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Russian Journal Of Cardiology, 2018, 3 (23)

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Русскоязычная версия


Address to the readers

Russ J Cardiol 2018, 3 (155): 6

CLINICAL MEDICINE NEWS

Clinical medicine updates: a review of international news

Russ J Cardiol 2018, 3 (155): 82

EDITORIAL

PERCUTANEOUS INTERVENTION IN STABLE ANGINA: WHAT ISSUES DO WE SOLVE?

Karpov Yu. A., Kozlovskaya I. L., Bulkina O. S., Lopukhova V. V.

Abstract

In the article, a role of percutaneous intervention discussed in stable ischemic disease of the heart, and an evolution presented of the perspectives on its influence on prognosis and clinical presentation of the disease. The results provided, of recent trials, including the ORBITA. According to current clinical guidelines, endovascular treatment does improve prognosis in patients with the left coronary artery stem lesion and proximal left descending artery lesion, as in a significant area of damaged myocardium involved in temporary ischemia. Percutaneous coronary intervention should be done in patients with continued clinical presentation of angina and nonsatisfactory life quality regardless the optimal medication treatment.

Russ J Cardiol 2018, 3 (155): 7–10

dx.doi.org/10.15829/1560-4071-2018-3-7-10

Key words: percutaneous coronary intervention, stable ischemic disease, angina pectoris.

National Medical Research Center of Cardiology of the Ministry of Health, Moscow, Russia.

ORIGINAL ARTICLES

EVALUATION OF THE PREVALENCE OF CARDIOVASCULAR EVENTS AND MORTALITY IN STABLE CORONARY HEART DISEASE PATIENTS DEPENDING ON BASELINE CORONARY COLLATERAL BLOOD

FLOW (FIVE YEAR FOLLOW-UP)

Kozlova E. V., Starostin I. V., Bulkina O. S., Lopukhova V. V., Karpov Yu. A.

Abstract

Aim. To evaluate the prevalence of cardiovascular events and death depending on baseline coronary collateral blood flow (CBF) in five year follow-up of stable coronary heart disease (CHD) patients.

Material and methods. To the study, 579 stable CHD patients included, who during scheduled coronary angiography (CAG) were diagnosed with at least one stenosis in one coronary artery (diameter no less than 1,5 mm), narrowing its lumen by ≥50%. CBF was assessed by Rentrop modified method. In 5 years post index CAG, the cardiovascular events were counted (relapse or worsening of functional class of angina, non-fatal myocardial infarction, coronary bypass surgery, acute stroke) and mortality.

Results. In multifactorial analysis (Cox regression) the association revealed of the good CBF with lower cardiovascular mortality (HR 0,5; р=0,02) and all-cause mortality (HR 0,5; р=0,004). In multifactorial analysis (logistic regression) there was association of good CBF with lower rate of relapse/worsening of angina in long term period — (OR 0,36, p=0,002). There was no relation found for CBF condition and non-fatal myocardial infarction, percutaneous coronary intervention.

Conclusion. By the data from five year follow-up, good CBF correlates with less cardiovascular and all-cause mortality and with the frequency of relapse/worsening of the FC of angina pectoris in chronic CHD patients, including those underwent revascularization, regardless of the severity of disease, coronary flow lesion and other factors associated with cardiovascular complications.

Russ J Cardiol 2018, 3 (155): 11–16

dx.doi.org/10.15829/1560-4071-2018-3-11-16

Key words: coronary collateral blood flow, coronary heart disease.

SMRC of Cardiology of the Ministry of Health, Moscow, Russia.

FIVE YEAR PROGNOSIS IN PATIENTS WITH CORONARY HEART DISEASE AND COMORBIDITIES: DATA FROM MULTICENTER STUDY IN INGUSHETIA REPUBLIC

Ugurchieva P. O.1, Didigova R. Т.1, Ugurchieva Z. О.1, Mamedov М. N.2

Abstract

Aim. Analysis of the primary endpoints occurence in male and female cohort of coronary heart disease (CHD) patients comorbid with other somatic pathology, during 5 years.

Material and methods. To the study, 320 patients included (143 males, 177 females, age 46-72 y. o.) with CHD stable angina I-III functional class, and underwent investigations in the year 2012 in three medical centers in the Republic of Ingushetia. In 2017 patients were invited for second investigation or were contacted by phone. As the primary endpoints the following accounted:

revascularization surgery (CBG), endovascular surgery in coronary, carotid, peripheral arteries, diagnosed myocardial infarction, ischemic stroke, diabetes and its complications, fatal outcome from cardiovascular diseases (CVD) and death from other causes.

Results. The number of CHD patients with comorbidities was 196, and with no comorbidities — 124. During the follow-up, stroke developed in 17 (5 males, 11 females) patients, myocardial infarction in 37 (20 males, 17 females), diabetes in 38 (15 males, 23 females), fatal CVD outcome in 11 (8 males, 3 females; of those in 5 — acute coronary syndrome, 4 — stroke, 3 — chronic heart failure), and death from other causes in 8 (5 males, 3 females). We also analyzed the development of composite endpoints in CHD patients depending on the presence and absence of comorbidities. Stroke was registered in 13 comorbid patients vs 3 in CHD with no other diseases. Myocardial infarction found in 33 patients with CHD and three comorbidities vs 4 cases in CHD with no

comorbidities. Diabetes was found in 32 vs 6 patients, respectively; CVD death in 10 vs 1, resp.; all-cause death in 5 vs 3, resp.

Conclusion. Comorbid CHD with 2 and more somatic diseases, during the 5-year period of follow-up, does increase the risk of complications and death from CVD.

Russ J Cardiol 2018, 3 (155): 17–22

dx.doi.org/10.15829/1560-4071-2018-3-17-22

Key words: angina pectoris, comorbidity, prospective study, primary endpoints.

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

TWELVE MONTHS OUTCOMES IN PATIENTS WITH ACUTE CORONARY SYNDROME, BY THE NATIONAL REGISTRY RECORD-3

Erlikh A. D. on behalf of the RECORD-3 registry workteam

Abstract

Aim. In the article, the analysis of the Russian independent registry presented on acute coronary syndrome (ACS) — RECORD-3, aimed for evaluation of adverse outcomes rate by 12 months after ACS, as the long term management of ACS patients.

Material and methods. To analysis, 966 patients included (43% of all discharged). By most anamnesitcal and clinical data, as by management specifics, patients groups that were and those that were not assessed for 12 month outcomes, did not differ significantly.

Results. The rate of fatal outcomes developed post discharge during 12 months after ACS, was 8,4% (4,8% in ACS with ST elevation (STEACS) and 10,5% in ACS non-ST elevation (NSTEACS); р=0,0012), summated events death+myocardial

infarction (MI) + stroke was 12,8% (8,4% in STEACS and 15,4% in NSTEACS; р=0,0012). Mortality in 12 months from the onset of ACS was 15,8% (18,3% in STEACS and 14,2% in NSTEACS; р=0,077), summated events death+MI+stroke in 12 months from the onset of ACS was 19,9% (21,4% in STEACS and 18,9% in NSTEACS; р=0.32). The proportion of patients that continued to follow the prescribed at discharge aspirin, clopidogrel, ticagrelor, ACE inhibitor/angiotensine receptor blocker (ARB), beta-blocker and statin was, respectively, 83,4%, 47,8%, 28,1%, 66,8%, 77,3% and 68,7%. The relation was evaluated, of the “completeness

of treatment” in 6 months post ACS with the rate of fatal outcomes in 12 months. In patients, who in 6 months post ACS continued to take ≥2 groups of medications (double antiplatelet therapy, beta-blocker, ACE inhibitor/ARB, statin) the rate of fatal outcomes during 12 months was significantly higher comparing to those who were taking ≤1 group (1,4% vs. 4,9%; р=0,01). Multifactorial regression showed the independent predictors of fatal outcomes post discharge in 12 months. These were coronary arteriography in-patient (odds ratio (OR) 0,11; 95% confidence interval (95% CI) 0,02-0,56; р=0,008), age ≥75 y. o. (OR 5,48; 95% CI 1,57-19,30; р=0,008), ST elevation on baseline ECG ≥1 mm (OR 3,43; 95% CI 1,02-11,48; р=0,046).

Conclusion. The analysis of data of the Russian registry RECORD-3 showed that the prevalence of fatal outcomes developed in 12 months after ACS, post discharge from hospital, was 8,4%, and the prevalence of fatal outcomes from the ACS onset — 15,8%. Best adherence to treatment in 12 months was found for aspirin (83,4%), worst — for ticagrelor (28,1%). Independent predictors of fatal outcomes in 12 months post discharge were age ≥75 y. o., not performed coronary arteriography in-patient, and ST elevation on baseline ECG ≥1 mm.

Russ J Cardiol 2018, 3 (155): 23–30

dx.doi.org/10.15829/1560-4071-2018-3-23-30

Key words: acute coronary syndrome, registry, RECORD-3, long term outcomes, mortality, treatment adherence.

Bauman City Clinical Hospital № 29, Moscow, Russia.

COMPLEX ASSESSMENT OF ARTERIES STIFFNESS PARAMETERS AND TRADITIONAL RISK FACTORS AS THE PREDICTORS OF EARLY VASCULAR AGEING SYNDROME

Oleynikov V. E., Khromova A. A., Burko N. V., Salyamova L. I., Borisova N. A., Matrosova I. B.

Abstract

Aim. Evaluation of structural and functional properties of arteries in healthy persons and in coronary heart disease (CHD) patients with various severity of coronary lesion, in different age groups.

Material and methods. To the study, 135 patients included, with various CHD types, and 56 healthy persons at the age 35 to 65 y. o. All participants underwent laboratory testing for glucose level and lipid profile in blood. Applanation tonometry was done, and volumetric sphygmography, ultrasound scanning of common carotid arteries with the technology of high frequency RF signal.

Results. All participants were selected into two cohorts: younger and older than 50 y. o., which included patients with no hemodynamically significant stenoses of coronary arteries, with significant stenosis of one artery and healthy persons. According to the results of traditional risk factors analysis, CHD patients more prevalently had tobacco addiction, arterial hypertension, as well as family anamnesis of lipid disorders. By ultrasound scanning data of common carotid arteries, the parameters of arterial stiffness predominated in patients with coronary lesions. Applanation tonometry showed that CHD patients and healthy persons had comparable levels of central arterial pressure in both age groups. In all healthy persons the carotid-femoral pulse wave velocity was within normal range, and in CHD it was higher by 10 m/s. Volumetric sphygmography showed that severity of coronary lesion correlated with the increase of vascular rigidity parameters.

Conclusion. The results of current study confirm the necessity for development of novel criteria of risk assessment and prevention of cardiovascular diseases early development. Screening for predictors of early vascular ageing syndrome will make it to identify persons with low relative but high absolute risk of coronary events.

Russ J Cardiol 2018, 3 (155): 31–36

dx.doi.org/10.15829/1560-4071-2018-3-31-36

Key words: EVA syndrome, intima-media thickness, cardiac-ankle vascular index, pulse wave velocity, coronary heart disease,

hemodynamically significant stenosis.

Penza State University, Penza, Russia.

CLINIC AND PHARMACOTHERAPY

AN EXPERIENCE OF TRIMETAZIDINE USAGE IN COMORBIDITY

Kochetkova I. V., Chernykh T. M., Panyushkina G. M.

Abstract

Aim. To assess the dynamics of heart rate variability (HRV) during the therapy with trimetazidine instable angina patients comorbid with diabetes.

Material and methods. Totally, 110 stable angina patients studied, of III functional class (FC), comorbid with type 2 diabetes (DM2), that is 53 with diabetic vegetative cardial neuropathy, and other 57 with no diabetes, that is with no vegetative cardialneuropathy, investigated with hardware and software complex.

Results. Usage of trimetazidine instable angina patients of III FC, comorbid with DM2, makes it to improve the myocardial index to normal levels, to restore variability parameters, clinical condition of the patient, and facilitates the improvement ofdiabetic neuropathy.

Conclusion. Usage of trimetazidine is practically worthy, making it to improve prognosis in coronary heart disease comorbid with DM2.

Russ J Cardiol 2018, 3 (155): 37–42

dx.doi.org/10.15829/1560-4071-2018-3-37-42

Key words: trimetazidine, ischemic heart disease, diabetes.

N. N. Burdenko Voronezh State Medical University, Voronezh, Russia.

INFLUENCE OF TORASEMIDE ON ELECTRICAL INSTABILITY OF THE HEART IN PATIENTS WITH ISCHEMIC MITRAL REGURGITATION POST MYOCARDIAL INFARCTION

Ibragimova I. B., Islamova U. A., Gafurova R. M., Abdullaev A. A.

Abstract

Aim. To assess the efficacy of torasemide for changes of electrical instability of the heart in patients with ischemic mitral regurgitation during the period after myocardial infarction.

Material and methods. Ninety six patients with mitral regurgitation, with Q-myocardial infarction (Q-MI) had been randomized to two groups. During six months after discharge, in the control group 1, of 46 patients, the standard therapy applied (clopidogrel, acetylsalicylic acid, nebivolol, perindopril). In the study group 2, of 50 patients, additionally torasemide was used. At baseline, in 3 and 6 months Holter ECG monitoring was performed.

Results. In the group 1 patients with mitral regurgitation post Q-MI, with the standard treatment, there was decrease of silent myocardial ischemia (3,6±0,5 — baseline; 3,3±0,5 and 3,1±0,3 — in 3 and 6 months, respectively, p<0,05). They showed decrease of the duration of silent and anginal ischemia, depression of ST segment >1 mm, number of patients with supra- and ventricular extrasystoles (p>0,05) and increase of the number of angina ischemia (2,1±0,4 — baseline, 2,2±0,2 and 2,3±0,1 — in 3 and 6 months, respectively, p>0,05). In the group 2 patients, in 6 months of treatment there was decrease of number of silent (2,1±0,3) ischemia episodes, duration of anginal (7,3±2,1 min) and silent (4,3±1,2 min) ischemia comparing to baseline (8,8±1,2; 10,6±2,7 and 8,8±1,2 min — respectively, p<0,05). Also, they showed decrease of ST depression >1 mm episodes (1,2±0,2 vs 2,0±0,4 mm at baseline) and relative values of the patients number with the registered supra- and ventricular extrasystoles (38% and 44%, respectively, versus 62% and 84% at baseline, p>0,05).

Conclusion. The usage of torasemide combination with standard treatment decreases the number of episodes, duration of silent and anginal myocardial ischemia, rate of registered supra- and ventricular extrasystoles in mitral regurgitation patients post Q-MI, comparing to separate standard treatment. Also, the rate of anginal ischemia episodes does not change in 3 and 6 months of standard treatment.

Russ J Cardiol 2018, 3 (155): 43–48

dx.doi.org/10.15829/1560-4071-2018-3-43-48

Key words: myocardial infarction, mitral regurgitation, torasemide, electrocardiogram.

Dagestan State Medical University of the Ministry of Health, Makhachkala, Russia.

ОТВЕТ НА КЛОПИДОГРЕЛ У ПАЦИЕНТОВ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ И ПОЛИМОРФИЗМАМИ CYP2Y12*2 И CYP2Y12*3

Rahmatini R.1*, Aliska G.1, Syafri M.2, Achyar A.3

Abstract

Цель. Оценить характеристики реактивности тромбоцитов по P2Y12 у 30 пациентов с острым коронарным синдромом (ОКС) на территории Минанг в стационаре доктора М. Джамил в Паданге, Индонезия.

Материал и методы. Исследование было кросс-секционным, в сентябре 2016 года. Эффективность клопидогрела во влиянии на реактивность тромбоцитов оценивалась при помощи VerifyNowR с порогом 208 единиц P2Y12-реактивности. По величине этого показателя можно оценить наличие ответа или резистентности у пациента.

Результаты. Среди 30 получавших клопидогрел пациентов 24 (80%) были мужского пола. Самым важным фактором риска ОКС была гипертензия. Среди пациентов 11 (36,77%) были резистентны и 19 (63,33%) отвечали на клопидогрел. Около 46,67% имели экстенсивную метаболическую активность. Реактивность по P2Y12 была ниже, чем при промежуточном и плохом метаболизме.

Заключение. Пациенты с ОКС и функциональной недостаточностью CYP2C19 имеют сниженную активность тромбоцитов, когда получают клопидогрел. Рекомендуется рутинное тестирование CYP2C19 и реактивности по P2Y12.

Нужны дополнительные исследования с большим количеством пациентов для оценки фармакогенетического профиля CYP2C19 и причин резистентности к клопидогрелу в Минанге.

Российский кардиологический журнал 2018, 3 (155): 49–53

dx.doi.org/10.15829/1560-4071-2018-3-49-53

Ключевые слова: острый коронарный синдром, клопидогрел, CYP2C19 полиморфизм, P2Y12.

1Отделение фармакологии и терапии, Медицинский факультет, Университет Андалас, Паданг; 2Отделение кардиологии и сосудистой медицины больницы д-ра М. Джамил и медицинского факультета, Университет Андалас, Паданг; 3Биомедицинская лаборатория, Медицинский факультет, Университет Андалас, Паданг, Индонезия.

CLINICAL CASE

BARTH SYNDROME IN PRACTICE OF CARDIOLOGY

Melnik О. V.1, Loevets Т. S.1, Vershinina Т. L.1, Gudkova А. Ya.1,2, Fomicheva Yu. V.1, Kostareva А. А.1, Pervunina Т. М.1, Vasichkina Е. S.1

Abstract

Barth syndrome is an X-bound inherited recessive disorder with the prevalenсe 1:300000 — 1:400000 of live bornt, caused by mutations in the gene TAZ; manifesting with dilation cardiomyopathy, neutropenia, proxymal myopathy, delayed physical and motoric development. In the article, a clinical case provided of the Barth syndrome, confirmed by target sequencing of TAZ gene in a boy of 1st year of life, presented in 3 months age by an episode of infectious disease and dilation cardiomyopathy, with family anamnesis of sudden death at the moment of infectious disease in the grand uncle of proband. In dynamics, the patient showed delayed motoric development, as the delay in mass and height (<3 percentile), persistent absolute neutropenia, stable high levels of cardiospecific enzymes, NT-proBNP, symptomes of severe heart failure with following fatal outcome at age of 12 months from sudden death during an episode of infectious disease. The multidisciplinarity presented, as the necessity for clear understanding by practitioners of the specifics of the disease course and absence of specific pathogenetic therapy, of high sudden death risk, high probability of progression of heart failure at the background of infection.

Russ J Cardiol 2018, 3 (155): 54–59

dx.doi.org/10.15829/1560-4071-2018-3-54-59

Key words: Barth syndrome, dilation cardiomyopathy, non-compaction myocardium, sudden death, neutropenia, myopathy.

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

LITERATURE REVIEWS

IVABRADINE OUTSIDE THE CLINICAL GUIDELINES: INTEREST OF A PRACTITIONER

Tarlovskaya E. I.

Abstract

The article is focused on the data concerning the influence of ivabradine on myocardial electrophysiology in experimental and clinical studies. It is shown that ivabradine decreases ventricular rate in chronic atrial fibrillation, and prevents the paroxysms of atrial fibrillation. In myocardial hypertrophy patients or in serious chamber dilation, ivabradine shows moderate antiarrhythmic effect on ventricular arrhythmias.

Russ J Cardiol 2018, 3 (155): 60–64

dx.doi.org/10.15829/1560-4071-2018-3-60-64

Key words: ivabradine, atrial fibrillation, ventricular arrhythmia.

Nizhny Novgorod State Medical Academy, Nizhniy Novgorod, Russia.

INHIBITION OF THE FACTOR Xa (WITH RIVAROXABAN) SLOW DOWN PROGRESSION, PREVENTS COMPLICATION AND DECREASE MORTALITY IN CORONARY HEART DISEASE

Khirmanov V. N.

Abstract

A review presented, of the novel scientific data, mostly the results of large clinical trials, witnessing on clinical efficacy and safety of rivaroxaban — the anticoagulant, selective blocker of Xa factor — in treatment of acute and chronic coronary heart disease. The mechanisms explained, of the drug influence on atherothrombosis, especially the specifics of dosages and its combination with other antithrombotic drugs in various clinical situations.

Russ J Cardiol 2018, 3 (155): 65–70

dx.doi.org/10.15829/1560-4071-2018-3-65-70

Key words: atherothrombosis, Xa factor blockers, rivaroxaban, acute coronary syndrome, stable angina, atrial fibrillation.

A. M. Nikiforov Russian Center of Urgent and Radiation Medicine of the EMERCOM, Saint-Petersburg, Russia.

EXPERIMENTAL STUDY

FUNCTIONAL STATE OF MYOCARDIUM AFTER APPLICATION OF A NON-CELLULAR ALLOGENIC MATERIAL FOR STIMULATION OF REGENERATION CAPACITY IN EXPERIMENTAL INFARCTION

Afanasiev S. А.1, Kondratieva D. S.1, Lebedeva А. I.2, Muslimov S. А.2, Popov S. V.1

Abstract

Aim. Evaluation of influence of the stimulated regeneration abilities of myocardium with non-cellular allogenic material (NAM) on contractility restoration in experimental post-infarction remodelling.

Material and methods. The experiment was done on the Wistar rodents with postinfarction cardiosclerosis (PICS), and PICS rodents post injection of the NAM at the moment of coronary artery stenosing. PICS was being formed during 45 days after coronary occlusion. The assessments were the formation and size of postinfarction scar of the left ventricle in rodents of different groups. Myocardial contractility was assessed by inotropic reaction of isolated papillary muscles on rest periods (4-60 s) with stimulation frequency 0,5 Hz, under conditions of perfusion with oxygenated Krebs-Henseleit solution.

Results. PICS in the rodents after injection of NAM developed only in 56%, and in comparison group 100%. The size of the scar area was 22% smaller in NAM group (p<0,05). Development of an aneurysm was 45% less in NAM group than in PICS group (p<0,05). Potentiation phenomenon for inotropic response on the periods of papillary muscles rest in PICS rodents myocardium was not observed. In increase of the duration of resting period there was increase of potentiation of inotropic response in rodents myocardium, and in this group the amplitude of response was significantly higher than changes in the other group of PICS animals.

Conclusion. Results of the study show possibility of preservation of myocardial functional capacity after stimulation of its regeneration abilities with allogenic noncellular biomaterial, composed with the technology AlloplantR in experimental infarction.

Russ J Cardiol 2018, 3 (155): 71–75

dx.doi.org/10.15829/1560-4071-2018-3-71-75

Key words: postinfarction cardiosclerosis, rats, papillary muscles, non-cellular allogenic biomaterial, alloplant.

1SRI of Cardiology, Tomsk National Research Medical Center of RAS, Tomsk; 2National Center of Ophthalmology and Plastic Surgery of the Ministry of Health, Ufa, Russia.

EXPERT CONSENSUS

ARTERIAL HYPERTENSION WORKGROUP RESOLUTION. THE ROLE OF SARTANS IN TREATMENT OF SYSTEMIC HYPERTENSION IN THE 21ST CENTURY

Konradi А. О.1, Zhdanova О. N.2, Rotar О.P.1, Karpov Yu.А.3, Podzolkov V.I.4, Lebedev P.А.5, Chesnikova А.I.6, Nebieridze D.V.7, Miller О. N.8, Solovjova Е. V.9, Kulikov А. N.10

Russ J Cardiol 2018, 3 (155): 76–81

dx.doi.org/10.15829/1560-4071-2018-3-76-81

1Federal Almazov North-West Medical Research Center of the Ministry of Health, Saint-Petersburg; 2Pavlov Saint-Petersburg State Medical University, Saint-Petersburg; 3Myasnikov Scientific Medical Research Center of Clinical Cardiology of the Ministry of Health, Moscow; 4I.M. Sechenov First Moscow State Medical University of the Ministry of Health, Moscow; 5Institute for Professional Education of SamSMU, Samara; 6Rostov State Medical University, Rostov-na-Donu; 7National Research Center for Preventive Medicine of the Ministry of Health, Moscow; 8Novosibirsk State Medical University, Novosibirsk; 9Nizhny Novgorod State Medical Academy of the Ministry of Health, Nizhny Novgorod; 10Kirov Military Medical Academy, Saint-Petersburg, Russia.

INFORMATION

Russ J Cardiol 2018, 3 (155): 83-90

CLINICAL GUIDELINES

DIAGNOSIS AND T REATMENT OF CARDIOVASCULAR DISEASES DURING PREGNANCY 2018. NATIONAL GUIDELINES

Developed by the Committee of experts of the Russian society of cardiology (RSC). Section of cardiovascular diseases in pregnant women.

Russ J Cardiol 2018, 3 (155): 91–134

dx.doi.org/10.15829/1560-4071-2018-3-91-134

Key words: cardiovascular diseases, pregnancy, hypertension, congenital heart defects, acquired heart defects, valve prosthesis, pulmonary hypertension, cardiomyopathy, cardiac arrhythmias.

8 мая 2018 г.
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