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Russian Journal Of Cardiology, 2017, 12 (22)

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CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2017, 12 (152): 6

Address to the readers

Russ J Cardiol 2017, 12 (152): 7

ORIGINAL ARTICLES

EVALUATION OF THE OUTCOMES OF STABLE ANGINA MANAGEMENT AFTER SELECTIVE PERCUTANEOUS CORONARY INTERVENTION (PILOT RESULTS)

Ratova L.G.1, Parizhskaya E.N.1, Kovaleva К.А.2, Zvartau N.E.1,3, Ionov М.V.1, Semenov А.P.1, Fedorenko А.А.1, Nedoshivin А.О.1, Nemyatykh О. D.2, Konradi А. О.1,3

Abstract

Aim. To evaluate the possibility for electronic data collection about the patients with stable angina after selective percutaneous coronary intervention (PCI) (angioplastics with coronary arteries stenting) in FSBI Almazov Center. To perform the study of life quality and patients satisfaction by PCI results in real clinical setting.

Material and methods. The questionnaire developed, that includes valid Russian language versions of Seattle Angina Questionnaire (SAQ) and EQ-5D-5L. The questionnaires are filled by patients at admission for selective PCI, at discharge, in 1 week, 1, 6 and 12 months post discharge. After the discharge from hospital the questionnaires are mailed via e-mail or the data is collected by phone calls. Study is funded by Russian Science Foundation (project ID 17-15-01177).

Results. From 01.01 to 30.04 2017 the PCI was done in 558 patients (70,7% males) at the age 64,9±9,6 y. o. Informed consent was signed by 59%, of those less than 1% use e-mail. By EQ-5D-5L the points were: baseline 64,4±19,6, at discharge 67,0±19,4, in 1 week 67,7±17,6 and 1 month 63,3±19,2. By SAQ, in 1 month the patients noted increased physical activity, stability of angina, better life quality and decrease of angina severity. In 1 week and 1 month the unsatisfied by their treatment were 19% and 13% of patients, 68% and 69% noted high satisfaction by PCI results. The results of PCI matched the expectations in 78% and 79% patients, respectively.

Conclusion. At the information gathering, the response by e-mail is very low, that makes it necessary to collect data by phone. It is demanded to develop the methods for electronic data gathering (messages, mobile apps) for easier data collection and for feedback. The results of questionnaires processing showed non-matched data for different questionnaires to each other, that makes it to develop unified specific questionnaire with its further validization.

Russ J Cardiol 2017, 12 (152): 8–13

http://dx.doi.org/10.15829/1560-4071-2017-12-8-13

Key words: value-based medicine, outcomes, patient-reported outcomes, selective percutaneous coronary intervention.

1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Saint-Petersburg State Chemical and Pharmaceutical Academy of the Ministry of Health; 3Saint-Petersburg National Research University of Information Technologies, Mechanics and Optics (ITMO), Saint-Petersburg, Russia.

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY IN DIAGNOSTICS OF OBSTRUCTIVE LESION IN CORONARY ARTERIES

Sumin A. N., Korok E. V., Korotkevich A. A., Kachurina E. N., Kokov A. N., Barbarash O. L.

Abstract

Aim. To evaluate the potential of single photon emission computed tomography (SPECT) in diagnostics of obstructive lesion of coronary arteries (CA).

Material and methods. The studied group consisted of 107 patients, admitted for diagnostics and treatment in the SRI CICVD during 2012-2015 with former established diagnosis of coronary heart disease (CHD) or hospitalized to rule it out. For hemodynamically significant stenoses, coronary arteriography (CAG) was applied. Data from CAG was compared with SPECT. As a result, four groups were formed: 1 group — with positive results by SPECT and CAG (SPECT“+”/CAG“+”, n=24); 2 group — with positive SPECT and negative CAG (SPECT“+”/CAG“-”, n=6); 3 group — with negative SPECT and positive CAG (SPECT“-”/CAG“+”, n=36); 4 group — negative both SPECT and CAG (SPECT“-”/CAG“-”, n=41).

Results. In assessment of the patients with suspected CHD, positive result of pharmacological stress-test in SPECT was revealed in 28% cases, and hemodynamically significant CA lesion was found in 56% of patients. Myocardial infarction in anamnesis predominated in SPECT“+”/CAG“+” (79,2%), SPECT“+”/CAG“-” (83,3%), SPECT“-”/CAG“+” (55,6%) comparing to SPECT“-”/CAG“-” (39%; р=0,007). Also, in the group SPECT“-”/CAG“-” pre-test probability of CHD was the lowest (58%) comparing to other groups — 80,5%; 80,5% and 77% (р=0,002). Hence ejection fraction of the left ventricle was significantly lower in the group of SPECT“+”/CAG“+” (53%; р=0,011). In this group also subocclusion was found in circumflex (29,2%) and right CA (45,8%), respectively, р=0,033 and р=0,054. With the false negative results of SPECT there was association of male gender, former coronary bypass operation, increased cardiac volume. Sensitivity of SPECT in hemodynamically significant CA stenoses diagnostics was 40%, specificity — 87%.

Conclusion. The results of current study are important for further elaboration onthe approaches to obstructive CHD diagnostics.

Russ J Cardiol 2017, 12 (152): 14–20

http://dx.doi.org/10.15829/1560-4071-2017-12-14-20

Key words: single photon emission computed tomography, significant stenoses of coronary arteries.

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

SIGNIFICANCE OF M1 AND M2 POLARIZATION OF MONOCYTES-MACROPHAGES IN THE BLOOD FOR ATHEROSCLEROSIS RISK ASSESSMENT IN TYPE 2 DIABETES COMPARING WITH CORONARY HEART DISEASE

Galstyan К. О.1, Nedosugova L. V.1, Nikiforov N. G.2, Kolmychkova К. I.3, Kirichenko Т. V.3, Sobenin I. А.2

Abstract

Aim. To assess the phenotypes of proinflammatory (M1) and anti-inflammatory (M2) activation of blood monocytes in type 2 diabetes (DM2) comparing to coronary heart disease patients (CHD).

Material and methods. Totally, 55 CHD patients assessed, of those 28 (11M/17F) were first time diagnosed with DM2 at current hospitalization (HbA1c level 9,7% SD=2,4), not taking previously any glucose lowering therapy; and 27 patients with CHD (20M, 7F), with no glucose metabolism disorders. By immune enzyme assay method (IEA) proinflammatory monocyte activation was evaluated by spontaneous and interferon gamma (IFN-ɣ) induced secretion of proinflammatory cytokine tumour necrosis factor alpha (TNF-α), and anti-inflammatory activation of monocytes by spontaneous and interleukin-4 (IL-4) induced secretion of anti-inflammatory cytokine CCL18.

Results. There was found an increased ability of monocytes in DM2 patients to secrete pro- and anti-inflammatory cytokines comparing to the controls and CHD patients. Basal TNF-α secretion was higher than control level 2,8 times, and stimulated — 2,2 times. Values of the basal and stimulated TNF-α secretion in CHD patients were significantly lower than in controls. There was positive correlation of HbA1c level and basal secretion of TNF-α. Basal and stimulated secretion of anti-inflammatory cytokine CCL18 in DM2 patients was significantly higher than control level — 28 pg/mL (SD=3) and 1158 (SD=68) pg/mL of the cultural medium, respectively, and in CHD patients these parameters were lower than the control level — 0,26 pg/mL (SD=0,14) and 65 (SD=33) pg/mL, respectively.

Conclusion. In DM2 there is disbalance of M1/M2 activation of monocytes comparing to controls and CHD, that points on overactivation by proinflammatory phenotype.

Russ J Cardiol 2017, 12 (152): 21–25

http://dx.doi.org/10.15829/1560-4071-2017-12-21-25

Key words: type 2 diabetes, atherosclerosis, CHD, M1/M2 monocyte activation, inflammation, oxidative stress.

1I. M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 2Scientific Medical Research Center of Cardiology of the Ministry of Health, Moscow; 3ANO SRI of Atherosclerosis of RANS, Moscow, Russia.

PREDICTIVE VALUE OF ERYTHROCYTE ANISOTROPY COEFFICIENT IN PATIENTS HOSPITALIZED FOR ACUTELY DECOMPENSATED CHRONIC HEART FAILURE

Kostenko V. A.1, Sitnikova М. Yu.2, Skorodumova Е. А.1, Skorodumova Е. G.1, Fedorov А. N.1

Abstract

Aim. To evaluate the role of erythrocyte anisotropy (RDW) coefficient as a predictor of adverse outcome in acutely decompensated chronic heart failure (ADCHF).

Material and methods. Totally, 422 patients, age 37-82 y. o. (mean 66,8±2,3 y. o.) investigated, who had been hospitalized for ADCHF of ischemic origin with decreased ejection fraction (EFLV). All participants underwent routine tests, including the coefficient of erythrocyte anisotropy variation (RDW-CV, RDW-SD), C-reactive peptide (CRP) and brain natriuretic peptide (BNP). Instrumental methods included echocardiography in M- and B-regimens with EFLV measurement. Follow-up in 24 months was done via phone calls with the patient or relatives, and original questionnaire.

Results. At admittance, mean values of RDW-CV were 16,3±2,9%, at discharge — 16,7±3,3%; RDW-SD — 48,7±7,3 fL and 53,6±8,7 fL, respectively. T-test for the relation of these two parameters with fatal outcome showed that only RDW-SD is significantly (p=0,045) relevant, for the period 24 months post discharge. Main group was separated to two subgroups — А (RDW-SD <46,5 fL (n=173)), and B (RDW-SD ≥46,5 fL (n=249)). In aspect of the adverse outcome, group comparison with T-criteria by Student was 6,9 (p=0,0001). There was direct correlation of average strength between hemoglobin contents (r=0,53, р<0,05), creatinine (r=0,55, р<0,05) and С-reactive protein (CRP) (r=0,35; р>0,05), negative correlation for EFLV (r=-0,54, p<0,05) with RDW-SD.

Conclusion. In ADCHF patients the RDW-SD parameter seems to be more significant than RDW-CV in relevance to prediction, and its values correlate with CRP, hemoglobin, creatinine, as negatively also correlate with EFLV. The RDW-SD value higher than 46,5 fL, regardless the other factors, significantly predicts the increase of patients mortality after ADCHF.

Russ J Cardiol 2017, 12 (152): 26–30

http://dx.doi.org/10.15829/1560-4071-2017-12-26-30

Key words: acute decompensation, heart failure, two year follow-up, negative prognosis, RDW-SD.

1I. I. Dzhanelidze Institute of Emergency Medical Care, Saint-Petersburg; 2Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg, Russia.

DISTRIBUTION OF CHEMICAL ELEMENTS IN KIDNEY SPECIMENS OF PATIENTS WITH SYSTEMIC HYPERTENSION

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

Abstract

Aim. To assess quantitative macroelement contents of kidney tissue in arterial hypertension (AH) patients.

Material and methods. By the method of nephrobiopsy, in AH patients (n=12, duration of AH 6,3±1,5 y.) during surgery on upper urinary tract, specimens were collected of biological tissue of kidney. As the controls, elements in kidney tissue of healthy persons were studied, from those died in traffic accidents (n=18). Mean age of the patients was 48,3±1,6 y. o. By the method of atom-emission spectrometry with nanotechnologies: scanning (SEM; FEI Quanta 200, FEI Quanta 600) and scanning transmission electronic microscopy (STEM; FEI Nova NanoSEM) the contents of macroelements and microelements were assessed.

Results. It was found that concentration of atomic C in AH patients comparing to control group shows tendency to increase, exceeding the controls by 9%. In AH patients kidney tissue shows significant decrease of all main elements (N, O, Na, Mg, P, S, Cl, K, Zn).

Conclusion. Further study on the mechanisms of AH development with evaluation of chemical elements concentration directly in the tissues where do chemical reactions act, is important for understanding of the grade of involvement of specific organs into these processes. Creation of database of overall element contents of biological tissues is a novel direction in cardiology. The results of elements assessment of kidney tissue in cardiovascular diseases will open new opportunities for treatment and target organ damage prevention.

Russ J Cardiol 2017, 12 (152): 31–35

http://dx.doi.org/10.15829/1560-4071-2017-12-31-35

Key words: arterial hypertension, microelements, kidney.

1Belgorodsky State National Research University, Belgorod; 2National Research Center for Preventive Medicine of the Ministry of Health, Moscow, Russia.

ELECTROCARDIOGRAPHIC CONTROL FOR CARDIOVASCULAR SYSTEM IN SPORTSMEN AT PRECOMPETITION TRAINING

Garganeeva N. P.1, Taminova I. F.1,2, Vorozhtsova I. N.1,3

Abstract

Aim. To investigate on the electrocardiographic specifics of sportsmen at various stages of training and competition processes according to the sport type, intensity and training load type.

Material and methods. Totally, 136 male sportsmen assessed. Qualified sportsmen 116 persons (groups of improvement and mastery, age 22,07±4,10 y. o., in-sport time 5-15 years) were selected to the groups: I — wrestling (n=30), II — ski racing, biathlon (n=27), III — powerlifting (n=33), IV — volleyball (n=26). Group V — the controls (n=20), age 17,95±1,55 y. o., in-sport less than 3 years. Study methods were electrocardiography (ECG), Holter monitoring of ECG, echocardiography (EchoCG), veloergometry (VEM).

Results. During the preparation period of training-competition process, ECG changes, including cardiac rhythm disorders (CRD), were found in 93 of 136, that is 86 (63,2%) of quality sportsmen and 7 (5,1%) of controls (p=0,00001); during competition period — in 104 (76,5%) and 8 (5,9%) (p=0,00001), respectively. The prevalence of ECG changes in quality sportsmen at preparation tranings was 116 cases, in competition period — 165 (p<0,05). During the competition period, there was not just an increase of total number of CRD sportsmen, but sinus bradicardia cases number (p=0,0321), His bundle branches blocks (p=0,0455), repolarization disorders (p=0,0034) and other changes, including concomitant. In 15 sportsmen there were first time discovered CRD required more detailed investigation (serious bradicardia, ventricular extrasystoly (VE), two-bundle blocks, WPW phenomenon, serious repolarization disorders).

Conclusion. With the increase of mastery, there is increased rate of ECG changes and CRD cases, that demands additional dynamic electrocardiographic control during the process of intensive training at competition period.

Russ J Cardiol 2017, 12 (152): 36–40

http://dx.doi.org/10.15829/1560-4071-2017-12-36-40

Key words: electrocardiography, quality sportsmen, sport type, cardiac rhythm disorder.

1Siberian State Medical University (SSMU), Tomsk; 2BI KMAO-Yugra Clinical Medical-Exercises Dispensary, Nizhnevartovsk branch, Nizhnevartovsk; 3Cardiology Research Institute, Tomsk National Research Medical Centre of RAS, Tomsk, Russia.

EARLY ECHOCARDIOGRAPHIC MARKERS OF CARDIOVASCULAR RISK IN WOMEN

Krikunov P. V., Brytkova Ya. V., Berns S. A., Kozhukhovskaya O. L., Stryuk R. I.

Abstract

Aim. To define early echocardiographic markers of cardiovascular risk in women.

Material and methods. In 76 females, of 1st degree of kinship, from 61 families, two groups were selected: 26 daughters, whose mothers have arterial hypertension (AH) — group 1; 41 daughters from normotensive mothers — group 2. Anamnesis was assessed, including registration of cardiovascular risk factors, heredity, anthropometry, bidimensional echocardiography (EchoCG), and tissue Doppler.

Results. In women from group 1, waist circumference (WC) and waist/hip ratio were significantly higher than in group 2. In bidimensional EchoCG, structural and functional parameters of the left ventricle function (LV) were within the reference values, however left atrium volume index in group 1 was significantly higher in comparison with the daughters from normotensive mothers. Also, in the group 1, there were significant differences od tissue Doppler values that characterize diastolic LV function. Relation E/e’ on lateral and septal areas of the mitral valve did not reach pathological values in both groups, as the in groups almost healthy persons were included; in the group of daughters form hypertensive mothers though, these parameters were significantly higher than in the group 2.

Conclusion. Early adverse factors of cardiovascular risk in women are inheritance for cardiovascular diseases and AH, markers of metabolic syndrome (increased WC and waist/hip ratio), and left atrium volume and E/e’ that represent diastolic function of the LV.

Russ J Cardiol 2017, 12 (152): 41–46

http://dx.doi.org/10.15829/1560-4071-2017-12-41-46

Key words: cardiovascular risk markers in women, arterial hypertension, abdominal obesity, echocardiography, diastolic dysfunction.

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

CARDIAC MAGNETIC RESONANCE IMAGING IN DIFFERENTIAL DIAGNOSTICS OF ACUTE CORONARY

SYNDROME IN PATIENTS WITH NON-OBSTRUCTION CORONARY ATHEROSCLEROSIS

Ryabov V.V.1,2,3, Gomboeva S. B.1,2, Shelkovnikova Т. А.1, Baev А. Е.1, Rebenkova М. S.1,2, Rogovskaya Yu. V.1,2, Usov V. Yu.1

Abstract

Aim. To investigate on the nosological structure of acute coronary syndrome (ACS) in patients with non-obstruction coronary atherosclerosis (NOCA) before and after magnetic resonance imaging (MRI) of the heart.

Material and methods. A non-randomized, open, controlled study (NCT02655718). The patients included, with ACS, older than 18 y. o., with NOCA (intact coronary arteries or stenosis ≤50%) confirmed by invasive coronary arteriography (ICAG). Patients with previous revascularization were not included.

Results. In the year 2016, to emergency cardiology department (ECD) 913 ACS patients admitted. In 44 (4,8%) the NOCA was found. Mean age 54±10,4 y. o., males 68%, and the groups with ACS with ST elevation (STEACS) and none (NSTEANS) were comparable by clinical and anamnestic parameters. Intact coronary arteries were visualized in 16 (53%), non-significant coronary atherosclerosis was diagnosed in 14 (32%), slower coronary flow — 22 (73%). By MRI with contrast, performed in 11±8 days (2-43 days) from ACS beginning, myocardial oedema was found in 18 (41%), hyperemia in 13 (30%) and fibrosis in 40 (91%); there were no changes in 1 patient. Nosological structure of ACS in NOCA after MRI has been represented: by acute myocardial infarction (MI) in 24 (55%) cases, unstable angina (UA) — in 6 (14%), pseudocoronary myocarditis in 10 (23%), acute aorta dissection in 1 (2%), posttraumatic atherosclerosis in 1 (2%), congenital valve defect in 1 (2%), manifested Wolf-Parkinson-White (WPW) — in 1 (2%). In-hospital mortality was 2%. In comparison of ACS before and post MRI there was significant increase number of patients with myocarditis, by 20%.

Conclusion. The prevalence of ACS in NOCA is 4,8%, that is comparable to literature data. Patients with ACS and NOCA are heterogenic group with MI, UA, myocarditis, acute aorta dissection, posttraumatic atherosclerosis, congenital defects, WPW syndrome. In-hospital mortality was 2%. Comparing the structure of the diagnoses before and after MRI, there was significant increase of myocarditis patients number. A high accuracy of MRI was found for differential diagnostics of ACS in NOCA, which was 78%.

Russ J Cardiol 2017, 12 (152): 47–54

http://dx.doi.org/10.15829/1560-4071-2017-12-47-54

Key words: acute coronary syndrome, non-obstructive coronary atherosclerosis, magnetic resonance tomography, myocardial infarction, myocarditis.

1Cardiology Research Institute, Tomsk National Research Medical Centre of RAS, Tomsk; 2National Research Tomsk State University, Tomsk; 3Siberian State Medical University (SSMU), Tomsk, Russia.

HEMODYNAMIC AEROBIC MECHANISMS OF EXERCISE TOLERANCE INCREASE IN STABLE ANGINA PATIENTS ON ANTIANGINAL TREATMENT

Vasiliev A. P., Streltsova N. N.

Abstract

Aim. To reveal possible hemodynamic aerobic mechanisms of exercise tolerance improvement in stable angina patients having taken the typical pharmacological antianginal group drugs: nitrates, beta-blockers, calcium channel blockers.

Material and methods. Totally, 164 stable angina male patients of II-IV functional class, participated in the study (mean age 55,2±2,1 years), who underwent doubled veloergometry before and after single intake of a mean therapeutical dosage of propranolol (PR) (n=58), isosorbidi dinitras (ID) (n=54), nifedipine (NF) (n=52). At the threshold of exercise intensity, the oxygen consumption (VO2) was measured, cardiac index (CI), arteriovenous gradient by oxygen (АVРО2), peripheral vascular resistance (PVS), and Robinson index (RI).

Results. The efficacy of single NF dosage was found in 55,5% of angina patients, ID — in 48%, and PR — in 58%. The increase of threshold intensity was supported by an adequate VO2, which, after the PR intake was realized within analogous to the baseline CI parameters (4,6±1,7 L/min/m2 and 4,9±1,7 L/min/m2). In this case АVРО2 was higher than baseline by 43,1% (p<0,001). Increase of exercise tolerance by the same value after the intake of NF was followed by CI increase comparing to the primary values, by 40,5% (p<0,001) and increase of RI from 157,7±39,0 units to 210,0±68,6 units (р<0,001). Value of АVРО2 did not change. Intake of ID also was followed by significantly higher threshold values of CI and RI, however, less prominent comparing to PR (by 9,6 and 17,6%), which also were followed by 39,8% increased oxygen extraction from blood (p=0,018).

Conclusion. Antianginal effect of the drugs is mediated primarily by activation of the various parts of oxygen transporting system than realizes additional oxygen transport to working tissues (muscles). Intensification of oxygen transportation might be followed by the increase of hemodynamic productivity (NF), mostly by activation of extracardiac oxygen consumption factors (PR) and combination of both (ID).

Russ J Cardiol 2017, 12 (152): 55–61

http://dx.doi.org/10.15829/1560-4071-2017-12-55-61

Key words: angina, antianginal medications, antianginal mechanism.

Tyumen Cardiological Scientific Center, Tomsk National Research Medical Center of RAS, Tomsk, Russia.

DIAGNOSTICS OF ATRIAL FIBRILLATION IN PATIENTS WITH IMPLANTABLE CARDIAC ELECTRONIC DEVICES: PREVALENCE AND RISK FACTORS

Sazonova Yu. S.1,2, Andreev D. А.1, Samoylenko I. V.1,2, Syrkin А. L.1, Serova М. V.1, Bykova А. А.1

Abstract

Aim. To evaluate the prevalence and to search for the risk factors of atrial fibrillation (AF) development in patients with implantable cardiac electronic devices (dualchamber stimulators (ECS), implantable cardioverter-defibrillators and resynchronizers).

Material and methods. The design of the study is prospective single center, with consequent inclusion of 304 patients at the age ≥18 y. o. and with no documented AF in anamnesis, with indications for implantation of replacement of ECS. Patients followup

lasted for 12-18 months with 1-3 months periodicity visits. In the analysis of data on rhythm disorders, stored in ECS memory, as significant the episodes of high cardiac rate with duration more 6 minutes per day and detection rate more than 175-180 beats per minute were taken. Also, in all the patients clinical and demographic data was assessed, laboratory and echocardiography methods applied.

Results. The study was completed in 224 patients, the rest were lost at different stages. AF was found in 57 (25,4%), and in 43 (75,4%) the episode were nonsymptomatic. In 3 months after implantation, AF revealing rate was 14,9% (38 patients of 255 at the 1st visit). Independent risk factors for AF were thromboembolic complications in anamnesis (HR 4,72; 95% CI 2,279-9,77; р<0,0001), increased left atrium volume index (HR 2,07; 95% CI 1,075-3,975; р=0,029), and hemoglobin level decrease (HR 2,58; 95% CI 1,245-5,35; р=0,011).

Conclusion. The prevalence of AF in the patients with implantable cardiac devices is quite high. Most patients have their episodes asymptomatic. Most commonly, AF is found during 3 months from the operation. Risk factors for AF according to our data, were thromboembolic complications in anamnesis, increased left atrium volume index, and hemoglobin level decrease.

Russ J Cardiol 2017, 12 (152): 62–67

http://dx.doi.org/10.15829/1560-4071-2017-12-62-67

Key words: atrial fibrillation, dual chamber pacemaker, high cardiac rate episodes.

1I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 2City Clinical Hospital № 4, Moscow, Russia.

ROBOTIC CATHETER ABLATION OF PERSISTENT ATRIAL FIBRILLATION (RANDOMIZED TRIAL RESULTS)

Naymushin M. A., Lebedev D. S.

Abstract

Aim. Comparison of efficacy and safety of the robotic catheter and manual catheter ablation in management of patients with persistent atrial fibrillation (PsAF).

Material and methods. In the study, 80 patients included, with PsAF. They were randomized to groups of manual ablation (MA) and robotic ablation (RA). After ablation, patients were followed up during 1 year every 3 months. Sinus rhythm retention was evaluated with Holter 24-hour ECG monitoring and 12-channel ECG. As efficacy criteria, the absence was taken of registered paroxysms of atrial fibrillation and other tachiarrhythmias lasted 30 sec and more. As primary endpoint, the absence was taken of any atrial tachiarrhythmias (AFib/AFlut) after the ablation procedure during 12 months, with every 3 months ECG monitoring. As secondary endpoints the following were taken: complications rate, duration of procedure and x-ray exposition, rate of recovery of conduction through the ablation line in acute phase (in 30 min post ablation) with intravenous ATP.

Results. Mean procedure time and x-rays exposition in MA group was 164±28 min and 45±14 min, respectively. Mean duration of procedure in RA was 200±35 min (p<0,05). However x-ray duration was lower in RA group: 30±12 min, and the time of rentgenoscopy per operator was even lower: 18±6 min (p<0,05) In the MA group, in 9 (25%) patients there was recovery of conduction through the border, with ATP injection at acute stage, and in RA group — in two patients (5%), p<0,05. Total number of adverse events did not differ in groups (p=0,5).

Conclusion. RA in patients with PsAF makes in to effectively isolate pulmonary veins ostia during the surgery, and to block the conduction through the borderline. The percentage of major and minor adverse events in acute and chronic period of RA is not higher than that in MA and is 10%. Application of RA makes it to decrease x-ray exposition per operator 2,5 times, and on a patient — by 30%. Training period in RA is 10 operations that is significantly lower than in MA.

Russ J Cardiol 2017, 12 (152): 68–72

http://dx.doi.org/10.15829/1560-4071-2017-12-68-72

Key words: atrial fibrillation, robotic catheter ablation, left atrium, pulmonary veins, atrial flutter.

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

CLINICAL AND ELECTROPHYSIOLOGICAL PREDICTORS OF RECURRENT POSTINFARCTION VENTRICULAR TACHICARDIAS AFTER CATHETER ABLATION

Tatarsky R. B.1, Nemtsov S. V.1, Mikhaylov Е. N.1, Lebedeva V. К.1, Lebedev D. S.1

Abstract

Aim. To find out the clinical and electrophysiological predictors of recurrent ventricular tachyarrhythmias (VTA) after catheter homogenization of post-infarction scar areas.

Material and methods. Patients included, with myocardial infarction (MI) in anamnesis and documented sustained VTA, regardless effective treatment by implantable cardioverter-defibrillator. Totally, 72 patients included (mean age 64±13 y. o.), of those 63 males with postinfarction VTA. In 12 cases there were “electrical storms” demanded urgent catheter management. In such patients, the extended catheter homogenization of the scar was performed, that is ablation of all conduction channels, anomalous potentials and surrounding ablation of infarction zone. Patients were selected to 2 groups according to recurrent VT in post-surgery period. First group included 27 (37%) VTA recurrent patients, mean age 62±10 y. o. Second group included 45 patients (63%) with non tachyarrhythmias recurrence, mean age 63±12 y. o. The evaluation was done, of the selected parameters with the aim to

define predictors of rhythm disorders recurrence.

Results. Main clinical predictors of VTA recurrence after catheter ablation were the duration of post MI period and its anterior localization. Full area of the scar surface (bipolar voltage lower 1,5 mV) was comparable in patients with recurrent VT and with

none (66±51 cm2 vs 82±49 cm2). However the area of the dense scar (bipolar amplitude ≤0,5 mV) and percent of the dense scar in relation to entire scar was significantly smaller in the recurrence group (group 1 — 23±22 cm2 and 24±18%, in group 2 — 41±22 cm2 and 45±21%; p<0,05). The differences were found in the cycle length of clinical VTA assessment in groups 1 and 2 (290±62 and 330±93 ms, respectively, p<0,05).

Conclusion. The analysis that was done, made it to define the following variables and VT predictors: localization of the MI (anterior vs inferior), duration of ischemic anamnesis, cycle of clinical VT, non-homogeneity of the scar, area of the fractionized

potentials and delayed potentials of electrograms, area of the dense scar.

Russ J Cardiol 2017, 12 (152): 73–78

http://dx.doi.org/10.15829/1560-4071-2017-12-73-78

Key words: myocardial infarction, postinfarction tachycardias, catheter ablation of ventricular tachycardias, electrical storm.

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

GENDER DIFFERENCES OF THE ATRIA REMODELLING AND INTRAMURAL INNERVATION IN STRUCTURAL DISEASES OF THE HEART

Mitrofanova L. B., Patsyuk A. V., Konovalov P. V., Lebedev D. S., Mikhaylov E. N.

Abstract

Aim. To perform the comparative analysis of atria morphometry and histological composition of myocardium in men and women with structural pathology of the heart.

Material and methods. As the materials, case histories were used and autopsy records of 41 patient, age 43 to 88 y. o., 23 males and 18 females; of those 28 had coronary heart disease, 10 — other cardiovascular disorders, 3 — non-cardiac pathology. Organometry was done of the atria in 23 zones. Paraffin slices of all 23 localizations, as of the sinus and atrio-ventricular nodes were colored with hematoxiline and eosine, and by van Hison. Morphometry was done, with assessment of ganglia and nervous fibers localization density, relative square of fibrosis and lipomatosis areas, mean relative square or antigens expression areas in

ganglia and nervous fibers. Comparison was done, of morphometric and clinical parameters in men and women.

Results. In men, there was statistically significantly higher mean cardiac mass, distance between inferior pulmonary veins, thickness of the left atrial wall, the cuff height of inferior right pulmonary vein (p<0,05). It was also noted that men and women have difference in the spread of fibrosis and fatty tissue in different atrial areas. Maximal density of ganglia in men was at the ostium of coronary sinus and between inferior pulmonary veins, and in women — between superior and inferior pulmonary veins.

Conclusion. Morphometry showed that remodelling of the atria in cardiovascular diseases has its gender differences, including the diversity of nervous fibers localization in various zones. Further in-depth study of cardiac innervation might help to elaborate different approaches to surgical tactics of the heart diseases in men and women.

Russ J Cardiol 2017, 12 (152): 79–83

http://dx.doi.org/10.15829/1560-4071-2017-12-79-83

Key words: gender differences, atrial fibrillation, heart innervation, nervous fibers.

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

CLINIC AND PHARMACOTHERAPY

MODERN OPPORTUNITIES FOR ANTIHYPERTENSION THERAPY: THE PLACE OF AZILSARTAN MEDOXOMIL

Skibitsky V. V., Fendrikova A. V.

Abstract

Modern approaches to antihypertension therapy suppose the usage of combination drugs, making significant positive influence on the values of systemic blood pressure (BP) in daily and nocturnal periods, optimization of 24-hour BP profile, achieved target BP in most of patients. Also, it is important to fulfill organ protection and vessel protection. To all these criteria does respond azilsartan medoxomil and its combination with chlorthalidone. The combination azilsartan/chlorthalidone shows serious antihypertension properties, including the patients with metabolic disorders, facilitates optimization of BP at night, decrease of vascular stiffness. Collection of positive properties of the combination makes it to apply broadly in real clinical practice to increase efficacy of hypertension patient’s management.

Russ J Cardiol 2017, 12 (152): 84–89

http://dx.doi.org/10.15829/1560-4071-2017-12-84-89

Key words: target levels, antihypertension therapy, azilsartan medoxomil.

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

APPROACHES TO SELECTION OF ANTIHYPERTENSION DRUG WITHIN APPLIED LOWER TARGET BLOOD PRESSURE LEVELS

Gilyarevsky S. R.1, Golshmid М. V.1, Kuzmina I. М.2

Abstract

In the article, contemporary tendencies are discussed, of the shifts in targeted and threshold systemic blood pressure levels (BP), as the specifics of antihypertension therapy, which are induced by such tendencies. The issue discussed, on the risk increase for acute kidney injury while achieving target BP and possible approaches to its solution. Evidence data is shown on the angiotensin II receptor blockers influence on kidney function. The data presented, that makes it to suppose special role of irbesartan in prevention of kidney dysfunction prevention.

Russ J Cardiol 2017, 12 (152): 90–96

http://dx.doi.org/10.15829/1560-4071-2017-12-90-96

Key words: arterial hypertension, chronic kidney disease, angiotensin II receptor blockers, irbesartan.

1Russian Medical Academy of Continuous Professional Education of the Ministry of Health, Moscow; 2N. V. Sklifosovsky SRI of Emergency Care, Moscow, Russia.

COMPARISON OF HEMODYNAMIC EFFECTS OF INHALATORY ILOPROST AND NITRIC OXIDE IN PATIENTS WITH SEVERE LEFT VENTRICLE DYSFUNCTION

Bautin A.E., Yakovlev A.S., Zayashnikov S. V., Tashkhanov D. M., Marichev A. O., Fedotov P. A., Bortsova M. A., Sazonova Yu. V.,

Sukhova I. V., Titova I. E., Simonenko M. A., Sitnikova M. Yu., Novikov V. K., Moiseeva O. M.

Abstract

Aim. To compare the effect of nitric oxide (NO) and inhalatory iloprost (IIP) on the hemodynamics of pulmonary hypertension patients, associated with severe systolic dysfunction of the left ventricle (LV).

Material and methods. A retrospective description research performed, of the results of 158 consequently done tests for reversibility of pulmonary hypertension with NO and IIP in 124 candidates for cardiac transplantation, with pulmonary vascular resistance (PVR) more than 2,5 units of Wood. Totally, 32 females and 92 males investigated (mean age 48,9±11,2 y. o.) with heart failure (HF) of ischemic (n=59) and non-coronary (n=65) origin, with the LF ejection fraction 22,5±5,2%. Inhalation of NO in 80 ppm concentration was applied in 47 cases (39 patients), IIP with dosage 20 mcg — in 111 cases (93 patients). Pressure measurement in pulmonary artery (PA) and hemodynamics parameters was done with Swan-Ganz catheter. The data presented as the mean ± standard deviation.

Results. Decrease of the mean pressure in PA was noted: at NO from 34,7±8,4 to 32,7±9,7 mmHg (p=0,015), IIP from 36,7±10 to 31,1±9,2 mmHg (p<0,001). Pulmonary resistance decreased at NO from 4,8±1,7 to 3,6±1,6 Wood units (p<0,001) and IIP — from 4,9±2 to 3,1±1,4 Wood units (p<0,001). With NO, total peripheral vascular resistance (TPVR) and blood pressure (BP) did not change, but IIP decreased TPVR from 1772±495 to 1445±444 dyn·sec·cm-5 (p<0,001) and BPav from 79,7±10 to 74,8±11,5

mmHg (p<0,001). NO caused mild overload on the LV: PA wedge pressure increased from 19,6±6,5 to 21,2±7,9 mmHg (p=0,038), contrary, IIP decreased wedge pressure from 20,2±6,5 to 18,7±6,6 mmHg (p<0,001). Increase of pre- and postload at NO inhalation led to decrease of the stroke volume index (SVI) from 23,8±7,9 to 22,4±6,3 mL/m2 (p=0,023). And IIP increased SVI from 26,2±7,2 to 30,7±8,7 mL/m2 (p<0,001).

Conclusion. In patients with severe systolic dysfunction of the LV, IIP (contrary to NO) positively influenced the injured LV.

Russ J Cardiol 2017, 12 (152): 97–103

http://dx.doi.org/10.15829/1560-4071-2017-12-97-103

Key words: pulmonary hypertension, iloprost, nitric oxide, heart failure.

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

PULSE REDUCTION IN MANAGEMENT OF HYPERTROPHIC CARDIOMYOPATHY (TWO CLINICAL CASES)

Krylova N. S.1,2, Kovalevskaya Е. А.1,2, Poteshkina N. G.1,2, Mershina Е. А.3, Sinitsyn V. Е.3, Sonicheva N. А.4, Monserrat L.4

Abstract

Two clinical cases presented, of the patients with hypertrophic cardiomyopathy and individualized pulse reduction therapy approach. Patients were prescribed consequently bisoprolol and ivabradine (Coraxan®, “Les Laboratoires Servier”, France) with comparative efficacy assessment by a complex investigation that included EchoCG, exercise tests, 24-hour monitoring of ECG and BP.

Russ J Cardiol 2017, 12 (152): 104–112

http://dx.doi.org/10.15829/1560-4071-2017-12-104-112

Key words: hypertrophic cardiomyopathy, bisoprolol, ivabradine, stress echocardiography.

1N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia; 2City Clinical Hospital № 52, Moscow, Russia; 3Center of Treatment and Rehabilitation of the Ministry of Health, Moscow, Russia; 4Genetics Laboratory HealthInCode, La Corugna, Spain.

INFLUENCE OF THE COMBINATION DRUG PRESTANS (PERINDOPRIL A, AMLODIPINE) ON MORPHO-FUNCTIONAL PARAMETERS OF ARTERIAL BED IN ESSENTIAL HYPERTENSION

Danilogorskaya Yu. A., Zheleznykh E. A., Privalova E. V., Shchendrygina A. A., Belenkov Yu. N., Ilgisonis I. S., Tishman M. I.

Abstract

Aim. Recently, the problem of endothelial dysfunction is in high interest. It was proved that microcirculatory disorders play main role in development and progression of target organ damage in essential arterial hypertension (EAH). Microcirculatory bed itself should be the target of EAH. Modern antihypertension drugs, despite of normalization of blood pressure (BP), should fulfill the prevention of target organ damage. In our study, the influence was evaluated, of treatment with the fixed combination of perindopril A and amlodipine (Prestans®, “Les Laboratoires Servier”, France) on structural and functional parameters of the heart and vessels.

Material and methods. In the study, 30 patients with grade II-III EAH included, mean age 54,12±9,15 y. o., duration of EAH — 12,6 (4;21) years. For the assessment of endothelial function and structural and functional condition of capillary net of a

finger skin, photopletysmography were applied and videocapillroscopy, respectively.

Results. Therapy with Prestans® led to improvement of functioning of the middle sized vessels and microcirculatory vessels (MC) (increase of occlusion index on MC level from 1,5 to 1,8, p<0,006); on the large vessels level led to phase shift from 6,0 to 10,3 (р<0,00005). There was influence of Prestans® on the parameters characterizing vascular bed remodelling on the levels of cappilars: density of capillary net in the skin at rest (cap/mm2) increased from 47 cap/mm2 to 51 cap/mm2 (р<0,00005), and the density of capillar net after venous occlusion test — from 53 cap/mm2 to 60 cap/mm2 (р<0,006).

Conclusion. Prestans® is a medication of choice not only for AH treatment, but for prevention of target organs damage, that is based on correction of endothelial dysfunction and morphofunctional parameters at the level of MC.

Russ J Cardiol 2017, 12 (152): 113–119

http://dx.doi.org/10.15829/1560-4071-2017-12-113-119

Key words: arterial hypertension, endothelial dysfunction, vascular wall remodelling, cognition disorder, antihypertension therapy.

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

LITERATURE REVIEW

PREDICTIVE VALUE OF ECHOCARDIOGRAPHY IN POST MYOCARDIAL INFARCTION SETTING. PART 1.

Krikunov P. V., Vasyuk Yu. A., Krikunova O. V.

Abstract

Echocardiography is a useful tool for risk stratification and prognosis assessment after myocardial infarction. It was shown, that for prediction related data acquisition, it is possible to apply multiple echocardiographic parameters, such as the volumes and ejection fraction of the left ventricle, wall motion index, left atrium volume, and existence of atrial regurgitation. Development of the method of tissue Doppler and “speckle-tracking” led to invention of novel prediction parameters, as deformation, deformation velocity, desynchrony of the left ventricle. Method of contrast echocardiography makes it to evaluate myocardial perfusion and safety of microvascularity, gives valuable data on myocardial viability, which is closely related to prognosis. Stress echocardiography makes it to assess myocardial ischemia and find viable myocardium, and the Doppler of coronary arteries — to evaluate coronary flow reserve. Finally, 3D echo makes possible the gathering of optimal data on the volumes, functioning and sphericity of the left ventricle, which are significant parameters of long term prognosis.

Russ J Cardiol 2017, 12 (152): 120–128

http://dx.doi.org/10.15829/1560-4071-2017-12-120-128

Key words: echocardiography, mitral regurgitation, myocardial infarction, prognosis, diastolic dysfunction, systolic function of the left ventricle.

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

15 декабря 2017 г.
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