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Russian Journal Of Cardiology, 2018, 1 (23)

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Address to the readers

Russ J Cardiol 2018, 1 (153): 5

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2018, 1 (153): 6

ORIGINAL ARTICLES

THE INFLUENCE OF HEART RATE VARIABILITY ON CLINICAL COURSE OF CHRONIC HEART FAILURE AND RENAL FUNCTION IN ATRIAL FIBRILLATION PATIENTS

Polyanskaya E. A., Mironova S. V., Koziolova N. A.

Abstract

Aim. Evaluation of structural and functional condition of the left ventricle (LV) and kidneys in permanent atrial fibrillation patients (AF) with ischemic chronic heart failure (CHF) according to mean 24 hour heart rate and heart rate variability.

Material and methods. Sixty patients, age 35-60 y. o., with permanent AF of ischemic origin. All patients underwent echocardiography for the dysfunction verification: systolic function was assessed by ejection fraction of the left ventricle by Simpson, diastolic function was assessed via the velocity of transmitral currents and visualization of tissues of the mitral valve; Holter ECG monitoring was done, as volumetric sphygmopletysmography of peripheral arteries, assessment of kidney function by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) by creatinine and cystatin C, evaluation of the status of collagen production by the tissue inhibitor of matrix metalloproteases type 1 (TIMP-1), measurement of NT-proBNP. In the first part of the study, patients were selected to 3 groups: by GFR <30 mL/min/1,73 m2, 30-60 mL/min/1,73 m2 and >60 mL/min/1,73 m2. In the second — by cystatin C levels below or higher than the referent.

Results. There is negative moderate correlation of the heart rate >110 bpm and SDNN (r=-0,64, p=0,040) and <70 bpm and SDNN (r=0,50, p=0,042); direct moderate correlation of cystatin C and mean 24 hour heart rate >70 bpm (r=0,44, p=0,022); negative moderate correlation of GFR by CKD-EPIcys and mean daily heart rate >110 bpm (r=-0,55, p=0,030). Correlational analysis also showed that in permanent AF and ischemic CHF the mean 24 hour heart rate correlates strongly with E/e’ (r=0,53, р=0,011) and with NT-proBNP (r=0,57, р=0,002). Also the negative strong correlation found for SDNN with mean 24 hour heart rate (r=-0,59, p=0,001), with NT-proBNP (r=-0,65, p=0,002), with EF LV (r=-0,50, p=0,019), with the relation E/e’ (r=-0,61, p<0,001), with TIMP-1 (r=-0,53, p=0,048), moderate — with the LV myocardial mass index (r=-0,41, p=0,026) and cystatin С concentration (r=-0,38, p=0,036).

Conclusion. In patients with permanent AF comorbid with CHF of ischemic origin the risk of sudden cardiac death, estimated by SDNN, is in U-shaped relation with mean 24 hour heart rate. More prominent decrease of HRV reflecting the increase of sudden death risk was found in a range of 24 hour heart rate >110 bpm. With the increase of mean 24 hour heart rate there was increase of CHF severity, progression of LV diastolic dysfunction and renal dysfunction. Low HRV in a range of mean daily heart rate >110 bpm was associated with adverse cardiac remodeling presenting with LVH, and of kidney remodeling. One of possible mechanisms of the target organs with HRV decline, by our data, might be transformation of collagenolysis towards collagenogenesis in intracellular matrix, according to the dynamics of TIMP-1.

Russ J Cardiol 2018, 1 (153): 7–13

dx.doi.org/10.15829/1560-4071-2018-1-7-13

Key words: atrial fibrillation, heart rate variability, SDNN, chronic heart failure.

E. A. Wagner Perm State Medical University of the Ministry of Health, Perm, Russia.

REMODELING OF THE HEART AND VESSELS IN ATRIAL FIBRILLATION PATIENTS WITH CHRONIC HEART FAILURE ACCORDING TO CYSTATIN C-RELATED GLOMERULAR FILTRATION RATE

Mironova S. V., Polyanskaya E. A., Surovtseva M. V.

Abstract

Aim. To investigate on structural and functional specifics of the left cardiac chambers and arteries in patients with permanent atrial fibrillation (AF) comorbid with chronic heart failure (CHF) of ischemic origin, with relation to cystatin C-dependent glomerular filtration rate (GFR).

Material and methods. Sixty patients, age 35-60 y. o., with permanent AF of ischemic origin. All patients underwent echocardiography for the dysfunction verification: systolic function was assessed by ejection fraction of the left ventricle by Simpson, diastolic function was assessed via the velocity of transmitral currents and visualization of tissues of the mitral valve; Holter ECG monitoring was done, as volumetric sphygmopletysmography of peripheral arteries, assessment of kidney function by Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) by creatinine and cystatin C, evaluation of the status of collagen production by the tissue inhibitor of matrix metalloproteases type 1 (TIMP-1), measurement of NT-proBNP. In the first part of the study, patients were selected to 3 groups: by GFR <30 mL/min/1,73 m2, 30-60 mL/min/1,73 m2 and >60 mL/min/1,73 m2. In the second — by cystatin C levels below or higher than the referent.

Results. In the permanent AF with ischemic CHF patients, concentration of cystatin C in the blood correlates strongly depending on the NT-proBNP (r=0,60; р=0,003), left ventricle myocardial mass index (r=0,68; р=0,005), mean E/e’ (r=0,73; p<0,001), isovolumetric relaxation time (r=0,53; р=0,012), mean daily heart rate (r=0,51; р=0,016); correlates weakly with TIMP-1 (r=0,26, p=0,002); correlates negatively strongly with SDNN (r=-0,59; р<0,001). The GFR (CKD-EPIcys) correlates negatively strongly with the septal e’ (r=-0,51; р=0,041), with R-AI (r=-0,74; p<0,001), with CAVI1 (r=-0,53; р=0,008), and directly moderately with SDNN (r=0,42; р<0,001).

Conclusion. Assessment of cystatin C in the blood and cystatin C-dependent GFR in permanent AF and ischemic CHF are not only the early markers of CKD, but are the risk factors of development and progression of target organs (heart, vessels).

Russ J Cardiol 2018, 1 (153): 14–20

dx.doi.org/10.15829/1560-4071-2018-1-14-20

Key words: atrial fibrillation, chronic heart failure, glomerular filtration rate, cystatin C.

E. A. Wagner Perm State Medical University of the Ministry of Health, Perm, Russia.

CHARACTERISTICS OF THE CHRONIC HEART FAILURE COURSE AND TARGET ORGAN CONDITION

IN CARDIORENAL SYNDROME

Kolegova I. I., Chernyavina A. I., Koziolova N. A.

Abstract

Aim. To investigate on the specifics of chronic heart failure (CHF) course and functional remodeling of target organs in coronary heart disease (CHD) patients with chronic renal disease (CRD).

Material and methods. According to the criteria, 162 patients included, with CHD and CHF II-III functional class (FC), selected to 2 equal groups: group 1 — CRD patients, group 2 — with no renal dysfunction. For comparison, the parameters were), evaluated that represent the specifics of CHF pathogenesis, structural and functional condition of the left heart chambers, of arteries and kidneys.

Results. The presence of CRD was related to more serious diastolic dysfunction in CHD with CHF patients (p<0,001 for E/e’ and mean e’) and increase of the left ventricle myocardial mass index (p=0,0043) and preserved ejection fraction of the left ventricle (p<0,001), followed by higher level of N-terminal natriuretic peptide (p=0,018). More significant filtration disorders of kidneys (p<0,001 for all values) with no progression of tubular disorders (p=0,078), more prominent arterial stiffness (p<0,001 by index CAVI1 and augmentation index) with the increase of TIMP-1 (p=0,002) registered in CHD with CHF plus CRD patients.

Conclusion. With CRD, there is more serious CHF with preserved LV EF and diastolic dysfunction. Target organ remodeling in CHD and CHF with CRD patients was characterized by some specific regularities of structural and functional condition of the heart, of arterial vessels and kidneys, and of one of the mechanisms there was a disordered balance of collagenolysis towards risk of fibrosis.

Russ J Cardiol 2018, 1 (153): 21–26

dx.doi.org/10.15829/1560-4071-2018-1-21-26

Key words: chronic heart failure, chronic renal disease.

E. A. Wagner Perm State Medical University of the Ministry of Health, Perm, Russia.

DYNAMICS OF THE POLYUNSATURATED FATTY ACIDS VALUES IN THE BLOOD OF CHRONIC HEART), FAILURE PATIENTS

Vlasov А. А.1, Salikova S. P.1, Grinevich V. B.1, Bystrova О. V.2, Osipov G. А.2, Zaplatina А. А.1

Abstract

Aim. To assess the dynamics of levels of eicosapentaenoic (EPA), docosahexaenoic (DHA), arachidonic (AA) and linoleic (LA) fatty acids (FA), omega-3 index, relation of omega-3/omega-6 polyunsaturated FA (PUFA) in the blood of decompensated chronic heart failure (CHF) patients under the standard management.

Material and methods. The values of 22 FA were assessed in stable CHF (SCHF, n=12) and decompensated CHF (DCHF, n=24) and after decompensation treatment. The omega-3 index was calculated (relation of the sum of EPA and DHA to the sum of all FA) and relation of the sum of EPA and DHA to the sum of AA and LA.

Results. Values of EPA and DHA, omega-3 index in DCHF group were lower in SCHF (0,085 [0,06;0,17] vs 0,26 [0,15;0,4] mM/mL, p=0,0005; 0,37 [0,16;0,62] vs 0,84 [0,55;1,10] mM/mL, p=0,004; 1,11 [0,65;2,11] vs 2,44 [1,80;3,71]%, p=0,0008, respectively). After the treatment of DCHF, levels of EPA and DHA, omega-3 index raised, and reached 0,16 [0,11;0,21] mM/mL, p=0,0016; 0,46 [0,35;0,76] mM/mL, p=0,045; 1,74 [1,14;2,42]%, p=0,043, respectively. Statistically significant differences of AA and LA in the blood of SCHF and DCHF were not found. With the treatment, there was increase of AA value growth (3,40 [2,56;4,91] mM/mL, p=0,011) and tendency of LA increase (9,13 [5,08;11,28] mM/mL, p=0,09). Dynamics of omega-3/omega-6 relation witnessed the predominant part of omega-6 of PUFA in all participants, especially in DCHF. After treated fluid retention syndrome in patients this relation changed due to the raise of omega-3 PUFA.

Conclusion. In the DCHF there is significant increase of omega-3 index in the blood, concentrations of EPA and DHA. Standard therapy of CHF decompensation supports the increase of EPA, DHA, AA, omega-3 index. Mechanisms of the revealed PUFA dynamics in CHF patients, including the treatment outcomes, are subject for further investigation.

Russ J Cardiol 2018, 1 (153): 27–31

dx.doi.org/10.15829/1560-4071-2018-1-27-31

Key words: arachidonic acid, docosahexaenoic acid, linoleic acid, omega-3 index, polyunsaturated fatty acid, chronic heart failure, eicosapentaenoic acid.

1S. M. Kirov Military Medical Academy of the Ministry of Defense, Saint-Petersburg; 2International Center for Analytics of RAS, Moscow, Russia.

BIOMARKERS OF MYOCARDIAL STRESS AND FIBROSIS FOR CLINICAL OUTCOMES ASSESSMENT IN POST MYOCARDIAL INFARCTION HEART FAILURE PATIENTS

Shilyaeva N. V., Shchukin Yu. V., Limareva L. V., Danilchenko O. P.

Abstract

Aim. To assess the prognostic significance of the ST2 and N-terminal pre-brain natriuretic peptide (NT-proBNP) in patients with chronic heart failure (CHF) of ischemic origin.

Material and methods. The study included 127 patients with CHF, post myocardial infarction (age median 57 y. o., left ventricle ejection fraction — 54%), consequently admitted at Clinic. The biomarker concentrations representing myocardial stress (NT-proBNP) and fibrosis with remodeling of the ventricles (ST2) were measured with the immune enzyme assay. Endpoint was all-cause mortality and repeat hospitalizations during 9-month follow-up.

Results. Levels of ST2 and NT-proBNP were higher in adverse outcome patients (n=19) comparing to the patients with no repeat cardiovascular events (р=0,004 and 0,001, respectively). Receiver operating characteristic (ROC) analysis for outcomes prediction defined the optimal threshold values of 43,6 ng/mL for ST2 and 285 pg/mL for NT-proBNP. In comparison of ROC-curves, biomarkers had comparable areas under the curves (p=0,659). In binary regression model, statistically significant predictors for combination endpoint were ST2, NT-proBNP and traditional risk factors (class by New York Heart Association, left ventricle aneurysm, stroke anamnesis, estimated glomerular filtration rate <90 mL/min/1,73 m2). The model had the under-curve-area 0,900 (p<0,001).

Conclusion. ST2 and NT-proBNP are significant predictors of adverse clinical outcomes in CHF patients post myocardial infarction.

Russ J Cardiol 2018, 1 (153): 32–36

dx.doi.org/10.15829/1560-4071-2018-1-32-36

Key words: heart failure, biomarkers, ST2, NT-proBNP.

Samara State Medical University of the Ministry of Health, Samara, Russia.

SUGGESTED CONSERVATIVE APPROACH TO PREVENTION OF LATE RECURRENT ATRIAL FIBRILLATION AFTER CATHETER ABLATION (PILOT STUDY)

Tatarsky B. А.

Abstract

Aim. To workout a hypothesis that combinational usage of late sodium channel blocker ranolazine with imidazoline receptor agonist moxonidine might lead to reduced rate of recurrent atrial fibrillation (AF) in long-term post-ablation period.

Material and methods. To the study, 30 patients included, age 35 to 60 y. o. (17 males and 13 females) after catheter radiofrequency ablation for symptomatic, resistant to therapy paroxysmal AF. In a week before the scheduled procedure, patients had been taking moxonidine 0,2 mg per day and ranolazine 1000 mg per day. They continued to take these medications after the procedure for 12 months in the same dosages.

Results. Among 28 patients included to the analysis after 3-month blanking period, 25 ended the study. Of those 4 (16%) had non-symptomatic or mild symptomatic recurrent AF. Rest 21 (84%) did not present with paroxysms at control visits with long term ECG monitoring.

Conclusion. The analysis of this pilot study showed that combination of the late sodium channels antagonist ranolazine with imidazoline central receptor moxonidine is effective and safe therapy to reduce late post-ablation AF.

Russ J Cardiol 2018, 1 (153): 37–42

dx.doi.org/10.15829/1560-4071-2018-1-37-42

Key words: atrial fibrillation, late sodium channels blockers, imidazoline receptors agonists.

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

IMPACT OF POLYMORPHISM OF CARDIOVASCULAR RISK GENES ON ARTERIAL REMODELLING

DEVELOPMENT DEPENDING ON PRESENCE OF SYSTEMIC HYPERTENSION

Chernyavina A. I., Surovtseva M. V.

Abstract

Aim. To investigate on clinical and genetic characteristics of patients with multiple cardiovascular risk factors depending on the presence or absence of arterial hypertension (AH) and severity of pure arterial stiffness.

Material and methods. To the study, 330 patients of economically active age were included, with multiple cardiovascular risk factors at one of Perm city factories. Mean number of the risk factors 5,25±1,04. Mean age 46,67±8,46 y. o. Among the participants 205 (62,12%) males and 125 (37,88%) females. In 177 (53,6) there was AH of grade 1-3 diagnosed. All participants underwent genotype assessment by the markers AGT Thr174Met rs4762, GNB3 C825T rs5443, MTHFR C677T rs1801133,

MTRR Ile22Met rs1801394, ApoE Cys130Arg rs 429358, PPARα G/C rs4253778; volume sphygmopletysmography with the CAVI1 measurement. In the first part of the study, patients were selected to 2 groups according to AH presence. In the second part — by CAVI1 level, selected to 3 subgroups: 1st subgroup — no lesion of arteries and CAVI1 <8, 2nd subgroup — borderline arteries lesion and CAVI1 8-8,9; 3rd subgroup — serious arteries lesion and CAVI1 >9.

Results. Among the patients with borderline arteries lesion with AH or with none, the most significant are genotypes С/Т and ТТ of polymorphism Thr174Met rs4762 gene AGT, genotypes С/Т and Т/Т of polymorphism C825T rs5443 gene GNB3, genotypes С/Т and Т/Т of polymorphism C677T rs1801133 gene MTHFR, and genotypes С/С of polymorphism G/C rs4253778 gene PPARα. In patients with the CAVI1 >9 also, regardless of AH presence, were significant the С/Т and ТТ polymorphism Thr174Met rs4762 of gene AGT, genotypes С/Т and Т/Т polymorphism C677T rs1801133 gene MTHFR, genotypes A/G and G/G of polymorphism Ile22Met rs1801394 gene MTRR, and genotype G/С and С/С polymorphism G/C rs4253778 gene PPARα. Presence of AH with no target organ lesion is associated with С/Т polymorphism of the gene GNB3, genotype Т/Т polymorphism of gene MTHFR, and genotypes G/С and С/С of gene polymorphism PPARα. Correlational analysis showed moderate direct correlation of CAVI1 and polymorphism of the genes AGT (r=0,35; p=0,022), GNB3 (r=0,43; p=0,029), MTHFR (r=0,42; p=0,002), MTRR (r=0,43; p=0,025), PPARα (r=0,39; p=0,036). Relation with САVI1 and gene polymorphism АроЕ was not significant.

Conclusion. The study witness on the fact that cardiovascular risk shaping and the development of arterial stiffness depend not only on blood pressure level, but patient’s genotype. The data showed that some definite genotypes can be regarded as early markers of cardiovascular risk and arteries lesion in AH patients, and in no AH as well.

Russ J Cardiol 2018, 1 (153): 43–50

dx.doi.org/10.15829/1560-4071-2018-1-43-50

Key words: genes polymorphism, arterial hypertension, arterial stiffness, index CAVI1.

E. A. Wagner Perm State Medical University of the Ministry of Health, Perm, Russia.

CLINIC AND PHARMACOTHERAPY

REGULATORY-ADAPTIVE STATUS IN COMPARISON OF BISOPROLOL AND SOTALOL EFFICACY IN VENTRICULAR RHYTHM DISORDERS

Tregubov V. G., Shubitidze I. Z., Kanorsky S. G., Pokrovsky V. M.

Abstract

Aim. To compare the efficacy of combinational therapy with added bisoprolol or sotalol, in patients with ventricular rhythm disorders (VRD) via the assessment of regulatory-adaptive status (RAS).

Material and methods. Sixty VRD patients with II-III Bigger type or I-IV Lown, and with essential systemic hypertension II-III stages and/or coronary heart disease, were randomized to two groups. Group 1 received bisoprolol 6,4±1,8 mg daily, group 2 — sotalol 166,7±49,4 mg daily. As combinational therapy, all patients were taking lisinopril (12,5±4,1 mg daily and 14,0±4,6 mg daily, respectively). At baseline and in 6 months of combinational therapy, the following measures were done: quantitative assessment of RAS (by the test with cardiorespiratory synchronism), echocardiography, threadmill-test, 6-minute walking test, Holter blood pressure and electrocardiography monitoring, life quality assessment.

Results. Sotalol less prominently decreases RAS than bisoprolol. Both equally improved structural and functional condition of the heart, increased exercise tolerance, showed comparable hypotensive and antiarrhythmic effects. Sotalol, comparing to bisoprolol, improved life quality more significantly.

Conclusion. In VRD patients with essential systemic hypertension and/or coronary heart diease, combinational therapy with sotalol, comparing to bisoprolol, might be more preferrable due to less negative influence on RAS.

Russ J Cardiol 2018, 1 (153): 51–56

dx.doi.org/10.15829/1560-4071-2018-1-51-56

Key words: regulatory-adaptive status, ventricular rhythm disorders, bisoprolol, sotalol.

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

TRIMETAZIDINE INFLUENCE ON FILTRATION AND TUBULOINTERSTITIAL FUNCTION OF KIDNEYS IN ISCHEMIC HEART DISEASE PATIENTS WITH CHRONIC HEART FAILURE AND RENAL DYSFUNCTION

Koziolova N. A., Kolegova I. I., Surovtseva M. V.

Abstract

Aim. Evaluation of trimetazidine influence on the parameters of filtration and tubulo-interstinal function of kidneys in angina patients of II-III functional class (FC) and stable chronic heart failure (CHF) of II-III FC with chronic kidney disease (CKD) stage 3.

Material and methods. Totally, 288 stable angina (II-III FC) patients included, among them a cohort selected of 162 (56,3%) CHF II-III FC. In 62 (38,3%) CKD of stage 3 was diagnosed. All CHF and stage 3 CKD patients were randomized to equal 2 groups depending on the kind of treatment. First group patients, together with standard CHF and coronary heart disease (CHD) management, were taking trimetazidine (Preductal МR®, Servier, France) 35 mg in the morning, and the second group patients did not receive trimetazidine. Treatment duration lasted 6 months. For renal function assessment, glomerular filtration rate (GFR) was implemented (CKD-EPIcre), calculated via serum creatinine and cystatin C in the blood (CKD-EPIcys), albumincreatinine ratio in single urine portion (UACR), molecules of tubules damage (KIM-1) in urea, tissue inhibitor of matrix proteases type 1 in the blood (ТIMP-1).

Results. Introduction of trimetazidine to the standard therapy of CHD with CHF and CKD stage 3 makes it to not only improve clinical course of the disease, but increases exercise tolerance and demonstrates regression of disorder of kidney function by the dynamics of cystatin C (p=0,005), GFR increase, calculated by cystatin С (p=0,012), decrease of UACR (p=0,002), KIM-1 (p<0,001), restores positive collagenolysis in renal interstitium by dynamics of TIMP-1 decline (p<0,001).

Conclusion. Trimetazidine shows nephroprotective effect if added to the treatment of CHD and CHF patients comorbid with CKD stage 3. The effect is characterized by improved filtration function, decrease of albumin secretion with urine, decrease of tubular disorder by suppression of collagen formation in renal interstitium.

Russ J Cardiol 2018, 1 (153): 57–62

dx.doi.org/10.15829/1560-4071-2018-1-57-62

Key words: angina, heart failure, renal dysfunction, trimetazidine.

E. A. Wagner Perm State Medical University of the Ministry of Health, Perm, Russia.

CLINICAL CASE

RISK OF CARDIOEMBOLISM AND THE ISSUE OF INDIVIDUALIZATION OF APPROACHES: CLINICAL CASE

Kudinova М. А.1, Klykov L. L.1, Saykin А. А.1, Romashenko О. V.1, Shaydyuk О. Yu.2

Abstract

The clinical case illustrates successfully restored blood flow after cardioembolism into upper mesenteric artery with none open or laparoscopic surgery. The specifics of this case are patient age: 90 y. o., and that the ischemic syndrome developed delayed — two days after atrial fibrillation paroxysm treatment.

Russ J Cardiol 2018, 1 (153): 63–65

dx.doi.org/10.15829/1560-4071-2018-1-63-65

Key words: embolism, left atrium appendage, anticoagulants, atrial fibrillation, senile patient, longevity, mesenteric thrombosis.

1O. M. Filatov CCH № 15, Moscow; 2N. I. Pirogov Russian National Research Medical University (RNRMU), Moscow, Russia.

LITERATURE REVIEWS

SMOKING INFLUENCE ON THE OUTCOMES AND COMPLICATIONS OF CORONARY BYPASS SURGERY

Yablonsky P. K.1,2, Sukhovskaya О. А.1

Abstract

In the article, the analysis provided, of the literary data on smoking and smoking cessation influence on coronary bypass surgery efficacy and life duration of the patients. Most scientific articles provide data on the increase of both the mortality and complications number in smokers. Meta-analysis of 564 works on the influence of smoking on coronary bypass outcomes, convincing evidence was provided on the necessity to quit smoking. Ten, 20- and 30-year lasting observations post coronary bypass surgery demonstrate the benefits of smoking cessation for life duration increase in coronary heart disease. Meta-analysis of the various approaches efficacy in cardiovascular patients has been done in 2017 and shows the efficacy of medication therapy. Among the drugs for nicotin addiction treatment in cardiovascular patients, the most effective is varenicline, with confirmed safety in chronic stable cardiovascular disorders patients, as in acute coronary heart disease patients. To overcome the psychological component of the addiction it is worthy to conduct cognitive-behavioral therapy that can be done by the specialists of Call Center for smoking cessation organized by the Ministry of Health of Russian Federation.

Russ J Cardiol 2018, 1 (153): 66–71

dx.doi.org/10.15829/1560-4071-2018-1-66-71

Key words: coronary bypass, clinical outcomes, complications, smoking, tobacco addiction.

1SPb SRI of Phthisiopulmonology of the Ministry of Health, Saint-Petersburg; 2Saint-Petersburg University, Saint-Petersburg, Russia.

IMMUNE RESPONSE IN DECOMPENSATED CHRONIC HEART FAILURE OF ISCHEMIC ORIGIN

Kruchinkina E. V.1, Ryabov V. V.1,2,3

Abstract

Recently, a significance has been established, for the role of inflammation in the pathology of chronic heart failure (CHF). It is well known that raised level of circulating pro-inflammatory cytokines in ischemic CHF patients correlate with the severity and prognosis of the disease. Monocytes play key role in an inflammatory cascade and are the main source of pro-, as contra-inflammatory cytokines. Disbalance of physiological inflammation in alteration and healing of the myocardium might lead to formation of pathological chronic inflammation. In the article, the role of monocytes discussed, and of inflammation, in CHF and its decompensation. The kinds of cytokines observed with their role in inflammation. Also, the analysis presented, of the drugs used for modulation of immune response in CHF.

Russ J Cardiol 2018, 1 (153): 72–77

dx.doi.org/10.15829/1560-4071-2018-1-72-77

Key words: acute decompensation of chronic heart failure, macrophages, cytokines, innate immunity, adaptive immunity.

1SRI of Cardiology, Tomsk National Research Medical Center of RAS, Tomsk; 2Tomsk National Research State University, Tomsk; 3Siberian State Medical University, Tomsk, Russia.

OBSTRUCTIVE SLEEP APNEA SYNDROME IN CONGESTIVE HEART FAILURE: CARDIOLOGIST

PERSPECTIVE

Medvedeva Е. А.1, Korostovtseva L. S.1, Sazonova Yu. V.1, Bochkarev М. V.1, Sviryaev Yu. V.1,2, Konradi А. О.1,3

Abstract

In the review, the data presented, on sleep disordered respiration in chronic heart failure patients with emphasis on sleep apnea syndrome (SAS). The aspects of prevalence are discussed, as of pathogenesis, diagnostics and specifics of SAS management in decreased or normal ejection fraction. The original results presented, on the disordered breathing assessment in patients with severe systolic dysfunction. The necessity underscored for personalized diagnostic and management approach to obstructive sleep apnea syndrome which is not just a risk factor for heart failure, but is a comorbidity at various stages of cardiovascular continuum.

Russ J Cardiol 2018, 1 (153): 78–82

dx.doi.org/10.15829/1560-4071-2018-1-78-82

Key words: obstructive sleep apnea, chronic heart failure, polysomnography, CPAP therapy.

1Federal Almazov North-West Medical Research Centre of the Ministry of Health, Saint-Petersburg; 2Sechenov Institute of Evolution Physiology and Biochemistry, Saint-Petersburg; 3Saint-Petersburg National Research University of Informational

Technologies, Mechanics and Optics, Translational Medicine Institute, Saint-Petersburg, Russia.

A PSYCHOSOMATIC VICIOUS CIRCLE OF MYOCARDIAL INFARCTION

Taratukhin Е. О., Gordeev I. G., Lebedeva А. Yu.

Abstract

The review presents recent studies demonstrating somatic shifts in psychological processes regarded as the risk factors for myocardial infarction: depression, stress, anxiety. Based upon a metaphorical term “a perfect storm”, inflammatory, immunological, neuro-humoral predisposing factors are presented, important for myocardial infarction development, as such shifts themselves, which are the somatic substrate for psychological states mediating myocardial infarction development through behavioral and biological risk factors: “sickness behavior”, “depression illness”. Both directions complete a vicious circle of psychosomatic changes. The emphasis is set on the importance of individual approach to rehabilitation and secondary prevention of myocardial infarction, as, from biopsychosocial point of view, the bottom-up and top-down psychosomatic links are unique for any patient.

Russ J Cardiol 2018, 1 (153): 83–88

dx.doi.org/10.15829/1560-4071-2018-1-83-88

Key words: patient-centered medicine, biopsychosocial, psychosomatics, somatization, biopsychocultural, myocardial infarction

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

PREDICTIVE VALUE OF ECHOCARDIOGRAPHY IN POST MYOCARDIAL INFARCTION SETTING. PART 2.

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, dissynchrony 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 2018, 1 (153): 89–100

dx.doi.org/10.15829/1560-4071-2018-1-89-100

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.

JUBILEE

Rafael G. Oganov

Russ J Cardiol 2018, 1 (153): 101-102

5 марта 2018 г.
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