pathology.

Russ J Cardiol 2017, 8 (148): 90–95

http://dx.doi.org/10.15829/1560-4071-2017-8-90-95

Key words: QRS fragmentation, electrical instability of myocardium, depolarization, ECG, Holter monitoring,. ventricular arrhythmias (VA).

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

CLINIC AND PHARMACOTHERAPY

EVALUATION OF ASPIRIN USAGE SAFETY IN CORONARY BYPASS SURGERY

Chernyavsky А. М.1, Kurguzov А. V.1, Lukinov V. L.2

Abstract

Recent guidelines it is permitted to continue aspirin before coronary bypass operation (CBG) (Class I, Level B). Nevertheless, absence of randomized multicenter studies makes it possible not to follow these in routine practice as the only. Practive of aspirin discontinuation before CBG is quite common due to anticipated risks of post-surgery complications.

Aim. To evaluate the safety of CBG with continued aspirin.

Material and methods. For the safety assessment of aspirin before CBG, we conducted prospective randomized study. Patients with stable coronary heart disease were included, who underwent CBG with continued aspirin (aspirin group), and another group included those who had aspirin discontinued (controls). Totally, 74 patients randomized. Treatment group included 37 patients, and 37 controls. Follow-up lasted for 5 minutes. As primary endpoint, the volume of operational blood loss was taken, during the next 24 hours post-surgery. As the second endpoint, the combination was taken as any cardiovascular adverse event: cardiac death, perioperational myocardial infarction, ischemic stroke.

Results. There was noted, the comparability of intraoperational blood loss in comparison groups (p=0,166). Summary blood loss in 24 hours of postoperational blood loss showed statistical significance between groups (mean difference 100 mL, 95% CI 0-110 mL, p=0,027). This amount of blood loss is clinically non-significant. In aspirin group, there were 2 cases of perioperational myocardial infarction, by cardiac enzymes elevation, not statistically significant.

Conclusion. Results of the study witness for the safety of CBG operations under continued aspirin as well as discontinued at least 5 days before surgery.

Russ J Cardiol 2017, 8 (148): 96–101

http://dx.doi.org/10.15829/1560-4071-2017-8-96-101

Key words: cardiovascular system, coronary bypass grafting, aspirin.

1E.N. Meshalkin Novosibirsk Scientific-Research Institute of Circulation Pathology, Novosibirsk; 2Institute of Computational Mathematics and Mathematical Geophysics, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.

COMBINATION OF AZILSARTAN MEDOXOMIL AND CHLORTHALIDONE: IS IT POSSIBLE TO FIGHT SYSTEMIC HYPERTENSION AND OBESITY TOGETHER?

Vasyuk Yu. A., Shupenina E. Yu., Nesterova E. A., Golubkova E. I., Nesvetov V. V.

Abstract

Arterial hypertension (AH) and obesity are the main risk factors of chronic noncommunicable diseases. Adipous tissue is not only a depot for energetic compounds, but is an active endocrine organ synthetizing biologically active substances that facilitate development of AH. Patients with AH and obesity are in the high cardiovascular risk group and demand effective combination antihypertension therapy. One of such drugs is the fixed combination of azilsartan medoxomil and chlorthalidone, which safety and efficacy are confirmed by various trials. Our clinical case demonstrates positive action of Edarbi Сlo on office and 24-hour blood pressure (BP), main parameters of aorta stiffness and structural and functional condition of myocardium at rest, as in exertion in patient with AH and obesity.

Russ J Cardiol 2017, 8 (148): 102–106

http://dx.doi.org/10.15829/1560-4071-2017-8-102-106

Key words: arterial hypertension, obesity, aortic stiffness, diastolic dysfunction, exercise tolerance.

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

ANALYSIS OF THE PRACTICE OF COMBINATIONAL ANTIHYPERTENSION THERAPY BY THE DATA FROM TWO OUTPATIENT REGISTRIES

Martsevich S . Yu.1, Zagrebelniy А. V.1, Lukina Yu. V.1, Lukyanov M. М.1, Vorobyev А. N.2, Pravkina Е. А.2 on behalf of the workgroups of PROFILE and RECVASA studies

Abstract

Aim. To investigate on the ways antihypertension drugs (AD) prescription, including, firstly, combinational therapy, in real conditions, by the data from two outpatient registries done in district polyclinics of Ryazan city (RECVASA) and in specialized scientific center in Moscow (PROFILE).

Material and methods. To the RECVAZA registry, 3690 patients were included, with cardiovascular diseases, and in 3648 (98,9%) arterial hypertension was diagnosed. Among 1531 patient’s data included into PROFILE registry during August 2011 — August 2015, hypertension was diagnosed in 1230 (80,3%). Mean age of RECVASA and PROFILE patients was 66,3±12,8 и 63,7±11,4, respectively. In overall data, males and females ratio were 28% and 72%, respectively, in RECVASA, and 54% and 46%, resp., in PROFILE.

Results. In comparative analysis of the registries, it was found that RECVASA patients were older, and women predominated (72%). Hypertension was diagnosed in almost 100%, was more severe and more comorbid. By the number of prescribed AD, both registries were almost identical: every third patient was prescribed 2 drugs, every fourth — 3, every fifth was taking 1 drug. Fixed combinations of AD were used in 15%, in both registries. The target blood pressure profile was reached in 26,1% of hypertension patients in RECVASA and in 37,6% in PROFILE; in hypertension of 3rd degree — in 21,9% and 34,2% cases, respectively.

Conclusion. In generally analogical approaches to AD, matching with current clinical guidelines, final result of treatment in terms of reached target blood pressure values, was significantly better in specialized cardiological center. This, probably, reflects better adherence to therapy in PROFILE patients.

Russ J Cardiol 2017, 8 (148): 107–113

http://dx.doi.org/10.15829/1560-4071-2017-8-107-113

Key words: outpatients registries, arterial hypertension, combination antihypertension therapy, fixed combinations.

1National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 2Ryazansky State Medical University named after I. P. Pavlov, Ryazan, Russia.

Workgroup of the PROFILE registry: Voronina V. P., Dmitrieva N. A., Zakharova A. V., Zagrebelny A. V., Kutishenko N. P., Lerman O. V., Lukina Yu. V., Tolpygina S . N., Martsevich S . Y.

Workgroup of the RECVASA registry: Vorobyev A. N., Zagrebelniy A. V., Kozminsky A. N., Lukina Yu. V., Lukyanov M. M., Moseichuk K. A., Nikulina N. N., Pereverzeva K. G., Pravkina E. A., Boitsov S . A., Martsevich S. Yu., Yakushin S. S.

PHARMACOLOGICAL PRECONDITIONING. FOCUS ON NICORANDIL

Gostishchev R. V.1, Soboleva G. N.1, Samko A. N.1, Osiev A. G.2

Abstract

The review focuses on the gathered data related to preconditioning phenomenon and, particularly, pharmacological preconditioning of myocardium. The information presented, on the activator of ATP-dependent potassium channels nicorandil. Mechanism of action is discussed, as efficacy and safety data. The evidence shows that, recently, nicorandil is not an obligatory medication to follow percutaneous intervention on coronary arteries, though clinical trials data confirm the possibility of periprocedural myocardium damage risk reduction, if the drug is prescribed in advance. The data presented, on positive influence of nicorandil on myocardial contractility and clinical outcomes.

Russ J Cardiol 2017, 8 (148): 114–121

http://dx.doi.org/10.15829/1560-4071-2017-8-114-121

Key words: pharmacological preconditioning of myocardium, nicorandil, activator of ATP-dependent potassium channels, percutaneous coronary interventions, cardiac enzymes.

1National Medical Research Center for Cardiology, Moscow; 2Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russia.

ALCOHOL-BASED SEPTAL ABLATION OF INTERVENTRICULAR SEPTUM WITH CONTRAST ECHOCARDIOGRAPHIC CONTROL

Osiev A. G., Gegenava B. B., Paleev F. N., Grigoryeva N. M.

Abstract

Alcohol septal ablation was introduced in 1994 as an alternative for surgical septal myectomy in patients with obstructive hypertrophic cardiomyopathy refractory to drug treatment. The procedure decreases symptoms of the disease creating targeted localized infarction focus of the upper part of interventricular spetum leading to increase of outgoing tract diameter, decrease of pressure gradient at the level of outgoing left ventricle tract and hypertrophy regression caused by overload. Such clinical improvement can be achieved in most cases. Main complication of the alcohol-based ablation — complete atrioventricular block with necessity, in some patients, of permanent cardiostimulator. Contrast echocradiography during alcohol septal ablation makes it to localize infarction, to use less amount of alcohol and, therefore, to decrease complications rate.

Russ J Cardiol 2017, 8 (148): 122–127

http://dx.doi.org/10.15829/1560-4071-2017-8-122-127

Key words: alcohol-based septal ablation, obstructive hypertrophic cardiomyopathy, atrioventricular block, contrast echocardiography, coronary arteriography.

Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russia.

2 октября 2017 г.
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